Program Report: Improving Patient Experience at an Outpatient Clinic Using Continuous Improvement Tools.

Patient satisfaction with prompt and high-quality healthcare services plays a pivotal role in healthcare settings. The delivery of high-quality services within the healthcare sector is closely associated with continuous quality improvement (CQI), which is an incremental and progressive process that prioritizes the safety of all participants, favorable outcomes, systematic processes, and a regulated and improved working environment, particularly in later stages. Surprisingly, these aspects are less frequently explored in Middle Eastern countries. Thus, this research paper aims to assess the impact of quality services on patient satisfaction in tertiary care clinics located in the Middle East. To improve the quality of services in our clinic, we employed patient feedback as a valuable resource. We proactively reached out to all patients who had visited our hospital via mobile phone messages and requested their feedback on the services they received. Approximately 5% of all visitors responded and completed a comprehensive questionnaire. The majority of respondents expressed satisfaction with the services provided across various departments. However, they also offered valuable suggestions that helped us identify further areas for improvement and enhance the overall patient experience within our clinic. Drawing upon the feedback received, we meticulously considered the identified issues, redesigned our policies, and implemented strategic changes. Following the implementation of these new approaches, we once again sought patients' feedback on the quality of our services. Patient feedback highlighted the significant impact of optimized service delivery methods, resulting in a substantial increase in patient satisfaction. Overall, this study sheds light on the vital factors that can enhance patients' experience in outpatient clinics, emphasizing the importance of integrating patient feedback into continuous quality improvement initiatives. By utilizing this approach, healthcare providers, administrators, and researchers can effectively improve service quality and patient satisfaction. Consequently, this research paper serves as a valuable reference for public health stakeholders, administrators, and researchers in their pursuit of delivering exceptional healthcare experiences.

Assessment of hepatotoxicity and nephrotoxicity in Cirrhinus mrigala induced by trypan blue - An azo dye.

Cytotoxicity in freshwater fishes induced by industrial effluents and dyes is a global issue. Trypan blue dye has many applications in different sectors, including laboratories and industries. This study determines to detect the cytotoxic effects of trypan blue dye in vivo. The objective of this study was to estimate the sub-lethal effects of azodye in fish. Cirrhinus mrigala, a freshwater fish, was exposed to three different grading concentrations of dye 5 mg/L, 10 mg/L, and 20 mg/L in a glass aquarium. Significant (p < 0.05) decrease in the weight of fish was observed as 0.728 ± 0.14 g and 2.232 ± 0.24 g, respectively, in the trial groups exposed to 10 and 20 mg/L of dye in a week. After exposure to trypan blue dye, fishes were dissected to remove liver and kidney tissues. Histopathological assessments determined hepatotoxicity and nephrotoxicity induced by trypan blue through the paraffin wax method. This dye induces mild alterations in the liver such as congestion, hemolysis, dilated sinusoids, ruptured hepatocytes, vacuolization, edema of hepatocytes, necrosis, degeneration, aggregation, and inflammation. This dye not only alters liver tissue, also induces an acute level of tissue alterations in the kidneys, such as degeneration of epithelial cells of renal tubules, shrinkage of the glomerulus, congestion, reduced lumen, degeneration of glomerulus, absence of space of bowmen, glomerulonephritis, necrosis in hematopoietic interstitial tissues and glomerulus, reduced lumen, vacuolar degeneration of renal tubules, increased per tubular space. The current study concludes that trypan blue dye released even in small amounts is found to be associated with a high incidence of cytotoxicity. Such tissue alterations in this species could be used as biomarkers for azo dyes.

Effect of Health Education on Dengue Fever: A Comparison of Knowledge, Attitude, and Practices in Public and Private High School Children of Jeddah.

Objective More than half of the world's population live in areas with a potential risk of acquiring dengue fever (DF). Health education interventions are effective, barring a language communication gap. The objective of this study was to estimate the effect of health education in the knowledge, attitude, and practices (KAP) towards DF control and prevention in public and private schools. Materials and methods We assessed the DF control and prevention strategy KAP of students of eight public and private schools in Jeddah, Saudi Arabia before the dengue health education intervention sessions (pre-I) and three months following the education intervention sessions (post-I) using the same closed-ended validated questionnaire. Schools and students were selected by a multistage stratified random sample method. Statistical analysis was done using the paired and independent T-test in IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY). Results We found a significant mean difference in the overall knowledge (pre-I, 7.86 ± 2.61; post-I, 10.94 ± 2.35), attitude (pre-I, 5.16 ± 1.50; post-I 6.23 ± 1.30), and practice (pre-I, 2.96 ± 1.33; post-I, 3.94 ± 1.12) scores. Private schools scored better post-intervention scores in knowledge and practice compared to public schools in local and English language medium. Conclusions Health education programs are essential for DF prevention and management. Institutes whose populations consists of students with various language backgrounds should not be ignored. Bilingual educational sessions are important in such private institutes. Our results indicate additional emphasis is required on putting interventional knowledge into practice.

Vitamin D deficiency in patients with tuberculosis.

OBJECTIVE: To determine the frequency and association of Vitamin D deficiency in patients with tuberculosis. STUDY DESIGN: Case control study. PLACE AND DURATION OF STUDY: Medical Department, Combined Military Hospital, Kharian, from July 2010 to June 2012. METHODOLOGY: One hundred and five outdoor patients of tuberculosis were selected with 255 gender matched controls. Tuberculosis was diagnosed by presence of acid fast bacilli in sputum smears, positive culture for Mycobacterium tuberculosis or demonstration of chronic caseating granulomatous inflammation in tissue specimens. Controls were drawn randomly from general population. Serum 25 hydroxyvitamin D [25 (OH) D3] levels < 25 ng/ml was considered Vitamin D deficiency. The results were analyzed on SPSS version 17. RESULTS: Mean Vitamin D levels were 23.23 ± 6.81 ng/ml in cases, 29.27 ± 8.89 ng/ml in controls (p < 0.0001). Vitamin D deficiency was found in 57% of cases and 33% controls (p < 0.0001). Mean Vitamin D levels were significantly lower in females with tuberculosis (20.84 ng/ml) as compared to males (25.03 ng/ml, p = 0.002). Mean BMI in patients of tuberculosis with Vitamin D deficiency were 19.51 ± 1.77 kg/m2 and in patients with normal Vitamin D were 21.65 ± 1.79 kg/m2 (p < 0.0001). Mean Vitamin D levels in patients with multi-drug resistant tuberculosis was lower to a mean of 15.41 ± 4.67 ng/ml (p < 0.0001). CONCLUSION: There is significant deficiency of Vitamin D in patients with tuberculosis as compared to controls. This deficiency is more pronounced in females, individuals with low BMI, extra pulmonary and MDR tuberculosis.

Prevalence of vitamin B12 deficiency in patients of type 2 diabetes mellitus on metformin: a case control study from Pakistan.

INTRODUCTION: Diabetes Mellitus is the most common endocrine disorder and metformin is the most commonly prescribed oral hypoglycemic agent. Metformin is well known to cause viamin B12 deficiency due to effect on calcium-dependent membrane action in the terminal ileum leading to malabsorption of vitamin B12. The purpose of this study is to determine prevalence and associations of Vitamin B12 deficiency in patients of type 2 diabetes mellitus treated with metformin. METHODS: This case control study was carried out in department of medicine, Combined Military Hospital, Kharian from 1(st) Jan 2012 to 30 december 2012. We enrolled 114 outdoor patients of type 2 diabetes mellitus currently on metformin for atleast 12 months, by consecutive sampling, and 105 age and sex matched patients taken as control. Patients with vitamin B12 levels of less than 150 pg/ml were said to be B12 deficient. The results were analyzed on SPSS version 16. RESULTS: Serum B12 levels were low in 35 patients (31%) on metformin as compared to only 9 patients (8.6%) among controls,(p value 0.002). Mean B12 levels were significantly low in metformin group 311 pg/ml (±194.4), p value 0.03. Dose of metformin had inverse correlation with B12 levels and the difference was statistically significant with p-value < 0.001. CONCLUSION: Our study demonstrated significantly high prevalence of vitamin B12 deficiency in patients treated with metformin with significant effect of dose and duration of metformin use on B12 levels. Physicians must recognize this important fact and screen diabetics on metformin therapy for underlying B12 deficiency.