Choice of Place of the Death of Children with Cancer during End-of-Life Care - Parent's Perspectives in a Developing Country.

Objectives: The place of a child's death is an indicator of the quality of paediatric palliative and end-of-life care. This study aimed to identify the choices of parents about the place of death of their children with cancer and to evaluate whether they had any regrets about their choices retrospectively. Material and Methods: All children who were treated in our centre for the past 9 years with palliative intent treatment to improve their quality of life were included in this study. For the children whose place of death was the hospital, data were collected from the case records. For the children who passed away at home, a telephone call was made to the families, informing them of the study, allowing time for there to be any clarifications. A verbal consent was requested for the study. Data were collected through the telephone conversation. Results: Out of the 59 children who died during the study period from 2012 to 2021, 31 children (52.5%) died in hospital settings. Eighteen (58.1%) families who had opted hospital as the place of death had regretted their choices. Families who chose home as a place of death were upset about inadequate pain management. The majority of the families had desired home care services for adequate symptom control and to keep the child comfortable in a familiar environment. Conclusion: Most children with life-limiting conditions continue to die in the hospital setting in developing countries due to a lack of dedicated palliative care services and home care. Most of the families retrospectively, regretted their choices of place of death. Most of the families, however, would prefer home as the place of death, if there was better end-of-life care support for symptom control at home. Specific policies institutional and nationwide need to be formulated to provide guidance to the professionals on the discussion of goals of care and place of care, with a supporting network to ensure its provision.

Effect of a Community Health Worker-Based Approach to Integrated Cardiovascular Risk Factor Control in India: A Cluster Randomized Controlled Trial.

BACKGROUND: Eighty percent of premature mortality from cardiovascular disease occurs in low- and middle-income countries. Hypertension, diabetes, and smoking are the top risk factors causing this disease burden. OBJECTIVES: The study aimed to test the hypothesis that utilizing community health workers (CHWs) to manage hypertension, diabetes and smoking in an integrated manner would lead to improved control of these conditions. METHODS: This was a 2-year cluster (n = 12) randomized controlled trial of 3,556 adults (35 to 70 years of age) in a single town in India, who were screened at home for hypertension, diabetes, and smoking. Of these adults, 1,242 (35%) had at least 1 risk factor (hypertension = 650, diabetes = 317, smoking = 500) and were enrolled in the study. The intervention group had behavioral change communication through regular home visits from community health workers. The control group received usual care in the community. The primary outcomes were changes in systolic blood pressure, fasting blood glucose, and average number of cigarettes/bidis smoked daily among individuals with respective risk factors. RESULTS: The mean ± SD change in systolic blood pressure at 2 years was -12.2 ± 19.5 mm Hg in the intervention group as compared with -6.4 ± 26.1 mm Hg in the control group, resulting in an adjusted difference of -8.9 mm Hg (95% confidence interval [CI]: -3.5 to -14.4 mm Hg; p = 0.001). The change in fasting blood glucose was -43.0 ± 83.5 mg/dl in the intervention group and -16.3 ± 77.2 mg/dl in the control group, leading to an adjusted difference of -21.3 mg/dl (95% CI: 18.4 to -61 mg/dl; p = 0.29). The change in mean number of cigarettes/bidis smoked was nonsignificant at +0.2 cigarettes/bidis (95% CI: 5.6 to -5.2 cigarettes/bidis; p = 0.93). CONCLUSIONS: A population-based strategy of integrated risk factor management through community health workers led to improved systolic blood pressure in hypertension, an inconclusive effect on fasting blood glucose in diabetes, and no demonstrable effect on smoking. (Study of a Community-Based Approach to Control Cardiovascular Risk Factors in India [SEHAT]; NCT02115711).

What type of lectures students want? - a reaction evaluation of dental students.

INTRODUCTION: An one hour didactic lecture is the common method of teaching in dental colleges in India. Lengthy lectures are boring and students are passive recipients of the information. Interactive lectures are suggested as a means of overcoming the disadvantages of regular lectures. AIMS: The present study was conducted to pilot various methods of making lectures interactive and to find the students' reactions to interactive lectures as compared to regular lectures. MATERIAL AND METHODS: An entire batch of first year dental students (n = 78) was exposed to both interactive and regular lectures for the cardiovascular system in physiology. Among the total number of 12 lectures, alternate lectures were conducted in an interactive style. At the end of the 12 lecture series, students' opinions were obtained using a structured feedback evaluation questionnaire, consisting of five statements, on a five point Likert scale. Statistical Analysis was done using SPSS software, version 15. RESULTS: Interactive lectures were found to be more useful than regular lectures by 92% of the students. Significantly more number of students agreed or strongly agreed that interactive lectures kept them attentive, created interest, overcame monotony, motivated them for self learning and provided well defined learning than regular lectures. Among the different techniques which were used, the students preferred use of video clippings (58.1%), followed by each-one-teach-one. RESULTS of the present study support the use of interactive lectures for ensuring increased interest and attention of students during lectures. CONCLUSION: Interactive lectures were more accepted and considered to be more useful than regular lectures by the students.