Critical Care Nursing in India.

Critical care nursing and medicine have evolved significantly over the past few decades. Critical care in India began the major urban hospitals and has not yet become established in rural health care facilities. The formation of Indian critical care nursing and medical societies led to emerging regular conferences, updates, continuing nursing and medical education, workshops, and training programs for the further training of nurses and doctors. Future challenges include development of guidelines and consolidation of research activities on the outcome of patients with critical illness. This article describes the organization and practice of critical care nursing in India.

A cross-sectional study of surveillance of adverse drug reactions in inpatient departments of a tertiary care hospital.

BACKGROUND: Pharmacovigilance plays an imperative role in providing information about adverse drug reactions (ADRs) and drug safety in a hospital. Hence, it was considered worthwhile to study the surveillance of ADRs in inpatient departments (IPD). Our study aims to evaluate the frequency, type, characteristics, causality, and severity and avoidability of ADRs in the IPDs. METHODS: This prospective observational study was done in the IPDs of a 550-bed tertiary care hospital in South India during the period April to September 2012. All the patients had experienced at least one suspected ADR after hospitalization and drug treatment; patients who are hospitalized due to suspected ADR(s) in the last 6 months were assessed after obtaining permission from the Institutional Research and Ethics Committee. All the ADRs were recorded on the appropriate, prescribed form for reporting ADRs designed by the Central Drugs Standard Control Organization. RESULTS: A total of 147 ADRs were reported with the use of 96 drugs used by 91 IPD patients. The maximum number of ADRs reported in our study was with antipsychotic drugs and the maximum number of patients reported rashes (n=30) followed by extrapyramidal symptoms (n=17). Causality assessment by the WHO scale and Naranjo's algorithm showed 48 and 59 ADRs possibly related to drugs, respectively. Of this, 45 patients with ADR had moderate severity and 41 patients with ADRs were not preventable. CONCLUSIONS: The maximum number of ADRs reported in our study was with antipsychotic drugs and the most common ADR reported was rashes. Most of the ADRs reported had a possible causality, were moderate in severity, and were not preventable. The majority of patients had recovered from the ADRs.

Can symptom relief be provided in the home to palliative care cancer patients by the primary caregivers? An Indian study.

BACKGROUND: A large proportion of cancer deaths occur in the developing world, with limited resources for palliative care. Many patients dying at home experience difficult symptoms. OBJECTIVE: The objective of this study was to assess the feasibility of a structured training program on symptom management along with an acute symptom management kit for primary caregivers of cancer patients receiving home care. METHODS: Descriptive design was used. Thirty primary caregivers of cancer patients attending the palliative care clinic in Vellore, South India, were provided training on the administration of drugs for acute symptoms. A plastic box with partitions for drugs specific to symptom was provided. On follow-up visits, the usage of the kit, drugs used, and routes of administration were noted. A structured questionnaire with a 4-point scale was used to assess primary caregiver views and satisfaction. RESULTS: Of primary caregivers, 96.7% used a kit. The common medications used were morphine, metoclopramide, dexamethasone, and benzodiazepines. Seventy-three percent of primary caregivers administered subcutaneous injections at home. Hospital visits for acute symptoms reduced by 80%; 90% were satisfied with the training received; 73% stated it was not a burden to treat the patient at home. CONCLUSION: The training program and acute symptom management kit were favorably received and appropriately used by caregivers of diverse backgrounds. Rural backgrounds and illiteracy were not barriers to acceptance. IMPLICATION FOR PRACTICE: Healthcare professionals should train caregivers during hospital visits, empowering them to manage acute symptoms and provide simple nursing care. This is doubly important in countries where resources are limited and palliative care facilities scarce.

Stereotactic radiosurgery for brain lesions: an observation and follow-up.

Stereotactic radiosurgery (SRS) is a technique for obliterating intracranial targets that are inaccessible or unsuitable for open surgical techniques. By means of well-collimated beams of ionizing radiation, a high-dose, single fraction of radiation is delivered to a defined volume of tissue. The entrance and exit doses are distributed in such a way that tissue outside the target is minimally affected. Treatment effects are seen on scans or angiograms after several months or a few years; consequently, follow-up scans are necessary. The first 72 patients who underwent SRS at the Department of Neurological Sciences and Radiation Therapy, Christian Medical College and Hospital were followed. Of the 72 treated, 35 had arteriovenous malformations, while 37 had brain tumors. Of the 37 patients with brain tumors, 14 had meningioma and 17 had acoustic neuroma. Six patients had other lesions such as pineal tumor, hemangioblastoma, astrocytoma, or metastasis. Of 72 patients, 43 came for follow-up. Twenty-three of the followed-up patients showed improvement; 10 clinically and radiologically remained the same, and 2 died due to recurrence. Of 43 patients, 3 continue to have cranial nerve deficit. Four patients were later found to have central necrosis and clinical deterioration. Observation of outcomes following SRS helps neuroscience nurses identify home healthcare strategies such as chest care, eye care, facial massage, and exercises along with the other specific nursing care. Although nursing care has become more technically oriented, the patient's physical, educational, spiritual, and emotional needs must be addressed.