Search results for: hospital retrofitting

Authors: Parimalakrishnan Sundararjan, Madheswaran Murugan, Dhanya Dharman, Yatindra Kumar, Sudhir Singh Gangwar, Guru Prasad Mohanta

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Antibiotic resistance AR is a global issue, India started to redress the issues of antibiotic resistance late and it plans to have: active surveillance of microbial resistance and promote appropriate use of antibiotics. The present study attempted to achieve appropriate use of antibiotics through pharmacists’ intervention at practice point. In a quasi-experimental prospective cohort study, the cases with bacteremia from four hospitals were identified during 2015 and 2016 for intervention. The pharmacists centered intervention: active screening of each prescription and comparing with the selection of antibiotics with susceptibility of the bacteria. Wherever irrationality noticed, it was brought to the notice of the treating physician for making changes. There were two groups: intervention group and control group without intervention. The active screening and intervention in 915 patients has reduced therapeutic regimen time in patients with bacteremia. The intervention group showed the decreased duration of hospital stay 3.4 days from 5.1 days. Further, multivariate modeling of patients who were in control group showed that patients in the intervention group had a significant decrease in both duration of hospital stay and infection-related mortality. Unlike developed countries, pharmacists are not active partners in patient care in India. This unique attempt of pharmacist’ invention was planned in consultation with hospital authorities which proved beneficial in terms of reducing the duration of treatment, hospital stay, and infection-related mortality. This establishes the need for a collaborative decision making among the health workforce in patient care at least for promoting rational use of antibiotics, an attempt to combat resistance.

Keywords: antibiotics resistance, intervention, bacteremia, multivariate modeling

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Authors: Inayatullah Khan, Afzal Khan, Hamzullah Khan, Afzal Khan

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Objectives: The objective of this study was to compare different statistical variables for vaccinated and unvaccinated children in measles cases. Material and Methods: This cross sectional comparative study was conducted at Isolation ward, Department of Paediatrics, Lady Reading Hospital (LRH), Peshawar, from April 2012 to March 2013. A total of 566 admitted cases of measles were enrolled. Data regarding age, sex, address, vaccination status, measles contact, hospital stay and outcome was collected and recorded on a proforma. History of measles vaccination was ascertained either by checking the vaccination cards or on parental recall. Result: In 566 cases of measles, 211(39%) were vaccinated and 345 (61%) were unvaccinated. Three hundred and ten (54.80%) patients were males and 256 (45.20%) were females with a male to female ratio of 1.2:1.The age range was from 1 year to 14 years with mean age with SD of 3.2 +2 years. Majority (371, 65.5%) of the patients were 1-3 years old. Mean hospital stay was 3.08 days with a range of 1-10 days and a standard deviation of ± 1.15. History of measles contact was present in 393 (69.4%) cases. Fourty eight patients were expired with a mortality rate of 8.5%. Conclusion: Majority of the children in Khyber Pukhtunkhwa are unvaccinated and unprotected against measles. Among vaccinated children, 39% of children attracted measles which indicate measles vaccine failure. This figure is clearly higher than that accepted for measles vaccine (2-10%).

Keywords: measles, vaccination, immunity, population

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Authors: Lillian Musila, Valerie Oundo, Daniel Erwin, Willie Sang

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Staphylococcus aureus infections are a major cause of nosocomial infections in Kenya. Methicillin resistant S. aureus (MRSA) infections are a significant burden to public health and are associated with considerable morbidity and mortality. At a hospital in Western Kenya two clusters of MRSA cases emerged within short periods of time. In this study we explored whether these clusters represented a nosocomial outbreak by characterizing the isolates using phenotypic and molecular assays and examining epidemiological data to identify possible transmission patterns. Specimens from the site of infection of the subjects were collected, cultured and S. aureus isolates identified phenotypically and confirmed by APIStaph™. MRSA were identified by cefoxitin disk screening per CLSI guidelines. MRSA were further characterized based on their antibiotic susceptibility patterns and spa gene typing. Characteristics of cases with MRSA isolates were compared with those with MSSA isolated around the same time period. Two cases of MRSA infection were identified in the two week period between 21 April and 4 May 2015. A further 2 MRSA isolates were identified on the same day on 7 September 2015. The antibiotic resistance patterns of the two MRSA isolates in the 1st cluster of cases were different suggesting that these were distinct isolates. One isolate had spa type t2029 and the other had a novel spa type. The 2 isolates were obtained from urine and an open skin wound. In the 2nd cluster of MRSA isolates, the antibiotic susceptibility patterns were similar but isolates had different spa types: one was t037 and the other a novel spa type different from the novel MRSA spa type in the first cluster. Both cases in the second cluster were admitted into the hospital but one infection was community- and the other hospital-acquired. Only one of the four MRSA cases was classified as an HAI from an infection acquired post-operatively. When compared to other S. aureus strains isolated within the same time period from the same hospital only one spa type t2029 was found in both MRSA and non-MRSA strains. None of the cases infected with MRSA in the two clusters shared any common epidemiological characteristic such as age, sex or known risk factors for MRSA such as prolonged hospitalization or institutionalization. These data suggest that the observed MRSA clusters were multi strain clusters and not an outbreak of a single strain. There was no clear relationship between the isolates by spa type suggesting that no transmission was occurring within the hospital between these cluster cases but rather that the majority of the MRSA strains were circulating in the community. There was high diversity of spa types among the MRSA strains with none of the isolates sharing spa types. Identification of disease clusters in space and time is critical for immediate infection control action and patient management. Spa gene typing is a rapid way of confirming or ruling out MRSA outbreaks so that costly interventions are applied only when necessary.

Keywords: cluster, Kenya, MRSA, spa typing

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Authors: Hind Bouami

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Handling life-critical systems complexity requires to be equipped with appropriate technology and the right human agents’ functions such as knowledge, experience, and competence in problem’s prevention and solving. Human agents are involved in the management and control of human-machine system’s performance. Documenting human agent’s situation awareness is crucial to support human-machine designers’ decision-making. Knowledge about risks, critical parameters and factors that can impact and threaten automation system’s performance should be collected using preventive and retrospective approaches. This paper aims to document operators’ situation awareness through the analysis of automated organizations’ feedback. The analysis of automated hospital pharmacies feedbacks helps to identify and control critical parameters influencing human machine interaction in order to enhance system’s performance and security. Our human machine system evaluation approach has been deployed in Macon hospital center’s pharmacy which is equipped with automated drug dispensing systems since 2015. Automation’s specifications are related to technical aspects, human-machine interaction, and human aspects. The evaluation of drug delivery automation performance in Macon hospital center has shown that the performance of the automated activity depends on the performance of the automated solution chosen, and also on the control of systemic factors. In fact, 80.95% of automation specification related to the chosen Sinteco’s automated solution is met. The performance of the chosen automated solution is involved in 28.38% of automation specifications performance in Macon hospital center. The remaining systemic parameters involved in automation specifications performance need to be controlled.

Keywords: life-critical systems, situation awareness, human-machine interaction, decision-making

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Authors: N. Khursheed, M. Fatima, S. Jamal, A. Raza, S. Rattani, Q. Ahsan, A. Rasheed, M. Jawed

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Introduction: Antibiotics are among the commonly prescribed medicines to treat bacterial infections. Their misuse intensifies resistance, and overuse incurs heavy losses to the healthcare system in terms of increased treatment costs and enhanced disease burden. Studies show that 40% of empirically used antibiotics are irrationally utilized. The objective of this study was to evaluate prescribing pattern of antibiotics at six public sector tertiary care hospitals across Pakistan. Methods: A multicenter cross-sectional point prevalence survey (PPS) was conducted in selected wards of six public sector tertiary care hospitals in Pakistan as part of the Clinical Engagement program by Fleming Fund Country Grant Pakistan in collaboration with Indus Hospital & Health Network (IHHN) from February to March 2021, these included Jinnah Postgraduate Medical Center and Dr. Ruth K. M. Pfau Civil Hospital from Karachi, Sheikh Zayed Hospital Lahore, Nishtar Medical University Hospital Multan, Medical Teaching Institute Hayatabad Medical Complex Peshawar, and Provincial Headquarters Hospital Gilgit. WHO PPS methodology was used for data collection (Hospital, ward, and patient level data was collected). Data was entered into the open-source Kobo Collect application and was analyzed using SPSS (version 22.0). Findings: Medical records of 837 in-patients were surveyed, of which the prevalence of antibiotics use was 78.5%. The most commonly prescribed antimicrobial was Ceftriaxone (21.7%) which is categorized in the Watch group of WHO AWaRe Classification, followed by Metronidazole (17.3%), Cefoperazone/Sulbactam (8.4%), Co-Amoxiclav (6.3%) and Piperacillin/Tazobactam (5.9%). The antibiotics were prescribed largely for surgical prophylaxis (36.7%), followed by community-acquired infections (24.7%). One antibiotic was prescribed to 46.7%, two to 39.9%, and three or more to 12.5 %. Two of six (30%) hospitals had functional drug and therapeutic committees, three (50%) had infection prevention and control committees, and one facility had an antibiotic formulary. Conclusion: Findings demonstrate high consumption of broad-spectrum antimicrobials and emphasizes the importance of expanding the antimicrobial stewardship program. Mentoring clinical teams will help to rationalize antimicrobial use.

Keywords: antimicrobial resistance, antimicrobial stewardship, point prevalence survey, antibiotics

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Authors: S. I. Nwadioha, M. S. Odimayo, G. T. A. Jombo, E. O. P. Nwokedi

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Aims and Objectives: To determine the baseline CD4 positive T lymphocytes count of HIV/AIDS treatment naïve adults clients presenting for the first time treatment in Benue State University Teaching Hospital. Subjects and Methods: A total of 700 subjects age between 18 years to 70 years, were recruited for the study, comprising 600 HIV sero-positive patients and 100 healthy controls in Benue State University Teaching Hospital, Makurdi from 2013 to 2014. The CD4 counts of the subjects were evaluated using a Partec flow cytometer. Results: CD4 count of 200-299 cells/μl peaked with 25% (n=150/600)[control; 0%( n= 0/100)]. The study also showed that 44% (266/600) of HIV subjects had acquired immunodeficiency syndrome as defined by low CD4 counts below 200 cells/μl. Seventy-five per cent (n=451/600)of our patients would require to be placed on antiretroviral therapy with CD4 count of less than 350 cells/μl. At CD4 350 baseline criterion, age group 20-29 years had the highest demand 35%(160/451) for ARV followed by age groups 30-39 and 40-49 years with 28%(128/451) and 22%(98/451) respectively. Conclusion: There is a high prevalence of acquired immunodeficiency syndrome as defined by CD4 counts below 200 cells/μl, among the young active productive age group. The strict adopting of the ART WHO 2010 scale- up criteria doubles the number of the HIV clients that would qualify for ART with its attendant health benefits on the long run.

Keywords: CD4 counts, HIV patients, young age group, Nigeria

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Authors: Somayeh Abedian, Pirhossein Kolivand, Hamid Reza Lornejad, Amin Karampour, Ebrahim Keshavarz Safari

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For emergency and relief service providers such as pre-hospital emergencies, quick arrival at the scene of an accident or any EMS mission is one of the most important requirements of effective service delivery. Response time (the interval between the time of the call and the time of arrival on scene) is a critical factor in determining the quality of pre-hospital Emergency Medical Services (EMS). This is especially important for heart attack, stroke, or accident patients. Location-based e-services can be broadly defined as any service that provides information pertinent to the current location of an active mobile handset or precise address of landline phone call at a specific time window, regardless of the underlying delivery technology used to convey the information. According to research, one of the effective methods of meeting this goal is determining the location of the caller via the cooperation of landline and mobile phone operators in the country. The follow-up of the Communications Regulatory Authority (CRA) organization has resulted in the receipt of two separate secured electronic web services. Thus, to ensure human privacy, a secure technical architecture was required for launching the services in the pre-hospital EMS information management system. In addition, to quicken medics’ arrival at the patient's bedside, rescue vehicles should make use of an intelligent transportation system to estimate road traffic using a GPS-based mobile navigation system independent of the Internet. This paper seeks to illustrate the architecture of the practical national model used by the Iranian EMS organization.

Keywords: response time, geographic location inquiry service (GLIS), location-based service (LBS), emergency medical services information system (EMSIS)

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Authors: Rosalina Penaloza, Joanna Navarro, Pauline Jolly, Anna Junkins, Carlos Seas, Larissa Otero

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Background: Tuberculosis (TB) case detection in Peru relies on passive case finding. This strategy relies on the assumption that the community is aware that a persistent cough is a possible symptom of TB and that formal health care needs to be sought. Despite its importance, health knowledge specific to TB is underexplored in Peru. This study aimed to assess health literacy and level of TB knowledge among outpatients attending a referral hospital in Lima, Peru. The goal was to ascertain knowledge gaps in key areas relating to TB, to identify and prioritize subgroups for intervention, and to provide insight for policy and community interventions considering health literacy. Methods: An observational cross-sectional study was conducted using a survey to measure sociodemographic factors, tuberculosis knowledge, and health literacy. Bivariate and Multivariate logistic regression was performed to study the associations between variables and to account for potential confounders. The study was conducted at Hospital Cayetano Heredia in Lima, Peru from June – August 2017. Results: 272 participants were included in the analysis. 57.7% knew someone who had had TB before, 9% had had TB in the past. Two weeks a cough was correctly identified as a symptom that could be TB by 69.1%. High TB knowledge was found among 149 (54.8%) participants. High health literacy was found among 193 (71.0%) participants. Health literacy and TB knowledge were not significantly associated (OR 0.9 (95%CI 0.5-1.5)). After controlling for sex, age, district, education, health insurance, frequency of hospital visits and previous TB diagnosis: High TB knowledge was associated with knowing someone with TB (aOR 2.7 (95%CI 1.6-4.7)) and being a public transport driver, (aOR 0.2 (95%CI 0.05-0.9)). Not being poor was the single factor associated with high health literacy (aOR 3.8 (95%CI 1.6-8.9)). Conclusions: TB knowledge was fair, though 30% did not know the most important symptom of TB. Tailoring educational strategies to risk groups may enhance passive case detection especially amongst transport workers in Lima, Peru.

Keywords: health literacy, Peru, tuberculosis, tuberculosis knowledge

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Authors: F. N. Bolu-Steve, T. A. Ajiboye

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A study was carried out on the awareness of counselling needs of psychiatric patients as perceived by medical personnel in the Federal Neuropsychiatric hospital, Aro, Abeokuta, Nigeria. The respondents comprised of medical personnel of the Neuropsychiatric hospital in Aro. Purposive sampling technique was used to select the respondents. The target population of the study consisted of all medical doctors treating the psychiatric patients. A total of 200 respondents participated in the study out of which 143 were males and 57 of them were females. With their years of experience as a medical doctors, 49.5% of them have worked between 1-5 years, 30.5% of the respondents have 6-10 years’ experience while those with 16 years and above experience are 7.0%. The major counselling need of psychiatric patients as expressed by medical doctors is the need to have information about the right balance diet. The data were analyzed using percentages, mean, frequency, Analysis of Variance (ANOVA) and t-test statistical tools. The instrument used for data collection was the structured questionnaire titled “Counselling Needs of Psychiatric Patients Questionnaire” (CNPPQ). This instrument was drafted by the researchers through the review of related literature. The reliability of the instrument was established using test-retest method. A reliability index of 0.74 was obtained. Three of the hypotheses were rejected while two of them were accepted at 0.05 alpha level of significance. Based on the findings of the study, it was recommended that broad based counselling services should be provided to psychiatric patients in order to assist them to develop positive self- image and to cope with their challenges.

Keywords: counselling, needs, psychiatric, medical personnel, patients

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Authors: Priyanka Sharma, Manoj Jais, Poonam Gupta, Suraiya K. Ansari, Ravinder Kaur

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Introduction: As much as the Health Care is necessary for the population, so is the management of the Biomedical waste produced. Biomedical waste is a wide terminology used for the waste material produced during the diagnosis, treatment or immunization of human beings and animals, in research or in the production or testing of biological products. Biomedical waste management is a chain of processes from the point of generation of Biomedical waste to its final disposal in the correct and proper way, assigned for that particular type of waste. Any deviation from the said processes leads to improper disposal of Biomedical waste which itself is a major health hazard. Proper segregation of Biomedical waste is the key for Biomedical Waste management. Improper disposal of BMW can cause sharp injuries which may lead to HIV, Hepatitis-B virus, Hepatitis-C virus infections. Therefore, proper disposal of BMW is of upmost importance. Health care establishments segregate the Biomedical waste and dispose it as per the Biomedical waste management rules in India. Objectives: This study was done to observe the current trends of Biomedical waste generated in a tertiary care Hospital in Delhi. Methodology: Biomedical waste management rounds were conducted in the hospital wards. Relevant details were collected and analysed and sites with maximum Biomedical waste generation were identified. All the data was cross checked with the commons collection site. Results: The total amount of waste generated in the hospital during January 2014 till December 2014 was 6,39,547 kg, of which 70.5% was General (non-hazardous) waste and the rest 29.5% was BMW which consisted highly infectious waste (12.2%), disposable plastic waste (16.3%) and sharps (1%). The maximum quantity of Biomedical waste producing sites were Obstetrics and Gynaecology wards with a total Biomedical waste production of 45.8%, followed by Paediatrics, Surgery and Medicine wards with 21.2 %, 4.6% and 4.3% respectively. The maximum average Biomedical waste generated was by Obstetrics and Gynaecology ward with 0.7 kg/bed/day, followed by Paediatrics, Surgery and Medicine wards with 0.29, 0.28 and 0.18 kg/bed/day respectively. Conclusions: Hospitals should pay attention to the sites which produce a large amount of BMW to avoid improper segregation of Biomedical waste. Also, induction and refresher training Program of Biomedical waste management should be conducted to avoid improper management of Biomedical waste. Healthcare workers should be made aware of risks of poor Biomedical waste management.

Keywords: biomedical waste, biomedical waste management, hospital-tertiary care, New Delhi

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Authors: Sanjeev Singh

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Background: Obstructed total anomalous pulmonary venous connection (OTAPVC) typically presents with severe cardiovascular decompensation and requires urgent surgical management. Pulmonary arterial hypertension (PAH) is a major risk factor affecting mortality. Perioperative management focuses on providing inotropic support and managing potential pulmonary hypertensive episodes. The aim of this study was to determine the outcome of patients with high pulmonary arterial pressure (PAP) with milrinone alone and a combination of milrinone and inhaled nitric oxide (INO). Material and Methods: After the approval of the ethical committee, this single-center prospective randomized and observational study was conducted over a period of two years among eighty-six patients with obstructed TAPVC repair with severe PAH. Group-I patients received milrinone, and Group-II patients received both milrinone (after aortic cross-clamp removal) and INO during the post-operative period at the cardiac care unit (CCU). Clinical outcomes such as ventilation time, length of stay (LOS) in the CCU, LOS in the hospital, complications, and hospital mortality were compared between the two groups. Result: The average ventilation time, LOS in CCU, and LOS in hospital for group I were 96.82 ± 19.46 hours, 10.91 ± 7.53 days, and 14.46 ± 7.58 days, respectively, and for group II, it was 85.14 ± 15.79 hours, 7.28 ± 3.68 days, and 10.21 ± 3.14 days, respectively, which was statistically significantly lower for group II. Reintubation, RV dysfunction, and hospital mortality were 16.3%, 37.2%, and 6.9% in group I, and 4.8%, 14.6%, and 2.4% in group II, respectively. The P value for each variable was significant < 0.05 (except mortality). Conclusion: Preoperative obstruction is a risk factor for postoperative obstruction, as 235 patients with obstructed TAPVC had severe PAH (39.98%) in this study. Management of severe PAH with a combination of milrinone and INO had a better outcome than milrinone alone.

Keywords: inhaled nitric oxide, milrinone, pulmonary artery hypertension, total anomalous pulmonary venous connection

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Authors: Uwizera Egide

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Introduction: Dermatological conditions are one of the most burdensome diseases in our health system. Global studies suggest that around 1 in 3 people gets a skin disease at a certain point in their life, though this does not necessarily guarantee the urge to consult. For a high-ranking disease, it is surprising how there is not enough data to support its effect on the economy and the general health system impact. It is for that reason that this study’s aim is to identify the burden of dermatological conditions in Rwanda so as to have a general picture of what our population is going through in regards to dermatological conditions. Methods: We used a cross sectional retrospective study. Data were obtained from patient’s information recorded in an open clinic at CHUB in a period of six months from July to December of the year 2021. Results: The study had a total of 4600 patients who attended dermatology service in a period of six months from July to December of the year 2021. We found a list of 102 dermatological diseases that presented at variable rates. The most prevalent disease was atopic dermatitis, at a rate of 23%. About 90% of presented conditions had only one choice of treatment from the hospital pharmacy. Most patients who presented were between 18-35 years old and with a predominance of the female gender; the level of education was either secondary or University Degree in our study, 65.4% of patients who presented were female; the majority, around 45% were between 18-35 years old, mostly being single 56%. The majority came from Southern province as it is the location of the hospital. The insurance mostly used was community-based health insurance with 63.8%, followed by RSSB with 18.5%, MS/UR, and other private insurances. The frequency of group drugs prescribed among all dermatological medications, steroids were the most commonly given medications at a rate of 39%, followed by emollients, antibiotics, and antifungal. The drugs prescribed were mostly available in the pharmacy of CHUB, with 60% and 40% being found in pharmacies outside the hospital. Conclusion: Dermatological conditions are prevalent in all age groups and distributed through all socioeconomic classes. About 9.2% of patient who consulted CHUB in 2021 presented one Dermatological condition of which 40 % of prescribed medications is never found in Hospital urging a need to buy medication in private pharmacies with more expenses and a risk of not complying on prescribed medication if in case they can’t afford paying them outside the CHUB. This finding urges a need to avail all essential dermatological drugs in hospital pharmacies to allow our patients to get them for the proper compliance of prescribed drugs in the management of skin diseases.

Keywords: atopic dermatitis, CHUB (centre hopitalier univerisitaire de butare), dermatological condition, fungal infections

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Authors: Sonto Maputle

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Background: Support during labour increase women's chances of having positive childbirth experiences as well as childbirth outcomes. The purpose of this study was to determine the support provided by midwives to women during labour at the public hospital in Limpopo Province. The study was conducted at the Tertiary hospital in Limpopo Province. Methods: A qualitative, participant observation approach was used. Population consisted of all women that were admitted to deliver their babies and the midwives who provided midwifery care in the obstetric unit of one tertiary public hospital in Limpopo Province. Non-probability, purposive and convenience sampling were used to sample 24 women and 12 midwives. Data were collected through participant observations which included unstructured conversations with the use of observational guide, field notes of events and conversations that occurred when women interact with midwives were recorded verbatim and a Visual Analog Scale to complement the observations. Data was analysed qualitatively but were presented in the tables and bar graphs. Results: Five themes emerged as support provided by midwives during labour, namely; communication between women and midwives, informational support, emotional support activities, interpretation of the experienced labour pain and supportive care activities during labour. Conclusion: The communication was occurring when the midwife was rendering midwifery care and very limited for empowering. The information sharing focused on the assistive actions rather than on the activities that would promote mothers’ participation. The emotional support activities indicated lack of respect and disregard cultural preferences and this contributed to inability to exercise choices in decision-making. The study recommended the implementation of Batho Pele principles in order to provide woman-centred care during labour.

Keywords: communication between women and midwives, labour pains, informational and emotional support, physical comforting measures

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Authors: Kathryn Norgang, Sarah Howrath, Auni Idi Muhire, Pacifique Umubyeyi

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Description : A group of nurses address the shortage of trained staff to respond to critical patients at Rwanda Military Hospital (RMH) by developing a training program and a resuscitation response team. Members of the group who received the training when it first launched are now trainer of trainers; all components of the training program are organized and delivered by RMH staff-the clinical mentor only provides adjunct support. This two day training is held quarterly at RMH; basic life support and exposure to interventions for advanced care are included in the test and skills sign off. Seventy staff members have received the training this year alone. An increased number of admission/transfer to ICU due to successful resuscitation attempts is noted. Lessons learned: -Number of staff trained 2012-2014 (to be verified). -Staff who train together practice with greater collaboration during actual resuscitation events. -Staff more likely to initiate BLS if peer support is present-more staff trained equals more support. -More access to Advanced Cardiac Life Support training is necessary now that the cadre of BLS trained staff is growing. Conclusions: Increased access to training, peer support, and collaborative practice are effective strategies to strengthening resuscitation capacity within a hospital.

Keywords: resuscitation, basic life support, capacity building, resuscitation response teams, nurse trainer of trainers

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Authors: Amir H. Farivarrad, Kiarash M. Dolatshahi

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During earthquake events, aftershocks can significantly increase the probability of collapse of buildings, especially for those with induced damages during the mainshock. In this paper, a practical approach is proposed for seismic rehabilitation of mainshock-damaged buildings that can be easily implemented within few days after the mainshock. To show the efficacy of the proposed method, a case study nine story steel moment frame building is chosen which was designed to pre-Northridge codes. The collapse fragility curve for the aftershock is presented for both the retrofitted and non-retrofitted structures. Comparison of the collapse fragility curves shows that the proposed method is indeed applicable to reduce the seismic collapse risk.

Keywords: aftershock, the collapse fragility curve, seismic rehabilitation, seismic retrofitting

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Authors: Basuki Supartono, Nunuk Nugrohowati, Ryan Gamma Andiraldi

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Osteoarthritis of the knee can occur due to scoliosis. The purpose of this study is to determine the effect of scoliosis cause secondary osteoarthritis on the knee. This research use an analytic cross-sectional design. The total sample of 92 athletes scoliosis taken by simple random sampling technique. The data obtained were analyzing with Chi-square test, Fisher and Prevalence Ratio. The results of analysis show that there are influences on the incidence of scoliosis secondary osteoarthritis on the knee in athletes at the National Sports Hospital. Based on the criteria in the Cobbs angle had the results (p = 0.022 (p <0.05)), moderate Cobbs angle degree were 7.5 times more at risk of causing secondary osteoarthritis on the knee than a mild degree. While the shape of the curve scoliosis is getting results (p = 0.038 (p <0.05)), the shape of the S curve scoliosis 3.2 times more at risk of causing secondary osteoarthritis on the knee than the curve C. It can be concluded that there is significant influence between the Cobbs angle, shape of the curve scoliosis on the incidence of secondary osteoarthritis on the knee in National Sports Cibubur Hospital on July 2013- April 2014

Keywords: Cobbs angle, curve shape scoliosis, secondary osteoarthritis on the knee, analytic cross-sectional design

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Authors: J. N. Nackler, K. Saleh Pascha, W. Winter

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WHISCERS™ (Whole House In-Situ Carbon and Energy Reduction Solution) is an innovative process for Internal Wall Insulation (IWI) for energy-efficient retrofitting of heritage building, which uses laser measuring to determine the dimensions of a room, off-site insulation board cutting and rapid installation to complete the process. As part of a multinational investigation consortium the Austrian part adapted the WHISCERS system to local conditions of Vienna where most historical buildings have valuable stucco facades, precluding the application of an external insulation. The Austrian project contribution addresses the replacement of commonly used extruded polystyrene foam (XPS) with renewable materials such as wood and wood products to develop a more sustainable IWI system. As the timber industry is a major industry in Austria, a new innovative and more sustainable IWI solution could also open up new markets. The first approach of investigation was the Life Cycle Assessment (LCA) to define the performance of wood fibre board as insulation material in comparison to normally used XPS-boards. As one of the results the global-warming potential (GWP) of wood-fibre-board is 15 times less the equivalent to carbon dioxide while in the case of XPS it´s 72 times more. The hygrothermal simulation program WUFI was used to evaluate and simulate heat and moisture transport in multi-layer building components of the developed IWI solution. The results of the simulations prove in examined boundary conditions of selected representative brickwork constructions to be functional and usable without risk regarding vapour diffusion and liquid transport in proposed IWI. In a further stage three different solutions were developed and tested (1 - glued/mortared, 2 - with soft board, connected to wall with gypsum board as top layer, 3 - with soft board and clay board as top layer). All three solutions presents a flexible insulation layer out of wood fibre towards the existing wall, thus compensating irregularities of the wall surface. From first considerations at the beginning of the development phase, three different systems had been developed and optimized according to assembly technology and tested as small specimen in real object conditions. The built prototypes are monitored to detect performance and building physics problems and to validate the results of the computer simulation model. This paper illustrates the development and application of the Internal Wall Insulation system.

Keywords: internal insulation, wood fibre, hygrothermal simulations, monitoring, clay, condensate

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Authors: Agodo Mugenyi Herbert

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Background: A high prevalence of both HIV infection and mental disorders exists in Sub-Saharan Africa, however there is little integration of care for mental health disorders among HIV-infected individuals. The study aimed at determining the management of common mental disorders among HIV/AIDS clients attending Antiretroviral clinic in Hoima regional referral hospital. Significancy of the study: The information generated by this study would help mental health advocates, ministry of health, Civil society organizations in HIV programming to advocate for enhanced mental health care for PLWHA. The result will be used in policy development and lobbying for integration of mental health care in HIV/AIDS care. Methods: This study applied a cross sectional design. It involved data collection from clients with HIV/AIDS attending ART clinic in Hoima regional referral hospital at one specific point in time. It aimed at providing data on the entire population under study. Data was collected from Hoima Regional Referral Hospital at the ART clinic. Data analysis was performed using SPSS version 24. Results: 66 HIV/AIDS clients and 10 health workers in the ART clinic who participated fully completed the study. The overall prevalence of at least one form of mental disorder was 83%. Majority of the health care practitioner do not use pharmacological, psychological, and social interventions to manage such disorders. Conclusion: These results are suggestive of a significant proportion of the HIV-infected patients experiencing psychological difficulty for which they do not receive treatment Recommendations: Current care practices applied to patients with HIV/AIDS should be integrated more generally to include treatment services to identify and manage common mental disorders.

Keywords: common mental disorders, mental health, mental illness, and severe mental illness

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Authors: Preethi Sudarshanie Dassanayake, R. A. Sudath Weerasiri

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Objective: The objective of this study were to find out highest expectation and perception,highest gap between perception and expectation of service quality, and to find out such gaps between perception and expectation with regard to service quality dimensions were whether statistically significant. Methodology: This study carried out at the Out Patient Department (OPD) of the Veterinary Teaching Hospital (VTH), University of Peradeniya. Modified version of SERVQUAL with 22-pairs of items regarding expectation and perception of service quality in dimensions of tangible, reliability, responsiveness, assurance and empathy were included in Part 1 and the Part 2 of the questionnaire consisted of questions regarding socio-demographic factors. Sample size was 200 and sampling procedure was Systematic Random Sampling. Customers above 18 years of age, able to read, write and understand Sinhala or English language, visits more than twice in last six months and who willing to respond were selected. Findings: The analysis revealed customers expectations of service higher than the perceived for all 22- items of the SERVQUAL. This high expectation suggests that there is sufficient room for further improvement of service quality in all five dimensions. Originality/Value of the Paper: This study gave a new insight for poorly researched area of veterinary health service quality in Sri Lankan context. It provides hospital administrators and policy makers to develop strategies for further improvement of service quality according to customers' view.

Keywords: expectation, perception, service quality, SERVQUAL, veterinary health care

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Authors: Liong-Rung Liu, Yu-Hui Chiu, Wen-Han Chang

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Firearm injuries are high-energy injuries. The ballistic pathways could cause severe burns or chemical damages to vessels, musculoskeletal or other major organs. The high mortality rate is accompanied by complications such as sepsis. As laws prohibit gun possession, civilian gunshot wounds (GSW) are relatively rare in Taiwan. Our hospital, Mackay Memorial Hospital, located at the center of Taipei city is surrounded by nightclubs and red-light districts. Due to this unique location, our hospital becomes the first-line trauma center managing gunshot victims in Taiwan. To author’s best knowledge, there are few published research articles regarding this unique situation. We hereby analyze the distinct characteristics and length of stay (LOS) of GSW patients in the emergency room (ER) at Mackay Memorial Hospital. A 6-year retrospective analysis of 27 patients treated for GSW injuries from January 2012 to December 2017 was performed. The patients’ records were reviewed for the following analyses, 1) wound position and the correlated clinical presentations; 2) the LOS in ED of patients receiving emergency surgery for major organ or vascular injuries. We found males (96.3%) were injured by guns more often than females (3.7%) in all age groups. The most common injured site was in the extremities. With regards to the ER LOS, the average time were 72.2 ± 34.5 minutes for patients with triage I and 207.4 ± 143.9 minutes for patients with triage II. The ED LOS of patients whose ISS score were more than 15 was 59.9 ± 25.6 minutes, and 179.4 ± 119.8 minutes for patients whose ISS score were between 9 to 15, respectively. Among these 27 patients, 10 patients had emergency surgery and their average ED stay time was 104.5 ± 33.3 minutes. Even more, the average ED stay time could be shortened to 88.8 ± 32.3 minutes in the 5 patients with trauma team activation. In conclusion, trauma team activation in severe GSW patients indeed shortens the ED LOS and might initially improve the quality of patient care. This is the result of better trauma systems, including advances in care from emergency medical services and acute care surgical management.

Keywords: gunshot, length of stay, trauma, mortality

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Authors: Margaret Elaine J. Villamayor, Lobert A. Padua, Neil S. Bacaltos, Virgilio P. Bañez

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Significance: This study aimed to determine the prevalence of Hepatobiliary Tuberculosis (HBTB) with biliary obstruction and to compare the outcomes of ERCP versus PTBD in these patients. Methodology: This is a cross-sectional study involving patients from PGH who underwent biliary drainage from HBTB from January 2009 to June 2014. HBTB was defined as having evidence of TB (culture, smear, PCR, histology) or clinical diagnosis with the triad of jaundice, fever, and calcifications on imaging with other causes of jaundice excluded. The primary outcome was successful drainage and secondary outcomes were mean hospital stay and complications. Simple logistic regression was used to identify factors associated with success of drainage, z-test for two proportions to compare outcomes of ERCP versus PTBD and t-test to compare mean hospital stay post-procedure. Results: There were 441 patients who underwent ERCP and PTBD, 19 fulfilled the inclusion criteria. 11 underwent ERCP while 8 had PTBD. There were more successful cases in PTBD versus ERCP but this was not statistically significant (p-value 0.3615). Factors such as age, gender, location and nature of obstruction, vices, coexisting pulmonary or other extrapulmonary TB and presence of portal hypertension did not affect success rates in these patients. The PTBD group had longer mean hospital stay but this was not significant (p-value 0.1880). There were no complications reported in both groups. Conclusion: HBTB comprises 4.3% of the patients undergoing biliary drainage in PGH. Both ERCP and PTBD are equally safe and effective in the management of biliary obstruction from HBTB.

Keywords: cross-sectional, hepatobiliary tuberculosis, obstructive jaundice, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic biliary drainage

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Authors: Naima Nur, Safa Islam, Saeema Islam, Faridul Alam

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Background: Drug-resistant pulmonary tuberculosis (DR-PTB), particularly multidrug-resistant tuberculosis (MDR-TB) and pre-extensive drug-resistant (pre-XDR), is a major challenge in effectively controlling TB, especially in developing. This study aimed to identify the strains of M. tuberculosis complex (MTC) and drug resistance patterns among the pulmonary tuberculosis patients. Methods: The study used a cross-sectional design, and 815 patients were recruited randomly in three study periods. In the first-period, 210 treated PTB patients, who were completed their treatment, received their diagnoses using light microscopy, fluorescence microscopy and cultured on Lowenstein-Jensen (L-J) slant, and then strains were identified as MTC by biochemical tests, and then sensitivity test in National Institute of Diseases of the Chest and Hospital. In the second-period, 220 re-treated PTB patients, who were completed their treatment, received their diagnoses using culture on L-J slant, line probe assay (LPA), and GeneXpert in the same hospital. In the last-period, during treatment, 385 MDR-PTB patients received their diagnoses using culture on L-J slant and LPA in the same hospital. Results: Among sixty-two (29.5%) PTB patients, 13% were sensitive to all first-line anti-TB drugs, 26% were MDR-TB patients, and 14.2% were pre-XDR-TB among 14 MDR-TB patients. After three years, 31% were MDR-TB among 220 re-treated PTB patients. After five years, 16.4% was pre-XDR-TB among 385 MDR-TB patients. Compared to females, male patients were significantly higher at all times. Conclusion: The current study demonstrated that in three study periods, the proportions of DR-TB, MDR-TB, and pre-XDR patients were an alarming issue and increasing daily.

Keywords: multi-drug resistant, drug-resistant, pre-extensive drug resistant, pulmonary tuberculosis

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Authors: Getachew Belay, Getachew Kahsu, Brhane Berhe, Kebede Tesfay, Fitsum Mardu, Nigus Shishay, Hadush Negash, Aster Tsegaye

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Background: Malaria kills million people around the world, and it is still a serious public health problem in Ethiopia. Over the past years, the disease has been consistently reported as leading cause of outpatient visits, hospitalization and death in health facilities across the country. This study assessed malaria trend in Humera Town Kahsay Abera Hospital Tigrai region, Northern Ethiopia. Method: A Health facility retrospective cross sectional study was conducted in Kahsay Abera General Hospital from January 2011 to December 2019. Data of Malaria cases were reviewed from Health Management Information System with the help of experts in the office. The nine year data were extracted and analyzed using Excel by excluding those which lack demographic data. Result: A total of 36,604 smear positive malaria cases were confirmed in last nine years in the study area. Plasmodim falcifarum was the most prevalent reported species. Higher number of malaria cases were reported during October season.Males were more infected by the disese (63.1%) than females and males aged 15 years and above were the most iffected ones. The percentage proportion of P.falcifarum and P.vivax were 61.6% to 38.4%, respectively. There was a decreasing trend over the nine years following the peak in 2013. Conclusion: Malaria smear positivity, with highest cases being recorded in October, was declined over the nine years after peaking in 2013. Males aged 15 years and above were more affected, and P falciparum was the predominat species. Strengtheing the prevention and control activities is warranted in the study area.

Keywords: trend, malaria, kahsay abera general hospital, tigray, ethiopia

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Authors: Adnan Sahin, Ufuk Uylas, Ercument Pasaoglu, Tarik Caga, Enver Ihtiyar, Serdar Erkasap, Ersin Ates, Fatih Yasar

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Background: In this study, it was evaluated the demographic features, etiological factors and the management of acute pancreatitis. Methods: 106 patient hospitalized due to acute pancreatitis were retrospectively examined from 1 January 2015 to 31 December 2015 in Department of General Surgery of ESOGUMF. The data of gender, signs and symptoms, etiological factors, WBC, AST, ALT, Amilase, USG and CT findings treatment options ERCP, and complications, mortality rate were analysed. Results: The mean age of patients were 58.8 (53 men and 53 women). The causes of acute pancreatitis were as follows: gallbladder stone was 89, hyperlipidemia was 5 and idiopathic were 16 patients. Severe pancreatitis was developed in 16 patients in the biliary pancreatitis group and ERCP was performed. Cholecystectomy was performed to all biliary pancreatitis group patients after acute pancreatitis subside. The mean hospital stay period was 9.33 (2-37) day. Discussion and conclusion: Severe acute pancreatitis is a mortal disease. The most common etiological cause of acute pancreatitis is biliary origin. The first line treatment modality of acute pancreatitis is medical. Cholecystectomy should be planned to the all-biliary caused acute pancreatitis patients after the attack subside. ERCP is a useful treatment modality in the case of clinical worsening and suspicion of acute cholangitis. ERCP procedure used 16 patients in our series and these patients have a good morbidity and mean hospital period is lower than the others. We suppose that ERCP procedure should be planned selectively and conservatively.

Keywords: acute pancreatitis, ERCP, morbidity, treatment

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Authors: Kimberly Winnie Achieng Otieno

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The Nairobi Hospital plays a pivotal role in healthcare provision in East and Central Africa, yet it faces challenges in providing accessible dialysis care. This paper explores strategic interventions to enhance dialysis care, improve access and streamline health information management, with an aim of fostering an integrated and patient-centered healthcare system in our region. Challenges at The Nairobi Hospital The Nairobi Hospital currently grapples with insufficient dialysis machines which results in extended turn around times. This issue stems from both staffing bottle necks and infrastructural limitations given our growing demand for renal care services. Our Paper-based record keeping system and fragmented flow of information downstream hinders the hospital’s ability to manage health data effectively. There is also a need for investment in expanding The Nairobi Hospital dialysis facilities to far reaching communities. Setting up satellite clinics that are closer to people who live in areas far from the main hospital will ensure better access to underserved areas. Community Outreach and Education Implementing education programs on kidney health within local communities is vital for early detection and prevention. Collaborating with local leaders and organizations can establish a proactive approach to renal health hence reducing the demand for acute dialysis interventions. We can amplify this effort by expanding The Nairobi Hospital’s corporate social responsibility outreach program with weekend engagement activities such as walks, awareness classes and fund drives. Enhancing Efficiency in Dialysis Care Demand for dialysis services continues to rise due to an aging Kenyan population and the increasing prevalence of chronic kidney disease (CKD). Present at this years International Nursing Conference are a diverse group of caregivers from around the world who can share with us their process optimization strategies, patient engagement techniques and resource utilization efficiencies to catapult The Nairobi Hospital to the 21st century and beyond. Plans are underway to offer ongoing education opportunities to keep staff updated on best practices and emerging technologies in addition to utilizing a patient feedback mechanisms to identify areas for improvement and enhance satisfaction. Staff empowerment and suggestion boxes address The Nairobi Hospital’s organizational challenges. Current financial constraints may limit a leapfrog in technology integration such as the acquisition of new dialysis machines and an investment in predictive analytics to forecast patient needs and optimize resource allocation. Streamlining Health Information Management Fully embracing a shift to 100% Electronic Health Records (EHRs) is a transformative step toward efficient health information management. Shared information promotes a holistic understanding of patients’ medical history, minimizing redundancies and enhancing overall care quality. To manage the transition to community-based care and EHRs effectively, a phased implementation approach is recommended. Conclusion By strategically enhancing dialysis care access and streamlining health information management, The Nairobi Hospital can strengthen its position as a leading healthcare institution in both East and Central Africa. This comprehensive approach aligns with the hospital’s commitment to providing high-quality, accessible, and patient-centered care in an evolving landscape of healthcare delivery.

Keywords: Africa, urology, diaylsis, healthcare

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Authors: A. Al Hajeri, M. E. Minton, B. Haskins, F. H. Cummins

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The pre-hospital endotracheal intubation is fraught with difficulties; one solution offered has been video laryngoscopy (VL) which permits better visualization of the glottis than the standard method of direct laryngoscopy (DL). This method has resulted in a higher first attempt success rate and fewer failed intubations. However, VL has mainly been evaluated by experienced providers (experienced anesthetists), and as such the utility of this device for those whom infrequently intubate has not been thoroughly assessed. We sought to evaluate this equipment to determine whether in the hands of novice providers this equipment could prove an effective airway management adjunct. DL and two VL methods (C-Mac with distal screen/C-Mac with attached screen) were evaluated by simulating practice on a Laerdal airway management trainer manikin. Twenty Emergency Medical Technicians (basics) were recruited as novice practitioners. This group was used to eliminate bias, as these clinicians had no pre-hospital experience of intubation (although they did have basic airway skills). The following areas were assessed: Time taken to intubate, number of attempts required to successfully intubate, ease of use of equipment VL (attached screen) took on average longer for novice clinicians to successfully intubate and had a lower success rate and reported higher rating of difficulty compared to DL. However, VL (with distal screen) and DL were comparable on intubation times, success rate, gastric inflation rate and rating of difficulty by the user. This study highlights the routine use of VL by inexperienced clinicians would be of no added benefit over DL. Further studies are required to determine whether Emergency Medical Technicians (Paramedics) would benefit from this airway adjunct, and ascertain whether after initial mastery of VL (with a distal screen), lower intubation times and difficulty rating may be achievable.

Keywords: direct laryngoscopy, endotracheal intubation, pre-hospital, video laryngoscopy

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Authors: Pampita Chakraborty, Sukumar Mukherjee

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This study was done to determine the prevalence of nosocomial infections in the ICU and to identify the common microorganisms causing these infections and their antimicrobial sensitivity pattern. Nosocomial infection or hospital-acquired infection is a localized or a systemic condition resulting from an adverse reaction to the presence of infectious agents. Nosocomial infections are not present or incubating when the patient is admitted to hospital or other health care facility. They are caused by pathogens that easily spread through the body. Many hospitalized patients have compromised immune systems, so they are less able to fight off infections. These infections occur worldwide, both in the developed and developing the world. They are a significant burden to patients and public health. They are a major cause of death and increased morbidity in hospitalized patients, which is a matter of serious concern today. This study was done during the period of one year (2012-2013) in the ICU of the tertiary care hospital in eastern India. Prevalence of nosocomial infection was determined; site of infection and the pattern of microorganisms were identified along with the assessment of antibiotic susceptibility profile. Patients who developed an infection after 48 hours of admission to the ICU were included in the study. A total of 324 ICU patients were analyzed, of these 79 patients were found to have developed a nosocomial infection (24.3% prevalence). Urinary tract infection was found to be more predominant followed by respiratory tract infection and soft tissue infection. The most frequently isolated microorganism was E. coli, Pseudomonas aeruginosa, Klebsiella pneumoniae followed by other organisms respectively. Antibiotic susceptibility test of these isolates was done against commonly used antibiotics. Patients admitted to the ICU are especially susceptible to nosocomial infections. Despite adequate antimicrobial treatment, nosocomial ICU infections can significantly affect ICU stay and can cause an increase in patient’s morbidity and mortality. Adherence to infection protocol, proper monitoring and the judicious use of antibiotics are important in preventing such infections on a regular basis.

Keywords: antibiotic susceptibility, intensive care unit, nosocomial infection, nosocomial pathogen

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Authors: Siti Rahmah Fitrianti, Mela Milani

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Inadequate of water intake has negative effects on the health of the body, which can cause kidney failure and death. One of the factors that can affect someone intake of water is level of knowledge about the importance of water intake itself. A good knowledge of the daily water intake can increase the awareness of daily needed of water intake. Therefore, researchers initiated a study on the relationship of water intake to the level of knowledge related with water intake in food workers, at “Puspa” Hospital. Type of this research is quantitative research with cross-sectional approach. The research data was collected by measuring the independent and dependent variable at a time. This study took place in the food production unit of Nutrition Installation in "Puspa" Hospital, Jakarta in October 2016. The population target in this study were workers in food production unit aged 30-64 years. The instrument was a questionnaire question regarding water intake and 24 hours food recall. The result is 78.6% of respondents have less knowledge about the importance of water intake. Meanwhile, as many as 85.7% of respondents have adequate water intake. Tested by Chi-Square test, showed that no significant relationship between water intake with the level of knowledge related to water intake in workers of food production unit. Adequate intake of water in food workers commonly may be not caused by the level of knowledge related to water intake, but it may be cause of work environment factor which has a high temperature.

Keywords: food production unit, food workers, level of knowledge, water intake

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Authors: Jake Tempo, Stephen Brough

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Introduction and Objectives: Urine cytology has a role in the diagnosis of urothelial cancer when used alongside cystoscopy and imaging, according to the European Association of Urology guidelines. It also has a role in the surveillance post-treatment of urothelial carcinoma. Collecting and analysing urine cytology is costly and time-consuming. We investigated the use of urine cytology in an Australian regional hospital to determine whether clinicians are following international guidelines. Materials and Methods: We analysed all urine cytology requests performed in an Australian regional hospital between 1st January 2017 and 31st December 2018. We reviewed the indication for urine cytology and the patients’ case notes to determine whether urine cytology changed management. Results: During the two-year study period, 153 patients had urine cytology analysed for a variety of indications. In no cases did cytology change the outcome of patient management significantly. In total, 69 of 153 (41%) urine cytology requests were not supported by urological society guidelines. Fifty requests were for haematuria, and twenty requests were for urothelial cancer surveillance. Seven were analysed for follow-up from previous urological investigations. Nine samples were sent for ureteric obstruction of unknown origin. Conclusion: Urine cytology, even when positive, did not significantly change management for the investigation of potential urothelial cancer, and therefore, its use as a diagnostic tool for this purpose should be reconsidered. Many cytology tests are expensive, unnecessary, and not supported by urological society guidelines.

Keywords: cytology, bladder cancer, urine, urothelial carcinoma

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Authors: O. A. Akinsanya

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This paper presents the emerging trends in household energy usage in Nigeria for sustainable development. The paper relied on a direct appraisal of energy use in the residential sector and the use of a structured questionnaire to establish the usage pattern, energy management measures and emerging advances. The use of efficient appliances, retrofitting, smart building and smart attitude are some of the benefitting measures. The paper also identified smart building, prosumer activities, hybrid energy use, improved awareness, and solar stand-alone street/security lights as the trend and concluded that energy management strategies would result in a significant reduction in the monthly bills and peak loads as well as the total electricity consumption in Nigeria and therefore it is good for sustainable development.

Keywords: household, energy, trends, strategy, sustainable, Nigeria

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