ABSTRACT
Background: Hypertension is a major risk factor contributing to cardiovascular and cerebrovascular diseases and death. Medical officers play an important role in Indian public health care system. The objective of this study was to evaluate the impact of training program on knowledge about hypertension among medical officers working in government health centres in Gujarat, India.Methods: A one day training program was conducted for medical officers of various Primary Health Centres (PHCs) and Community Health Centres (CHCs) in Narmada district of Gujarat. This training focussed on screening, diagnosis and management of hypertension, essential and secondary hypertension, lifestyle modifications, various anti-hypertensive drugs and practical aspects of examining a patient with hypertension. Impact of the training program was evaluated by a questionnaire consisting of 10 questions which was used as a pre-test and a post-test.Results: A total of 30 medical officers (18 male and 12 female) attended the training. The mean age of participants was 37.4 years and average clinical experience was 11 years. The pre-test mean score of participants was 4.52 and post-test mean score was 8.44. This improvement in the post-test mean score was found to be statistically significant. On comparison of questions answered incorrectly in pre-test and post-test, we found that there was a significant reduction in the number of questions answered incorrectly in the post-test.Conclusion: There was a significant improvement in the knowledge of medical officers regarding screening, diagnosis and management of hypertension as a result of their training.
ABSTRACT
Background: Primary care physicians play a crucial role in managing patients with common skin disorders who form around one-third of outpatient attendees. Aim: This study aimed to assess the need for dermatology training among primary care physicians by assessing their knowledge, self-perception of ability to diagnose and manage skin disorders, and their difficulties in managing these patients. Methods: A descriptive, cross-sectional, needs assessment study was done among primary care physicians (n = 61) of rural (n = 34) and urban (n = 27) areas of Vadodara district. A pre-validated semi-structured questionnaire (for self-rating of the ability to diagnose/manage skin disorders and difficulties faced in managing patients) was used along with a photo-quiz (for knowledge assessment) while approaching primary care physicians during their monthly review meeting with prior permission. Data were analyzed by Epi InfoTM software and manual content analysis. Results: The mean score on the photo-quiz was 4.1/10. Forty-three (70.5%) participants rated their ability to diagnose/manage skin disorders as 'average' on a five-point Likert scale. Various difficulties (n = 89) narrated by participants were related to their knowledge/skill, disease factors, patients and administrative aspects. Three-fourths of the participants managed difficulties by referring patients to dermatologists. One-third suggested conducting training in common skin disorders. Limitations: The study population included primary care physicians from the government healthcare setup only. Knowledge assessment was done using a short ten-item photo-quiz instead of actual patients. Conclusions: Primary care physicians had poor knowledge of skin disorders, and a majority overrated their own ability for clinical management of these disorders. Most common difficulties faced were related to clinical management. There is a need for training on common skin disorders.
ABSTRACT
Background: Neonatal hypernatremia is less common but significant' metabolic problem' with acute morbidity as well as long term consequences. Many causative' factors have been identified such' as inadequate breastfeeding, hot' weather with high' evaporative losses ,' infections etc. It is important to identify, anticipate and correct the condition before it leads to damaging consequences. The objective of the present study was evaluation of clinical profile, renal parameters and causative factors associated with hypernatremia in exclusively breast-fed infants.Methods: A retrospective review of' 30 new-borns less than 28 days of age admitted in' GMERS General hospital for hypernatremia was conducted. The study group included inborn and out born admissions. Records were reviewed, feeding history, severity of hypernatremia and altered renal parameters were analysed. The study period was from April 2018to June2018i.e summer months.Results: Total NICU admissions were 303 during these months' out of which 30 were diagnosed' with hypernatremia completely and discharged. Mean age of presentation was 8.4 days. Sodium levels ranged from 146-179 mmol/l. Mild hypernatremia was most common (56.7%), followed by moderate hypernatremia in 40%. All neonates were on' exclusive breast feeding. Majority of the affected neonates were term SGA followed by term AGA and preterm AGA. Renal parameters were altered in quarter of affected' infants.' Most common clinical feature noted was lethargy(70%), followed' by fever(53.3%),significant weight loss ,jaundice and dehydration. 29 patients were successfully discharged on breast milk feeding.Conclusions: Hypernatremia though rare, is common in young infants in summer months. It is preventable and treatable condition. It is important to anticipate, identify and treat such patients at the earliest. Treating physicians and nursing staff should be more vigilant for establishment of breast feeding in low birth weight infants. Exclusive breast feeding for first six months of life should always be promoted.