Repeatability of wavefront aberration measured by adaptive optics visual simulator and agreement of OPD-Scan Ⅲ / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To assess the repeatability and agreement of higher-order aberration obtained by adaptive optics visual simulator(VAO)compared with OPD-Scan Ⅲ.METHODS: A cross-sectional study was conducted from August to September 2023, including a total of 204 patients(204 eyes)with myopia whose right eyes were measured. The examinations were performed by the same skilled examiner using both devices separately. The VAO device was used to measure higher order aberrations of orders 3 to 6 at a pupil diameter of 4.5 mm, while both the VAO and OPD-Scan Ⅲ devices were utilized to measure total higher-order aberration(tHOA), spherical aberration(SA), coma aberration(Coma), and trefoil aberration(Trefoil)of the entire eye at pupil diameters ranging from 3 to 6 mm. Furthermore, the repeatability of whole eye aberration measurements obtained with the VAO device was evaluated and the agreement of the two devices was assessed.RESULTS: The whole-eye higher-order aberrations measured by VAO demonstrated excellent repeatability(0.767≤ICC≤0.941, Sw<0.01 μm, TRT<0.1 μm). There was no statistically significant difference in Coma measured by VAO or OPD-Scan Ⅲ for pupil diameters ranging from 4 to 6 mm(P>0.05), while a statistically significant difference was observed in whole-eye tHOA of other pupil diameters(all P<0.05). The agreement of aberration measurements for each order between VAO and OPD-Scan Ⅲ for 3 mm pupil diameters, SA at 4 and 5 mm pupil diameter and Coma at 4 mm pupil diameter showed a 95% limit of agreement(LoA)<0.1, indicating good agreement; however, poor agreement was found for the remaining aberration measurements at different pupil diameters, with a 95%LoA>0.1, and there were significant differences in higher-order aberrations measured by two devices under a pupil diameter of 3 mm(r=0.218-0.317, P<0.01), 4 mm(r=0.406-0.672, P<0.01), 5 mm(r=0.538-0.839, P<0.01 and r=0.030-0.109, P>0.01)and 6 mm(r=0.369-0.766, P<0.01).CONCLUSION: The VAO demonstrates favorable repeatability when assessing whole-eye higher order aberration under pupil diameters of 3-6 mm. However, there is inadequate agreement and interchangeability in whole-eye higher order aberration at 3-6 mm pupil diameter between VAO and OPD-Scan Ⅲ for clinical purposes.

Association between waiting time, service time and patient satisfaction in the out-patient department of a tertiary care hospital in Maharashtra

Background: Quality patient care is controlled by various factors - degree of fulfilment of patients' needs being one of them. Lesser waiting times, empathetic doctors and availability of medications yield more satisfied patients. Methods: A descriptive cross-sectional study was carried out among 80 patients attending the OPD of a tertiary care hospital from 9 am to 1 pm, Monday to Saturday from 8th February 2021 to 8th April 2021. Consenting patients were shadowed and observed until they completed their visit. Actual waiting time, consultation time and overall visit duration were calculated. An exit interview was conducted to assess satisfaction with waiting time, infrastructure and doctor-patient interaction. Results: The mean waiting time in one visit was 59.025±39.497 minutes. The mean consultation time with the doctor was 6.925±7.688 minutes. Statistical analysis showed that patients with lesser waiting time were significantly more satisfied with hospital services (p=0.004). Domains of dissatisfaction were waiting time at the registration desk, outside the OPD, seating arrangement, cleanliness and availability of medications. Doctor-patient interaction and consultation time were rated highly. Conclusions: The results showed that significant changes are required in the queueing system and hospital infrastructure. The positive response received in case of doctor-patient interaction is a step in the right direction. Regular surveys can help us rectify oversights in the present healthcare system.

A prospective observational study of prescription pattern in dermatology outpatient department of associated hospitals of Rajasthan University of Health Sciences-college of medical sciences, Jaipur

Background: Skin diseases are chronic in nature and they require lifetime treatment. Prescription pattern reflects health professional attitude towards the disease and role of drugs in its treatment. The study of prescription pattern is important to make medical care rational and monitoring adverse drug reactions. Methods: An observational and prospective study was carried out in Skin and VD department along with department of pharmacology, RUHS college of medical sciences, Jaipur. Data collection was done in three months after ethical approval. Data was entered and analysed with latest Microsoft Excel version. Descriptive statistics were used to analyse the results. Results: During the study period, a total of 979 prescriptions were included and analysed, out of which the usage of dermatological drugs was maximum among males (n=520, 53.11%). Total 2848 drugs were prescribed in 6 different dosage forms. The most common dosage form prescribed was tablet (1267, 44.49%) followed by cream (685, 24.05%). Total 1632 (57.30%) drugs were prescribed through oral route and 1216 (42.70%) drugs were prescribed through topical route. the present study depicted that dermatophytosis (n=243, 24.82%) was one of the most common dermatological manifestations. antihistaminic (673, 23.63%) were the most commonly prescribed drug. Conclusions: The study of drug use is an effective tool to promote rational drug prescribing. Such type of study will help in formulation of proper antibiotics, drugs policy, prescription of cost-effective drugs, improvement in the patient compliance and reduction in undesirable effect of drugs.

Technical expertise and behavior of the doctor- a major determinant of waiting time of OPD patients

Background: The study was conducted to understand various factors affecting waiting time spent by the patients in outpatient department (OPD) and to provide recommendations for reducing the waiting time in OPD of the selected hospital. Methods: It was a descriptive cross-sectional pretested questionnaire-based study involving all new 100 consenting patients at OPD recruited into the study using a systematic sampling technique after calculating the sampling interval. Results: The study indicates that 70% of patients were satisfied and only 30% were dissatisfied with the attention given by the OPD staff, cleanliness, attentiveness of doctor but shows great dissatisfaction regarding the waiting time spent by them in the outpatient department. Most of the subjects gave the reason for their satisfaction despite more time because of expertise of the doctor, behavior of the doctor, association of hospital with non-government organizations and insurance companies for free medicine and surgery. The dissatisfaction was not because of lack of administration but because of low level of awareness amongst patients attending the OPD about internet booking of appointment, COVID protocols, priorities given to recommendations given by other doctors/VIPs and walk in OPDs attended without prior appointment. Conclusions: A very important observation which evolved from the study was the version of patients that waiting time does not matter because they want to be treated from same doctor due to his/her expertise. Second important observation was that the addressing and greeting of patient by his/her name gave a great satisfaction and level of comfort to patients and affects the waiting time.

Effect of selected physical exercises on low back pain

Background: Men and women are equally affected by low back pain (LBP), which can range in intensity from a dull, constant ache to a sudden, sharp sensation that hinders the person. Pain can begin abruptly due to an accident or by lifting something heavy, or it can develop over time due to age-related changes in the spine. LBP is one of the primary healthcare problems in all developing countries; nurses play a vital role in giving different interventions to treat back pain effectively. This study aims to study the effect of selected physical exercise on LBP among patients attending the outpatient department (OPD) in selected hospitals. Materials and Methods: A quasi-experimental, one-group pretest–posttest time series research design was used to conduct a study among the patients attending OPD in selected hospitals. A total of 160 respondents were studied from October 2021 to February 2022. A numerical pain scale and a semistructured self-administered questionnaire were used to collect data. Only respondents who gave informed consent were issued the questionnaire to complete at their convenience. Physical exercises were demonstrated and done by patients for 6 weeks, thrice a day in a week for 30 min regularly. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 24.0. Descriptive data were presented in the form of bar graphs and frequency tables. Results: The study showed that 59.37% of the respondents had severe LBP in the pretest. After doing selected physical exercises, the severe pain level reduced to 56.25% in post-test-1, 32.5% in post-test-2, and 14.37% in post-test-3. The t value of the difference in mean reduction of LBP was tabulated, and the calculated t values were (0.78, 5.60, 9.64) statistically significant at 0.05 level of significance ( P < 0.05). Conclusion: LBP is seen as an issue for all ages and all sectors of society. One common component of pain treatment programs focuses on increased physical exercise reconditioning, and exercise would increase strength and concomitantly decrease pain as a long-term effect. The investigator found that physical activities were very effective and beneficial in reducing back pain among patients with LBP.

Agreement of corneal high-order aberrations measured by three wavefront aberrometers in myopic adults / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the agreement of corneal high-order aberrations from Topcon KR-1W, i.Profiler and OPD-Scan Ⅲ wavefront aberrometers in myopic adults.METHODS:A prospective clinical study. A total of 92 adult patients(92 eyes)with myopia in the department of optometry, the People's Hospital of Guangxi Zhuang Autonomous Region from June to August 2022 were enrolled. The third-order and fourth-order corneal aberrations at the pupil diameter of 4 and 6mm were measured by Topcon KR-1W, i.Profiler, and OPD-Scan Ⅲ, respectively. The difference and agreement of the three aberrometers were evaluated.RESULTS: The measurements at 6mm pupil diameter were all greater than those at 4mm pupil diameter. Although there were no statistical differences in the measurements of Z-44、Z-24 by the three aberrometers at 4 pupil diameter(P&#x003E;0.05), there were statistical differences in other measurements(P&#x003C;0.05). The aberration results measured by the three aberrometers were statistically different at the 6mm pupil diameter(P&#x003C;0.05). The 95% limit of agreement(95%LoA)of the measurements of higher-order aberration, including the third-order aberrations at 4mm pupil diameter and the third-order and fourth-order aberrations at 6mm pupil diameter(except for the Z-24)were greater than 0.1μm. The concordance correlation coefficient(Pc)was lower than 0.90, indicating a poor consistency. The correlation coefficients of corneal higher-order aberrations were significantly different among the three aberrometers at 4 and 6mm pupil diameter(r4mm=0.215～0.805, P4mm&#x003C;0.05; r6mm=0.561～0.916, P6mm&#x003C;0.001).CONCLUSION:There were significant differences in the measurements of the third- and fourth-order corneal aberrations at 4 and 6mm pupil diameter among Topcon KR-1W, i.Profiler, and OPD-Scan Ⅲ, and the agreements were poor, so they are not interchangeably in clinical applications.

A Time-Motion Analysis of An Urban Immunization Facility in The Konkan Region of India

Context/Background: Time motion studies involve the collection of data regarding the amount of time necessary to perform a specific movement or task by individuals or groups of people. Thus, hospital ad-ministrators can determine how much time is needed to execute that activity and whether the time is used efficiently and whether there is any possibility of improvement. Aims/Objectives: To study the operational efficiency of an immunization clinic attached to the urban health training centre. To assess the perception of patients regarding the health service delivery in the immunization OPD. Methodology: It was an observational study carried out in the immunization clinic of an urban health training center attached to a tertiary medical college, in the Konkan region of India for over 6 months. About 300 patients were included in the study. Results: According to 23.34% of study participants, the total time was too long. 24% of study partici-pants were not satisfied with the total time taken while 48.33% of study participants were satisfied with the total time. Conclusions: Management of time at various levels of the healthcare system is a need for the hour and necessary remedial actions should be initiated for optimal functioning of the healthcare system.

Analysis Of Completeness Of Blood Vacuume Tube Filling At A Clinical Laboratory Attached To Tertiary Care Center, A Cross Sectional Study

Background:Overfilled and under filled tube are most important cause of pre-analytical error and failure to complete requested examination in sample. The study was performed to analyse relationship betweentime of receiving of sample, location of sample, type of vacuum tube, method of collection, total volume required in a patient and volume incompleteness.Material And Methods:The study involved collection and patient samples data, i.e. receiving time of sample, place of collection, type of vacuum tube, blood collection method, total volume required in a patient, measurement of volume before processing. Average incompleteness of vacuum tube was calculated and average relationship between incompleteness and these parameters done.Result:Average incompleteness in OPD samples is better than Non-OPD samples. Averageincompleteness is better during 9 am to 12 am than early morning hour s. Incompleteness with relation to vacuum tube type is in general Plain > (EDTA/Fluoride) > Citrate. Average incompleteness better in sample collected with vacuum tube needle with holder than use of syringe. Average incompleteness increases as total volume required in a patient increases.Conclusion:Dedicated phlebotomist and use of vacuum tube needle with holder is required to bring overall improvement in completeness of blood collection.

Evaluation of Pathogens Causing Urinary Tract Infection and Their Sensitivity Pattern

Background: UTI constitute a major public health problem in India accounting 2nd most common infection next to respiratory tract infection. They are responsible for increasing treatment cost and significant morbidity.Aim:-To determine the incidence of UTI, evaluation of pathogens responsible and their antimicrobial susceptibility pattern in the population.Methods:Urine samples were collected from 300 patients attending the OPD Patna medical college, Patna during the period of 18 months (January 2017 to June 2018) Antimicrobial sensitivity testing was done for the bacterial isolates present in the sample by Kirby- Bauer disc diffusion method. Only those samples were taken into consideration which develops count equal to or greater than 1*105CFU/ml as indicated by Kass.Results:Out of 300 samples collected 146 (48.66%)) yielded bacterial growth. Out of 146 culture isolates E.Coli was the most common pathogen followed by klebsiella, CoNS and staphylococcus. Antibiotic sensitivity was performed on all the isolates. It was observed that highest sensitivity was 49.31% to amikacin, gentamycin (45.89%), nitrofurantoin (38.35%) meropenem (27.39%).Conclusions:It was observed that high grade of resistance to ampicillin, cotrimoxazole, ciprofloxacin, cefuroxime, chloramphenicol, cefotaxime, cefazolin, amoxicillin + clavulanic acid and gentamycin is present as a result of misuse or improper use of antibiotic in the community. Hence urine culture is necessary for the diagnostic screening of UTI before the treatment.

Clinical application of OPD-Scan Ⅲ aberration analyzer in evaluating the implantation of trifocal intraocular lens in patients with high myopia complicated with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the visual quality of patients with high myopia complicated with cataract after implantation of trifocal intraocular lens by OPD-Scan Ⅲ aberration analyzer.METHODS: Totally 32 patients(38 eyes)with high myopia complicated with cataract who underwent femtosecond laser assisted cataract phacoemulsification combined with trifocal intraocular lens implantation in Foshan Aier Eye Hospital from June 2018 to December 2020 were selected. Uncorrected distance visual acuity(UCDVA), uncorrected intermediate visual acuity(UCIVA)and uncorrected near visual acuity(UCNVA)were compared before, and 1wk, 3mo after surgery; OPD-Scan Ⅲ aberration analyzer measured objective visual quality before, and 1wk and 3mo after surgery. RESULTS: There were significant differences in UCDVA, UCIVA and UCNVA before, and 1wk, 3mo after operation(<i>P</i><0.05). The average orientation and centration distance was 0.12(0.08-0.15)mm and the average axial was(212.68±90.45)°in 3mo postoperative. There were significant differences in spherical aberration(<i>P</i><0.05), Strehl ratio(SR)and area ratio(AR)before, and 1wk, 3mo after operation(<i>P</i><0.001). In comparison, SR at 1wk and 3mo postoperative was higher than that before operation, whereas AR in 1wk and 3mo postoperative were both higher than that before operation(all <i>P</i><0.001). There was a negative correlation between SR and spherical aberration at 3mo postoperative(<i>rs</i>=-0.420, <i>P</i><0.01); There was a negative correlation between SR and trefoil at 3mo postoperative(<i>rs</i>= -0.418, <i>P</i><0.01); There was a negative correlation between AR and trefoil at 3mo postoperative(<i>rs</i>=-0.400, <i>P</i><0.05).CONCLUSION: Femtosecond laser assisted cataract surgery combined with trifocal intraocular lens implantation can provide a comfortable and natural full-range vision. The orientation and centricity of trifocal intraocular lens using OPD-Scan Ⅲ has shown that there was a good reliability and consistency. The vision quality using OPD-Scan Ⅲ is satisfactory.

Psychodynamic Profile in an Early Dropout Case: Comparing Therapist's and External Judges' perspectives

INTRODUCTION: contemporary psychodynamic therapy research supports combining clinical judgment with empirical evidences. Recent studies suggest that systematically analyzing single cases may contribute to such efforts. Also, current criteria for evidence-based case studies recommend different perspectives on therapeutic process and outcome, such as therapist's and external judges' ratings. Finally, client's dropout conforms a challenge for psychotherapy research. AIMS & METHODS: as part of a SPR Small Research Grant, this study analyzed and compared the psychodynamic profile proposed both by therapist and two external judges, for the same case of early dropout from focused psychodynamic psychotherapy, consisting of two diagnostic interviews and five subsequent sessions, in a patient with an emotional disorder. Being blind to the rating process of the counterpart, Operationalized Psychodynamic Diagnosis (OPD-2) was used by therapist and judges to generate a psychodynamic profile including five therapeutic foci. External judges rating was achieved through consensus, following CQR's guidelines. RESULTS & DISCUSSION: similarities and differences among therapist's and judges' psychodynamic profiles were found. Result's contributions to the understanding of case's early dropout are discussed, along with OPD-2's usefulness for psychodynamic practice-oriented research.(AU)

Patterns of change: tracking the therapeutic focus

INTRODUCTION: Brief dynamic psychotherapy has been increasingly important in the actual clinical practice. For its brevity, focalization must be accomplished. The work on focus consolidates the material, abbreviates psychotherapy, and is considered to be a change mechanism. Operationalized Psychodynamic Diagnosis OPD-2 proposes a concept of focus as the specific problem areas that are significant for patient's psychodynamics, in terms of relational pattern, inner conflicts, and structural vulnerabilities. The study on foci becomes a research and clinical imperative, where change on foci must be considered. AIMS & METHODS: This study aimed to (1) identify foci in change episodes and (2) establish the relationship between them during the process. A multiple single-subject design was used, considering the analysis of 13 outpatient psychotherapies done as treatment as usual (average of 18 sessions each process). OPD-2and Level of Presence of Foci were used to identify foci worked by therapist and patient during change episodes, already codified in a previous research usign the list of Generic Change Indicators. RESULTS & DISCUSSION: 208 change episodes were analysed. Conflict focus relates inversely with structural focus at the initial phase, and the latter appears to increase during the process. Some focus relates to different levels of patients change. Results are discussed in their clinical relevance. (AU)

Propriedades psicométricas do protocolo de sistema diagnóstico Operationalization of Psychodynamic Diagnosis 2 (OPD-2) em pacientes com transtorno mental grave em psicoterapia / Psychometric properties of the Operationalization of Psychodynamic Diagnosis 2 (OPD-2) diagnostic system protocol in patients with severe mental disorder undergoing psychotherapy

INTRODUCTION: In order to expand the descriptive classification of symptoms in mental disorders, and to bring empirical consistency to psychodynamic/psychoanalytic models, a multiaxial instrument called Operationalized Psychodynamic Diagnosis (OPD-2) has been developed, allowing psychotherapy research to encompass the complexity of the relationships between conditions and factors that determine the phenomena of mental pathologies, from a psychodynamic point of view. METHODOLOGY: Longitudinal naturalistic study with 80 outpatients with severe mental disorders, who were treated with a) psychodynamic psychotherapy, b) interpersonal psychotherapy and c) cognitive behavioral psychotherapy. All patients were interviewed at baseline and after six months, according to OPD-2's criteria. They all also completed two self-report measures (WHOQOL-BREF and SCL-90R) to evaluate symptoms and quality of life at each assessment point. RESULTS: According to OPD-2's axis I, better personal resources, psychosocial support, and introspective capacity significantly correlated with fewer symptoms in the BDI's and SCL-90's measures. Also, symptoms' reduction and quality of life's domains significantly correlated with items that assessed OPD-2's "desire for care versus autarchy" and "identity" conflicts. There was also a significant correlation between all items that evaluate structural functioning according to OPD-2 and the SCL-90R's psychotic index. Regarding predictive validity analysis, we observed mean differences in the structural functioning of patients with a history of suicide attempt and previous history of hospitalization. DISCUSSION: results support that OPD-2's criteria significantly correlates with data from validated self-report measures. When administered by trained raters, OPD-2 displayed good quality in assessing patients' conflicts and structural issues. This evidence suggests that the Brazilian version of OPD-2 is a valid and reliable instrument in evaluating psychodynamic properties and can be a useful tool within the clinical and research contexts. (AU)

Contributions of Operationalized Psychodynamic Diagnosis (OPD-2) in Colombia: training, practice and research

In this paper we summarize some experiences with Operationalized Psychodynamic Diagnosis (OPD-2) in the colombian context, and put into perspective other possibilities for its implementation grounded on our teaching and clinical practice. Given OPD-2 develops as a modular system for diagnosis and treatment planning, it has been used in different areas of both clinical practice and empirical research. Based on this, we have chosen different application scenarios to illustrate OPD-2'susefulness, focusing on different axes or modules of the instrument, reharding Colombia's interculturality, clinical work at the general hospital, teaching and practice integration, and OPD-2's contributions to dynamic psychology. The possibilities of OPD-2 related to each application area are discussed and gathered into a final conclusion.(AU)

Comparative study on the evaluation of Toric intraocular lens axial position using OPD scanⅢ and traditional slit lamp method / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the consistency and accuracy of the axial position of the astigmatism correction intraocular lens(Toric IOL)measured by OPD scan Ⅲ(optical path difference analyzer)and the traditional slit lamp method.<p>METHODS: A prospective observational control study. A total of 118 patients with 156 eyes who underwent phacoemulsification combined with Toric IOL implantation in our hospital from July 2018 to October 2019 were selected. The residual astigmatism was followed up at 1wk, 1mo and 3mo after the operation, and the axial position of Toric IOL was measured with OPD scan Ⅲ under the small pupil(Axial intraocular astigmatism method)and after dilated pupils(Axial OPD method), while using traditional slit lamp method to measure Toric IOL axis position(Axial Slit method). Analyze the difference and consistency of the measurement results of the three methods, and calculate the Lens axis deviation(LAD)between the measurement results of the three methods and the target axis. <p>RESULTS: The residual astigmatism of the patients in this group was significantly lower than that before the operation at 1wk, 1mo and 3mo after operation(<i>P</i><0.05). The proportion of residual astigmatism ≤ 0.75D at 3mo after surgery was 73.7%. Three months after the operation, the axial position of the Toric IOL measured by the axial Slit method, the axial OPD method, and the axial intraocular astigmatism method were: 111.0°(10, 178)°, 113.5°(12, 180)°, and 113.0°(15, 178)°. Consistency analysis showed that the average value of the difference between the axial OPD method and the axial Slit method, the axial intraocular astigmatism method and the axial slit method, the axial OPD method and the axial intraocular astigmatism method at 3mo after the operation, they were -0.58°, -0.19°, 0.40°, which were all close to 0°, with high consistency. 95% <i>LoA</i> were(-7.01-5.84)°,(-12.44-12.07)°,(-10.69-11.49)°. At 3mo postoperatively, the proportions of patients with LAD ≤5° measured by axial Slit method, axial OPD method, and axial intraocular astigmatism were 82.0%, 80.1%, and 59.0%, respectively.<p>CONCLUSION: OPD scan Ⅲ can directly measure Toric IOL axial position after dilated pupils. It was an objective and accurate measurement method, which can replace the traditional slit lamp method to measure axial position and avoid subjective limitations. The Toric IOL axial position can also be measured by intraocular astigmatism under the small pupil, which has certain practical application value in ophthalmology clinical work.

Prescription audit of online booked outpatients for department of medicine and dermatology in a tertiary care hospital: a comparative observational study

Background: A regular and effective prescription audit is a key tool to ensure rational use of drugs and to assess drug utilization in the health care system. This study is first of its kind, in Rajendra Institute of Medical Sciences (RIMS), Ranchi, highlighting comparative assessment of prescriptions of online booked appointments in department of medicine and dermatology via online registration system (ORS) using WHO prescribing indicators. This ORS is an integral part under Digital India Initiative.Methods: This was a comparative, observational study conducted in Department of Pharmacology of RIMS, Ranchi. The study period was 6 months from 1 March 2019 to 31 August 2019. Prescriptions details of outpatient department (OPD) patients were collected from the government authorized pharmacy facility “Dawai Dost “at RIMS. 75 prescriptions from each of the departments were analyzed.Results: 75 prescriptions from patients who attended medicine and dermatology outpatient department (OPD) during the study period, after registering appointment via ORS, was collected and comparative assessment was done. This audit highlights important correctable parameters although legibility was not the major concern. Adherence to National List of Essential Medicines (NLEM) was 45% and 49% for department of medicine and dermatology respectively.Conclusions: The prescription audit process should be done regularly to assess ORS prescription to ensure high quality rational prescribing and support Digital India initiative. Adherence to NLEM of India should be 100%. The latest NLEM of India should be provided to the concerned departments and feedback should be provided to the physicians.

Focos Terapéuticos en un Caso de Abandono Temprano: Perspectivas del Terapeuta y de Jueces Externos / Therapeutic Foci in an Early Dropout Case: Therapist's and External Judges' Perspectives

Introducción: es necesario mayor estudio de la experiencia de abandono terapéutico temprano. Indagar sistemáticamente casos únicos puede conformar una respuesta orgánica a este desafío. Objetivos y métodos: se analizó y comparó la evolución de focos terapéuticos, planteados por el terapeuta tratante y por dos juezas externas, para un caso de abandono temprano de psicoterapia psicodinámica focalizada de un trastorno emocional. Ciegos a la codificación de la contraparte, terapeuta y juezas utilizaron el Diagnóstico Psicodinámico Operacionalizado-2 (OPD-2) para generar un perfil psicodinámico y establecer focos de tratamiento. Para cada foco, aplicaron la Escala de Presencia de Foco y la Escala de Cambio Estructural de Heidelberg. Resultados y discusión: se observaron puntos de convergencia y divergencia entre las perspectivas de terapeuta y juezas externas. Se discute la utilidad de dichos puntos para la comprensión del abandono temprano del paciente, así como las implicancias del OPD-2 como herramienta de investigación orientada a la práctica

Introduction: more study on the experience of therapeutic early dropout is needed. The systematic study of psychodynamic single cases can conform an organic response to this challenge. Aims & Methods: therapeutic foci's evolution, proposed by both treating therapist and two external judges, for the same early dropout case of a focused psychodynamic psychotherapy for an emotional disorder, were analyzed and compared. Blind to the counterpart's rating process, therapist and judges employed Operationalized Psychodynamic Diagnosis (OPD-2) in order to generate a psychodynamic profile and establish therapeutic foci. For each focus, they applied the Focus Presence Scale and the Heidelberg Structural Change Scale. Results & Discussion: specific convergences' and discrepancies' points between therapist's and judges' perspectives were observed. Such points' usefulness for the understanding of patient's early dropout, together with OPD-2' implications as a practice-oriented research tool, are discussed

Referral Of Patients With Chest Symptoms From Adult Out-Patient Department To Designated Microscopy Centre In A Medical College Hospital Of Kolkata

Background: Referral for microscopy plays a crucial role in case identification for pulmonary tuberculosis. Objectives: The study was conducted to assess the proportion of referral to designated microscopy centre. Methods: A cross–sectional study among 100 chest symptomatic willing patients attending adult medical outdoor department was done. Interview and prescription auditing were data collection method to assess referral. Statistical analysis was done through Epi–Info program. Results: Mean age of the patients was 41.21 years. Co–morbidity (16%) & history of contact (6%) was evaluated. Only cough, both cough and chest pains were the predominant symptoms among 39 percent, 51 percent of patients respectively. Significant amount of patients (73.58%) had no idea for duration of chest pain. Associated symptoms were low grade fever (60%), weight loss (13%). Time–interval for care–seeking was found by < 4 weeks (41%), > 4 weeks (19%), at 8 weeks (21%) and at 1st day (19%). Chest symptomatics were referred to Designated Microscopy Centre (11%) in significantly lower than referred to chest department (92%). Conclusion: The chest symptomatics were not referred to DMC at the proposed level. A sizable number of patients (21%) attended hospital for health care services after a long interval (8 weeks). Implications: Sensitization of doctors on the program protocol is required to overcome the poor situation of referral to Designated Microscopy Centre.

Evaluation of Antihypertensive Drug Prescription Patterns, Rationality, and Adherence to Joint National Committee-8 Hypertension Treatment Guidelines among Patients Attending Medicine OPD in a Tertiary Care Hospital.

Introduction: The increasing prevalence of hypertension isattributed to population growth, ageing and behavioural riskfactors, such as unhealthy diet, harmful use of alcohol, lackof physical activity, excess weight and exposure to persistentstress. The present study was conducted to study on variousfacets of antihypertensive drugs prescribing at present scenarioat Dr B.C. Roy Hospital, Haldia, and with objectives of studyingprescribing patterns and rationality of antihypertensive drugsin essential hypertension with or without specific co-morbidconditions and to check compliance of treatment as per JNC-8hypertension treatment guidelines in the outpatients attendingthe Department of Medicine.Material and Methods: Data regarding anti-HTN monotherapy and combination therapy was recorded. Evaluation forrational drug therapy by evaluating average number of drugsper prescription, fixed dose combination (FDC) prescriptionrate, prescription laying down importance of lifestylemanagement, prescription with defined anti-HTN goals,prescriptions with correct dose strength and dosage schedulewas evaluated.Results: Out of 100 hypertensive patients under evaluation 67was males (67%) with a M:F ratio of 2.03:1. Mean SBP wasslightly higher in male patients. Hypertension was classifiedaccording to JNC-8 guidelines and found 22 (22%) (Prehypertension/pre-HTN), 57 (57%) (Stage 1 hypertension),and 13% (stage 2 hypertension) cases. Dyslipidemia wasnoted much more common associated disorders among newlydiagnosed hypertensive of either sex.Conclusion: Diuretics (8%) were most widely prescribeddrugs followed by ARBs (6%), ACE Inhibitors (5%) andcalcium channel blockers (4%) as monotherapy. Adherence ofJNC 8 guidelines among all study hypertensive participantswhile prescribing medications varied between 62% to 92%,with an average of 75%. None of the prescriptions mentionedban drug formulation(s). Still 15% of the prescriptionshad suggested combined drugs with debated rationalityformulations.

Drug utilization pattern of antimicrobials in OPD of ENT in teaching hospital

Background: A drug utilization study may be helpful to identify the problems, suggest the remedial measures and promote rational use. Antimicrobials are commonly used to treat infections caused by bacteria, viruses, protozoa and fungi, evidently require huge prescriptions in India.Methods: A prospective, observational study was carried out for a period of four months from February to May 2019 in the Department of ENT (OPD) at NRI Medical College and General Hospital. Prescriptions were collected randomly from around 300 patients attending the ENT outpatient department after obtaining informed consent. The data were collected in the predesigned proforma for analysis.Results: 300 ENT patients were selected for the study, 62% were male and 38% were female. Out of 300 patients 190 ear disorders, 50 nasal, and 60 throat infections. Antimicrobial therapy were most commonly instituted in ear diseases (67.66%), nose (16.95%) and throat (15.37%) respectively. The most commonly used agents were amoxicillin with clavulanic acid- n=295, cefixime- n=1260, gentamicin- n=200, ciprofloxacin- n=157, azithromycin- n=199, nitroimidazoles (metronidazole- n=111).Conclusions: Cefixime and amoxicillin+clavulanic acid combination was the most commonly prescribed antibiotic in our study. Interventions to rectify the use of brand names are necessary to promote rational drug use. An antibiotic policy has to be developed for the doctors in treating infections so that rationality in using the antibiotics will be developed and the occurrence of antibiotic resistance can be reduced.