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Objective: To develop and validate a new tool viz., Intravenous Infiltration and Extravasation Risk Assessment Tool (IIEART) for assessing risk of fluid extravasation in children. Participants: 120 children (aged 2-18 year) undergoing peripheral intravenous cannulation were recruited from four hospitals of Haryana to determine the IIEART scale’s psychometric properties. Methods: The tool was developed under four phases with Modified Delphi rounds among nine experts. After experts’ confirmation of final draft, the reliability and validity of the tool was ascertained. Results: The final IIERAT with 11 items showed good internal consistency (?=0.81) with inter-rater reliability of (?=0.88). To calculate predictive validity, sensitivity and specificity were assessed for 3 consecutive days from the day of cannulation. At a score >21, the sensitivity was 100% and specificity was 100% with area under curve of 1.0 (95% CI 1.0, 1.0) on second day of cannulation. Conclusion: The IIEART developed was found to be valid and reliable and can be used by healthcare personnel to predict pediatric patients at risk for intravenous infiltration and extravasation.
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Background: To assess the role of intravitreal bevacizumab (1.25 mg) in patients with proliferative diabetic retinopathy with macular edema in terms of change in leakage area and best-corrected visual acuity.Methods: This prospective randomized interventional study was conducted in the Department of Ophthalmology from September 2013 to August 2015 and included thirty eyes of twenty patients.After a detailed history and ocular examination, diagnosed cases of proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) underwent sequential fundus fluorescein angiography. Bevacizumab was administered intravitreally. Patients were assessed two hours after injection for anterior chamber reaction and intraocular pressure and were advised follow-ups at 24 hours and then at 1, 4, 8 and 12 weeks. For the outcome, the change of retinal new vessels by assessment of leakage area using Quantitative Planimetric Analysis (QPA) of photographs as well as the change in best-corrected visual acuity (BCVA) from baseline to the 12 weeks follow-up, were done. Results were analyzed statistically by applying t-test.Results: Intravitreal bevacizumab injection lead to a significant decrease in leakage in DME and PDR, and improvement in mean BCVA. The effect was maximum at 4 weeks which weaned off as the study progressed through it remains statistically significant at the end of 12 weeks.Conclusions: Intravitreal bevacizumab plays a major role in treating and reducing visual deterioration in patients with proliferative diabetic retinopathy and diabetic macular edema.
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ABSTRACTBackground: Mobile Applications are being developed at a rapid speed and are intensively used by students. It can help to achieve better performance in organizing, managing, and monitoring classroom activities.Aims and objectives: Present study aimedto assess and compare the knowledge and practice regarding FBNC among nursing students in MBL group and MABL group before and after the administration of MBL and MABL. The conceptual framework of the study was based on CIPP model by Stufflebeam.Methods: A Quantitative research approach with quasi-experimental and 'non-equivalent controlgroup pre'test post'test design. The study was conducted at two nursing colleges of Ambala, Haryana. A total of 70 B.Sc. Nursing 3rd Year students, randomly allocated to 2 groups i.e. 35 in MBL and 35 in MABL. The tool used for the study consisted of structured knowledge questionnaire and observational check list was used to assess knowledge and practices by OSCE method of nursing students regarding FBNC. Data collection was done in January, 2017. The obtained data was analyzed and interpreted in terms of objectives and researchResults: Findingsof the study indicate that revealed that mean post- test knowledge and practices score in MBL group (21.4 '0.89) and in MABL group (22.4 ' 0.54) was significantly higher than pre-test knowledge score in MBL group (14.6'15.0) and in MABL group (16.2'17.0). Also, the mean post-test practice score in MBL group (38.1'1.91) and in MABL group (38.9' 1.20) was significantly higher than pre-test practicescore in MBL (20.4 ' 3.70) as well as in MABL group (20.5 ' 4.26). Mild positive significant relationship (r=0.03) was found between post test score of knowledge and practicesConclusion: MABL was more effective in developing the practices of nursing students regarding FBNC than MBL.
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The third National Family Health Survey (NFHS-3) is a large dataset on indicators of family welfare, maternal and child health, and nutrition in India. This article using NFHS-3 data is an attempt to bring out the impact of economic status, i.e., the wealth index on maternal health. The study was based on an analysis of the NFHS-3 data. Independent variables taken were the wealth index, literacy, and age at first child birth. Effects of these variables on the maternal health care services were investigated. Out of the total 124,385 women aged 15-49 years included in the NFHS-3 dataset, 36,850 (29.6%) had one or more childbirth during the past 5 years. The number of antenatal care (ANC) visits increased as the wealth index increased and there was a pattern for choice of place of delivery (for all deliveries during the last 5 years) according to the wealth index. Logistic regression analysis of the abovementioned variables were sought to find out the independent role of key determinants of the different aspects of maternal health care. It showed that the wealth index is the leading key independent determinant for three or more ANC received: Tetanus toxoid (TT) received before delivery, iron tablet/syrup taken for more than 100 days, and institutional delivery. Mother's literacy was the leading independent key determinant for early antenatal registration. The study suggested that along with the mother's literacy, the wealth index that is an important predictor of maternal health care can be added for categorization of the districts for providing differential approach for maternal health care services.
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Background: The need for research into bed sores in orthopedic patients is evident from the increased number of beds they occupy and the considerable morbidity from pressure sores in orthopedic wards. Objective: To analyze and ascertain the prevalence and clinical evaluation of Pressure Ulcers from orthopedics wards of a tertiary care teaching hospital. Material and methods: The present prospective study was conducted by the Department of Orthopedics of a tertiary care teaching hospital from July 2009 to August 2014 among 228 patients seeking care for trauma to proximal femur, hip joint, pelvis and undergone elective surgery or surgery for removal of old implants. Braden scale was used for predicting pressure ulcers in the study subjects. All patients showing the potentiality of developing clinical signs of bed sores were selected and put on the study list. Patients aged ≥ 80 years, sick patients due to terminal illnesses and the worst pressure sores were excluded from the study. Results: Out of total 228 study subjects, 61 subjects developed pressure ulcers giving a prevalence of 26.75%. According to Braden Scale, 16.39% of patients were at high risk for developing the pressure ulcers. 68.85% of ulcer patients were treated for trauma mostly for fracture hips, pelvis or proximal femur or spine. Majority of patients (60.66%) developed pressure ulcers after the second week of admission. The lengths of stay of patients with bed sores exceed the stay of non sores patients on orthopedic wards by several times. Sacrum was the most commonly affected part of body. Conclusion: The findings of the current study highlight the multi-factorial etiology of pressure ulcers and they are preventable. Its prevention would require multidimensional approach including the collaboration of all the nursing and surgical staff. Frequent patient turning, close monitoring and frequent skin checks would delay the onset of pressure ulcers.
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Context and Setting: Attainment of health objectives depends on the capacity building of all categories of staff. While Medical Education has some provision for faculty development, the existing initiatives for staff development are too few and floating. We describe our experience in conducting a pilot training program for the administrative staff at AIIMS. Need for innovation: The competency and motivation of the administrative staff are crucial for better public dealing, and for organization’s effectiveness. In the existing system, there was no such mechanism to drive these. Description of innovation: We selected Assistants and Office Supervisors (71) for the training program. Based on brain storming meetings with administrators and keeping in view the time constraints, we identified four modules - Team building, Effective Communication, Stress management and Use of computers (Application of MS Office).Each module was of three hours duration conducted by medical faculty, educationists and management experts. All sessions were highly interactive including case scenarios, exercises, games, role play and psychometric tools. We obtained feedback from the participants to evaluate the effectiveness. Lessons learnt: An overwhelming majority (>90% participants) perceived the content and the training process as “Highly Useful” (strongest rating). The trainees found ‘Computer Application’ highly useful, because of its utility potential. ‘Communication skills’, ‘Team work’ and ‘Stress management’ were also perceived as useful for their professional and personal lives. Effective collaboration of medical faculty, educationists and management experts led to the success of this program. We recommend that such model should be a regular feature and be linked with performance appraisal.
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Premenstrual syndrome (PMS) is a group of psycho behavioural symptoms experienced by many susceptible young women prior to menstruation. It is suggested that there is altered autonomic activity in the late leuteal phase of their endometrial cycle. The present study is aimed to see the autonomic reactivity in women suffering from PMS and to compare it with control ones. The results revealed that the autonomic activitysympathetic as well as parasympathetic, is insignificantly higher in PMS group during follicular phase. During leuteal phase, the parasympathetic activity is significantly lowered but the sympathetic activity is significantly increased. A positive correlation was also seen between both limbs of autonomic system with number of symptoms. It appears that increased sympathetic activity coupled with decreased parasympathetic activity during the leuteal phase might be responsible for psycho- physiological changes in these women. However, the exact mechanism is still unknown.
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A 4-month-old male baby who presented in a moribund condition with seizures was found to have hepatomegaly, hypoglycemia and milky serum. Serum triglycerides were markedly elevated (3168 mg/dL) with cholesterol being 257 mg/dL and high density lipoprotein levels were low (19 mg/dL). The possibility of glycogen storage disease type I was considered in the diagnosis. Infants with glycogen storage disease type I may present like sepsis. The association of hepatomegaly, hypoglycemia and abnormal lipid profile stated above should alert the physician to consider glycogen storage disease type I in the diagnosis.
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Reports of violent conflicts between patients or patients’ families and hospital staff have increased substantially in recent times . We need procedures in place to minimise the scope for such friction and enable proper resolution of any conflicts that might develop despite such systems.
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Trichinosis is a parasitic zoonosis caused by ingestion of infected meat containing larvae of Trichinella, more prevalent in developing countries. Although infection with Trichinella is globally distributed, it has been documented only rarely in India. The reports are available where Trichinella larvae were found from animals in India but, to our knowledge, only one human case has been reported from India (Punjab), so far. This is the first report of small multiple outbreaks of human trichinosis in India (2009-2011). Epidemiological, clinical, and laboratory findings of trichinosis patients belonging to remote areas of Uttarakhand were analyzed retrospectively and prospectively. Patients belonged to remote areas of Garhwal, Uttarakhand, 77.78% were male, and 22.22% were female. The age of patients ranged from 9-55 yrs. History of eating meat of wild boar was given by all (100%). The signs and symptoms of the patients varied even after intake of same diet, and included generalized weakness/malaise, myalgia, fever, gastrointestinal symptoms, facial/periorbital edema, subconjunctival hemorrhages, retinal hemorrhages, muscle atrophy, and dyspnea. Laboratory investigations revealed eosinophilia, leukocytosis, creatine phosphokinase (CPK) and serum glutamic oxaloacetic transaminase (SGOT) elevation in 100%, 88.89%, 50% and 16.67%, respectively. Muscle biopsies revealed larvae in 27.78%. One patient expired while others improved. The prevalence of trichinosis is likely to be underestimated. The aim of this study is to emphasize on the magnitude of the problem, to educate people, especially in the affected areas about this health hazard and help implementation of epidemiological studies and preventive measures.