Journal Issue: Volume: 31, No. 1, April 2009
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Volume
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Issue Date
2009
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Journal ISSN
ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Rolling audit on the quality of discharge summary in TU Teaching Hospital
(Institute of Medicine, 2009) Guragain, RPS; Adhikari, P
Abstract
Background: Audit 2007 (December) was significant in that it was the third rolling audit on the discharge performance started in TU Teaching Hospital. The audit was started in 2005 and it intends to transfer important clinicalinformation from inpatient to outpatient settings and between hospital admissions.
Materials and Methods: There were 20 discharge summary forms picked up from each of seven departments of TU Teaching Hospital between November 2007 and December 2007. All summaries were looked for the inclusion of modified Van Walraven criteria. Apart from Van Walraven eight points, admission and discharge date and follow up instructions were also checked by the second author. These summaries were compared with previous discharge summary performed 2 ½ years ago.
Results: Department of ENT and HNS showed the best discharge summary as per modified Van Walraven criteria whereas Department of Orthopaedics had the least inclusion of criteria. Previous study showed best summaries in Department of Gynaecology while poor in Department of Orthopaedics. Regarding completeness of hospital discharge summary form, Department of ENT and HNS had the highest number of almost completely filled discharge summaries (>90%) while Department of Medicine had the least number of properly filled discharge summaries. Previous audit showed Department of ENT and HNS to be the best while Department of orthopaedics to be the worst. On analyzing the previous recommendations, they were not properly followed.
Conclusion: Discharge summary should be filled up completely without missing necessary information. Although ENT and HNS has best discharge summary according to Van Walraven discharge criteria as well as completeness of our hospital discharge summary, it needs to follow previous recommendations. The recommendations previously given should be strictly followed and informed to the heads of all Departments concerned.
A comparison of 10% Ichthalmmol Glycerine pack with steroid-antibiotic pack for relieving pain in cases of Acute otitis Externa
(Institute of Medicine, 2009) Bhatta, Rishi; Pokharel, Rais; Adhikari, Prakash; Neupane, Yogesh
Abstract
Background: Acute otitis externa, a common painful clinical condition is managed by aural packing to reduce edema and pain. Pack usually contains 10% Ichthalmmol Glycerine (IG) or commercially prepared steroid with antibiotic cream. The aim of study is to compare the clinical efficacy of 10% IG pack with steroid-antibiotic pack in relieving pain in cases of acute otitis externa. Materials and Methods: A prospective randomized clinical trial was carried out in 106 patients at Ganesh Man Singh Memorial Academy (GMSMA) of ENT and Head Neck studies, Institute of Medicine. Pain was assessed by Wong –Baker Scale in d”12years child and Numerical Rating Scale (NRS) in patients more than 12years of age on the day of presentation and subsequent visits till tragal tenderness disappeared. Results: Age ranged from 1 to 75 years (mean 20.08 years) out of which 46 (43.4%) were females and 60 (56.6%) were males. Average duration of pain at presentation was 3.9 days (range1-15days). Average number of visits in IG pack group (n=55) was 2.82 (2-4 visits) while in steroid-antibiotic group (n= 51) it was 2.38 (2-4 visits). There was statistically significant decrease in the number of visits in steroid group (p < 0.05). However, decrease in pain score in second visit as compared to first visit was not significant (p > 0.05) in both groups. Average number of visits in steroid-antibiotic group required to have reduction in Wong –Baker Scale by 50% or more was 2.0 which was statistically significant (p < 0.01) as compared to IG pack group (2.9). Similar results in NRS were not significant (p > 0.05). Conclusion: Steroid-antibiotic pack can be used for earlier relief of pain and decrease number of visits in management of acute otitis externa.
Keywords: acute otitis externa, ichthalmmol glycerine (IG) pack, steroid-antibiotic aural pack
Phytoestrogens and cancer
(Institute of Medicine, 2009) Mathew, BC; Reji, SD; Jamal, AI BB; Campbell, IW
Abstract
Abstact: Phytoestrogens are a group of compounds found in plants that are structurally or functionally similar to the hormone estradiol, and act as selective estrogen receptor modulators. Epidemiological studies show an inverse correlation between consumption of a high phytoestrogen-rich diet, as seen in traditional Asiatic societies, and the incidence of certain hormone- dependent cancers such, as breast and prostate cancer. Clinical studies to find a relationship between phytoestrogens, and breast and prostate cancers, have produced conflicting results. Phytoestrogens may protect against hormone-dependent cancers through their ability to lower the level of endogenous estrogens and their genotoxic metabolites, activation of estrogen receptor beta and peroxisome proliferator activated receptor gamma, inhibiting cell signaling pathways of growth factors, upregulating expression of antioxidant genes, tumor suppressor genes and immunomodulatory effects. There is little clinical evidence to suggest that phytoestrogens through their estrogenic activities will increase breast cancer risk in healthy women or worsen prognosis of breast cancer patients. Although phytoestrogens appear to hold promise as chemo preventive agents against cancer, more in-depth studies are required before definitive conclusions can be drawn.
Keywords: breast cancer, chemoprevention, phytoestrogen, prostate cancer, SERMs
Spontaneous omental hematoma
(Institute of Medicine, 2009) Bhandari, RS; Sapkota, R; Mishra, P; Singh, KP
Abstract
Spontaneous omental bleeding is a rare entity, and usually presents with various combination of sudden abdominal pain, shock, peritonitis and hemoperitoneum. A 68 year female presenting with acute abdomen and without antecedent trauma had obscure hemoperitoneum. Exploration revealed hemoperitoneum and hemorrhagic omentum with a huge clot.
Keywords: Spontaneous omental hematoma, acute abdomen, hemoperitoneum, surgery