Barriers to comprehensive nutrition care for cancer patients: a review

This comprehensive review studies the multifaceted barriers that delay cancer patients from accessing adequate nutrition throughout their cancer journey. Addressing these barriers is paramount, considering their profound implications on treatment efficacy, patient well-being, and overall outcomes. The analysis encompasses a range of obstacles comprises physiological, psychological, economic, social, and healthcare system factors, highlighting their intricate impact on nutritional intake and patient care. The exploration of nutritional barriers reveals a landscape encompassing challenges such as malnutrition, treatment-related side effects, psychological distress, physical limitations, lack of knowledge, cultural influences, financial constraints, and limited access to specialised nutritional support. These hurdles, if left unaddressed, can lead to adverse consequences including malnutrition, weakened immunity, impaired treatment response, decreased quality of life, and ultimately, poorer prognosis. The intricate interplay between inadequate nutrition and cancer outcomes is underscored, emphasising the pivotal role of proper nutrition in boosting the immune system, supporting treatment effectiveness, and hastening recovery. Strategies to overcome these barriers emerge through multidisciplinary approaches integrating medical and nutritional needs, personalised dietary plans, psychosocial support, and the integration of yoga and wellness practices to foster mindful eating and holistic well-being. This review provides valuable insights into the complexities of nutritional barriers in cancer care and emphasizes the critical need for comprehensive strategies to ensure cancer patients receive the vital nutritional support necessary for optimizing their journey through treatment and recovery.

Assessment of patients satisfaction with mobile medical clinics in the two districts of north Bengal, India

Background: Patient satisfaction is an important indicator to measure the quality of healthcare services and plays a crucial role in enhancing the quality of health service delivery. The aim of the study was to assess the patient’s satisfaction level with the quality of health care delivered at the mobile medical clinics (MMC) in two districts of north Bengal, India. Methods: A cross-sectional survey was done using a purposive sampling method, and total of 294 samples were recruited. A questionnaire (PSQ-18) was used to assess the patient satisfaction level. Chi-square tests were used for categorical variables. F-test and t-test were used for mean differences between the variables. Linear regression analysis was done to examine the linear effect of social factors on patient satisfaction. Results: The present study shows that overall satisfaction was 74.04%, with a mean value of 3.702. In the Jalpaiguri district, 27.5% of patients are highly satisfied, whereas 17.0% are in Alipurduar. Alipurduar district has a higher low satisfaction rating (39.7%) than Jalpaiguri district (19.7%), and a district-wise significant association was found (p<0.001). Overall satisfaction level effects by occupation (p<0.001), population and socio economic status (p<0.05). Conclusions: Policymakers may consider that MMCs could be an effective strategy to improve primary health care in remote, underserved areas where there are no public health care facilities.

Rabies and its prevention: are our medical students well informed?

Background: Rabies is a vaccine-preventable, viral disease. However, once clinical symptoms appear, rabies is 100% fatal. Significantly, India accounts for 36% of the world’s rabies deaths. Recently, in Kerala, a surge in dog bite cases and a consequent rise in the incidence of rabies deaths has been noted, which is a serious public health medical concern. The present study was done to assess the level of knowledge of rabies and its prevention among medical students of Government T D Medical College, Alappuzha to identify lacunae in knowledge if any and to provide sessions on rabies prevention and control. Methods: A cross-sectional study was conducted among the medical students of Government T. D. Medical College, Alappuzha in 2022. Convenient sampling was done, and data was collected using a pre-tested questionnaire which was analysed using SPSS software. Results: Out of the 261 students who took part in the study, 88.13% of the study participants were observed to have medium to sufficient level of knowledge regarding rabies and its prevention, while 11.87% had low level of knowledge. In general, the level of knowledge was noted to be roughly proportional to the year of study of MBBS. Conclusions: The level of knowledge of the participants with regards to the schedule of vaccination and knowledge of symptoms of rabies, was observed to be less than what would be desirable. Structured training and education of medical students can rectify this lacuna, and thereby bring about significant reduction in fatality rates.

Information related to tobacco products in Indian undergraduate college syllabus: a content analysis

Background: Health education through college textbooks is effective in promoting knowledge, reforming, and improving health related behaviours among youths. This study evaluated the amount of tobacco related health and other information among the undergraduate college syllabus in their curriculum. Methods: Under graduate college courses that were enrolled by students in the academic year 2019-2020 according to the All-India survey on higher education were included in the study. A total of 28 undergraduate courses under 12 governing bodies were included for content analysis. These curriculums were analysed by three examiners for the search of tobacco related keywords obtained from the WHO glossary of tobacco terms. The inter examiner reliability was calculated using the Cohen's Kappa in the SPSS software (version 25). Results: Total of 3383 pages of the curriculum from different undergraduate courses were analysed. Results showed that the total number of information related to tobacco appeared in the form of text as 15 and tabulations as 4, to a total of 19. Among the different courses, the tobacco-related contents were higher in MBBS curriculum. Distribution of the tobacco related contents under health information were found to be higher when compared to the tobacco cessation contents and laws. Conclusions: The distribution of tobacco related contents were found to be very less among the undergraduate courses. There is a lack of information regarding the cessation process and guidance against tobacco related habits.

A Comparative Study On Pharmacoeconomic Analysis Of Rheumatoid Arthritis Patient In Two Different Hospitals In Tamil Nadu

Objective: The objective of the present study is to compare the prescribing patterns and cost of illness of Rheumatoid arthritis patients in two different hospitals. Methods: This is an observational study conducted in two different tertiary care hospitals in Salem district after obtaining approval of the Institutional Ethics Committee (IEC) (Registration Number EC/PHARM D/2019.06). A sample size of 102 (above 18 y) patients were included (52 from group 1 hospital and 50 from group 2 hospital). The study was conducted over a period of 6 mo from February 2019 to July 2019. The cost was collected by a patient face-to-face interview. Results: Out of 102 patients, females (57.84%) patients were more prevalent than men with the age group of 50-59 y in both groups. Methotrexate was most commonly prescribed drug in group 1(36.5%), whereas in group 2 are Sulfasalazine (37%). Among the DMARDs unit cost of methotrexate is high but the monthly cost was high for Sulfasalazine, because the methotrexate is prescribed on a once-weekly basis while sulfasalazine is taken twice a day. The cost of NSAIDs comes around 46.47% of the total drug cost of the month. In steroids, cost comes around 11.73% of the total drug cost. Among the direct cost of two groups, the drug cost and transportation cost is higher when compared with other costs. Indirect costs such as lost wages, due to disease is higher in group 1. Conclusion: The study concluded that the burden of RA to the patient is huge, Appropriate standard prescribing guidelines should be developed and implementation of the rational drug must be promoted. Polypharmacy was reported in group 1 hospital, the progression of symptoms was the same in both hospitals, it increases the cost of therapy and overall cost of patients. Hence it becomes vital to diagnose and control the disease at an early stage to control the economic burden on the patient.

Etiology of graft dysfunction in renal transplant recipients

Background: Kidney transplantation is the preferred mode of renal replacement therapy for the endstage renal disease, with dramatic improvements in patient and graft survival over the last 50 years. In the modern era of immunosuppression, 1-year patient survival is close to 98%, and 1-year allograft survival rates have improved to 90% for deceased donor kidney transplants and 95 % for living donor kidney transplants with some inter-center variability. The aim of the study: To elucidate the etiology of graft dysfunction among renal transplant recipients. Materials and methods: A retrospective study was conducted among 155 patients who underwent both cadavers and live donor transplant from October 2009 to March 2011 at a tertiary care center in Chennai, South India. All the transplant recipients were regularly followed with serum urea and creatinine, urine routine, calcineurin inhibitor drug levels in the serum, USG Abdomen, urine culture depending on the graft status. Graft dysfunction defined by a rise in the creatinine more than 25% or 0.3 to 0.5 mg per dl from the baseline. Those who developed graft dysfunction were presented for graft biopsy and managed based on the report accordingly. S. Thirumavalavan, Krishna Kumar, S. A. K. Noor Mohamed, R Vijaya Kumar. Etiology of graft dysfunction in renal transplant recipients. IAIM, 2019; 6(3): 313-318. Page 314 Results: Among the 155 transplant recipient patients, 66 (44%) patients developed graft dysfunction and underwent renal biopsy. The graft dysfunction was due to chronic allograft dysfunction (interstitial fibrosis and tubular atrophy) in 24 (15.4%) patients, acute cellular rejection in 13 (8.4%) patients, acute antibody-mediated rejection in 2 (1.3%) patients, acute tubular necrosis in 9 (5.8%) patients, calcineurin toxicity in 6 (3.9%) patients, thrombotic microangiopathy in 6 (3.9%) patients, IgA nephropathy in 3 (1.9%) patients and transplant renal artery stenosis in 1(0.6%) patient. Conclusion: Among the various causes, acute cellular, acute antibody rejection and chronic allograft nephropathy holds nearly 25% of the incidence of graft dysfunction. It indicates appropriate immunological evaluation, appropriate immunosuppression, use of induction agents in high-risk patients and protocol renal biopsy to identify early rejection in high-risk patient and appropriate early intervention is important to improve long-term term graft and patient survival.