Impact of perceived social support on psychological resilience: A comparison between medical and surgical postgraduate residents.

OBJECTIVE: To identify the predictable relationship and differences between perceived social support and psychological resilience among medical and surgical postgraduate residents. Methods: The analytical cross-sectional study was conducted from July to September 2021 at Dr Ruth K.M. Pfau Civil Hospital, Karachi, and comprised postgraduate medical and surgical residents of either gender. Data was collected using validated self-administered questionnaires. Data was analysed using SPSS 22. RESULTS: Of the 200 residents, 100(50%) were medical residents and 100(50%) were surgery residents. Besides, 161 (80.5%) were females and 39(19.5%) were males. The overall mean age was 27.57±2.13 years. Mean perceived social support score was 62.53±15.41 and mean score for psychological resilience was 70.40±13.73. Perceived social support was a significant predictor of resilience (p=0.0001). Medical residents scored significantly higher (p=0.034) on perceived social support compared to residents from surgery departments. Marital status, residency year, and birth order in the family significantly differed with reference to perceived social support and resilience (p<0.05). Conclusion: There was a favourable role of perceived social support in building resilience among postgraduate residents.

Burdening caregivers of patients with schizophrenia at Edward Francis Small Teaching Hospital, The Gambia.

PURPOSE: Deinstitutionalization of persons living with mental illness has led to many patients residing in communities with family members and shifting the burden of care and caregiving from hospitals to homes. The aim of the study was to determine the burden on caregivers of patients with schizophrenia at Edward Francis Small Teaching Hospital (EFSTH). METHODS: This was a descriptive cross-sectional study design with a sample consisting of 161 randomly selected caregivers of patients with schizophrenia. The GHQ-12 questionnaire was used to determine the general health status of the caregivers. The caregivers' burden was assessed using the Zarit Burden Scale. The data were collected using the researcher-administered method. The collected data were analyzed with IBM SPSS Version 20 using descriptive statistics, mean differences, and the general linear model (GLM). RESULTS: The main findings of this study were that caregivers experienced a significantly high level of burden. Most of them experienced high levels of physical (70%), psychological (93.2%), social (78.3%) and financial (55.3%) burdens. Employment status, specifically unemployment status and belonging to the Wolof ethnic group, was a significant predictor of the level of financial burden on the caregivers. Similarly, the total score for social burden was also significantly greater among unemployed caregivers. Educational level was a significant predictor of the total score on the psychological and physical burden scale. CONCLUSION: The caregivers of patients with schizophrenia at EFSTH are experiencing a high level of burden as a result of their caregiving role, which affects their health, and this calls for urgent intervention.

Exploring paediatric rheumatology care: a ten-year retrospective analysis of the patient population in Ghana.

BACKGROUND: Rheumatic diseases can seriously impact children's general health, development, and growth. However, due to a lack of resources, paediatric rheumatology is a largely underdeveloped speciality in many African nations. Children with rheumatic disorders face obstacles in accessing specialized medical care, including lack of specialists, care centres, medication access, and limited research and education to increase understanding of paediatric rheumatic disease among healthcare practitioners. This study described the disease characteristics, prevalence, and challenges faced by paediatric rheumatic disease patients receiving care at a teaching hospital in Accra, Ghana. METHODS: A retrospective record-based study was conducted among all paediatric cases presenting to the rheumatology clinic of the Korle Bu Teaching Hospital (KBTH) from January 2011 to December 2021. Data collected include clinical features, laboratory findings at disease presentation, andtherapeutic regimens prescribed per standard guidelines and experiences. RESULTS: A total of 121 cases were identified as of 2021, indicating a point prevalence of 0.0011%. The majority (73%) were females with a mean age of 13.4 ± 3.2 years. The mean duration of symptoms in months experienced by patients before being successfully referred to a rheumatologist was 18 months. There were significant differences between referred and confirmed diagnoses, especially in cases involving mixed connective tissue diseases (MCTD), systemic lupus erythematosus (SLE), and juvenile dermatomyositis (JDM), suggesting that these conditions may be under-recognised. Arthralgia and arthritis were the most common presenting symptoms. More than three-quarters (86.8%) of the cases studied were treated with steroids (oral or intravenous). In cases requiring immunosuppressive therapy, methotrexate was the most commonly prescribed in 33.9% of instances. Mortality was recorded at 8.3%, with the majority involving SLE cases. Most (95.7%) of the primary caregivers expressed positive experiences regarding care received at the adult rheumatology clinic. CONCLUSION: There were significant delays in diagnosis and diagnostic accuracy for patients with paediatric rheumatic disease (PRD). This highlights the pressing need for strengthening paediatric rheumatology services in Africa, including increasing awareness about these conditions among the public and healthcare providers to improve early diagnosis and quality of life for children with these conditions.

The role of medical-grade maggots in facilitating healing of diabetic foot ulcers in Kano, northern Nigeria: a case series.

OBJECTIVE: Approximately 13% of people living with diabetes develop one or more ulcers during the course of the disease, and diabetic foot ulcer (DFU) is responsible for >60% of lower limb amputations worldwide. This case series aimed to demonstrate the effectiveness of medical-grade maggots on DFUs in promoting wound healing and reducing related hospital stays in northern Nigeria. METHOD: Maggot debridement therapy (MDT) was applied to the DFUs of patients who consented to this treatment between January-August 2021 at the Orthopaedic Unit of the Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Sterile first instar larvae of Lucilia sericata were obtained indigenously and applied using the confinement (free-range) method under aseptic procedure. RESULTS: A total of 15 patients with DFUs of Wagner classification grades III (33.3%) and IV (66.7%), were seen and documented. The patients included 10 (66.7%) females and five (33.3%) males, giving a female:male ratio of 2:1. The mean age (±standard deviation) of the respondents was 51.6±10.8 years. The surface area of the wounds ranged from 24-140cm2, with a median value of 75cm2. Among the patients, 60% had two cycles of MDT, with a median duration of five days. Most of the wounds (53.3%) were debrided within five days; 13.3% (two wounds) took seven days to be fully debrided. A paired sample t-test showed a statistically significant association between wound surface area and therapy duration (t=8.0; p=0.000) and between wound surface area and cycles of therapy (t=8.3; p=0.000). Before maggot application, 14 (93.3%) DFUs were completely (100%) covered with slough and only one (6.7%) was 95% covered with slough. After maggot application, 10 (66.7%) wounds were completely debrided while five (33.3%) wounds required bedside surgical debridement to achieve complete debridement. A paired sample t-test showed statistically significant difference between the pre- and post-MDT slough covering the wounds (t=45.1; p=0.000). CONCLUSION: In this case series, MDT was successfully used in the debridement of DFUs, which facilitated the healing process with an encouraging clinical outcome.

Evaluating a vertical nurse-led service in the integration of palliative care in a tertiary academic hospital.

Background: Groote Schuur Hospital is a large Academic Hospital in South Africa that is in the process of integrating palliative care (PC) via a vertical nurse-led doctor-supported (VNLDS) service that was initially established to deliver clinical care. PC integration should occur across multiple dimensions and may result in variable degrees of integration between levels of the healthcare system. This research evaluates the VNLDS through a theory-driven evaluation to describe how the service affected integration. Methods: A mixed-method sequential design consisting of a narrative literature review on the theory of integration and PC, retrospective quantitative data from a PC service delivery database, qualitative data from semi-structured interviews and document analyses. It was structured in three phases which assisted in confirming and expanding the data. Statistical analyses, deductive thematic coding and documentary analyses were conducted according to the conceptual framework of PC integration. Results: The PC integration process was facilitated in the following ways: (i) the service provided good clinical PC; (ii) it was able to integrate on a professional level into specific diseases, such as cancer but not in all diseases; (iii) developing organizational structures within the service and (iv) the observed benefit of good clinical care increased the value stakeholders assigned to PC, thereby driving the adoption of PC. However, there are still clinicians who do not refer to PC services. This gap in referral may be grounded in assumptions and misconceptions about PC, especially at the organizational level. Discussion: Observed PC service delivery is core to integrating PC across the healthcare system because it challenges normative barriers. However, the VNLDS could not achieve integration in leadership and governance, education and hospital-wide guidelines and policies. Whole system integration, foregrounding organizational commitment to PC excellence, is core to integrating PC. Conclusion: The VNLDS service has effectively linked PC in specific disease profiles and normalized the PC approach where healthcare workers observed the service. These integrational gaps may be grounded in assumptions and misconceptions about PC, especially at the organizational level.

How does a nurse led palliative care service affect palliative care integration in a big teaching hospital? This article evaluates a nurse led doctor supported service in providing palliative care and how it affected the integration of palliative care in an Academic Hospital in South Africa. This study will help us understand the goals of integration, the extent of integration achieved by this service and how and why it was achieved or not.

Nurses' barriers to the pressure ulcer risk assessment scales implementation: A phenomenological study.

AIM: The aim of the study was to explore nurses' barriers to the pressure ulcer risk assessment scales implementation. DESIGN: A qualitative descriptive phenomenological study. METHODS: The research participants comprised of 10 nurses at various medical and surgical departments in a teaching hospital northeast of Namibia. Data were collected between August and September 2022 through in-depth, semi-structured face-to-face individual interviews and analysed using Colaizzi's 7-step method. RESULTS: The interviews with nurses, led to two major themes being discovered: (1) factors hindering the effective prevention of pressure ulcers; (2) suggestions for improvements in the utilization of risk assessment scales. The participants noted that they had inadequate knowledge of the formal risk assessment scales; there were inadequate resources and insufficient staff; there were no policies or guidelines regarding the management of pressure ulcers, all of which influenced their utilization of pressure risk assessment scales. Education and training, the provision of equipment, the hiring of new staff and the formulation of policies/guidelines would thus improve the nurses' utilization of the scales. CONCLUSION: The findings of this study have uncovered three primary factors that have a detrimental impact on the utilization of risk assessment scales by nurses, that is their lack knowledge on pressure ulcer risk assessment scales; a shortage of staff and equipment; and an absence of policies/guidelines. The findings from this study provide valuable implications for guiding quality improvement initiatives aimed at enhancing the standard of care in Namibia and other resource-limited settings.

Ten-year trends of antibiotic prescribing in surgery departments of two private sector hospitals in Central India: a prospective observational study.

BACKGROUND: Inappropriate antibiotic use contributes to the global rise of antibiotic resistance, prominently in low- and middle-income countries, including India. Despite the considerable risk of surgical site infections, there is a lack of antibiotic prescribing guidelines and long-term studies about antibiotic prescribing in surgery departments in India. Therefore, this study aimed to analyse 10 years' antibiotic prescribing trends at surgery departments in two tertiary-care hospitals in Central India. METHODS: Data was prospectively collected from 2008 to 2017 for surgery inpatients in the teaching (TH-15,016) and the non-teaching hospital (NTH-14,499). Antibiotics were classified based on the World Health Organization (WHO) Access Watch Reserve system and analysed against the diagnoses and adherence to the National List of Essential Medicines India (NLEMI) and the WHO Model List of Essential Medicines (WHOMLEM). Total antibiotic use was calculated by DDD/1000 patient days. Time trends of antibiotic prescribing were analysed by polynomial and linear regressions. RESULTS: The most common indications for surgery were inguinal hernia (TH-12%) and calculus of the kidney and ureter (NTH-13%). The most prescribed antibiotics were fluoroquinolones (TH-20%) and 3rd generation cephalosporins (NTH-41%), and as antibiotic prophylaxis, norfloxacin (TH-19%) and ceftriaxone (NTH-24%). Access antibiotics were mostly prescribed (57%) in the TH and Watch antibiotics (66%) in the NTH. Culture and susceptibility tests were seldom done (TH-2%; NTH-1%). Adherence to the NLEMI (TH-80%; NTH-69%) was higher than adherence to the WHOMLEM (TH-77%; NTH-66%). Mean DDD/1000 patient days was two times higher in the NTH than in the TH (185 vs 90). Overall antibiotic prescribing significantly increased in the TH (ß1 =13.7) until 2012, and in the NTH (ß2 =0.96) until 2014, and after that decreased (TH, ß2= -0.01; NTH, ß3= -0.0005). The proportion of Watch antibiotic use significantly increased in both hospitals (TH, ß=0.16; NTH, ß=0.96). CONCLUSION: Total antibiotic use decreased in the last three (NTH) and five years (TH), whereas consumption of Watch antibiotics increased over 10 years in both hospitals. The choice of perioperative antibiotic prophylaxis was often inappropriate and antibiotic prescribing was mostly empirical. The results of this study confirmed the need for antibiotic prescribing guidelines and implementation of antimicrobial stewardship programs.

Distance Electronic Learning Strategy in Medical Teaching During the COVID-19 Pandemic: Cross-Sectional Survey Study.

BACKGROUND: Teaching hospitals have been regarded as the primary settings where doctors teach and practice high-quality medicine, as well as where medical students learn the profession and acquire their initial clinical skills. A percentage of instruction is now done over the internet or via electronic techniques. The present COVID-19 epidemic has pushed distance electronic learning (DEL) to the forefront of education at all levels, including medical institutions. OBJECTIVE: This study aimed to observe how late-stage medical students felt about DEL, which was put in place during the recent COVID-19 shutdown in Jordan. METHODS: We conducted a prospective, cross-sectional, web-based, questionnaire-based research study during the COVID-19 pandemic lockdown between March 15 and May 1, 2020. During this period, all medical schools in Jordan shifted to DEL. RESULTS: A total of 380 students responded to a request to fill out the questionnaire, of which 256 completed the questionnaire. The data analysis showed that 43.6% (n=112) of respondents had no DEL experience, and 53.1% (n=136)of respondents perceived the DEL method as user-friendly. On the other hand, 64.1% (n=164) of students strongly believed that DEL cannot substitute traditional clinical teaching. There was a significant positive correlation between the perception of user-friendliness and the clarity of the images and texts used. Moreover, there was a strong positive correlation between the perception of sound audibility and confidence in applying knowledge gained through DEL to clinical practice. CONCLUSIONS: DEL is a necessary and important tool in modern medical education, but it should be used as an auxiliary approach in the clinical setting since it cannot replace conventional personal instruction.

Determinants of Jaundice Among Neonates Admitted to Neonatal Intensive Care Unit of Mizan Tepi University Teaching Hospital, Southwest Ethiopia, 2021: Unmatched Case Control Study.

Background. Jaundice is a common problem in the neonatal period, and it is one of multiple factors found in children who die. Despite the majority of pathological jaundice public health consequences, there is no evidence on risk factors of pathological jaundice among neonates in Southwest Ethiopia. Therefore, this study aimed to identify factors associated with jaundice requiring phototherapy management in neonates admitted to the neonatal unit of a university teaching hospital in Southwest Ethiopia (Mizan-Tepi). Methods. Facility-based, unmatched case-control study was conducted among 240 (80 cases and 160 controls) in the Neonatal Intensive Care Unit of Mizan-Tepi University Teaching Hospital. Neonates with pathological jaundice and neonates without pathological jaundice were considered as cases and controls, respectively. Data were collected using a structured questionnaire, and extraction checklist, including information on maternal demographics, obstetrics, and neonatal factors. Simple random sampling techniques were used to select respondents. Bivariate and multivariable analyses were used to examine the association. Finally, statistical significance was declared at a P-value < .05. Results. In this study, 237 mothers with their neonates were included, making a response rate of 98.7%. The mean birth weight of cases and controls was 2330.3 ± 698.9 and 2699.3 ± 686.7 g, respectively. Hypothermia (AOR = 4.28; 95% CI: [1.72-10.67], cesarean delivery (AOR = 4.09; 95% CI: [1.69-9.93]), breast milk feeding (AOR = 2.97; 95% CI: [1.04-8.47]) and being male (AOR = 2.67; 95% CI: [1.17-6.13]) were significantly associated with jaundice. Conclusion. Most of the risk factors of neonatal jaundice were found to be modifiable. Therefore, early prevention and recognition of identified factors are recommended.

Patients' Satisfaction With Virtual Phone Clinics During the COVID-19 Pandemic at Outpatient Clinics in a Teaching Hospital, Riyadh, Saudi Arabia.

Introduction The concept of virtual clinics, which have been in existence since the 1960s, was initially limited to military and space applications due to infrastructure limitations. However, with the evolution of communication technology and infrastructure improvements, virtual clinics became accessible to the general public, although they were not widely adopted until the coronavirus disease 2019 (COVID-19) pandemic. Virtual clinics offer several benefits, including overcoming distance-related challenges, providing healthcare services to underserved areas, reducing medical costs, and saving patients time. this research aims to assess patient satisfaction with virtual clinics in Saudi Arabia after the COVID-19 pandemic preventive measures are lifted, allowing for a comparison between virtual and traditional face-to-face clinics. This research aims to provide a more comprehensive assessment of patient satisfaction with virtual clinics. Methods We conducted a cross-sectional study and interviewed patients who had attended KKHU (King Khalid University Hospital) outpatient clinics during the COVID-19 pandemic to assess their level of satisfaction with virtual clinics through a questionnaire. Results The questionnaire was completed by 221 participants, 201 of whom met our inclusion criteria. The average score was 3.89, the standard deviation was 0.76, and the overall satisfaction ranged from 3.78 to 4. The mean and SD of the overall technical aspect satisfaction were 4.1 and 0.897, respectively. The mean and SD for the total perceived quality of care satisfaction were 3.89 and 0.95, respectively. The mean score for overall administration satisfaction was 3.74, and the SD was 0.92. The mean and SD for the virtual clinics as a whole were 3.82 and 0.73, respectively. Conclusion The overall level of satisfaction was 3.78 out of 5; however, 53% of participants did not want their next visit to be virtual and 73% of males and 63% of females were satisfied with KKHU outpatient clinics.

A comparative study of spinal cord compression management in metastatic prostate cancer: Teaching versus non-teaching hospitals in the United States.

BACKGROUND: Spinal cord compression (SCC) in metastatic prostate cancer (MPC) is a critical complication and multiple factors influence the optimal therapeutic strategy. We investigated the differences in practice patterns between teaching hospitals (TH) and non-teaching hospitals (NTH) across the United States. METHOD: Using the National Inpatient Sample Database (NIS), we performed a retrospective study on hospitalizations with MPC and SCC between 2016 and 2020 in US. We compared demographic factors, comorbidities, treatment modalities, duration of hospitalization, financial expenditures, and mortality between TH and NTH. We also examined the patients' characteristics and outcomes in TH and NTH based on their chosen therapeutic strategy. RESULTS: We identified 11,380 admissions with metastatic prostate cancer and SCC; 9610 in TH and 1770 in NTH. The median cost of hospitalization was $21,922 in TH and $15,141 in NTH. Although the median age and Charlson comorbidity score did not differ between two groups, patients in TH were more likely to receive intervention (radiation or surgery) compared to NTH (Surgery: 28.2% in TH vs. 23.0% in NTH & Radiation: 12.1% in TH vs. 8.2% in NTH). Mortality was lower in TH than NTH (4.5% vs. 7.9%). In both TH and NTH, a higher proportion of patients with private insurance underwent surgery (TH: Surgery 25.1% vs. Radiation 18.8% & NTH: Surgery 27.0% vs. 6.9%). Black patients were more likely to receive radiation than surgery in TH (34.2% vs. 26.8%). CONCLUSION: This study showed a greater percentage of patients underwent surgical intervention at TH compared to NTH. Additionally, the type of insurance and racial background were associated with distinctive treatment approaches.

Predictors of the onset of neonatal sepsis at the Neonatal Intensive Care Unit of a tertiary hospital in Ghana: A cross-sectional study.

Background and Aim: Neonatal sepsis is a systemic inflammatory response to infection during the first 4 weeks of an infant's life. It is a significant cause of neonatal morbidity and mortality in low- and middle-income countries. This study aimed to determine the predictors of the onset of sepsis at the Neonatal Intensive Care Unit of the Tamale Teaching Hospital, Ghana. Methods: A cross-sectional study was conducted among 275 mothers and their singleton neonates diagnosed clinically with sepsis. A univariate and multivariate logistic regression analysis adjusted for maternal occupational status was performed to determine the maternal and neonatal predictors of early-onset (EOS) and late-onset sepsis (LOS), respectively. Results: Single motherhood (AOR = 1.882, 95% CI = 0.926-3.822, p = .08) and home delivery (AOR = 3.667, 95% CI = 0.584-23.026, p = .17) were predictors of EOS, with single motherhood being the predictor for LOS (AOR = 2.906, 95% CI = 0.715-11.805, p = .14) in a univariate analysis. When maternal occupation was adjusted for in a multivariate analysis, single mother (AOR = 2.167, 95% CI = 1.010-4.648, p = .04) was the main predictor of EOS, with low neonatal birth weight being the main predictor of LOS (AOR = 0.193, 95% CI = 0.038-0.971, p = .04). Conclusion: Maternal marital status is a significant predictor of both EOS and LOS, with predictors of EOS being lower gestational age and low birth weight, while for LOS, low birth weight is the main predictor. Findings from this study can serve as a commencement point for developing predictive models for the onset of sepsis in neonates in the study facility.

The Large-Scale Implementation of a Health Information System in Brazilian University Hospitals: Process and Outcomes.

Governments around the globe are paving the way for healthcare services that can have a profound impact on the overall well-being and development of their nations. However, government programs to implement health information technologies on a large-scale are challenging, especially in developing countries. In this article, the process and outcomes of the large-scale implementation of a hospital information system for the management of Brazilian university hospitals are analyzed. Based on a qualitative approach, this research involved 21 hospitals and comprised a documentary search, interviews with 24 hospital managers and two system user focus groups, and a questionnaire of 736 respondents. Generally, we observed that aspects relating to the wider context of system implementation (macro level), the managerial structure, cultural nuances, and political dynamics within each hospital (meso level), as well as the technology, work activities, and individuals themselves (micro level) acted as facilitators and/or obstacles to the implementation process. The dynamics and complex interactions established between these aspects had repercussions on the process, including the extended time necessary to implement the national program and the somewhat mixed outcomes obtained by hospitals in the national network. Mostly positive, these outcomes were linked to the eight emerging dimensions of practices and work processes; planning, control, and decision making; transparency and accountability; optimization in the use of resources; productivity of professionals; patient information security; safety and quality of care; and improvement in teaching and research. We argued here that to maximize the potential of information technology in healthcare on a large-scale, an integrative and cooperative vision is required, along with a high capacity for change management, considering the different regional, local, and institutional contexts.

Factors Influencing the Implementation of Interprofessional Collaborative Practice in Teaching Hospital Setting: A Mixed-Method Study.

Introduction: Health service in the current global era requires health workers to provide qualified service, this also applies to teaching hospitals. Collaboration between several professions involved (doctors, nurses, and pharmacists) in an interprofessional collaboration system is needed in providing such service. Factors influencing interprofessional collaboration is unique to each health care center. The purpose of this study was to determine the factors that influence the implementation of interprofessional collaborative practice among health workers in Dr. Wahidin Sudirohusodo General Hospital. Methods: This is a mixed-method explanatory sequential design study, utilizing quantitative and qualitative data. Quantitative data were obtained from the Indonesian-validated Collaborative Practice Assessment Tool (CPAT) questionnaire. CPAT in Indonesian language has been validated in previous research by Findyartini, et al. in 2019 in Indonesian population. The questionnaire was internally validated with the study population with Cronbach alpha of 0.812. All health care professionals meeting the selection criteria were enrolled for the quantitative study. The questionnaire was given to 152 health professionals enrolled as research subjects, including nutritionists, nurses, doctors, pharmacists, and medical rehabilitation specialists serving in Dr. Wahidin Sudirohusodo Hospital for >3 years. Five participants with highest and lowest CPAT score from each profession were invited for FGD entitled "Exploring factors involved in interprofessional collaboration in Wahidin Sudirohusodo General Hospital" and divided into 2 groups according to the CPAT score. The score from each subscale in the questionnaire is obtained for each research subjects and the median is compared among each profession group using Kruskall-Wallis test significant to a p value of <0.05. Qualitative data as recording transcript is acquired from FGD; the transcript was then coded into several general themes by 2 of the authors and was discussed using thematic analysis using MaxQDA. Results: Research subjects were predominantly women (121 respondents (79.6%)), 32.9% were nurses, and most of the healthcare professional (81 subjects (55.1%)) have been working for >10 years. Among profession groups (Doctors, Pharmacists, Medical Rehabilitation Specialists, Nutritionists, and Nurses), difference in score distribution (p<0.05) was found in relationships among team members (40 vs 39 vs 39.5 vs 36 vs 42, p<0.001), barriers to team collaboration (10 vs 18.5 vs 14 vs 18 vs 10, p<0.001), and leadership (20 vs 20 vs 23 vs 20 vs 20, p 0.045). From the FGD, factors influencing interpersonal collaborative practice are leadership factors, system/rule factors, and personal factors. Conclusion: This research showed that personal, system/organizational and leadership factors influence the implementation of interprofessional collaboration. In this study, there is a different perception regarding relationships among team members, barriers to team collaboration, and leadership among profession group.

Demographic Characteristics and Disease Pattern Among Non-COVID-19 Patients Admitted to Medical Units of a Tertiary Care Hospital in Sri Lanka During Lockdown of the COVID-19 Pandemic: A Comparison During and Before Lockdown.

BACKGROUND: The COVID-19 infection was rapidly spreading almost all over the world, and the first case was confirmed on 27th January 2020 by a foreign tourist in Sri Lanka. The first Sri Lankan citizen with COVID-19 was confirmed on 11th March 2020. Soon after the confirmation of the disease, long days of lockdown were imposed in almost all parts of the world, including Sri Lanka, to control the spread of the disease.  Objectives: To determine the demographic characteristics such as age, sex, number of patients, and disease pattern among non-COVID-19 patients admitted to the medical units during the lockdown of the COVID-19 pandemic and to compare these characteristics with the data before the lockdown. METHODS: This was a cross-sectional analytical study. It was conducted at the Teaching Hospital in Batticaloa, Sri Lanka. All the non-COVID-19 patients admitted to medical wards and intensive care units (ICU) were included in this study. Patients admitted to the medical intensive care unit (MICU) and coronary care unit (CCU) were considered ICU admissions in this study. They were studied over a period of one month during lockdown (11th March 2020 to 10th April 2020) and compared with the patients admitted one month prior to the lockdown (11th February 2020 to 10th March 2020). RESULTS: Totally, 2340 non-COVID-19 patients (52.5% males) were admitted before the lockdown, and 1376 non-COVID-19 patients (56.2% males) were admitted during the lockdown. This reduction in admission is statistically significant (p-value is <0.001, df=3715). Patients admitted to the wards before lockdown were 2283 (97.6%) and during lockdown were 1309 (95.1%). ICU admissions were N=57 (2.4%) before lockdown and N=67 (4.9%) during lockdown. The common age distribution before the lockdown showed that 26.4% were 31-50 and 41.5% were 51-70 years. Similarly, during lockdown, the age distribution disclosed that 28.9% were 31-50 years and 42.9% were 51-70 years. The disease pattern demonstrated that before lockdown, the majority of patients were admitted for routine hemodialysis (13.2%), to get an injection (9.9%), ischemic heart disease (8.4%), chronic kidney disease (7.3%), and viral fever, including dengue (7.2%). Likewise, during lockdown, more patients were admitted for routine hemodialysis (10.7%), viral fever, including dengue (9.3%), ischemic heart disease (8.8%), to get an injection (8.5%), and chronic kidney disease (5.9%).  Conclusion: There was a significant reduction in the number of non-COVID-19-related admissions during the period of lockdown. However, there was not much difference in the proportion of admissions according to gender, age, and disease pattern before and during lockdown. More number of male patients were admitted than female patients. Most of the admitted patients were under the age group of 51-70 years. The highest number of patients were admitted for routine hemodialysis before and during lockdown. However, a slightly higher number of patients were admitted to the ICU during lockdown. Therefore, strengthening the ICU facilities may be an important preparation to accommodate more patients in the future if a similar kind of emergency lockdown occurs in a pandemic situation. In addition, admissions due to non-communicable diseases (NCD) didn't fall in proportion during the pre-COVID-19 period and the lockdown period. Therefore, the redistribution of healthcare facilities needs to be done wisely to face the challenges caused by the NCDs.

Hospital Civil de Santiago de Cuba: una historia de cambios, dificultades y realizaciones / Civil Hospital of Santiago de Cuba: a history of changes, difficulties and realizations i: en

El Hospital Civil de Santiago de Cuba fue fundado en 1863 y, desde entonces, se ha mantenido prestando asistencia a pacientes de esta provincia y de toda la región oriental. En 1960 fue trasladado a su sede actual y se convirtió en pilar fundamental del inicio de la docencia médica superior para todo el oriente de Cuba. Es mencionado en varios textos desde el siglo XIX, mas se desconoce su creación y trayectoria. En ese sentido, luego de una revisión exhaustiva de documentos y periódicos de la época, se realizó el presente artículo con el objetivo de describir la evolución de este centro y los contextos históricos fundamentales.

The Civil Hospital of Santiago de Cuba was founded in 1863 and, since that time, it has given assistance to patients of this province and of all east region. In 1960 it was transferred to the current head office and became fundamental column in the beginning of higher medical teaching for the whole east of Cuba. It is mentioned in several texts from the XIX century, but its creation and trajectory is not known. In that sense, after an exhaustive review of documents and newspapers of that time, the present work was carried out aimed at describing the evolution of this center and the fundamental historical contexts.

Correlation between Neonatal Outcomes and Maternal Anemia among Attending Pregnant Women in Al-Elwiya Maternity Teaching Hospital.

Background: Anemia in pregnancy can considerably elevate the maternal mortality risk and can negatively distress the development of fetus. Object of the Current Work: To assess the association between neonatal outcomes and maternal anemia (MA) among pregnant women (PW). Subjects and Methodology: The present work is a clinical prospective one performed at Al-Elwiya Maternity Teaching Hospital in Baghdad from January 1, 2022 to June 30, 2022. Current study selected 120 term PW with anemia admitted to hospital for caesarian section. Data were collected as a questionnaire. The data were directly taken from PW. The acquired data from anemic PW were distributed as followings: Age of anemic PW, which was classified into two groups; 25-29 years and 30-35 years. The gestational age of anemic PW, which was categorized into three groups; 37th week, 38th week, and 39th week of gestation. Anemia characteristics were studied, which included hemoglobin level (Hb) and packed cell volume test (PCV), which were done by taking 5 ml blood from each PW for s. ferritin, s.iron, Hb level, and blood film in laboratory of Al-Elwiya Maternity Teaching Hospital. The Hb helped in detecting anemic PW joined this study, as Hb was <10.5 g/dl at third trimester. Results: Mean gestational age (GA) of anemic PW was 37.5 ± 0.5 weeks; 58.3% of them were at 37th week, 39.2% of them were at 38th week, and 2.5% of them were at 39th week GA. So, the mean Hb of anemic PW was 8.6 ± 1.3 mg/dl, and the mean PCV was 28.6 ± 3.6%. Anemia was classified into mild (20%) and moderate (72.5%); also, mean ultrasound fetal head circumference (HC) among PW with mild anemia was 32.3 cm and for PW with moderate anemia was 32.1 cm, and mean ultrasound fetal abdominal circumference (AC) for PW with mild anemia was 31.3 cm and with moderate anemia was 31 cm, and validity results of MCA/UA-PI ratio regarding severe anemia of anemic were as follows: sensitivity (81.8%), specificity (79.8%), +ve predictive value (29%), -ve predictive value (97.8%), and accuracy (80%). Conclusion: The gestational mean age (GA) of anaemic PW was 37.50.5 weeks; 58.3% of them were in the 37th week and 39.2% were in the 38th week. Thus, the mean ultrasound foetal head circumference (HC) was 32.3 cm for PW with mild anemia and 32.1 cm for those with moderate anaemia. The mean ultrasound foetal abdominal circumference (AC) was 31.3 cm for those with mild anaemia and 31 cm for those with moderate anaemia, but 30 cm for those with severe anaemia, with no discernible difference. The following were the MCA/UA-PI ratio's validity findings for severe anaemia of anaemic: sensitivity (81.8%) and specificity (79.8%).

Hypertension and associated factors among patients attending HIV clinic at Korle-Bu Teaching Hospital.

Objectives: This study determined the prevalence of hypertension and its associated factors among patients attending the HIV clinic at the Korle-Bu Teaching Hospital (KBTH). Design: A hospital-based cross-sectional study was conducted at KBTH. The prevalence of hypertension was estimated among study participants, and socio-demographic, lifestyle, anthropometric, metabolic and HIV/ART-related factors associated with hypertension were determined by logistic regression modelling. Setting: Study participants were recruited from the HIV clinic at the KBTH. Participants: A total of 311 Persons Living with HIV were recruited as study participants. Interventions: Simple random sampling technique was used to recruit study participants. A questionnaire adapted from the WHO STEPwise approach to chronic disease risk-factor surveillance was used to collect study participants' data. Results: The prevalence of hypertension was 36.7%, and the factors associated with hypertension were increasing age, positive family history of hypertension, minimal exercising, current BMI ≥25.0 kg/m2, total cholesterol level ≥5.17 mmol/L, exposure to anti-retroviral therapy (ART) and increasing duration of ART exposure. Conclusions: This study shows a high prevalence of hypertension among patients attending the HIV clinic at KBTH, associated with exposure to ART and increasing duration of this exposure. Blood pressure monitoring should move from routine to a more purposeful screening of patients for hypertension. Patients with the identified risk factors should be encouraged to have regular blood pressure measurements at home and not only when they visit the HIV clinic. Funding: Office of Research, Innovation and Development (ORID) of the University of Ghana. The funding agency was not involved in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

Case study of a model primary health care program in Nigeria: History, evolution, challenges, and future perspectives.

This short report describes the historical evolution of a pioneer Model PHC programme located in Ogun State, southwest Nigeria, as a direct result of the vision and effort of Professor Olikoye Ransome-Kuti, and his drive to entrench the delivery of primary health care (PHC) in Nigeria. It describes some of the programmes inspired by the PHC philosophy at the Model PHC Centre, some of the challenges faced over the years, and the need to reposition the programme. It exemplifies key principles in PHC and its philosophy that are instructive for health practitioners, policymakers and development practitioners, especially those with interest in resource-poor countries.

Physician Disclosure and Patient Awareness of Resident Involvement During Podiatric Surgery: Do Patients Deserve to Know Who is Holding the Scalpel?

An anonymous questionnaire consisting of multiple-choice style questions was created at www.surveymonkey.com to assess physicians' perspectives regarding podiatric resident involvement disclosures in the surgical setting. The survey link was sent to podiatric residency program directors, attendings, residents, and fellows through email, social media outlets, and direct contact. For the purpose of this study, residents and fellows will be grouped together as trainees. A total of 201 participants were surveyed, including 63 program directors, 61 attendings, and 77 trainees. Of the respondents, 89.5% reported that at least 1 resident introduces themselves to the patient as a participant in the case. Additionally, 99% of responses revealed that trainees are performing at least 50% of the case. However, surgeons perceive that only 25% of patients are truly aware of this advanced level of involvement. This study suggests that 89.5% of podiatric physicians do in fact disclose trainee surgical participation. However, it is perceived that patients are still unaware of the extent of trainee involvement. Further studies are warranted which would account for both patient and physician understanding of this controversial topic.