International Journal of Medical Science and Dental Research

Volume 5 Issue 6 (November-December 2022)

    • Understanding and Enhancing Current Hospital Risk Management Procedures
      Objective: Many patients in the healthcare industry have unpleasant occurrences. To ensure patient safety, hospitals have developed risk management. However, present risk management procedures have a lot of opportunity for improvement. As a result, the goal of this study is to gain a better understanding of risk management methods in hospitals and propose recommendations to enhance them. While a questionnaire survey was developed to better understand current risk management applications, risk management literature was also studied in order to better understand and improve these risk management applications. According to the research, over 70% of practitioners and managers see risk management as defining patient hazards, while just a minority agree on the ISO definition of risk. In addition, over half of practitioners and managers believe that risk assessment is more important than risk mitigation. Participants generally employed Failure Mode and Effect Analysis (FMEA), brainstorming, and risk matrix strategies to control risks. Risk management procedures might be advanced based on the results of the questionnaire and the literature research by prioritizing safety culture, employee involvement, safety training, risk reporting systems, and risk management instruments.

      Keywords:: risk management, patient safety, and healthcare.

        A nine yrs old girl presented to the Outpatient Dept with pain in left leg since last 6 months. It was associated with pain in the hip and aggravated by movement. No associated history of pigmentation over the trunk or body, abnormalities in growth or similar symptoms in other parts of the body. Xray of the left leg revealed a translucent smooth lesion in the proximal part of femur with endosteal scalloping and cortical thinning in the neck of left femur (Fig 1).

        Keywords:: Biopsy Discussion

        • Bed Management Strategy for Overcrowding at the Emergency Department
          ED crowding has emerged as a new hazard to patient safety and health-care systems globally. As the problem of ED crowding continues to expand, it is critical to identify the elements that contribute to ED overcrowding. Hospital beds are a limited resource that is continually in demand. When a patient is admitted to the emergency department, there may not be a bed available that matches the specified speciality. As a result, the scarcity of available hospital beds has become a serious issue, and modifying bed-management policies could enhance patient flow. A PRISMA flowchart-based systematic review was undertaken utilizing online databases such as ProQuest and Google Scholar, using keywords such as bed management, emergency department, and overcrowding, and academic publications and articles published between 2003 and 2016. There are some reasons that contribute to ED crowding. Identifying, creating, and implementing solutions to reduce hold time and other barriers would be critical to improving patient flow. Changing hospital bed management policies is worth investigating in order to improve hospital patient flow and LOS (Length of stay). With this knowledge, hospital administration will be better able to create methods to prevent bed overflow and so improve patient care.

          Keywords:: bed management, emergency department, overcrowding

          • The Effect of Al-Qur'an Therapy on Insomnia Problems on Medical Students
            Background : Sleep disturbance is a need for sleep and sleep time that is not met (about 7 to 8 hours a day) resulting from difficulty falling asleep, maintaining sleep or getting up too early. Adolescence and adulthood are the ages with the highest risk of insomnia and of course have a negative impact on the performance of daily activities. One method that has developed is using Murattal Al-Qur'an therapy. This study is aimed at looking at the effectiveness of murottal Al-Qur'an therapy in reducing insomnia problems in Medical Students
            Methods:This study used a pre-experimental design with a one group pre-posttest without control design and used simple random sampling.
            Results: The level of mild insomnia was 19.4%, moderate insomnia was 63.2%, severe insomnia was 17.4% and there were no respondents who did not have insomnia before the intervention. After the intervention, it was found that severe insomnia reduced to 12.7%, moderate insomnia to 45.3%, mild insomnia to 34.0% and non-insomnia to 8.0%.
            Conclusion: It was found that murottal therapy was effective in reducing insomnia after the intervention.

            Keywords:: Quran Therapy, Students

              Parathyroid adenoma, generally presenting with hypercalcemia and high parathyroid hormone, is a rare cause of primary hyperparathyroidism. We present the case of a 48-year old woman who presented with persistent vomiting for 3 months along with mild epigastric pain and retrosternal burning associated with heaviness after meals, bloatedness and indigestion of food. She had generalized body aches and easy fatigability, lethargy and generalized weakness. She reported difficulty in going to sleep along with repeated awakenings during the night, low-mood and feeling anxious throughout the day along with inability to concentrate. On work up, she had hypercalcemia and was subsequently diagnosed with Parathyroid adenoma causing Primary Hyperparathyroidism.

              Keywords:: Hypercalcemia, Parathyroid Adenoma, Primary Hyperparathyroidism.

              • Participatory Action Research Methods in Promotive and Preventive Dental Health Programs in Traditional Communities of Kampung Naga in Tasikmalaya Regency
                Kampung Naga is one of the traditional villages in Neglasari Village, Salawu District, Tasikmalaya Regency. The traditional community of Kampung Naga is known for its strength in maintaining and preserving ancestral traditions. As a traditional village, people's lives are inseparable from customary rules, including in terms of health. Self-cleaning activities such as bathing are carried out in a fish pond. Interestingly, the people here do not use cosmetics such as soap, shampoo and toothpaste in their self-cleaning activities. The ingredients used for bathing and shampooing are “taneuh porang” (clay), crushed orang-aring leaves or aloe vera and some use lime. Meanwhile, for brushing teeth using “eurih jeung lebu” (fiber from weed leaves and rubbing ash). The results of the pre-study showed that the majority of the people of Kampung Naga in carrying out oral hygiene / brushing their teeth using traditional materials tend to be abrasive such as rubbing ash, this will cause the teeth to wear out / eroded the enamel layer, causing caries. Furthermore, people who experience toothache are still often treated by local "kuncen" and given certain incantations. The purpose of this study is to implement the Participatory Action Research method in the Promotive and Preventive Program for dental disease in the Naga village community in Tasikmalaya Regency. Methods This research is a qualitative research using an observational approach supported by a literature review. Results: Knowledge before and after treatment with p value = 0.000 and OHI-S before and after treatment obtained p value = 0.000. Conclusion: The application of the Participatory Action Research method to the Kampung Naga community in Tasikmalaya Regency can increase the knowledge and status of dental and oral hygiene as an effort to promotive and preventive dental disease.

                Keywords:: Participatory Action Research, traditional, community, promotive, preventive dental disease

                • Method Of Simultaneous Estimation of Nitazoxanide and Ofloxacin from Bulk and Tablet Dosage form Using RP-HPLC
                  For the simultaneous determination of Nitazoxanide and Ofloxacin in tablet dosage form, a simple reverse phase liquid chromatographic method was developed and validated. A mobile phase containing acetonitrile, methanol, and 0.4 M citric acid (60:30:10, v/v/v) was used for the separation. Thermo C18 (4.6mm*250 mm, 5 ) column was used, with a flow rate of 1 mL/min and UV detection at 300 nm. Nitazoxanide and ofloxacin had retention times of 3.071 and 12.47 minutes, respectively. The described method was linear over a concentration range of 5-30 g/mL for Nitazoxanide (r2>0.999) and 2-12 g/mL for Ofloxacin (r2>0.998). The mean percentage recovery for Nitazoxanide was 99.96% and 101.05% for Ofloxacin. Nitazoxanide and Ofloxacin had limits of detection (LOD) of 0.3788 and 0.0929 g/mL, respectively. The limit of quantification (LOQ) for Nitazoxanide and Ofloxacin, respectively, was 1.1479 g/mL and 0.2816 g/mL. The study's findings revealed that the proposed RP-HPLC method is simple, fast, precise, accurate, and cost effective, making it suitable for routine determination of Nitazoxanide and Ofloxacin in bulk and tablet dosage forms.

                  Keywords:: Nitazoxanide; Ofloxacin; RP-HPLC; Method Validation.

                  The genes thought to be effective in the pathogenesis of Diabetic nephropathy (DN), one of the important complications of diabetes, have been the focus of attention of researchers. In our study, three eNOS polymorphisms, the 27-bp repeat (4b/a) in Intron 4, the G894T missense mutation in exon 7, and the T786C single nucleotide polymorphism in the promoter region were examined. This study is conducted with the blood specimens of ninety patients with diabetic nephropathy and sixty healthy control groups. eNOS, G/T, and T/C gene polymorphisms were evaluated. The genotypic distribution and demographic/clinical findings obtained in our study were not significant between the two groups (p>0.05). But, the genotypical distribution in the patient group was significantly different (p<0.05). Our findings are consistent with much literature, and in our population, eNOS is thought to be an important genetic factor contributing to DN pathology. Studies show that NO gene polymorphism seen in diabetes may be a crucial risk factor for DN and atherosclerosis.

                  Keywords:: overcrowding; emergency department; hospital admission

                • Overcrowding in the Emergency Department: A Bed Management Strategy
                  Overcrowding in emergency departments (EDs) is a global phenomenon that has a substantial detrimental impact that spreads throughout the hospital. This has a number of ramifications that can affect both the number of available resources and the quality of service. Overcrowding is caused by a variety of variables that, in most circumstances, result in an increase in the number of individuals in the ED, an increase in mortality and morbidity, and a loss in the ability to offer crucial services to patients suffering from medical emergencies in a timely way. As a result of this phenomena, the Emergency Department reaches, and in some circumstances exceeds, its optimal capacity. The main causes and effects of this phenomena were compiled in this review, including the effect induced by the SARS-CoV-2 virus in recent years. Finally, special emphasis was made to the primary operational strategies that have been established over the years, strategies that can be utilized both at the ED level (microlevel strategies) and at the hospital level (hospital level strategies) (macrolevel strategies).

                  Keywords:: Diabetic nephropathy, diabetes mellitus, endothelial nitric oxide synthase gene, polymorphism

                • The psychological health of health care workers (HCWs) responding to the Covid-19 pandemic across the Middle East and Europe: A literature review
                  The global outbreak of the COVID-19 pandemic has led to an increased risk of psychological distress among health care workers (HCWs). As this global crisis continues with minimal signs of abatement, this study aims to investigate and compare the psychosocial health of health care workers (HCWs) responding to the Covid-19 pandemic in the Middle East and Europe. This study adopted a literature review approach to analyse and compare the psychological health of HCWs in the Middle East and Europe. This study utilised 42 peer-reviewed research articles, examined their findings and then drew comparisons between the Middle East and Europe. The results indicate that anxiety, depression, PTSD, sleep disorder and distress are the most common psychological effects that HCWs experienced. The results clearly demonstrate that the HCWs in the Middle East are more psychologically affected compared to HCWs in Europe. Furthermore, female staff appear to be more vulnerable and more psychologically affected by responding to the Covid-19 epidemic. From an occupational perspective, nursing staff were found to be more psychologically affected compared to doctors and other HCWs.

                  Keywords:: Psychology, health workers, covid-19, middle east, Europe

                  • The role of a point-of-care ultrasound in the emergency department
                    Background: Pediatric ED visits for superficial skin and soft tissue infections (SSTI) have steadily increased, and point-of-care ultrasound (POCUS) remains an effective modality for improving management and shortening ED lengths of stay.
                    Objective: We wanted to see how a soft tissue POCUS curriculum affected POCUS utilization, ED LOS, and cost-effectiveness.
                    Methods: A pre- and post-interventional study of pediatric patients aged 0 to 17 years was carried out. Patients who presented to the emergency department with an international classification of disease 9 or 10 code for abscess or cellulitis were included. Data were collected one year before and one year after the implementation of the curriculum, with a one-year washout training period in between. The training included continuing medical education, more than 25 quality assurance examinations, and a post-test. We compared diagnostic imaging type, ED LOS, and mean charges in SSTI patients.
                    Results: We examined data from 119 patients, 38 before and 81 after the intervention. The total number of POCUS examinations performed pre- to post-curriculum intervention increased significantly, from 26 to 59 (p = 0.0017). The average total charges were reduced from $3,762 (270) to $2,622 (158; p = 0.0009). There was a significant trend toward a decrease in average ED LOS, which was 282 (standard error of mean [SEM] 19) minutes vs 185 (13) minutes (p = 0.0001).
                    Conclusions: Implementing a soft tissue POCUS curriculum in a pediatric emergency department was linked to increased POCUS use, decreased LOS, and lower costs. These findings emphasize the significance of POCUS education and application in the treatment of pediatric SSTI.

                    Keywords:: Pediatric, Soft tissue, Ultrasound, Training, Curriculum, Emergency department, Point-of-care ultrasound, Infection, Curriculum, Pediatrics, Education

                      • Inhibitory Power of Liquid Soap Made from Hibiscus Flower (Hibiscus rosasinensis L.) on The Growth of Bacterial Colonies on Hands
                        Background:One of the easiest ways to prevent and control direct transmission is to maintain hand hygiene by hand washingusing water and antibacterial soap. It is recommended to use antibacterial agents from natural ingredients, one of which has this potential, namely hibiscus flower (Hibiscus rosasinensis L.).
                        Objectives: Analyzing the differences in the inhibitory power of non-antiseptic soap, antiseptic soap, and soap made from hibiscus flower on the growth of bacterial colonies on hands.
                        Methods: An experimental pre and post-test control group design study was conducted on 57 participants who were grouped into a hand washing group with: non-antiseptic soap, antiseptic soap, and hibiscus soap (containing 40% hibiscus flower extract). Samples were pre and post-hand swabs using sterile cotton swabs. Colony growth was assessed from the culture results on Nutrient Agar for 24 hours. Differences in inhibition between groups were analyzed using the Kruskal-Wallis test.
                        Results: There was a significant difference between the number of pre and post-hand washing bacterial colonies in the hibiscus soap group (p = 0.03) and in the antiseptic soap group (p = 0.042). The use of non-antiseptic soap did not show a significant difference in the number of pre-post handwashing colonies (p = 0.717).Nonetheless, it can be proved that the effectiveness of hibiscus flower soap, antiseptic soap, and non-antiseptic soap in reducing the number of hand bacteria by 84.2%; 68.4%; and 68.4%.
                        Conclusion: Hibiscus soap which contained 40% of hibiscus flower extract effective in reducing the number of colonies of hand bacteria (84.2%).

                        Keywords:: Hibiscus rosasinensis L., hibiscus soap, hand washing, hand bacterial colonies

                        • The Relationship of Balanced Nutrition Literature and Nutrition Consumption Behavior of Students of Muhammadiyah University, East Kalimantan
                          Nutrition literacy is the ability of everyone to have knowledge and skills in understanding nutritional information and as a tool for changing behavior. The purpose of this study was to determine the effect of the application of nutritional literacy on the healthy behavior of students at the Muhammadiyah University of East Kalimantan. This study uses a questionnaire as the material of the research, distributed via a google form to 481 respondents. It was concluded that students gained insight and understanding about balanced nutrition and physical exercise due to this learning activity. All are aware of adopting a balanced lifestyle and physical exercise for adolescents to affect health positively.

                          Keywords:: Student Nutrition, Nutrition Literacy, Student Consumption Behavior.

                          • Cerebral Fat Embolism Following Orthopedic Surgery (Case Report).
                            Fat embolism syndrome (FES) is a rare but a serious clinical condition occurring after traumatic injury to long bones. Cerebral involvement in the absence of pulmonary or dermatological manifestation on early presentation may delay the rapid diagnosis of cerebral fat embolism (CFE). We discuss a case of CFE with a challenge in diagnosis with absence of acute chest pain. The clinical presentations of these patients did not satisfy the clinical criteria the diagnosis of FES. Early MRI with neurological symptoms after trauma even in the absence of pulmonary and dermatological findings should be the goal.

                            Keywords:: Fat embolism syndrome, trauma.

                            • The Most Efficient Methods for Preventing Medication Errors and Enhancing Reporting Systems
                              Background:Numerous population-based studies have repeatedly found alarmingly high rates of medication errors and avoidable deaths. Reliable practice is built on an effective reporting system for medication errors, which also serves as a gauge of how far we have come in achieving safety. The goal of medication error reporting systems' improvement efforts and system changes should be to lessen the risk of harming future patients. However, the objective of this review is to provide an overview of the culture surrounding reporting medication errors, incidence reporting systems, developing efficient reporting techniques, analyzing medication error reports, and making suggestions to improve reporting systems.
                              Methods: NFrom 1 January 1998 to 30 June 2020, electronic databases including PubMed, Ovid, EBSCOhost, EMBASE, and ProQuest were examined. There were 180 articles found, and 60 papers were eventually used in the review. Two reviewers mined the data, and two additional reviewers verified it. The search produced 684 articles, which were then whittled down to 60 by eliminating duplicates through title, abstract, and full-text paper vetting.
                              Results: The majority of the studies came from the United States and the United Kingdom. Studies from Canada, Australia, New Zealand, Korea, Japan, Greece, France, Saudi Arabia, and Egypt were among the few that were submitted. Medication error detection, measurement, and analysis demand an active strategy rather than a passive one. There must be initiatives to promote reporting of medication errors, including educating staff about areas for development and identifying the underlying causes (s). A classification system for describing and examining the specifics surrounding individual medication error events is the taxonomy developed by the National Coordinating Council for Medication Error Reporting and Prevention.
                              Conclusion: A successful program for reporting medication errors should be safe for the reporter, yield beneficial suggestions and changes that benefit everyone, while also being inclusive and supported with the necessary resources. To move toward a more reliable practice, health organizations must adopt an effective reporting environment for the medication use process.

                              Keywords:: medical errors, medication error, improve, medication error reporting program, health care professional, patients, health organizations.

                              • Dimensions of Healthcare Service Quality and Their Measurement
                                Worldwide, both public and private healthcare institutions have been concerned about service quality. Numerous studies investigating what determines service quality and how it can be measured have been conducted as a result of the increased emphasis on patient-centered care. The goal of this paper is to examine and synthesize the body of published knowledge that is currently available in order to comprehend what constitutes high-quality healthcare services, their underlying dimensions, and the methods used to measure them. A review of the literature was conducted using the EBSCO and Google Scholar databases, covering important studies in the area of healthcare service quality, service quality dimensions, and its measurement. Aspects of the medical and non-medical aspects of healthcare service quality were used to present the findings. Conclusion: Patients evaluate dimensions of healthcare service quality differently depending on the context. Over gap score-based models, perceptions-only measures are dominant in the evaluation of healthcare quality. Additionally, the construct of healthcare service quality and its measurement have primarily been done from the perspective of the patient; the perspective of the provider regarding the healthcare service quality has not been taken into consideration.

                                Keywords:: Measurement, Healthcare Service Quality, and SERVQUAL

                                • Clarify the Concept of Healthcare Quality
                                  Public confidence is shaken by declining health care quality indicators. Healthcare quality is still conceptually and practically undefined, despite improvements in hospital safety and quality of care. So, the purpose of this analysis is to define the term "healthcare quality." The framework was based on the concept analysis technique developed by Walker and Avant, which is frequently cited in nursing literature. We looked through five academic literature databases, public domain websites, general and medical dictionaries, and dictionaries. Healthcare and quality were search terms, as well as terms related to health care. From 2004 to 2016, peer-reviewed papers and official reports that were published in English were included. Gray literature, discussions of the need for high-quality healthcare, related concepts, and conference proceedings were all excluded. During analysis, similar characteristics were categorized into themes. After removing duplicates and articles that weren't eligible, 42 pertinent articles were examined. Four defining characteristics were found after thematic analysis: (1) effective, (2) safe, (3) culture of excellence, and (4) desired outcomes. Based on these characteristics, the definition of high-quality healthcare is the evaluation and delivery of safe, effective care that is reflected in an excellence-centered culture and leads to the achievement of ideal or desired health. This analysis offers a conceptualization of healthcare quality that clarifies its underlying assumptions and may enhance the delivery of high-quality care. Theoretical and practical implications are provided to support a more thorough and consistent understanding of the elements required to enhance healthcare delivery and maintain public confidence.

                                  Keywords:: Quality in health care; health care quality; theory; concept analysis.

                                  • The Advantages of Accreditation for Healthcare Services
                                    Background:To evaluate and enhance the quality of medical care, accreditation is generally accepted as a trustworthy method. However, its impact on efficiency and productivity remains unclear. This review set out to collect and analyze any data that might be relevant to the question of how hospital accreditation affects patient outcomes.
                                    Methods: We searched PubMed, CINAHL, PsycINFO, EMBASE, MEDLINE (OvidSP), CDSR, CENTRAL, ScienceDirect, SSCI, RSCI, and SciELO in depth, as well as other relevant databases, using key terms related to our research question. All expert-reviewed, quantitative studies published in the last two decades were included. Two reviewers independently screened the primary articles, read the full texts of potentially relevant studies, extracted the necessary data, and assessed the methodological quality of the studies included in the analysis using a validated tool, all in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. After looking at the data on the effects of accreditation, six distinct impact themes emerged.
                                    Results: We looked over 17,830 studies and found only 76 empirical studies that looked into the effects of accreditation met our criteria and were therefore included. Each study took a unique tack in terms of how they went about collecting data. Our results show that accreditation has a positive and lasting impact on hospitals' safety cultures, process-related performance measures, efficiency, and patient lengths of stay. Accreditation was found to have no correlation with measures of employee happiness, patient happiness and experience, or the 30-day hospital readmission rate. It was challenging to draw firm conclusions about the effect of accreditation on healthcare-associated mortality and infections due to the existence of conflicting findings.
                                    Conclusion: There is evidence to suggest that a hospital's overall performance can improve if it complies with accreditation standards. This is just one of several possible benefits. Although there is insufficient evidence to support a definitive link between hospital accreditation and improved performance or patient safety, this has not stopped hospitals from implementing accreditation programs. In order to institutionalize and keep performance gains, it is suggested that efforts be made to modernize accreditation and provide incentives for getting it.

                                    Keywords:: Accreditation, Hospitals, Quality of health care, Health services

                                    • Using-Performance-to-Determine-the-Quality-of-Healthcare
                                      Background: In recent years, the healthcare system has undergone rapid transformation. Nonetheless, a recent Quality and Patient Safety Report highlighted declining levels of patient safety and quality culture among healthcare professionals. This highlights the importance of assessing care quality and patient safety from the perspectives of both patients and healthcare professionals.
                                      Objectives: This study sought to determine (2) which demographic factors are associated with overall quality of care and patient safety, as well as (1) patients' and healthcare professionals' perceptions of patient safety and overall quality of c are standards at two tertiary hospitals.
                                      Methods: The research design was cross-sectional. Data on two topics—overall quality of care and patient safety—were gathered using the Healthcare Professional Core Competency Instrument and the Revised Humane Caring Scale. Between the end of 2018 and the start of 2019, questionnaires were given out to patients (n = 600) and healthcare workers (n = 246) in three departments at two tertiary hospitals: medical, surgical, and obstetrics and gynecology. Binary logistic regression and descriptive statistics were used to analyze the data.
                                      Results 367 patients and 140 medical professionals completed the questionnaires, representing response rates of 61.2% and 56.9%, respectively. Overall, healthcare professionals gave higher ratings for patient safety (M = 4.39; SD = 0.675) and quality of care (M = 4.36; SD = 0.720) than did patients (M = 4.23; SD = 0.706) and the general public (M = 4.22; SD = 0.709). The research discovered a relationship between hospital characteristics and overall healthcare quality (OR = 0.095; 95% CI = 0.016- 0.551; p = 0.009) as well as patient safety (OR = 0.153; 95% CI = 0.027-0.854; p = 0.032) among medical staff. Additionally, a relationship between the admission/work area and the participants' perceptions of the quality of care was found (patients: OR = 0.257; professionals: OR = 0.093; 95% CI = 0.009-0.959; p = 0.046).
                                      Conclusions: With only minor differences, patients and healthcare professionals both rated the quality of care and patient safety as excellent, demonstrating high patient satisfaction and skilled healthcare delivery personnel. These viewpoints can provide beneficial and complementary insights into how to raise the general bar of healthcare delivery system standards.

                                      Keywords:: perspective of the patient, perspective of the healthcare provider, Care quality, patient safety, quantitative analysis