Objectives: To study clinical profile of obstetric patients admitted to intensive care unit and to analyze the relation of demographic factors like age, parity, literacy level, socio economic status, APACHE 2 score and level of delay with fetomaternal outcome. Design: Prospective Cross sectional Observational Setting and Population: Obstetric Admissions to ICU of tertiary hospital in North India Methods: After admission to ICU a detailed history, analysis of basic demographic variables along with level of delay was done. APACHE II score was calculated. These parameters were correlated with fetomaternal outcome. The Chi-square test was used to compare categorical variables. The one-way analysis of variance was used to compare the continuous variables among the strata with Tukey’s post hoc test. Outcome: Prolonged ICU stay, maternal mortality, perinatal morbidity, perinatal mortality and long hospital stay. Results: Incidence of obstetric ICU admission was 0.77%. Mean age was 26.03years. Most common indication of ICU admission was obstetrical hemorrhage (37.1%) followed by hypertensive disorders of pregnancy (25.8%). Type 1 delay was the most common followed by type 2 delay. Mean APACHE II score was 14.77±6.85. Observed mortality rate (30.6%) was found to be higher than predicted mortality rate (25%). APACHE II score was significantly high in the presence of level 1 (p=0.003) and level 2 delay (p=0.0001). Also, it was significantly increased with the duration of delays. Conclusion: Unbooked and referred cases had high incidence of ICU admission. Presence of delay was associated with poor outcome
Background: Psychosocial factors are significant drivers of inappropriate antibiotic prescription leading to antibiotic resistance (ABR). Objective: To ascertain the psychosocial predictors of outpatient antibiotic prescribing behavior among early-career clinicians in India. Methods: We enrolled 200 early-career clinicians, including 100 medical interns and 100 junior residents (postgraduate student doctors) in six clinical departments, and collected data using a self-administered questionnaire. Response options were coded on five-item Likert scales. Results: Antimicrobial resistance (AMR) was viewed as a significant public health problem by most (95%) participants. Presumptive antibiotic prescribing was reported by 84% of participants, although the participant attitude indicated a slight disinclination against the presumptive use of antibiotics (Mean = 2.8, SD = 0.72). The majority (52.5%) of the participants’ perceived social pressure frequently influenced their decision to prescribe antibiotics to their outpatients, which was most commonly attributed to patient expectation for antibiotics and from observing the antibiotic prescribing behavior of their peers and colleagues. The perception of increased social pressure stipulating antibiotic prescribing negatively correlated with the participant’s intention to reduce antibiotic use in outpatients (r=-0.124, p < 0.001). Social pressure was reported to be higher when treating adult patients reporting diarrheal symptoms, and children having cough. Conclusions: Outpatient antibiotic prescribing practices among early-career clinicians working in the government health sector in India are mediated by considerable social pressure despite their perceived intention for reducing antibiotic use.