Legal Limits Relaxed: Time to Look at Other Barriers Faced by Women Seeking Termination of Pregnancy for Fetal Anomalies.

Introduction Advancements in prenatal diagnostic techniques have led to an increase in demand for termination of pregnancy for fetal anomalies (TOPFA). While relaxation in the legal gestational age limits across various countries relieves an important barrier, there is a need to identify the reasons that lead to delays in seeking abortion for fetal anomalies, because abortion-related complications increase with gestational age. Methods In this hospital-based qualitative study, antenatal women referred to a tertiary care institute in North India because of major fetal anomalies were explained about the study. Those women who fulfilled the inclusion criteria were recruited after taking consent. Details of antenatal care and prenatal tests were recorded. An in-depth inquiry was made into the reasons for the delay in prenatal tests, the delay in the decision for abortion, and specific problems that they faced in seeking TOPFA. Results Out of 80 women who met the inclusion criteria and consented to participate, more than 75% had received antenatal care in public healthcare facilities. Less than 50% of women received folic acid in the first trimester while 26% had first contact with healthcare facilities in the second trimester. Only 21 women underwent screening for common aneuploidies. Second-trimester anomaly scan was delayed in 35 women due to women-centered reasons (n = 17) or provider-centered (n = 19) reasons. Only 37.5% of women were counseled about fetal anomalies by their primary care provider. Owing to delay at multiple levels, 40 women (50%) could receive counseling about fetal abnormality for the first time after 20 weeks. These women could not be offered abortion because this study was carried out before the amendments in the Medical Termination of Pregnancy Act in India. The older act allowed abortion up to 20 weeks of gestation. Seventeen women could obtain permission for an abortion from a court of law. Arrangements for travel and stay and dependence on family members were the main problems faced by women seeking TOPFA. Conclusions Delay in diagnosis of a fetal anomaly due to delay in seeking antenatal care, irregular follow-up, and lack of pre-test counseling are the major reasons for the delay in the decision for abortion. This is further compounded by inadequate post-test counseling. Lack of awareness, failure or delay in counseling, need to travel to another facility for abortion, dependence on family members, and financial issues are the major barriers.

Honoring Diversity: Developing Culturally Competent Communication Skills Through Simulation.

BACKGROUND: Students in nursing programs must learn how to communicate with patients in a culturally competent manner. METHOD: This article explores current best practices in nursing education regarding the inclusion of diversity and cultural humility in the program of study and provides recommendations for innovative ways of thoughtfully threading cultural competence into the curriculum. RESULTS: Mastering culturally competent communication is unlike any other nursing skill, deserving of a creative way of teaching. This article describes the use of the pedagogy in simulation to create the opportunity to introduce scenarios where students care for patients of diverse backgrounds. CONCLUSION: Establishing cultural competence encompasses more than just learning about different cultures. A true emergent experience using standardized patients and scenarios highlighting the cultural considerations that nurses need to be cognizant of and comfortable with can provide a new way of teaching this relevant and current topic.

Characterization of the hypoglycemic effects of Trigonella foenum graecum seed.

The whole powder of Trigonella foenum graecum seeds and its extracts were tested for their hypoglycemic effect on normal and diabetic model rats. The powder, its methanol extract, and the residue remaining after methanol extraction had significant hypoglycemic effects when fed simultaneously with glucose. The water extract of the methanol extractive-free residue of the seed powder showed significant hypoglycemic activity at different prandial states. The Soluble Dietary Fibre (SDF) fraction showed no effect on the fasting blood glucose levels of nondiabetic or NIDDM model rats. However, when fed simultaneously with glucose, it showed a significant hypoglycemic effect (p < 0.05) in NIDDM model rats. Chemical analysis showed that the major constituent of the SDF is a galactomannan. The results confirm the involvement of SDF in the hypoglycemic effect of T. foenum graecum seeds. However, compound(s) other than SDF is (are) also involved in the hypoglycemic activity.

Susceptibility of Plasmodium falciparum to chloroquine amodiaquine and Fansidar in Gujranwala district.

PIP: Mass blood surveys were carried out in selected localities of Chindiala, Shergarh, and Maha Chattha in Gujranwala district, Pakistan, on December 22 and 23, 1985. Parasite density per cubic mm of blood was determined. The Slide Positivity Rate was 45.1%. After the surveys, 51 falciparum malaria cases were selected for in vivo trial in the village of Maha Chatha. The remaining cases which were not selected were given radical treatment for malarial infections. The majority of falciparum malaria cases (69%) demonstrated resistance against chloroquine by the in vivo test. Follow up after chloroquine treatment was completed in all 51 cases. The examination of follow up slides showed that all the blood smears became negative by day 7 except in 3 cases, which remained positive up to day 7 (R-II resistant cases). In 29 cases, recrudescence of patient parasitemia was observed between day 7 to day 28. Approximately half of the R-I cases (clearance of patient parasitemia by day 7) recrudesced early, within the first 2 weeks and the other half during the 3rd and 4th week. When the 31 chloroquine-resistant falciparum infections were treated with amodiaquine, 19 cases were cured (61%). All R-1 cases recrudesced within 2 weeks. Fansidar tablets were administered to 12 cases, who did not respond to amodiaquine treatment and 1 chloroquine resistant falciparum infection (recrudescence of patient infection on day 28). The examination of follow-up blood smears showed that 12 of the 13 cases treated with Fansidar were sensitive, only 1 case was resistant with asexual parasites. Fansidar cured 92% of infections resistant to both chloroquine and amodiaquine. In amodiaquine treated cases, the pre-treatment parasitemias of the resistant cases were much higher than those from sensitive cases. Fansidar should only be given in those cases of blood smear confirmed falciparum infection that are not cured by a 3-day treatment with a total dose of 25 mg base/kg body weight of chloroquine.^ieng