The effects of the coronavirus disease 2019 pandemic on neurospine surgery practice in the referral center hospital developing country

Background:

The coronavirus disease 2019 (COVID-19) pandemic represents a once in a century challenge to human health care with over 4.5 million cases and over 300,000 deaths thus far. Surgical practice has been significantly impacted with all specialties writing guidelines for how to manage during this crisis. This study reported the effect of the COVID-19 pandemic on the neurosurgical practice, especially neurospine, in the outpatient visit, emergency department, and the surgical procedure.

Methods:

This study is the comparative retrospective about neurospine practice in the outpatient visit, emergency department, and the surgical procedure among before and during COVID-19 pandemic. We recorded data from January to December 2019 (before COVID-19 pandemic) and compared with the same period in the 2020 (during a COVID-19 pandemic).

Results:

A total of the outpatient visits, the average number per month was 28 ± 10.5 visits per month before the pandemic. The average number outpatient visit per month during the pandemic was 19 ± 11.1 visits per month, with the lowest in July 2020. The result of the average monthly neurospine surgical procedure before the pandemic was 5 ± 1.9 operations per month. Compared during the pandemic, there was decreased in the neurospine surgical procedure with the average number was 2 ± 2.7 operations per month. The decreased number significantly happens in the surgical procedure and emergency department patient (P < 0.05), while in the outpatient visit, the decreased statistically not significantly (P > 0.05).

Conclusion:

The COVID-19 pandemic changed all scopes of medical practice and training. Considering the limitation in the available resources, the number of educational cases may decrease in subspecialized disciplines such as neurospine neurosurgery. The COVID-19 pandemic affects in the neurospine and neurosurgery treatment policy in the referral tertiary hospital.

The impact of the pandemic on neurosurgical services: A study from a coronavirus disease 2019 referral hospital in Surakarta

Background:

A decrease in hospital visits including neurosurgery cases during the coronavirus disease 2019 (COVID-19) pandemic has been reported by many countries. This study aims to reveal important data regarding the effect that the COVID-19 pandemic has on services, neurosurgical surgery, and inpatients before and during the COVID-19 pandemic.

Methods:

This comparative study compares neurosurgical services, neurosurgical patients, outpatient visits, and monthly inpatients assessed from January to December 2020 (onset of the pandemic) with those of the same period in 2019.

Results:

The average number of outpatient visits per month during the pandemic (January to December 2020) was 369 visits per month, compared to 397 visits in the same period in the previous year. The lowest outpatient visits occurred in May 2020 with 227 outpatient visits. There was a decrease in the number of neurosurgical patients in January-December during the pandemic period compared to the same period in 2019. A significant decrease in outpatients during and before the pandemic was noted with P = 0.046 (P < 0.05).

Conclusion:

There are differences in the number of visits by outpatients, neurosurgical patients, and inpatients during the pandemic compared to the period before the onset of the pandemic.

Economic burden of cardiovascular diseases before and after Iran's health transformation plan: evidence from a referral hospital of Iran

Background

Different countries have set different policies to control and decrease the costs of cardiovascular diseases (CVDs). Iran was aiming to reduce the economic burden of different disease by a recent reform from named as health transformation plan (HTP). This study aimed to examine the economic burden of CVDs before and after of HTP.

Methods

This cross-sectional study was conducted on 600 patients with CVDs, who were randomly selected from a specialized cardiovascular hospital in the north-west of Iran. Direct and indirect costs of CVDs were calculated using the cost of illness and human capital approaches. Data were collected using a researcher-made checklist obtained from several sources including structured interviews, the Statistical Center of Iran, Iran’s Ministry of Cooperatives, Labor, and Social Welfare, the central bank of Iran, and the data of global burden of disease obtained from the Institute for Health Metrics and Evaluation to estimate direct and mortality costs. All costs were calculated in Iranian Rials (IRR).

Results

Total costs of CVDs were about 5571 and 6700 billion IRR before and after the HTP, respectively. More than 62% of the total costs of CVDs accounted for premature death before (64.89%) and after (62.01%) the HTP. The total hospitalization costs of CVDs was significantly increased after the HTP (p = 0.038). In both times, surgical services and visiting had the highest and lowest share of hospitalization costs, respectively. The OOP expenditure decreased significantly and reached from 54.2 to 36.7%. All hospitalization costs, except patients’ OOP expenditure, were significantly increased after the HTP about 1.3 times. Direct non-medical costs reached from 2.4 to 3.3 billion before and after the HTP, respectively.

Conclusion

Economic burden of CVDs increased in the north-west of Iran after the HTP due to the increase of all direct and indirect costs, except the OOP expenditure. Non-allocation of defined resources, which coincided with the international and national political and economic challenges in Iran, led to unsustainable resources of the HTP. So, no results of this study can be attributed solely to the HTP. Therefore, more detailed studies should be carried out on the reasons for the significant increase in CVDs costs in the region.

GIS-based approaches on the accessibility of referral hospital using network analysis and the spatial distribution model of the spreading case of COVID-19 in Jakarta, Indonesia

Background

The outbreak of the novel coronavirus (COVID-19) has rapidly spread, causing million confirmed cases, thousands of deaths, and economic losses. The number of cases of COVID-19 in Jakarta is the largest in Indonesia. Furthermore, Jakarta is the capital city of Indonesia which has the densest population in the country. There is need for geospatial analysis to evaluate the demand in contrast to the capacity of Referral Hospitals and to model the spreading case of Covid-19 in order to support and organize an effective health service.

Methods

We used the data from local government publicity for COVID-19 as trusted available sources. By using the verifiable data by observation from the local government, we estimated the spatial pattern of distribution of cases to estimate the growing cases. We performed service area and Origin-Destination (OD) Cost Matrix in support to existing referral hospital, and to create Standard Deviational Ellipse (SDE) model to determine the spatial distribution of COVID-19.

Results

We identified more than 12.4 million people (86.7%) based on distance-based service area, live in the well served area of the referral hospital. A total 2637 positive-infected cases were identified and highly concentrated in West Jakarta (1096 cases). The results of OD cost matrix in a range of 10 km show a total 908 unassigned cases from 24 patient’s centroid which was highly concentrated in West Jakarta.

Conclusions

Our results indicate the needs for additional referral hospitals specializing in the treatment of COVID-19 and spatial illustration map of the growth of COVID-19′ case in support to the implementation of social distancing in Jakarta.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-020-05896-x.

Determinants of non-adherence to inhaled steroids in adult asthmatic patients on follow up in referral hospital, Ethiopia: cross-sectional study

Background

Asthma is one of the major non-communicable diseases worldwide. The prevalence of asthma has continuously increased over the last five decades, resulting in 235 million people suffering from it. One of the main challenges in asthma control is adherence to pharmaceutical treatment (4) and leads to poor outcome and increases the economic and clinical burden. Non-adherence could be intentional or non-intentional.

Objective

To identify the determinants of inhaled steroid adherence among adult asthmatic patients.

Setting

The study was done in Jimma university medical center (JUMC) from March-August 22/2018.

Method

Cross-sectional observational study was conducted. Patient assessment was conducted (patient demography, inhalation technique, adherence, and asthma control status). Independent predictors of outcome identified and strength of association between dependent and independent variables determined by using binary logistic regression and statistical significance was considered at p < 0.05. Before computing binary logistic regression analysis, the presence of colinearity between independent factor and model fitness was checked.

Results

One hundred forty patients were included in the analysis. Substantial number of patients 53(37.9, 95%CI: 30-45) were non-adherent. Patient experience of previous adverse drug reaction (p = 0.011), educational status (p = 0.02), patient knowledge status (p = 0.028), previous education (p = 0.0001) and co-morbidity (p = 0.031) were significantly associated with adherence.

Conclusions

The rate of non-adherence to inhalational anti-asthmatics is high and different factors contributed. The health care provider should try to counsel patients about the effect of non-adherence on asthma control. Reassurance concerning adverse drug reactions should be an integral part of patient counseling.

Determinants of pneumonia among 2-59 months old children at Debre Markos referral hospital, Northwest Ethiopia: a case-control study

BACKGROUND

Pneumonia is a significant public health problem globally. The early identification and management of the determinants of pneumonia demands clear evidence. But, there is a limited data on this issue in the current study area. Thus, this study aimed to identify the determinants of pneumonia among 2-59 months old children at Debre Markos Referral Hospital, Northwest Ethiopia.

METHODS

A Hospital based unmatched case-control study was conducted among 334 (167 Cases and 167 Controls) children at Debre Markos Referral Hospital from February 1 to March 30, 2018. Consecutive sampling technique was employed and data were collected with a pre-tested interviewer administered questionnaire. Data were entered into Epi-Data version 4.2, and analyzed using SPSS version 25 software. Bi-variable and multi-variable logistic regression analyses were fitted. Variables having p-value < 0.05 were considered as statistically significant.

RESULTS

A total of 328(164 cases and 164 controls) 2-59 months old children were included in this study. Not opening windows daily [AOR:6.15(2.55,14.83)], household near to the street [AOR:4.23(1.56,11.44)], child care by the house workers and relatives [AOR:2.97 (1.11,7.93)], using only water for hand washing before child feeding [AOR:3.81 (1.51, 9.66)], mixed feeding practice from birth to six months [AOR: 7.62 (2.97, 19.55)], having upper respiratory tract infection in the last 2 weeks for the child [AOR: 5.33 (2.16, 13.19)] and children with history of co- residence with URTI family [AOR: 6.17 (2.36,16.15)] were found to be determinants of pneumonia.

CONCLUSIONS

The main contributing factors for pneumonia in this study are preventable with no or minimal cost. Therefore, we recommend appropriate and adequate health education regarding pneumonia prevention and control.

Cost of treatment among self-referred outpatients in referral hospitals compared to primary health care facilities in East Wollega, western Ethiopia: A comparative cross-sectional study

Patient self-referral is a condition when patients refer themselves to higher level health facilities without having to see anyone else first. Despite the expansion in the number of health facilities, it has been seen when patients routinely accessed referral hospitals without a formal referral. The study aims to evaluate cost of treatment among self-referred outpatients at referral hospitals compared to primary health care facilities. Comparative cross-sectional study design was used and the required sample size for the study was determined by using formula of double populations mean comparison cost of treatment for diseases leading to outpatient visits. A total of 794 participants (397 from referral hospital and 397 from primary health facilities) were included in the study. Data was collected using face-to-face interview from December 1 to 30, 2017. Data entry and analysis were made using SPSS version 20. Descriptive statistics and independent samples t-test were performed. A total of 783 outpatients responded to the interview of the study and 391 of them were from referral hospital and 392 from primary health facilities. The mean of outpatient visit cost per visit for the treatment of diseases leading to outpatient visits was significantly higher at referral hospitals compared to primary health facilities [95% CI=6.13 (5.07-7.18)] USD. The mean cost of outpatient visits for the treatment of all type of diseases leading to outpatient visits was significantly higher at referral hospitals and at least two times of primary level health facilities. Health care providers should create awareness in the community about referral linkages to inform patients and their families the additional costs they incur when they bypass the proximal primary health facilities.

Level of job satisfaction and associated factors among health care professionals working at University of Gondar Referral Hospital, Northwest Ethiopia: a cross-sectional study

Objectives

The main aim of this study was to assess the level of job satisfaction and associated factors among healthcare professionals working at University of Gondar Referral Hospital, Northwest Ethiopia. An institution based cross-sectional study was conducted among 416 healthcare professionals from March 27, 2017 to April 25, 2017. Simple random sampling technique was employed and data were collected with a pre-tested interviewer administered questionnaire. Data were entered into Epi-Info version 7, and analyzed using SPSS 20 softwares. Binary logistic regression analysis was employed.

Results

A total of 383 participants were involved in the study. The overall level of job satisfaction among health care professionals was 54% [95% CI (49.3–58.8)]. Marital status [AOR = 1.79 (1.140, 2.797)], salary [AOR = 2.75 (1.269, 5.958)], leadership style [AOR = 2.19 (1.31–3.65)], and supportive supervision [AOR = 2.05 (1.27–3.32)] were found significant determinants of job satisfaction. The overall level of job satisfaction among health care professionals at the University of Gondar Referral Hospital was low. Therefore, health service managers should focus their leadership style and provide supportive supervision in the hospital to improve the level of job satisfaction of health care professionals.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3918-0) contains supplementary material, which is available to authorized users.

High antiretroviral therapy service delivery satisfaction and its' associated factors at Midre-genet hospital; Northwest Tigray, Ethiopia

Background

Patient’s satisfaction occurs when patients feel their needs and expectations are being meet by the service delivery they receive in health institutions. The Objective of this research was to assess HIV/AIDS patients’ satisfaction with antiretroviral therapy service delivery and its associated factors at Midre – Genet hospital, Northwest Tigray, Ethiopia.

Methods

Institutional based cross-sectional study was conducted. Four hundred twenty study respondents were selected using systematic random sampling technique. Data was collected using pretested, structured interview questionnaire. Bivariate analysis was conducted to identify potential significantly associated variables and transferred to multivariate logistic regression analysis. P value < 0.05 is used to demarcate significantly associated variables.

Result

The overall HIV/AIDS patients’satisfaction on antiretroviral therapy service delivery at Midre-Genet referral hospital was 75.2%. Multivariate analysis revealed age, marital status, occupation, income, information provision and guidance, privacy, access of toilets and interpersonal communication as significantly associated factors with patient’s satisfaction on ART service delivery.

Conclusion

The overall HIV/AIDS patients’ satisfaction at Midre-Genet referral hospital was high. Age, marital status, occupation and, income was associated factors. Moreover, lack of functional CD4 machine, inaccessibility of toilets and water, waiting time, inadequate counseling services and lack of qualified health worker (Doctor) in the ART clinic were also challenges for ART patients in the hospital.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3055-4) contains supplementary material, which is available to authorized users.

Survey of Equine Referring Veterinarians' Satisfaction with Their Most Recent Equine Referral Experience

BACKGROUND

Little is known about the veterinary referral process and factors that contribute to positive outcomes.

OBJECTIVE

To investigate equine referring veterinarians' (rDVMs') satisfaction with their most recent referral experience and compare rDVM and specialist perspectives.

SAMPLE

187 rDVMs and 92 specialists (referral care providers).

METHODS

Cross-sectional observational study. An online survey was administered to both rDVMs and specialists. Referring veterinarian satisfaction with their most recent referral experience was evaluated. Both rDVMs and specialists were asked to identify factors influencing a rDVM's decision where to refer, and the top 3 factors they perceive are barriers to referral care.

RESULTS

Median rDVM satisfaction with their most recent referral care experience was 80 of 100 (mean, 75; range, 8-100). Referring veterinarians provided the lowest satisfaction score for the item asking about "The competition the referral hospital poses to your practice" (mean, 56.96; median, 62; range, 0-100). The top factor rDVMs identified as influencing their decision where to refer was "quality of care," whereas specialists identified "quality of communication and updates from the clinician." Referring veterinarians' top barrier to referral care was "high cost of referral care," and for specialists was "poor service provided to the client by the referral hospital."

CONCLUSIONS AND CLINICAL IMPORTANCE

Referring veterinarians generally were satisfied with referral care, but areas exist where rDVMs and specialists differ in what they view as important to the referral process. Exploring opportunities to overcome these differences is likely to support high quality care.

[Governance of tertiary referral hospitals in the Democratic Republic of the Congo: a critical interpretive synthesis of the literature]

INTRODUCTION

Because hospitals are complex enterprises requiring adaptive systems, it is appropriate to apply the theory and terminology of governance or even better adaptive governance to the interpretation of their management. This study focused on understanding hospital governance in Logo, Bunia, and Katana, three hospitals in two regions of the eastern DRC, which has been characterized by intermittent armed conflict since 1996. In such a context of war and continuous insecurity, how can governance be interpreted for hospitals required to adapt to a constantly changing environment to be able to continue to provide health care?

METHODOLOGY

A critical interpretive synthesis of the literature, identified by searching for keywords related to governance.

RESULTS

The concepts of governance, adaptive governance, performance, leadership, and complex adaptive system concepts are defined. The interpretation of the concepts helps us to better understand (1) the hospital as a complex adaptive system, (2) the governance of tertiary referral hospitals, (3) analysis of hospital performance, and (4) leadership for good governance of these hospitals.

DISCUSSION

The interpretation of these concepts raises several questions about their application to the eastern DRC. Conclusion. This critical interpretive synthesis opens the door to a new way of exploring tertiary hospitals and their governance in the eastern DRC.

Consequences of increased use of computed tomography imaging for trauma patients in rural referring hospitals prior to transfer to a regional trauma centre

BACKGROUND

Computed tomography (CT) plays an integral role in the evaluation and management of trauma patients. As the number of referring hospital (RH)-based CT scanners increased, so has their utilization in trauma patients before transfer. We hypothesized that this has resulted in increased time at RH, image duplication, and radiation dose.

METHODS

A retrospective chart review was completed for trauma activations transferred to an ACS-verified Level II Trauma Centre (TC) during two time periods: 2002-2004 (Group 1) and 2006-2008 (Group 2). 2005 data were excluded as this marked the transition period for acquisition of hospital-based CT scanners in RH. Statistical analysis included t test and χ(2) analysis. P<0.05 was considered significant.

RESULTS

1017 patients met study criteria: 503 in group 1 and 514 in group 2. Mean age was greater in group 2 compared to group 1 (40.3 versus 37.4, respectively; P=0.028). There were 115 patients in group 1 versus 202 patients in group 2 who underwent CT imaging at RH (P<0.001). Conversely, 326 patients in group 1 had CT scans performed at the TC versus 258 patients in group 2 (P<0.001). Mean time at the RH was similar between the groups (117.1 and 112.3min for group 1 and 2, respectively; P=0.561). However, when comparing patients with and without a pretransfer CT at the RH, the median time at RH was 140 versus 67min, respectively (P<0.001). The number of patients with duplicate CT imaging (n=34 in group 1 and n=42 in group 2) was not significantly different between the two time periods (P=0.392). Head CTs comprised the majority of duplicate CT imaging in both time periods (82.4% in group 1 and 90.5% in group 2). Mean total estimated radiation dose per patient was not significantly different between the two groups (group 1=8.4mSv versus group 2=7.8mSv; P=0.192).

CONCLUSIONS

A significant increase in CT imaging at the RH prior to transfer to the TC was observed over the study periods. No associated increases in mean time at the RH, image duplication at TC, total estimated radiation dose per patient, and mortality rate were observed.