ABSTRACT
We evaluated, through the prospective monitoring of 251 patients at Sadar Hospital in Bihar, India, the effectiveness and safety of 20 mg/kg body weight of liposomal amphotericin B for the treatment of visceral leishmaniasis. The treatment success rates for the intention-to-treat, per protocol, and intention-to-treat worse-case scenario analyses were 98.8%, 99.6%, and 81.3%, respectively. Nearly one-half of patients experienced mild adverse events, but only 1% developed serious but non-life-threatening lips swelling. The lost to follow-up rate was 17.5%. Our findings indicate that the 20 mg/kg body weight treatment dosage is effective and safe under routine program conditions. Given that the exorbitant cost of liposomal amphotericin B is a barrier to its widespread use, we recommend further study to monitor and evaluate a lowered dosage and a shorter treatment course.
Subject(s)
Amphotericin B/adverse effects , Amphotericin B/therapeutic use , Antiprotozoal Agents/adverse effects , Antiprotozoal Agents/therapeutic use , Leishmaniasis, Visceral/drug therapy , Adolescent , Adult , Amphotericin B/administration & dosage , Antiprotozoal Agents/administration & dosage , Child , Child, Preschool , Cohort Studies , Female , Humans , India , Liposomes , Male , Middle Aged , Young AdultABSTRACT
PURPOSE: When a mission statement is introduced to enhance the quality of health care management, it is vital to assess the actual impact. This article aims to consider the effect of introducing a single mission statement into an association of 18 not-for-profit hospitals by investigating the views of different groups of employees. DESIGN/METHODOLOGY/APPROACH: The paper explores the impact a mission statement has had by examining questionnaire responses from different groups of staff including the designers of the mission statement and those at the delivery point of services. FINDINGS: The study's outcomes indicate the value of examining the views of staff that are not in senior management. The evaluation of the mission statement's impact by senior managers was at variance with that of other staff. ORIGINALITY/VALUE: The findings highlight the inadequacy of only examining senior management's opinions when considering the benefits of having introduced a mission statement into an organisation. In this study we identify those who originated or contributed to the mission statement in the first place. Once launched, a mission statement can have an impact throughout all staff, and that information needs to be captured in any assessment. This is consistent with the high rating normally given to a mission statement being an aid to motivating all staff. An important dimension of this study is the impact of a single mission statement throughout a group of dissimilar hospitals.
Subject(s)
Hospitals, Voluntary/organization & administration , Organizational Objectives , Quality of Health Care , India , Medical Staff, Hospital/psychology , Surveys and QuestionnairesABSTRACT
Hospital-based records from major cities of India, where roughly a quarter of the population resides, identified the frequency of neural tube defects (NTDs) as ranging from 3.9 to 8.8 per 1000 births, but the incidence in rural areas is unknown. We did a population-based door-to-door survey of mothers living in remote clusters of villages in Balrampur District in Uttar Pradesh, a region ranked as the least-developed area in India. The data showed that the incidence of NTDs was 6.57-8.21 per 1000 livebirths, which is among the highest worldwide. India's Ministry of Health needs to produce a strategy to reduce the incidence of such defects.
