Validation of satisfaction questionnaire for services provided in the labour rooms of government health facilities

INTRODUCTION AND OBJECTIVES

Using the assessment of satisfaction of patients of labour room services, the caregiver or policymakers can identify the gaps in the implemented programmes and health policies. This study was aimed to design a valid and reliable satisfaction questionnaire that will help in identifying the aspects of gaps that need improvement.

METHODS

A facility and community-based observational cross-sectional study was conducted in the district of western Uttar Pradesh (India) between January 2019 and August 2020. Validation of the structured questionnaire with 34 dichotomous questions categorized under five subscales was performed by evaluating its validity and reliability. A total of 380 beneficiaries were selected from 48 government health facilities.

RESULTS

The calculated Content validity index was calculated to be 9.5 which was adequate as per the guidelines. The reliability analysis of the questionnaire showed that the internal consistency was high with an overall Cronbach's alpha of 0.710. The variation in Cronbach's alpha on the elimination of any question from the questionnaire ranged from 0.676 to 0.767. The mean patient satisfaction score in the total surveyed population was 24.39±4.684 (total score=34) and there was a greater variation in the satisfaction score of infrastructure when compared with other subscales.

CONCLUSION

The findings from this study support the reliability and validity of the patient satisfaction questionnaire as it is capable of evaluating the satisfaction in terms of delivery services provided in labour rooms as a whole.

Enhanced High-Temperature YSZ-polyester Abradable Honeycomb Seal Structures

The abradable coatings had significantly enhanced turbomachinery performance by acting as a sacrificial seal between rotating blades and stationary casing. Further improvement in seal design to meet the higher energy demand and increase the service time has been the key challenge to solve in the gas turbine industry. Honeycomb seals have become the industry standard clearance seal technique due to their unique design and high structural strength with minimum weight. The present study proposes a concept to form a thermal shock resistance structure to achieve higher temperature capability and improve the reliability of high-temperature abradable seal structures for a hot gas path of turbines. A cavity layer of honeycomb seal structure made of SS 321 alloy was coated with advanced high-temperature ZrO2 + 7.5%Y2O3 + 4% polyester seal material using TriplexPro-210 plasma spray system. The integrity of a seal structure was assessed by a cross-sectional analysis and evaluation of the coating microstructure. Additionally, the micro-hardness test was performed to estimate coating fracture toughness, and finite element analysis was used to assess its thermo-mechanical performance. The concept proposed in this study should be further validated to develop the most capable innovative technology for advanced gas turbine abradable seal structures.

Disaggregating the Differential Impact of Healthcare IT in Complex Care Delivery: Insights from Field Research in Chronic Care

This study focuses on the impact of digitizing medical information on the efficiency and perceived quality of chronic care delivery at the individual physician level. This study extends the theory of task technology fit to activity systems consisting of highly interdependent tasks. We find that the outcomes of efficiency and quality gains are driven by the structure of interdependencies between tasks that physicians perform. While structured information plays a key role in enabling both decision-making and task execution, we find that physician-created semistructured information is also an important predictor of both efficiency and quality gains. We show that the structure of activity systems (task interdependencies) has a strong moderating influence on the factors that drive efficiency and quality gains. We find that digitization enables physicians to preprocess patients’ records prior to their visit which in turn drives gains in both the efficiency and the perceived quality of care delivered.

P14.117 Cost efficient test algorithm for molecular subgrouping of medulloblastomas for day-to-day practice in resource limited countries

INTRODUCTION

Molecular classification of medulloblastomas(MB) is prognostically and therapeutically relevant and helps in better risk-stratification. Translation of this subgrouping to routine practice still remains a challenge. The most pathologist-accessible techniques for molecular subgrouping include immunohistochemistry(IHC), fluorescent in-situ hybridization(FISH) and Nanostring assay. Objectives:(1)Molecular subgrouping of MBs by IHC and FISH, and Nanostring Assay (2)To compare their efficacy against sequencing and DNA methylation, and cost for applicability in resource-constrained centers

METHODS

Ninety-five cases of MB with adequate tissue were included. Molecular subgrouping was performed by IHC for β-catenin, GAB1, YAP1, and p53; FISH for MYC amplification, and sequencing for CTNNB1, and by Nanostring Assay on the same set of MBs. Further, a subset of cases were subjected to 850k DNA methylation array.

RESULTS

IHC+FISH classified MBs into 15.8% WNT, 16.8% SHH, and 67.4% non-WNT/non-SHH subgroups; with MYC amplification identified in 20.3% cases of non-WNT/non-SHH. A single showed diffuse strong p53 positivity among the SHH subgroup. Nanostring successfully classified 91.5% MBs into 25.3% WNT, 17.2% SHH, 23% Group3 and 34.5% Group4. However, Nanostring assay failure was seen in eight cases, all of which were >8-years-old formalin-fixed paraffin-embedded tissue blocks. Concordant subgroup assignment was noted in 88.5% cases, while subgroup switching was seen in 11.5% cases. Both methods showed prognostic correlation. Among the 5 discrepant cases, which switched to WNT subgroup by Nanostring, only 2 were found to have CTNNB1 mutation. Methylation profiling performed on discordant cases revealed 1 out of 4 extra WNT identified by Nanostring to be WNT, others aligned with IHC subgroups; extra SHH by Nanostring turned out to be SHH by methylation.

CONCLUSIONS

Both IHC supplemented by FISH and Nanostring are robust methods for molecular subgrouping, albeit with few disadvantages. IHC cannot differentiate between Groups 3 and 4, while Nanostring cannot classify older-archived tumors, and is not available at most centres. WNT subgroup with the best prognosis is best detected by IHC or IHC followed by sequencing for confirmation. Nanostring Assay is better suitable to separate Group 3, the worst prognostic group from Group 4. Thus, both the methods complement each other and can be used in concert for high confidence allotment of molecular subgroups in clinical practice. The cost of IHC plus Nanostring will almost be the same as IHC plus FISH. We recommend a cost-efficient algorithmic approach using histopathological subtype and IHC as the first step followed by Nanostring or FISH, wherever suitable.

Design, synthesis, and applications of DNA-macrocyclic host conjugates

With this Feature Article we review, for the first time, the development of DNA-host conjugates-a nascent yet rapidly growing research focus within the ambit of DNA supramolecular chemistry. Synthetic hosts (such as cyclodextrins, cucurbiturils, and calixarenes) are well-suited to be partnered with DNA, since DNA assembly and host-guest binding both thrive in aqueous media, are largely orthogonal, and exhibit controllable and input-responsive properties. The covalent braiding of these two supramolecular synthons thus leads to advanced self-assemblies and nanostructures with exciting function that range from drug delivery agents to input-triggered switches. The latter class of DNA-host conjugates have been demonstrated to precisely control protein activity, and have also been used as modulable catalysts and versatile biosensors.

The infectious disease blood safety risk of Australian hemochromatosis donations

BACKGROUND

It has been suggested that blood donors with hereditary hemochromatosis may pose an increased infectious disease risk and adversely affect recipient outcomes. This study compares the infectious disease risk of whole blood (WB) donors enrolled as therapeutic (T) donors to voluntary WB donors to evaluate the safety of blood products provided by the T donors.

STUDY DESIGN AND METHODS

This was a retrospective cohort study of all WB donations at the Australian Red Cross Blood Service who donated between January 1, 2011, and December 31, 2013, comparing a yearly mean of 11,789 T donors with 107,773 total donations and a yearly mean of 468,889 voluntary WB donors with 2,584,705 total donations. We compared postdonation notification of infectious illnesses, bacterial contamination screening results, and positive tests for blood borne viruses in T and WB donors.

RESULTS

Rates of transfusion-transmissible infections in donations destined for component manufacture were significantly lower in therapeutic donations compared to voluntary donations (8.4 vs. 21.6 per 100,000 donations). Bacterial contamination (43.0 vs. 45.9 per 100,000 donations) and postdonation illness reporting (136.2 vs. 110.8 per 100,000 donations) were similar in both cohorts.

CONCLUSIONS

The Australian therapeutic venisection program enables T donors to provide a safe and acceptable source of donated WB that has a low infectious disease risk profile.

Dietary intake of trace elements, minerals and vitamins among severely malnourished children and its interrelationship with nutritional status:A prospective study

Dietary deficiency of trace elements, minerals and vitamins has been associated with severe malnutrition among young children. Although levels of severe malnutrition among children are high in developing countries, data on dietary intake of trace elements, minerals, vitamins and other nutrients by severely malnourished (SMN) children are limited. The present prospective study was conducted for a period of 12 months in order to assess the intake of trace elements, minerals, vitamins and other nutrients by SMN children and its possible interrelationship with their nutritional status. The nutritional status of 1643 children in the age group of 6 months to < 6 years, registered at 50 Anganwadi centres at district Alwar and Bharatpur in Rajasthan in India, was assessed using weight-for-age criteria. A total of 150 children were identified as severely malnourished. Mothers of 130 of the children consented to their children's participation in the study. At the end of 12 months, full data was available for 60 of the 130 SMN children. The nutritional status and intake of trace elements, minerals, vitamins and other nutrients of the 60 SMN children were analysed at monthly follow-up visits. Results revealed that there was an increase in the intake of trace elements, minerals and other nutrients during the follow-up period as compared to the baseline survey. However, in all of the follow-up visits, an overall deficient intake of all of the trace elements, minerals, vitamins and other nutrients was observed in the SMN children except for protein, calcium and magnesium. Out of 60 children, 35 moved to higher nutritional grades. It was found that the intake of trace elements, minerals, vitamin and macro-nutrients was higher among children whose nutritional status improved as compared with the group that remained in the severe malnutrition category. The present study highlights that the existence of multiple trace element and vitamin deficiencies in the diets of SMN children could play a role in the severe malnutrition of these children.

A cause of Sudden Cardiac Deaths on Autopsy Findings; a Four-Year Report

INTRODUCTION

Incidence of sudden cardiac death (SCD) has been steadily increasing all over the world. While knowing the cause of SCD is one of the favorites of the physicians involved with these cases, it is very difficult and challenging task for the forensic physician. The present report is a prospective study regarding cause of SCDs on autopsy examination in four-year period, Bangalore, India.

METHODS

The present prospective study is based on autopsy observations, carried out for four-year period from 2008 to 2011, and analyzed for cause of SCDs. The cases were chosen as per the definition of sudden death and autopsied. The material was divided into natural and unnatural groups. Finally, on histopathology, gross examination, hospital details, circumstantial, and police reports the cause of death was inferred.

RESULTS

A total of 2449 autopsy was conducted of which 204 cases were due to SCD. The highest SCDs were reported in 50-60 years age group (62.24%; n-127), followed closely by the age group 60-69 (28.43%; n-58). Male to female ratio was around 10:1. The maximum number of deaths (n=78) was within few hours (6 hours) after the onset of signs and symptoms. In 24 (11.8%) cases major narrowing was noted in both the main coronaries, in 87 (42.6%) cases in the left anterior descending coronary artery (LAD), and in 18 (51.5%) cases in the right coronary artery (RCA). The major cardiac pathology resulting in sudden death was coronary artery disease (n-116; 56.86%) and myocardial infarction (n-104; 50.9%). most of the SCDs occurred in the place of residence (n-80; 39.2%) followed closely by death in hospital (n-49; 24.01%).

CONCLUSION

Coronary occlusion was the major contributory cause of sudden death with cardiac origin and the highest number of deaths were reported in the age 50-59 years with male to female ratio of 10:1.

TRC4149 a novel advanced glycation end product breaker improves hemodynamic status in diabetic spontaneously hypertensive rats

OBJECTIVE

Advanced Glycation Endproducts (AGEs), implicated as one of the major causes of diabetic complications, either directly or via receptor mediated actions, trigger downstream events in the conduit vessels, microvascular bed as well as myocardium leading to microvascular and cardiac dysfunction. The aim of this study was to characterise the activity profile of TRC4149, a novel AGE breaker compound, to determine its ability to reduce the burden of AGEs in vitro and in vivo and to evaluate whether the reduced AGE burden could translate into improvement in hemodynamic function in a model of Streptozotocin induced diabetic Spontaneously Hypertensive Rats (SHR).

METHOD

AGEs were prepared in vitro by incubating BSA and lysozyme with glucose or ribose while AGE-LDL was generated by copper catalyzed LDL oxidation. TRC4149 was evaluated using in vitro assays to determine its capacity to reduce the burden of AGEs and to test its antioxidant activity. To study the effect of TRC4149 on hemodynamic function, diabetic SHR implanted with telemetry transmitter were treated with TRC4149 (20 mg/kg i.p., b.i.d.) or vehicle for 14 weeks. Losartan was administered once per week and blood pressure was monitored telemetrically throughout the treatment period. Cardiac indices of systolic and diastolic function were assessed terminally using MacLab system. AGE load in aorta was determined immunohistochemically and VCAM expression was quantitated by real time PCR analysis.

RESULTS

TRC4149 was able to break preformed AGEs as well as reduce further AGE accumulation in vitro in a dose dependent manner. It also demonstrated a potent free radical scavenging activity. In diabetic SHR, treatment with TRC4149 retarded the decline in response to losartan over the study period, and also improved cardiac function as evidenced by an improved dP/dtmax/min, left ventricular systolic pressure and decreased left ventricular diastolic pressure as compared to untreated group. AGE load as well as VCAM expression in aorta was also reduced upon treatment.

CONCLUSIONS

TRC4149, a novel AGE-breaker compound, by virtue of reducing AGE load preserved endothelial and cardiac function in diabetic SHR, a model that recapitulates the microvascular and cardiac dysfunction associated with hypertension along with long-term diabetes.

Serum magnesium level among pregnant women in a rural community of Haryana State, India

OBJECTIVE

Assessment of serum magnesium levels among pregnant women in a rural community.

DESIGN

A community-based cross-sectional study.

SETTING

Investigation was conducted in six villages of a rural block of District Faridabad, Haryana State, India.

SUBJECTS

In total, 283 pregnant women with pregnancy duration of 28 weeks and more were enrolled for the detailed study. Blood from the antecubital vein was drawn and serum magnesium levels were estimated by the atomic absorption spectrophotometric method.

RESULTS

In all, 44% of the pregnant women had serum levels less than the normal level (1.80 mg/dl). There was a significant decrease (P=0.01) in serum magnesium levels with the increase in parity.

CONCLUSION

A high prevalence of magnesium deficiency was found among the pregnant women.

Association of vitamin A, vitamin C and zinc with laryngeal cancer

BACKGROUND

The incidence of the cancers of the oral cavity, pharynx, esophagus and larynx in different population groups of India is amongst the highest reported in Asian countries. There is evidence that high dietary carotenoids and vitamin C may possibly decrease the risk of laryngeal cancer. Limited data is available from India on the association between these micronutrients and the risk of laryngeal cancer.

AIMS

To assess the levels of vitamin A, vitamin C and zinc in laryngeal cancer patients and healthy controls.

SETTING AND DESIGN

A hospital based case- control study.

MATERIAL AND METHODS

One hundred and fifty five laryngeal cancer patients and a control group of 155 healthy individuals constituted the study population. Individuals in the control group were individually matched with the patients for their age +/- 2 years, sex and place of residence. Venous blood was drawn from the cases and controls and estimations of vitamin A, zinc and vitamin C was done utilizing the standard procedures.

STATISTICAL ANALYSIS USED

Paired 't' test to compare the mean serum levels of vitamin A and zinc and plasma vitamin C between laryngeal cancer patients and controls. Univariate logistic regression analysis to calculate the odds ratios and the confidence intervals.

RESULTS

The mean serum vitamin A, zinc and plasma vitamin C levels were significantly lower in laryngeal cancer patients as compared to the controls.

CONCLUSIONS

The findings of the present study indicated a strong association of these micronutrients with laryngeal cancer in the Indian population.

Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview

BACKGROUND AND PURPOSE

"Stress" hyperglycemia may be associated with increased mortality and poor recovery in diabetic and nondiabetic patients after stroke. A systematic review and meta-analysis of the literature relating acute poststroke glucose levels to the subsequent course were done to summarize and quantify this relationship.

METHODS

A comprehensive literature search was done for cohort studies reporting mortality and/or functional recovery after stroke in relation to admission glucose level. Relative risks in hyperglycemic compared with normoglycemic patients with and without diabetes were calculated and meta-analyzed when possible.

RESULTS

Thirty-two studies were identified; relative risks for prespecified outcomes were reported or could be calculated in 26 studies. After stroke of either subtype (ischemic or hemorrhagic), the unadjusted relative risk of in-hospital or 30-day mortality associated with admission glucose level >6 to 8 mmol/L (108 to 144 mg/dL) was 3.07 (95% CI, 2.50 to 3.79) in nondiabetic patients and 1.30 (95% CI, 0.49 to 3.43) in diabetic patients. After ischemic stroke, admission glucose level >6.1 to 7.0 mmol/L (110 to 126 mg/dL) was associated with increased risk of in-hospital or 30-day mortality in nondiabetic patients only (relative risk=3.28; 95% CI, 2.32 to 4.64). After hemorrhagic stroke, admission hyperglycemia was not associated with higher mortality in either diabetic or nondiabetic patients. Nondiabetic stroke survivors whose admission glucose level was >6.7 to 8 mmol/L (121 to 144 mg/dL) also had a greater risk of poor functional recovery (relative risk=1.41; 95% CI, 1.16 to 1.73).

CONCLUSIONS

Acute hyperglycemia predicts increased risk of in-hospital mortality after ischemic stroke in nondiabetic patients and increased risk of poor functional recovery in nondiabetic stroke survivors.

Role of micro-nutrients and trace elements in carcinoma of larynx

Cancer of the larynx is fourteenth most common cancer in the world. Evidence from case-control studies conducted in developed as well as developing countries suggest that specific micro-nutrients and trace elements have been implicated to be significantly associated with laryngeal carcinoma. The association of these micro-nutrients and trace elements with laryngeal cancer has been discussed in this review article.