Use of information technology to improve patient compliance: A pilot study

Background: Compliance with treatment is the key link between treatment and outcome in medical care, non-compliance leads to failure of treatment. Noncompliance with antimicrobial agents (AMAs) is the important reason for Resistance to antimicrobials. Forgetting to take medicine is one of the important causes of non-compliance. Aim and Objectives: Hence, the present study was planned to evaluate the compliance for antimicrobial treatment in patients receiving a short course of antimicrobials, with or without reminding them to take medicine using a smartphone app. Materials and Methods: Prospective interventional study was planned in a tertiary care hospital after permission from the ethics committee. The present pilot work of the study was carried out on 30 patients receiving AMAs. Patients receiving a short course of chemotherapy were enrolled and stratified based on the frequency of administration of antimicrobials. They were then allocated alternately in control (15) and study (15) groups. After explaining the prescription to all, “Pill Reminder” app was downloaded on smartphones of participants in the study group. All were contacted to enquire about compliance at the end of the treatment period. Results: Baseline characteristics of participants in both groups were comparable. URTI, UTI Tinea cruris, Tinea capitis were the disorders for which they received AMAs. The frequency of administration was once/twice/thrice a day. Duration was 3–14 days in both groups. At the end of the study, 53.3% of patients in control group and 100% of patients in intervention group were compliant to the treatment. Conclusion: The use of the reminder app significantly improved patient’s compliance with medications. Further studies are required to validate these results.

Quality of Life in Children with Epilepsy.

Quality of life was assessed in 108 epileptic children (6-15 years) using a hindi translation of Quality of Life in Children with Epilepsy (QOLCE) questionnaire. The questionnaire consist of 76 items with 16 subscales covering five domains of life: physical function, social function, cognition, emotional and behavioral well being. Overall score was 62.62±21.32. Chronbach’s- for all 13 multi-item subscales was above 0.70, indicating good internal consistency and reliability. Pearson correlation revealed good construct validity. Overall quality of life was affected by age, type of epilepsy, seizure frequency and maternal education (P<0.05). Energy levels, language and attention (P<0.05) were better in older children whereas younger children had better self esteem and lower levels of anxiety. Seizure frequency compromised all fields except stigma, attention, and energy levels (P>0.05).

Changes in visual evoked potentials on acute induction to high altitude.

BACKGROUND & OBJECTIVES: Induction to high altitude leads to altered central nervous system (CNS) functions induced by hypobaric hypoxia. The sensory systems like visual and auditory systems are reported to be affected by hypoxia. The present study was undertaken to assess the effects of hypobaric hypoxia on visual evoked potentials (VEPs) at 3200 m and 4300 m. METHODS: The VEP of 30 human volunteers were recorded at sea level (SL) and then at high altitude (HA) of 3200 m (HA I) and 4300 m (HA II) in eastern Himalayas and on return to sea level (RSL). The absolute latencies and amplitude of positive and negative waves were recorded. RESULTS: High altitude of 3200 m did not alter the latency of major wave N1, P1 and N2 of the VEPs. At HA II (4300 m), there was a statistically significant increase (P < 0.01) in the latency of NI wave as compared to the SL value and HA I (3200 m) in both left and right eye. There was a slight increase in latenty of P1 wave in both left and right eye at HA II. INTERPRETATION & CONCLUSION: From these results it may be concluded that induction to HA causes increase in latency of N1 wave at 4300 m which is still within physiological limits. This increase in wave latency of N1 wave in both eyes may be due to synaptic delay and/or altered neuronal processing at HA.

Auditory evoked functions in ground crew working in high noise environment of Mumbai airport.

The continuous exposure to the relatively high level of noise in the surroundings of an airport is likely to affect the central pathway of the auditory system as well as the cognitive functions of the people working in that environment. The Brainstem Auditory Evoked Responses (BAER), Mid Latency Response (MLR) and P300 response of the ground crew employees working in Mumbai airport were studied to evaluate the effects of continuous exposure to high level of noise of the surroundings of the airport on these responses. BAER, P300 and MLR were recorded by using a Nicolet Compact-4 (USA) instrument. Audiometry was also monitored with the help of GSI-16 Audiometer. There was a significant increase in the peak III latency of the BAER in the subjects exposed to noise compared to controls with no change in their P300 values. The exposed group showed hearing loss at different frequencies. The exposure to the high level of noise caused a considerable decline in the auditory conduction upto the level of the brainstem with no significant change in conduction in the midbrain, subcortical areas, auditory cortex and associated areas. There was also no significant change in cognitive function as measured by P300 response.

Effect of chronic hypobaric hypoxia on components of the human event related potential.

BACKGROUND & OBJECTIVES: Induction to high altitude (HA) leads to deterioration in cognitive functions. The event related potentials (ERPs) like P300 are reported to be affected by hypoxia and bring about impairments in cognitive performance. The aim of the study was to investigate the effect of hypobaric hypoxia on event related potentials at two different altitudes i.e., 3200 m (HA I) and 4300 m (HA II) in ascending order to see how ERPs change with increasing altitude. METHODS: The study was carried out on 20 healthy male volunteers at sea level (SL) and thereafter at high altitude (HA) in Eastern Himalayas and on return to sea level (RSL). The P300 was recorded by using standard auditory odd ball paradigm with compact -4 (Nicolet, USA). RESULTS: The N1, N2 and P2 latencies were not significantly affected at HA I and HA II in comparison with SL indicating no effect of hypobaric hypoxia on sensory conduction. However, at HA II, most of the subjects showed an increase in latency of P3 component reflecting sensory discrimination and delay in evaluation process at 4300 m. At HA I, only 10 out of 20 subjects showed an increase in P3 wave latency and 3 did not show any change in N2-P3 components. INTERPRETATION & CONCLUSION: The results of the present study showed an increase in P300 wave latency at 3200 and 4300 m of high altitude. The observations suggest that hypoxia causes slowing of the signal processing at 4300 m, and magnitudes of the effects are altitude dependent with higher level of decline observed with increasing altitude.

Effect of high altitude on human auditory brainstem responses.

The effect of hypobaric hypoxia on Brain Stem Auditory evoked potentials (BAERs) were studied. BAERs were recorded in 30 volunteers at sea level (SL) and then at high altitude (HA) of 3200 m (HA I) and 4300 m (HA II) in Eastern Himalayas and on return to sea level (RSL). The BAERs were recorded using Nicolet Compact - 4 (USA) in response to monaural auditory stimuli consisting of clicks of 100 ps square pulse at a rate of 15/sec. The BAERs were recorded on day 4 of their stay at 3200 m and 4300 m respectively. Findings indicated an increase in absolute peak latencies of wave V at 3200 m, which was statistically significant. On further ascent to 4300 m there was an increase in absolute peak latencies of wave I and III indicating delay in sensory conduction at the medullo-pontine auditory pathways.

Effect of high altitude (HA) on event related brain potentials.

Event Related brain potentials (ERPs) were recorded in 15 subjects using standard auditory odd ball paradigm, in which subjects were presented a sequence of two distinguishable sound stimuli of that occurred frequently (frequently (frequent stimulus-non target) and the other infrequently (rare stimulus-target). These recordings were made at sea level (SL) and then the subjects were air lifted to 3500 m altitude (HA), where they stayed for 3 weeks. Their ERPs were recorded during the first and third week of stay at HA and on return to sea level (RSL). Data indicated impairment in cognitive function as a result of exposure to HA as depicted by increase in the latency of P3 which was significant during the 1st week of stay at HA compared to sea level. The P3 wave latency during the 3rd week of stay at HA showed an increase compared to SL but was not statistically significant. From the results it may be concluded that high altitude hypoxia induced slow processing of stimulus evaluation, may be responsible for increase in P3 latency. The difference in the latent period of P3 waves during the first and third week of stay at HA may be due to continuous stay at HA which might lead to the time dependent adaptive processes occurring with increasing duration of exposure to HA which may induce learning effects.

Effect of yogic exercises on physical and mental health of young fellowship course trainees.

A study was undertaken to observe any beneficial effect of yogic practices during training period on the young trainees. 54 trainees of 20-25 years age group were divided randomly in two groups i.e. yoga and control group. Yoga group (23 males and 5 females) was administered yogic practices for the first five months of the course while control group (21 males and 5 females) did not perform yogic exercises during this period. From the 6th to 10th month of training both the groups performed the yogic practices. Physiological parameters like heart rate, blood pressure, oral temperature, skin temperature in resting condition, responses to maximal and submaximal exercise, body flexibility were recorded. Psychological parameters like personality, learning, arithmetic and psychomotor ability, mental well being were also recorded. Various parameters were taken before and during the 5th and 10th month of training period. Initially there was relatively higher sympathetic activity in both the groups due to the new work/training environment but gradually it subsided. Later on at the 5th and 10th month, yoga group had relatively lower sympathetic activity than the control group. There was improvement in performance at submaximal level of exercise and in anaerobic threshold in the yoga group. Shoulder, hip, trunk and neck flexibility improved in the yoga group. There was improvement in various psychological parameters like reduction in anxiety and depression and a better mental function after yogic practices.

Effect of sojourn at altitude of 3,500 m on auditory evoked potential in man.

Auditory evoked potentials were studied on 27 male subjects to evaluate the effect of sojourn at high altitude (HA). They were initially studied at Delhi (260 m) for their auditory evoked potentials and were then flown to an altitude of 3,500 m. During their stay at HA the same parameter was tested twice, once on the second day of arrival at HA and another on 21st day of stay. Then they were flown back to sea level (SL) and were retested on the third day of return. The results showed a significant delay in the peak latency of wave I of both the right and left ears on the second day of arrival at HA with a persistent delay in wave V even after 3 days of return to SL. The results suggest that HA stress caused a delay in sensory conduction at the cochlear level during the first week of induction, which was normalised during further stay.

Effect of Sahaja yoga practice on seizure control & EEG changes in patients of epilepsy.

The effect of Sahaja yoga meditation on seizure control and electroencephalographic alterations was assessed in 32 patients of idiopathic epilepsy. The subjects were randomly divided into 3 groups. Group I (n = 10) practised Sahaja yoga for 6 months, Group II (n = 10) practised exercises mimicking Sahaja yoga for 6 months and Group III (n = 12) served as the epileptic control group. Group I subjects reported a 62 per cent decrease in seizure frequency at 3 months and a further decrease of 86 per cent at 6 months of intervention. Power spectral analysis of EEG showed a shift in frequency from 0-8 Hz towards 8-20 Hz. The ratios of EEG powers in delta (D), theta (T), alpha (A) and beta (B) bands i.e., A/D, A/D + T, A/T and A + B/D + T were increased. Per cent D power decreased and per cent A increased. No significant changes in any of the parameters were found in Groups II and III, indicating that Sahaja yoga practice brings about seizure reduction and EEG changes. Sahaja yoga could prove to be beneficial in the management of patients of epilepsy.

Brainstem auditory evoked potentials in epileptics on different anti-epileptic drugs.

The effects of anti-epileptic drugs (AEDs) on brainstem auditory evoked potentials (BAEPs) were studied on 32 female patients of epilepsy and 10 age-matched normal healthy females (NS). The patients were divided into 6 groups, those not receiving medication (drug free, DF) and those receiving AEDs: Phenytoin (PHT), Carbamazepine (CBZ), Phenobarbital (PB), a combination of PHT and PB and a combination of CBZ and PB. DF epileptics had shortened were V absolute latency (AL) and I-V interpeak latency (IPL) as compared to NS. Phenytoin and CBZ monotherapy produced a prolongation of wave III AL (by PHT only), wave V AL, wave I-III IPL and I-V IPL, as compared to DF epileptics. Phenytoin monotherapy also prolonged wave III AL and I-III IPL, as compared to NS. When PB in the dosage of 30-60 mg/d was used in combination with PHT the above mentioned changes were not observed. These findings indicate altered neuronal conduction and/or synaptic transmission in epileptics. Anti-epileptic drugs in the dosages studied, with exception of PHT appear to lead towards "normalization" of BAEPs.

Auditory evoked response in patients of diabetes mellitus.

Brainstem auditory evoked response (BAER) and the mid latency response (MLR) were recorded in 25 diabetic men and compared with a group of 25 control subjects. The threshold of hearing was higher (P less than 0.001) in the patients. The BAER peak latencies were also significantly prolonged in both the ears; however, the degree of prolongation was more prominent in the right ear. The interpeak latencies of waves I-III were also prolonged (P less than 0.01) in the left ear, with non significant increase noticed in the right ear also. The wave V amplitude was lower (P less than 0.05) in diabetics. The MLR, on the other hand, was not affected in patients. These findings suggest functional impairment in the auditory pathway in patients of diabetes mellitus.

Childhood neurocysticercosis in south India.

A total of 21 cases of childhood neurocysticercosis seen over five years (1985-89) at JIPMER hospital Pondicherry, are reported. Nine of these patients were males and twelve females. Their age ranged between 5 to 15 years. The presenting features were convulsive seizures (14), features of raised intracranial pressure (6) and meningoencephalitis syndrome (1). Diagnosis of neurocysticercosis was based on positive CSF serological tests (11), CT morphology (11), brain biopsy (1) and autopsy (1). Praziquantel therapy was given in 4 cases, 3 of them showed remarkable improvement in neurological status and one died of acute reaction.