ABSTRACT
Background:The neonatal period is the most vulnerable time for a child's survival. As survival perspective of extramural neonates significantly relies on the state of neonate at admission, various survival scores like CRIB, SNAP, MINT, TRIPS, TOPS etc. are designed to prognosticate the outcome of neonate at admission. This study was de signed to delineate correlation of TOPS score with outcome of referred neonates.Aims And Objectives:To recognise correlation of TOPS score with outcomes of extramural neonates. Material And Methods:It was prospective observational study conducted from September 2019 to February 2020 at nicu of tertiary care hospital. Clinico-demographic characteristics and TOPS score were documented in a pre-designed proforma. Hypothermia, Hypoxia, prolonged CRT and Hypoglycemia were defined as<36.5C, <90%, ?3 secs and <40mg/dl respectively. Each parameter was assigned a score of ‘1’ if abnormal and ‘0’ if normal. Neonates were treated as per standard protocol and their outcome was recorded as survive d or expired. Result:Out of 239 neonates 140 (58.6%) were males and 99 (41.5%) were females. The area under the ROC curve (AUROC) for TOPS Total predicting Outcome: Expired vs Outcome: Survived was 0.932. At a cut-off of TOPS Total ?2, it predicts Outcome: Expired with a sensitivity of 83% and a specificity of*The relative risk (95% CI) for Outcome: Expired when TOPS Total is ?2 was 25.68.Hypothermia (Chi-squared test, ?2 = 38.462, p = <0.001), hypoxia (Fisher's exact test, ?2 = 122.636, p = <0.001), poorperfusion (shock) (Fisher's exact test, ?2 = 103.563, p = <0.001) are found to be significantly associated with poor outcome. Conclusion:TOPS score is an easy, reliable and applicable tool for outcome prediction of transported neonates.
ABSTRACT
Background: Breast cancer is the most commonly diagnosed cancer among women, along with its diagnosis it brings disarray and economic burden on family. Its treatment is costliest compared to any other cancers. Health policies and health insurances are introduced to bridge the gap between patients and quality cancer care. We aim to understand the level to which health insurance help the breast cancer patients in reducing economic burden due to cancer Methodology: Cross sectional study done in Justice K.S Hegde Hospital in month June, 2018 to August, 2018 with participants being patients with breast cancer. Patients were contacted over the phone and a questionnaire was introduced to those willing to talk on their economic expenditure. Results: 73% of people had insurance to treat breast cancer of which 52% had advantage of Vajpayee Arogya Shree. 24% of people had insurance paid fully for treatment and 34% received partially, it reduced their burden by 51-75%. 46% of people had the cost >1 lakh for treatment which could be burden for 27% who didn’t have insurance, and this was among patients from neighboring state for treatment. Conclusions: Insurance reducing the burden is ensured; but choice of hospital for treatment is not with the patient, which is a burden.
ABSTRACT
Objecu've: On-site evaluation of laboratories with standard checklist is a first step to promote effective and consistent supervision. The present study was carried out to evaluate the impact of the RNTCP- Intermediate Reference Laboratory External Quality Assessment- On-Site Evaluation visits on quality of sputum smear microscopy services of Gujarat, India. Data of three IRL-EQA-OSE visit rounds, carried out between January 2005 and December 2010 are presented here. Materiaf and Methods: Within the Revised National Tuberculosis Control Programme EQA framework, the IRL, Ahmedabad visited all Gujarat District Tuberculosis Centres, and evaluated their sputum smear microscopy services. The study covered a cohort of 29 DTCs during each of the three IRL-EQA-OSE visits. The authors focused on section III of Annexure A to study and analyse the said impact. In order to convert qualitative data into quantitative one, the authors denoted a score of 1 to "Acceptable" (No Error) remark and 0 to "Not-Acceptable" (Error) one. Results.' Alarger degree of improvement was noted in Standard Operating Procedure practices, Disinfection practices, and Internal Quality Control practices. Many DTCs did not retrain their laboratory staff in EQA methodology. The Gujarat DTCs achieved an overall score of (8201957) 86% during the initial OSE visits which consistently improved to (842/957) 88% and (885/957) 92% during the two follow-up OSE visits along with sustenance and improvement in many important laboratory parameters. Conclusion' The co-sponsoring organisation (IRL) recognises the challenges and therefore, is committed to supporting state-level implementation of EQA through additional training, technical assistance to districts, and improving this technical guidance. By periodic IRL. EQA-OSE visits, sputum smear microscopy services can be sustained and improved at field level.
ABSTRACT
Objective: To assess the proficiency of Senior TB Laboratory Supervisors (STLSs) and district level Laboratory Technicians (LTs) in sputum smear microscopy. Method: Intermediate Reference Laboratory (IRL), Ahmedabad had manufactured and validated Proficiency Panel Testing slides from sputum samples, made On Site Evaluation (OSE) visits of District TB Centres (DTCs) in two rounds, and conducted Proficiency Panel Testing of STLSs & DTC-LTs from January 2005 to June 2009. Results: High level of concordance in Z-N smear grading was found between Microbiologist and district laboratory staff. DTC readers reported overall consistency level of more than 98% in Z-N grade agreement during both the IRL, EQA, OSE visits. The tendency to over-grade the panel slides was much higher (more than 22%) as compared to under-grade (less than 2%) them in “correct slides”. High False Positive (HFP) error was not observed in the present study. Conclusion: Laboratory supervisor’s proficiency can be quickly assessed by Proficiency Panel Testing, under multi-level quality assurance network system of sputum smear microscopy in public health programmes like the RNTCP. Proficiency Panel Testing is highly replicable and reproducible tool for quick and reliable assessment of proficiency of the staff and it can be made more effective by raising the proportion of lower grade positive slides in panel set of each reader. DTC readers’ overall agreement level of more than 98% in Z-N grade suggests high level of precision and excellent consistency during both the IRL, EQA, OSE rounds. It is concluded that even for a large network of sputum smear microscopy centres under public health programmes like the RNTCP in order to take corrective action, Proficiency Panel Testing can be effectively used for quick identification of suboptimal- technical performance of the supervisory staff.