The effect of heat therapy on pain intensity, duration of labor during first stage among primiparous women and Apgar scores: A systematic review and meta-analysis.

INTRODUCTION: Heat therapy may help in reducing pain during labor as it blocks the receptors of pain, according to gate control theory. This systematic review and meta-analysis study aims to evaluate the effect of heat therapy (HT) systematically and critically on pain intensity, duration of labor during the first stage of labor and Apgar scores. METHODS: We searched for randomized controlled trials published until October 2020 in PubMed/Medline, EMBASE, ClinicalKey, Ovid Discovery, and other sources. Randomized controlled trials (RCTs) comparing heat therapy with standard treatment were selected. RESULTS: Out of 7625 screened, 10 studies met the inclusion criteria. The results of pooled data have shown that heat therapy was significantly effective in reducing pain intensity in the first stage of labor (standard mean difference, SMD= -1.31; 95% CI: -1.88 - -0.73; p<0.001). Heat therapy had significantly reduced the duration of the first stage of labor (pooled MD= -50.09; 95% CI: -89.70-10.48; p=0.01) and was also superior to the standard therapy group in terms of better Apgar scores at the 5th minute of birth of the newborn (pooled MD= -0.10; 95% CI: -0.19-0.02; p=0.02). CONCLUSIONS: Current evidence shows that heat therapy effectively decreases labor pain intensity and shortens the duration of labor in the first stage, and it can be used as nonpharmacological management for labor pain.

Occurrence of urinary tract infection and preventive strategies practiced by female students at a tertiary care teaching institution.

BACKGROUND: Urinary tract infections (UTIs) are more common in females than males and predominantly based on their unhealthy practices in their day to day lives. This study is trying to assess the occurrence of UTI and strategies used by female student to prevent UTI. MATERIALS AND METHODS: A cross-sectional descriptive study carried out in a tertiary care teaching institute. A total of 338 conveniently selected B. Sc. Nursing and MBBS Medical students were surveyed. The data were collected by using a pretested, a self-structured questionnaire related to occurrence and practices to prevent UTI along with necessary demographic details. Descriptive (frequency, percentage, mean and standard deviation) and inferential (Chi-square test) statistics was used to compute the data. RESULTS: The result of this study shows that 10.05% female students reported of having UTI. The proportion was higher in nursing students (67.6%) than medical (32.4%) but did not show a significance difference (P = 0.61). Age, duration of hostel life, and marital status were significantly associated with the status of UTI (P = 0.001). To prevent UTI, students were using commercial product with Tea Tree Oil, soap, drinking 3-4 l water/day, increased frequency of peri-wash during menstruation period, and use of Citrus Fruits. The use of western toilet was also significantly associated with status of UTI (P = 0.04). CONCLUSION: The occurrence of UTI was more among nursing students. Most of the perineal hygienic practices by the female students were associated with occurrence of UTI; hence, it is necessary to emphasize on preventive practices to minimize re-occurrence.

Effect of buerger allen exercise on foot perfusion among patient with diabetes mellitus: A systematic review & meta-analysis.

AIM: Buerger-Allen exercise includes set of activities like elevation, movement and rest of the lower extremities. This systematic review and meta-analysis aimed to assess the effectiveness of BAE on foot perfusion among patient with diabetes mellitus. MATERIAL & METHODS: Five databases were searched for literatures published from inception to October 2020. Cochrane Collaboration Tool for RCTs and ROBINS-I tool for quasi-experimental studies were used for quality assessment. RESULTS: Four RCTs and six quasi-experimental studies were included, and pooled analysis have shown that the BAE was significantly effective in the improvement of ABI scores (MD = 0.14; 95% CI 0.08-0.19; I2 = 30%; p < 0.000). CONCLUSIONS: Studies showed that BAE effectively improves foot perfusion among patients with diabetes mellitus.

Status of respectful maternity care for women underwent normal vaginal delivery in selected hospitals in Rishikesh: A mixed-method study.

Background: Many women face disrespectful and abusive treatment during childbirth in facilities worldwide. Such treatment violates women's rights to respectful care and jeopardizes their rights to life, health, bodily integrity, and equality. This study aims at identifying the status of respectful maternity care (RMC) in selected hospitals in Rishikesh. Material and Methods: A mixed-method approach was adopted to explore RMC during normal vaginal delivery in a selected hospital in Rishikesh, Uttarakhand. In the quantitative part, 145 women were purposively selected, and data were collected by a pre-structured, validated RMC checklist, developed based on WHO RMC standards. Qualitative data were collected from 18 women, and a face-to-face semi-structured interview was conducted. Results: Forty-two elements of RMC categorized under eight domains show the type of mistreatment and its prevalence faced by women at a health care facility. Data showed that domain-7 (availability of competent and motivated human resources) had higher scoring (95%), and on the other hand, domain-4 (informed consent and effective communication) got lowest-scoring (68.45%). The overall mean percentage score of RMC was 85.68%. There was no statistically significant association between the total score of RMC and the selected socio-demographic variables. Conclusion: The overall RMC score was high, and there was no significant association with mothers' socio-demographic variables. The majority of mothers expressed that competent and motivated professionals were available during their delivery, but their communication skills were found to be lacking.

Comparison of L-Shape and Side-Lying Positions on Breastfeeding Outcomes among Mothers Delivered by Cesarean Section: A Randomized Clinical Trial.

Introduction: Ineffective breastfeeding techniques is one of the factors contributing to poor breastfeeding outcomes in post-cesarean mothers. To assist post-cesarean mothers to find a comfortable breastfeeding position, a trial was conducted to compare different positions of breastfeeding in these individuals. Methods: A randomized clinical parallel trial was carried out on primipara post-cesarean mothers admitted to All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India. Participants were enrolled by convenience sampling technique, which was further randomized (block size= 4) and allocated to receive either "L" shape (n= 30) or side-lying (n= 30) position for breastfeeding. The assigned intervention was provided at least six times a day for four consecutive days. Data were collected using breastfeeding assessment Tool, maternal breastfeeding evaluation scale and numeric pain rating scale. Data were analyzed using SPSS software version 23. Results: The baseline characteristics of participants in both groups were similar. The mean comparison of breastfeeding outcome and maternal satisfaction indicated no significant difference between the two positions. However, the mean scores of maternal pain were statistically significant. Hence, it was inferred that the maternal pain was significantly less in post-cesarean mothers in "L" shape compared to side-lying. Conclusion: There is significantly less pain in post-cesarean mothers during breastfeeding in "L" shape than side-lying. Furthermore, maternal satisfaction and breastfeeding outcomes were found to be similar in both positions.

Strategy to prevent infection from Covid-19 among security officers of tertiary care centre: A preexperimental study.

BACKGROUND: The extensive spread of Covid-19 pandemic globally became the main cause of concern for everyone, including security officers working in a health care setting. OBJECTIVE: To assess the effectiveness of instructional module for Covid-19 prevention among hospital security officers. METHODS AND MATERIALS: A preexperimental study was conducted at a tertiary care hospital from North India. A total of 344 security officers were selected by the convenient sampling technique. A self-structured knowledge and practice questionnaires and instructional module were developed based on the guidelines released by World Health Organization, Centre for Disease Control and Prevention and Ministry of Health and Family Welfare. Knowledge and practice were pretested, followed by the implementation of a video cum discussion instructional module for Covid-19 prevention. A posttest of knowledge and practice assessment was done after 7 days by using the same questionnaire. Descriptive and inferential statistics were used to compute and analyse the data. RESULTS: The mean age of participants was 29.5 ± 2.25; mos participants (75%) were male security officers. Knowledge and practice scores improved after the implementation of instructional module as mean scores of pretest to mean posttest scores had shown a significant difference (P = 0.00). In practice, instructional module was significantly effective, except for touching hair again and again, as it could be a source of covid-19 infection. CONCLUSION: This study finding highlights the significance of training security officers about the prevention of Covid-19.

Effectiveness of Video-Based Online Training for Health Care Workers to Prevent COVID-19 Infection: An Experience at a Tertiary Care Level Institute, Uttarakhand, India.

Purpose Amidst the current COVID-19 pandemic, traditional teaching methodology took a back foot. However, an urgent need for training health care worker (HCW) on preventive measures for COVID-19 infection was the need of the hour. Keeping in mind the precautionary measures required to combat COVID-19 infection, the only promising option for training was by adopting an online learning method. This study was undertaken to determine the effectiveness of video-based training using online platforms for infection prevention and control (IPC) training during the COVID-19 pandemic. Methods A quasi-experimental study, with only one experimental group comprising of HCWs, was undertaken to assess the effect of intervention which included video-assisted teaching-learning regarding IPC measures with a special focus on COVID-19 at a tertiary care Institute in North India. Online sessions were conducted on Do's and Don'ts, Hand Hygiene, donning and doffing of personal protective equipment (PPE), cleaning and disinfection, and bio-medical waste (BMW) management with the help of pre-recorded videos which was pre-validated. The session was followed by online interaction with participants by a single resource person. Pre-test and post-test were conducted through google forms before commencement and at the end of the online session respectively. The data were analyzed in terms of descriptive frequencies and percentages of different domains to describe the pre- and post-test knowledge. Results A total of 576 participants were included in the study. There was a statistically significant gain in scores of all questions related to cleaning and disinfection; and BMW. No significant change was observed in knowledge regarding the sequence of doffing (p-value: 0.94). The result of pairwise comparisons pre-test and post-test scores showed that intervention through video-assisted teaching-learning resulted in improvement of knowledge which was found to be statistically significant (p-value < 0.001). Conclusion Video-assisted teaching-learning through virtual platforms effectively trained health personnel on infection prevention and control practices during the COVID-19 pandemic. Video-assisted training can successfully be handled by a single resource person to impart the knowledge and skill to the trainee. Virtual teaching and learning is a feasible and efficient method to deliver training to HCWs on infection control practices and this methodology may be adopted in the future for several other training in manpower crunch situations, similar restrictive circumstances as posed by the COVID-19 pandemic.

Efficacy of Ginger in the Treatment of Primary Dysmenorrhea: A Systematic Review and Meta-analysis.

It has been evidenced that very few systematic reviews have examined the effectiveness of ginger for pain duration and its severity among women with primary dysmenorrhea. This meta-analysis was therefore performed to methodically incorporate and significantly evaluate randomized controlled ginger studies for the treatment of primary dysmenorrhea. The literature was searched using PubMed, Embase, Ovid, ClinicalKey, Medline, and electronic database. We have analyzed clinical trials by comparing ginger with placebo and non-steroidal anti-inflammatory drugs in women with primary dysmenorrhea. The primary outcomes assessed in our meta-analysis were pain severity and pain duration. Secondary outcomes were change in bleeding, side effects of the drug, and rate of satisfaction. We have screened a total of 638 studies, out of which narrative synthesis was formulated for eight studies. We have performed a meta-analysis of five trials examining ginger with placebo and other two randomized controlled trials comparing ginger with a non-steroidal anti-inflammatory drug (NSAID); it seems to be more helpful for relieving menstrual pain than a placebo (mean difference [MD] = 2.67, 95% CI = 3.51-1.84, P = 0.0001, I2 = 86%), although it was found that ginger and NSAIDs were equally effective in pain severity (risk ratios [RR] = 1.15, 95% CI = 0.53-2.52, P = 0.72, I2 =77%). We have not observed any significant difference between ginger and placebo on pain duration among primary dysmenorrheic women (MD = -2.22, 95% CI = -7.62-3.18, P = 0.42, I2 = 56%). Accessible information proposes that oral ginger can be a compelling treatment for primary dysmenorrhea. This meta-analysis strongly supports the requirement for high methodological quality consistency for upcoming trials.

Impact of COVID-19 Pandemic on the Psychological Status of Pregnant Women.

Introduction Pregnancy is a beautiful phase in every woman's life in which she undergoes several physical and psychological transformations. The level of stress and anxiety may increase due to a sudden outbreak of contagious diseases. Objective To evaluate the psychological status of pregnant women during the coronavirus disease-2019 (COVID-19) outbreak. Materials and methods A cross-sectional survey was conducted from July 15, 2020, to September 15, 2020, in Dehradun, Haridwar, and Nainital districts of Uttarakhand, India. A total of 333 pregnant women were surveyed through an online platform. The psychological impact of the COVID-19 pandemic was measured using the Impact of Event-Revised (IES-R) scale, and anxiety levels were measured using the Generalized Anxiety Disorder-7 (GAD-7) scale. Data were analysed using descriptive and inferential statistics. Results The survey results revealed that around three-fourths (73.6%) of the pregnant women reported minimal psychological impact, with a mean IES-R score of 16.93±11.23, whereas 69.4% of respondents had a minimal level of anxiety, with a mean GAD-7 score of 3.09±3.73. Multivariate linear regression found a positive association between psychological impact and gestational age, occupation, religion, locality, conception, history of abortion (p<0.05). Also, the level of anxiety was significantly associated with education, occupation, monthly income, religion, marital and family support, history of mental illness (p<0.01), conception type, and awareness regarding COVID-19 (p<0.05). Conclusion Psychological impact and anxiety levels were found to be minimal in pregnant women residing in Uttarakhand. Early identification of high-risk women is important to formulate necessary strategic planning to reduce the complications associated with maternal psychological stress on developing fetus.

Efficacy of hyperbaric oxygen therapy for diabetic foot ulcer, a systematic review and meta-analysis of controlled clinical trials.

Studies have suggested that hyperbaric oxygen therapy (HBOT) is effective in the healing of diabetic foot ulcer (DFU); however, there is a lack of consensus. Therefore, to assess the efficacy of HBOT on diabetic foot ulcer among diabetic patients, controlled clinical trials were searched through PubMed, EMBASE, Clinical key, Ovid Discovery, ERMED, Clinical Trials.gov databases for randomized controlled trials (RCTs) and other sources until 15 September 2020. Studies that evaluated the effect of HBOT on diabetic foot ulcer, complete healing, amputation, adverse events, ulcer reduction area, and mortality rate were included. Of 1984 study records screened, 14 studies (768 participants) including twelve RCTs, and two CCTs were included as per inclusion criteria. The results with pooled analysis have shown that HBOT was significantly effective in complete healing of diabetic foot ulcer (OR = 0.29; 95% CI 0.14-0.61; I2 = 62%) and reduction of major amputation (RR = 0.60; 95% CI 0.39-0.92; I2 = 24%). Although, it was not effective for minor amputations (RR = 0.82; 95% CI 0.34-1.97; I2 = 79%); however, less adverse events were reported in standard treatment group (RR = 1.68; 95% CI 1.07-2.65; I2 = 0%). Nevertheless, reduction in mean percentage of ulcer area and mortality rate did not differ in HBOT and control groups. This review provides an evidence that hyperbaric oxygen therapy is effective as an adjunct treatment measure for the diabetes foot ulcers. These findings could be generalized cautiously by considering methodological flaws within all studies.

Pattern and serological profile of healthcare workers with needle-stick and sharp injuries: A retrospective analysis.

BACKGROUND: Needle-stick and sharp injuries (NSSIs) are very hazardous to healthcare workers (HCWs) working in any healthcare setting. The burden of NSSIs is more common in developing countries than in developed countries. MATERIALS AND METHODS: A retrospective analysis was conducted in a multispeciality, tertiary level teaching medical institute. Total 78 NSSIs incidences from 2005 to 2013 were reviewed and included for the study. All the information were retrieved and entered in excel sheet for data analysis. RESULTS: Total of 78 NSSIs cases were reported over a period of 9 years. Maximum incidences of NSSI were reported by nurses (61.5%). A higher proportion (41%) of cases occurred in critical units and emergency and the most common procedure (64.1%) was parenteral medication during which HCWs got NSSIs. Almost half (53.8%) of HCWs had received complete HBV vaccination. Out of 78, 40 HCWs only completed follow-up for 6 months and were found non-reactive for viral markers. CONCLUSION: The healthcare workers who were involved in patient care are at risk to get NSSIs. The primary prevention of NSSIs is very important. Every institute should have policies on ongoing training programme, HBV vaccination protocol, smooth system of NSSIs reporting, post-exposure prophylaxis (PEP) facilities and follow-up of HCWs with NSSIs to prevent the occurrence.

Awareness and perception regarding tuberculosis among patients and their relatives attending a tertiary care hospital in Uttarakhand: A hospital-based exploratory survey.

BACKGROUND: Awareness about disease among tuberculosis (TB) patients plays a crucial role toward successfully achieving targets for control, prevention, and their relatives treatment adherence and is not well studied or documented. This study sought to explore the awareness and perceptions of TB patients in a tertiary care centre in northern India. METHODS: This was an exploratory study conducted between January and December 2016 among 1,000 pulmonary TB patients and their relatives. Structured and validated interview schedule was used to assess participants knowledge and perception regarding TB, which comprised of 41 questions. Ethical clearance was taken and written informed consent was obtained from each study participants. Data analysis was done using SPSS 22.0 version. RESULTS: A total of 1,000 study participants (mean age 40.2 ± 9.6 years, females 51%) were enrolled. More than two-third of the study participants were from Uttarakhand. Study participants had highest knowledge score (61.85%) regarding sign and symptoms, followed by scores in the aspect of prevention and treatment of TB (52.7%). However, a lower proportion (51.5%) knew about its causation. Overall knowledge score was 54.8%. Around half of the subjects (49.7%) disagreed that TB is a major health problem. CONCLUSIONS: Regardless of non-satisfactory knowledge of participants, their perception regarding TB was better. As to the associated factors, we found that participants' knowledge had significant association with religion, educational status, occupation, family income per month, type of family, and source of health information. Although there was insignificant difference between family monthly incomes, source of health information and perception regarding TB.

An exploratory study on traditional practices of families during the perinatal period among traditional birth attendants in Uttarakhand.

INTRODUCTION: India has a current maternal mortality rate of 130 which contributes to 20% of the total mortality rate in the world and more than a quarter of neonatal deaths; nearly 0.75 million neonates have died in India. The present study aimed to explore the cultural practices during the perinatal period including newborn care in Uttarakhand. MATERIALS AND METHODS: A qualitative descriptive design to explore self-experience for significant years in the field of maternal care and deliveries among 990 traditional birth attendants from 13 districts of Uttarakhand. Focused one-to-one in-depth interviews were done to collect the data. The data was expressed by participants in the form of narrations, picturizations, songs, and role-plays to show the techniques which were translated from the language of interviews to English before analysis of the data. RESULTS: Wide variety of cultural practices have been identified during various stages of the perinatal period. Most of the participants (80%) expressed that families believe that the pregnant women should not eat green vegetables, yam, pulses, red grams, papaya, and mangoes and that she should eat less during pregnancy. The routine activity should be done regularly to make labor process easier. Most of the mothers (90%) delivered on the floor of the cowshed demarcated with cow dung. Participants expressed that the mother had to walk for 2 km for taking bath after delivery before she touches the baby. Sprinkling cow's urine is also a common practice after delivery in and around the house and on the mother. It was also found that they don't breastfeed the baby for 3 days since colostrum is not considered good for the baby. CONCLUSION: The practices which are proven to be beneficial to the mother and baby should be advocated to keep our cultural practices alive, at the same time it is important to discourage communities from harmful practices concerning the mother and the baby.

Effect of magnification and changes in tobacco pictorial warning on asceticism of tobacco use: An exploratory survey.

BACKGROUND: Tobacco usage-related diseases pose serious threat for not only public health but also for country's economy and warning labels are considered as an effective strategy to spread more awareness on tobacco hazards. AIM: The aim of this hospital-based questionnaire survey was to assess the effect of magnified pictorial warning over tobacco products on asceticism of tobacco use and to measure the association of selected tobacco habits variables and asceticism of tobacco use. MATERIALS AND METHODS: Present exploratory survey based on triangulation method of data collection was conducted among conveniently selected 1,008 tobacco users or smokers attending OPD services at tertiary care center during the year 2018-2019. Quantitative survey data was collected through structured questionnaire and two FGDs were conducted for qualitative information. Data was analyzed using descriptive and inferential statistics. RESULTS: Magnification of health warnings over tobacco packets had impact on tobacco or cigarette consumption to some extent (415; 41.25%); but insisted only one third (383; 38.0%) participants to quit tobacco use. A significant association was observed between awareness about bad effect of tobacco use and attempt of quit tobacco uses (OR 0.29; CI 95%, 0.223-0.390; P = 0.001). Furthermore, significant effect of magnified warning over tobacco products was seen on reduction in tobacco use (OR 0.39; CI 95%, 0.300-0.531; P = 0.001) and quitting the tobacco (OR 0.38; CI 95%, 0.28620.513; P = 0.001). CONCLUSION: Study results concluded that magnification of pictorial warning is associated with the asceticism of tobacco use to some extent but alone it is not sufficient. Therefore, adjunct intervention of mass public education about bad effect of tobacco use is more essential to augment asceticism of tobacco use.

OSCE vs. TEM: Different Approaches to Assess Clinical Skills of Nursing Students.

INTRODUCTION: Nurses are trained with specific clinical skills, and objective structured clinical examination (OSCE) could be a better approach to assess clinical skills of nursing students. MATERIALS AND METHODS: A comparative study was conducted by observational checklist regarding antenatal care and opinionnaire on the usefulness of OSCE and tradition evaluation method (TEM) was used to assess the clinical skills and to get opinion. RESULTS: The mean score of OSCE was more than TEM and the difference was statistically significant (P < 0.001). The opinion of students regarding the usefulness of OSCE was higher than TEM. CONCLUSIONS: The study concluded that implementing OSCE will overweigh the advantages of the TEM.