Prenatal Pericardiocentesis and Postnatal Sirolimus for a Giant Inoperable Cardiac Rhabdomyoma

We describe the case of an antenatally diagnosed massive cardiac tumor in a fetus requiring cardiorespiratory support immediately following birth. We further discuss the successful management of this case and highlight the importance of a multidisciplinary team in managing such complicated cases. (Level of Difficulty: Advanced.).

Optimizing Utilization of Laboratory Investigations in Neonatal Intensive Care Unit

OBJECTIVE

To optimize utilization of laboratory tests by measuring baseline rates and appropriateness of investigations, assessing the barriers to rational use, and developing and implementing an educational package for resident doctors.

DESIGN

Quality improvement study.

SETTING

Neonatal intensive care unit (NICU) from August, 2015 to December, 2016.

PARTICIPANTS

All neonates admitted in NICU and resident doctors working in NICU.

INTERVENTION

Addressing barriers, educational package, posters and group discussions.

MAIN OUTCOME MEASURES

Laboratory test rates for hematology, biochemistry and blood gas. Proportion of tests judged to be inappropriate.

RESULTS

At the baseline, median (IQR) laboratory test rate patient/day was 0.6 (0.2-1.5) and one-fifth of tests were classified as inappropriate. Mechanical ventilation and sepsis were independent predictors of laboratory test rates but could explain only 35% of the disparities, indicating variations in clinical practice. Following a short period of intervention, hematology investigations showed a trend towards reduction, though overall test rates did not change significantly.

CONCLUSION

Addressing barriers, creating awareness and educational interventions were able to bring down hematology laboratory test rates in a short period. A longer period of sustained intervention is required to demonstrate significant effects on test ordering behavior.

Evaluation of an anti-stigma campaign related to common mental disorders in rural India: a mixed methods approach

BACKGROUND

Stigma related to mental health is a major barrier to help-seeking resulting in a large treatment gap in low- and middle-income countries (LMIC). This study assessed changes in knowledge, attitude and behaviour, and stigma related to help-seeking among participants exposed to an anti-stigma campaign.

METHOD

The campaign, using multi-media interventions, was part of the SMART Mental Health Project, conducted for 3 months, across 42 villages in rural Andhra Pradesh, in South India. Mixed-methods evaluation was conducted in two villages using a pre-post design.

RESULTS

A total of 1576 and 2100 participants were interviewed, at pre- and post-intervention phases of the campaign. Knowledge was not increased. Attitudes and behaviours improved significantly (p < 0.01). Stigma related to help-seeking reduced significantly (p < 0.05). Social contact and drama were the most beneficial interventions identified during qualitative interviews.

CONCLUSION

The results showed that the campaign was beneficial and led to improvement of attitude and behaviours related to mental health and reduction in stigma related to help-seeking. Social contact was the most effective intervention. The study had implications for future research in LMIC.