Vol 8 Issue 1 April 2020-September 2020

Abstract: There have been recorded that more 23,000 deaths occur each year due to bacterial resistance to antibiotics. Antibiotic resistance can be prevented by rational and appropriate use of antibiotics. The bacteriological profile and its resistance on antibiotics can provide a reference in giving antibiotics rationally and appropriately. This research was conducted at ICU Sanglah Hospital Denpasar in the span of 1st January 2020 to 31st March 2020. This study uses the results of bacteriological culture tests and antibiotic susceptibility tests on all patients who carried out bacterial culture at the study site. The bacteriological profile found dominant in samples was Acinetobacter baumannii (28.75%), Klebsiella pneumoniae ssp. pneumoniae (17.5%), and Pseudomonas aeruginosa (16.25%). The susceptibility of Acinetobacter baumannii to antibiotics is 81.8% sensitive to Amikacin and 100% resistant to Cefazolin, Cefixime, Cefuroxime, and Cefoperazone. Susceptibility of Klebsiella pneumoniae ssp. pneumoniae to antibiotics are 100% sensitive to Meropenem and 100% resistant to Ampicillin. The susceptibility of Pseudomonas aeruginosa to antibiotics is 90% sensitive to Amikacin, 84.6% sensitive to Gentamicin, and 83.3% resistant to Levofloxacin.

Keywords: Bacteriological pattern, antibiotic resistance, ICU.

Title: Bacteriological Pattern and Its Resistance on Antibiotics in Patient with Bacteriological Culture Test in ICU RSUP Sanglah Denpasar

Author: Khoirul Adi Nur Alfisyahri, I Wayan Suranadi, I Gusti Agung Gede Utara Hartawan, Dewa Ayu Mas Shintya

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Prescribing Extended VTE prophylaxis (EVTE) for 28days in abdominal cancer surgery is a NICE guideline NG89. In Europe, there are 544,000 VTE-related deaths every year (55-60% during or following hospitalisation), 25 000 in the UK. In the UK average annual costs for VTE treatment, hospital bed days, sanctions and litigation for 2016/17 was £938,357 per CCG. 71% of patients assessed to be at medium or high risk of developing VTE did not receive any form of mechanical or pharmacological VTE prophylaxis.

Objectives: To improve extended VTE prophylaxis prescription in the General surgery ward for patients who have undergone abdominal cancer surgery. At the time of the first audit cycle compliance was 79%. The aim was to achieve 100% compliance upon implementing our initiatives.

Methods: This involved both qualitative and quantitative methods. We utilised a process map and a driver diagram to achieve our goals. Audit cycle one was completed in December 2018. Cycle 2 was completed in May 2019 after introducing our initiatives. We reviewed Lower GI mortality and morbidity data. We compared this data with Electronic discharge notes for all cancer surgery within this period. This included date of surgery and date of discharge and Anticoagulation on discharge.

Results: NICE Guidelines are to prescribe 28 days of VTE prophylaxis postoperatively for patients discharged post lower GI cancer surgery. Audit cycle 1 in December 2018 looked at 53 patients. 11 of the 53 were non complaint = 21%. After our Quality initiatives the audit cycle 2 in May 2019 looked at 118 patients. Only 1 was non-complaint = 1%.

Conclusions: The project was able to improve compliance in prescribing to reduce the risk of VTE in post abdominal cancer surgery from 79% to 99% within 5 months. This was achieved by following the well tested pathway to successful teams. Leadership communicated clear measurable goals to a dedicated team and most importantly by keeping the project simple and not reinventing the wheel. The initiatives we implemented can be applied to improve services in other departments and other hospitals.

Keywords: EVTE: Extended Venous Thromboembolism, PE: Pulmonary Embolism DVT: Deep Venous Thrombosis, LMWH: Low Molecular Weight Heparin, EDN: Electronic Discharge Notification, QIP: Quality Improvement Project, CCG: Clinical Commissioning Group.

Title: How improved compliance was achieved in prescribing to reduce the risk of Venous thromboembolism (VTE) in post abdominal cancer surgery: A quality improvement project

Author: Mohammad IMTIAZ, Zwelibanzi Moyo, Kwaku Baryeh

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Maternal age at conception seems to have a significant correlation with pregnancy and childbirth outcomes. Classically, very young childbearing women and those over 35 years have been classified as high-risk categories for child bearing.. The specific objective of the study was to determine the prevalence of adverse pregnancy birth complications among elderly primigravidas in Kakamega County, Kenya. A cross sectional survey of childbearing women and selected hospital personnel in 3 selected hospitals and tertiary institutions in Kakamega County was carried out. Sampling strategies included purposive, quota and stratified sampling. The sample size was determined using Fishers formula, which was 177 childbearing women attending clinic, 177 child bearing women from tertiary institutions and 30 medical personnel. Data collection methods included structured questionnaires, focused group discussions, interview guides and observation checklists. . Qualitative methods were used to analyze data from focus group discussions and key informant interviews. SPSS was used to analyze quantitative data. Key results of the findings revealed that the prevalence of adverse complications occurred mainly in childbearing women from age 35 years and above. The complications included pre eclampsia, ante partum haemorrhage and premature rupture of membranes among others. The recommendations to mitigate the problem include health education to women on the dangers of late age pregnancy, development of government  policies on access to quality maternal health services for elderly primigravidas and maternity protection in the work place.

Keywords: prevalence, primigravidas, adverse, complications.

Title: The prevalence of adverse pregnancy and birth complications among elderly primigravidas in Kakamega County, Kenya

Author: MILLICENT AMBETSA

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Maternal age at conception seems to have a significant correlation with pregnancy and childbirth outcomes. Classically, very young childbearing women (less than 18 years) and above 35 years have been classified as high-risk categories. Strategic interventions to reduce obstetric risks found among these childbearing women seem to be lacking. There is need to reduce the effect of obstetric risks associated with late age pregnancy outcomes among the elderly primigravidas by evaluation of existing strategic interventions.

Methods; Cross sectional survey research design was used, childbearing women and selected hospital personnel in 3 selected hospitals and tertiary institutions in Kakamega County were sampled. Purposive and stratified sampling strategies were used. The sample size was determined using Fisher’s formula, which was 177 childbearing women attending clinic in the 3 health facilities, 177 child bearing women from tertiary institutions and 30 medical personnel from the various institutions. Data collection was carried out using structured questionnaires, focused group discussions, interview guides and observation checklists of the  medical equipment in the selected hospitals. Quantitative data was analyzed using SPSS and correlation techniques. Qualitative methods were used to analyze data from focus group discussions and key informant interviews.

Results:  Healthcare facilities in the county were not fully equipped to deal with the adverse complications that come up with late age pregnancy.

Conclusion: Hospitals should be adequately equipped with adequate personnel and facilities such as Intensive Care Unit/Neonatal Intensive Care Unit to cater for this emerging trend.

Keywords: Elderly Primigravidas, Intervention, maternal, birth outcomes.

Title: Strategic interventions in reducing obstetric risks associated with late age pregnancy among childbearing women in Kakamega County, Kenya

Author: Millicent Ambetsa

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Sudden, on-table cardiac arrest following spinal anaesthesia is rare but catastrophic with incidence of 6.4 per 10000 spinal anaesthetics¹. There are numerous possible causes in literature. We describe a case of cardiac arrest on operation theatre table after spinal anaesthesia. It was not less than a challenge to diagnose pulmonary thromboembolism in such setting where usually we think of high spinal or total spinal anaesthesia as the cause. This case report is being presented to bring forth the importance of vigilant monitoring and prompt intervention in management of sudden cardiac arrest after spinal anaesthesia.                

Keywords: Spinal Anesthesia, Cardiac Arrest, Pulmonary Thromboembolism.

Title: POST SPINAL ANESTHESIA CARDIAC ARREST: IS IT ALWAYS AN ANESTHETIC COMPLICATION? A CASE REPORT

Author: Dr Archana Ramalingam, Dr Samrin Sheik, Dr Disha Magatapalli

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Chronic kidney disease is a common and rapidly increasing public health problem all over the world, both in developed and developing countries. Majority of the patients with chronic kidney disease on maintenance of haemodialysis are not aware of self-care management such medication, fluid, proper diet intake and regular follow up. This study aimed to assess the knowledge regarding haemodialysis therapy among end stage renal disease patients at Teaching Hospital, Batticaloa (THB), Sri Lanka. This is a hospital based descriptive cross sectional study about knowledge on factors contributing to non-adherence in dialysis patients. Data was collected by interviewer administered questionnaires at Teaching Hospital Batticaloa, Sri Lanka. A total number of 95 CKD patients undergoing haemodialysis in THB between the ages of 21 to more than 60 years were included in our study. The majority of patients were between 41-50 years (37%)]. Among them 50 (53%) were male &45 (47%) were female.  There was association between respondents level of self-care knowledge regarding haemodialysis and demographic variables such as Educational status (p=0.001), Monthly income (p=0.002), Duration of dialysis (p=0.003) and Per weekly dialysis (p=0.013).The study provided overall knowledge regarding medication, fluid and diet of CKD patients 51% were found to have moderate knowledge and only 13% had very good knowledge. This result make us aware that patients who are affected with CKD  need more awareness regarding proper maintenance on medication, fluid and diet balance who are undergoing dialysis treatment.

Keywords: Chronic kidney Disease, Haemodialysis, Knowledge, Medication, Fluid, Diet.

Title: KNOWLEDGE REGARDING HAEMODIALYSIS THERAPY AMONG END STAGE RENAL DISEASE PATIENTS AT TEACHING HOSPITAL, BATTICALOA, SRI LANKA

Author: Sureshrupan J, Vijayakuma M, Arunprashath S, Antony MK, Shanmukanathan S, Josepha J

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: ADHD and BED comorbid nature is reviewed considering BED has a very strong relationship with obesity, a risk factor for cardiovascular diseases which is globally known as the leading cause of death. It is suggested that the comorbidity manifests as specific neurobiologic disorder in which ADHD and BED symptoms are overlapped. A review on the comorbidity of ADHD and BED is important as an effort to find out the pathological mechanism in both disorders and clinically, providing insights for effective case management strategies when both disorders occur simultaneously, as well as preventing BED behavior in ADHD cases through early detection of BED symptoms. The goal of this literature review is to further explore the currently proposed comorbidity mechanisms of both ADHD and BED pathophysiology.

Keywords: ADHD, Binge-eating Disorder, Comorbidity.

Title: Attention-deficit and Hyperactivity Disorder (ADHD) and Binge-Eating Disorder (BED) Comorbidity Mechanism: A Literature Review

Author: Nadia, Rafika Ayu, Purnawati, Susy

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Keratitis is mostly caused by adenovirus infection to the eye. Superficial epithelial infiltrates (SEI) and superficial punctate keratitis (SPK) are pathognomonic for the diagnosis of adenoviral conjunctivitis. There are no specific diagnostic methods and treatments for adenoviral conjunctivitis which has resulted in its incorrect diagnosis and unnecessary antibiotic use. In our case series, study of 10 misdiagnosed patients, 70% suffering with diabetes mellitus healed after an accurate diagnosis of adenoviral keratitis and treatment within 4-6 weeks of regular follow-up. Eye ointment, eye drop, and combination medicines, which are used to relieve pain, can act as the appropriate treatment options for SEI and SPK.

Title: Adenoviral keratitis and treatment in misdiagnosed patients: A follow-up report of the case series

Author: Dr. Vertika Kulshrestha

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: This paper seeks to review the current state of China’s electronic health system. It will bring to light the usage levels of hospitals and employees and the challenges of implementation. The health record of a patient or client to a hospital is the data source regarding the variations of health status and received health services throughout a client’s life.  All-inclusive electronic medical records (EMR) have been recognized to be an active tool for improving the quality and safety of healthcare services in China.  Reaching a state of personal healthcare information system that covers the whole population is one of the main goals of China by the year 2020. Digital databases have been established by most hospitals, counties and provinces in China for managing electronic health records and patient/client data. The main goal of Chinese digitization reform is to build integrated strong health information platforms at city, county, provincial and national levels. Regardless of the largest inhabitants and huge discrepancies among diverse regions, China has set a determined goal to complete the execution of a nationwide interoperable health information system that allows healthcare facilities to share residents’ healthcare information by the end of 2020. The findings obtained from the various literature reviewed indicate that China is doing very well in the implementation and usage of hospital electronic information systems (EHR, EMR etc.).

Keywords: Electronic Health Records; Medical Health Records; Health Information Management; Health Information Technology; China.

Title: A Narrative Review of Electronic Health Records (EHRs) Adoption in China’s Hospitals

Author: Joseph Owusu-Marfo, Zhou Lulin, Henry Asante Antwi, Maxwell Opuni Antwi

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Kenya is facing challenges of unsatisfactory clinical performance attributed to inadequate clinical incompetence’s among nursing students. Literature available locally indicate that the level of clinical perception of diploma nursing students to practice fully in clinical setting is low due to the ways they have been mentored, coached, supported and prepared for better clinical performance.   The study was to determine factors that influence clinical performance of diploma nursing students in three Kenya Medical Training Colleges in Western Kenya. The study design was descriptive cross-sectional survey that used both quantitative and qualitative methods to collect information from the study population. The study participants were diploma nursing students in Kenya Medical Training Colleges in Western Kenya. A sample of 265 students was selected from a total population of 750 in three colleges. Pretesting of the data tool was done, informed consent and confidentiality maintained. Presentation of data was done in form of inferential statistics, frequency distribution and graphs. Quantitative data from the questionnaire was analyzed using Statistical Package for Social Sciences (SPSS) computer software (version 22.0) and qualitative data that was collected from focus group discussion was analyzed thematically. Results showed that clinical performance was rated at 56% as favorable, 26.1 % was perceived as unfavorable, while those unable to determine their perception (Not sure) were 41.5%. Majority of respondents 49.5% perceived theoretical knowledge preparation as favorable, while 35.6% perceived as unfavorable. those unable to determine their perception (Not sure) were 14.9%. On adequacy of clinical methods 57.9% was perceived as favorable and 42.1% as unfavorable. The results from qualitative data showed that students were not adequately prepared as they learned on their own. The study discussion identified poor student-staff relationships, shortage of clinical educators, insufficient resources and supplies. From these findings the following conclusions were drawn: Few studies have been done in the area of clinical performance among nursing students and of the few done the reported relationship between performance in theory courses and clinical practice courses were weak. Therefore, diploma nursing students in Kenya Medical Training Colleges in Western Kenya are inadequately prepared for the nursing profession. These findings may have implication on the Kenya Medical Training Colleges and Nursing Council of Kenya curriculums and policies on clinical training. A consistent and coordinated effort is recommended to ensure improvement in quality of clinical performance.

Keywords: Clinical Performance, Clinical learning environment, Experiential learning, Nurse Educator .

Title: Factors Influencing Clinical Performance of Diploma Nursing Students in Kenya Medical Training Colleges in Western Kenya

Author: Jedidah O. Kweya, Dr. Silvenus Ochieng Konyole, Dr. Maximilla Wanzala

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Anxiety is becoming more common condition among adolescents and university students in Indonesia. Insomnia is also a common issue among the academic population in Indonesia. The increase in anxiety and insomnia can be linked to the increased stress of student life and activities. This research aims to identify the correlation between anxiety and insomnia among medical students at Faculty of Medicine Udayana University years of study 2019. The study design was cross-sectional observational analysis is done by distributing questionnaires to 144 respondents conducted in March 2020. Insomnia is measured by KSPBJ-Insomnia Rating Scale (KSPBJ-IRS) and anxiety by Depression Anxiety Stress Scale-21 (DASS21). Samples were taken by simple random sampling technique. Analysis of data using SPSS version 23 by chi square test. The result showed that only 25.4% of students had insomnia. However, the result showed that 56.3% of students had anxiety. A cross tabulation report that 45.7% of respondents who experienced insomnia also experienced anxiety. There is a moderate correlation between anxiety and insomnia among medical students (r=0,522; p=0.000). Therefore, it needs concern to know health impacts.

Keywords: Anxiety, anxiety disorder, insomnia, sleep disturbances, correlation, medical students.

Title: Correlation between Anxiety and Insomnia among Medical Student of Udayana University Class of 2016

Author: Muhammad Ariff Zafri

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Childhood obesity has escalated to an alarming proportion in the last twenty years. It is currently the most preventable nutritional disease of the 21^st century. School aged children have well-defined food preferences and dislikes, preferring large amounts of sugar and starches while avoiding vegetables and protein foods. These years may signal for the appearance of obesity.  This study was undertaken to evaluate the effectiveness of video assisted teaching program on knowledge regarding the impact of junk foods on obesity among school age children in a selected school at Bangalore. An evaluative approach was adopted and a quasi experimental one group pre-test post-test design was used for the study. 60 School age children (5^th & 6^th Standard) of Dayananda Sagar International School, Bangalore were selected by simple random sampling technique. The pre-test was followed by the implementation of video assisted teaching programme and post test was conducted after 7 days using the same structured questionnaire. The results were described by using descriptive and inferential statistical analysis. Results of the study revealed that the overall post test mean knowledge score 21.31 (85.26%) were significantly higher than the overall mean pre-test knowledge scores 8.63 (34.53%) and the computed paired‘t’ value 34.48 is higher than the table value 3.46 at P<0.001 level. The overall findings of the study clearly showed that the video assisted teaching programme was significantly effective in improving the knowledge regarding the impact of junk foods on obesity among school age children.

Keywords: Impact, Junk food, Obesity, School age Children.

Title: Effectiveness of Video Assisted Teaching Program on Knowledge Regarding the Impact of Junk Foods on Obesity among School Age Children in a selected School, Bangalore, Karnataka, India

Author: Sowmya. A.V

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract:  Radiation dose rate levels of nuclear medicine generated radioactive wastes within the Nuclear Medicine Unit of Mulago National Referral and Teaching Hospital has been assessed. The wastes considered in this study were used syringes, used cotton, used gloves and empty vials. Dose rate levels of these wastes were monitored using a Red eye PM1703M-01 electronic dosimeter of serial number 286775, which uses a cesium iodide scintillator and a Geiger Mueller tube. The radiation dose rate levels recorded were compared with the International  Atomic  Energy  Agency  (IAEA),  World  Health  Organization  (WHO),  International Commission on Radiological Protection (ICRP) and Atomic Energy Council of Uganda (AECU) guidelines and they were found to be low relative to the set guidelines for the shortest distance  from any individual bag containing the wastes to be disposed.

Keywords:  Radiation Dose rates, Generated Radioactive wastes, Working day, Red eye dosimeter.

Title: Radiation Dose Rate Levels of Nuclear Medicine Generated Radioactive Wastes in the Nuclear Medicine Unit of Mulago Natural Referral and Teaching Hospital

Author: Opio Peter, Kisolo Akisophel, Muyinda Zeridah

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: BACKGROUND: The COVID-19 pandemic is an unprecedented global crisis. Surgical providers have been compelled to alter almost every aspect of their clinical practice. The primary focus is global public health security and targeted efforts to preventing the spread of the highly contagious and lethal disease. This article seeks to describe the global impact of COVID-19 pandemic on general surgical services. The communique also suggested novel initiatives to help surmount this challenging situation.

METHODS: Published articles discussing COVID-19 pandemic up to April 2020 were obtained for review using a manual library search (PubMed), Medline, Embase, Cochrane Library, and Google.  Ultimately, 24 most pertinent articles were selected and critically reviewed in the final analysis.

CONCLUSION: The COVID-19 pandemic in some communities was overwhelming in nature and was characterized by the complete exhaustion of capital and human resources for healthcare.  A successful outcome requires a concerted effort, good organizational structure, careful preparedness, and an optimal preventive approach in such an emerging mass casualty incident response. Besides, the utilization of surgical appliances and staff must be well pondered and balanced. Prioritizing and skeletonizing operational activities during a pandemic is crucial and, as per the WHO and other Surgical bodies guidelines. Social distancing, quarantine, and isolation are veritable public health tools. The much-awaited breakthrough in vaccination and therapeutic solutions, Research as well as technological development needed to combat the scourge of COVID-19 pandemic is achievable only through comprehensive international collaboration. 

Keywords: COVID-19 Pandemic; Impact; Isolation; Social Distancing, Quarantine; Resources Management; Surgical Services.

Title: THE GLOBAL IMPACT OF COVID-19 PANDEMIC ON GENERAL SURGICAL SERVICES

Author: Alegbeleye Bamidele Johnson, Coker Akinoso Olujimi, Ohene Jerome E., Oke Olatunbosun O., Jantchou Prevost, Mohammed Rana K.

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Knee Osteoarthritis (OA) is a degenerative joint disease seen most frequently in adults and characterized by pain and loss of function. Prevalence of OA increases with age and it is most frequently seen in individuals above 65. Osteoarthritis is defined as a non-inflammatory disease causing metabolic, structural, biochemical changes in articular cartilage and affecting subchondral bone, joint capsule, synovial membrane and muscle around joint. Consequently it causes pain limitation of joint movement, disability and a decrease in muscle strength which affects ability for sitting on the chair, standing, walking and climbing stairs. It can affect any joint in the body but involvement of the spine or weight bearing joint such as hip and knee may result in more disabling condition than in other parts of the body.

Keywords: Musculoskeletal, Maladaptive, Strengthening, Kinesio Tape, Therapeutic Ultrasound.

Title: Role of Physiotherapy in Osteoarthritis of the Knee Joint: A Literature Review

Author: Beant singh Jattana, Simranjeet Kaur, Kavita Kaushal

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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