Strategic planning and designing of a hospital disaster manual in a tertiary care,teaching, research and referral institute in India

BACKGROUND:

As per the “Disaster Management Act, 2005” of India, it is mandatory for government hospitals in India to prepare a disaster plan. This study aimed to prepare a disaster manual of a 1 900 bed tertiary care hospital, in consultation and involvement of all concerned stakeholders.

METHODS:

A committee of members from hospital administration, clinical, diagnostic and supportive departments worked on an initial document prepared according to the Act and gave their inputs to frame a final disaster manual.

RESULTS:

The prepared departmental standard operating procedures involved 116 people (doctors and paramedical staff), and were then synchronized, in 12 committee meetings, to produce the final hospital disaster manual.

CONCLUSIONS:

The present disaster manual is one of the few comprehensive plans prepared by the stakeholders of a government hospital in India, who themselves form a part of the disaster response team. It also helped in co-ordinated conduction of mock drills.KEYWORDS: Disaster Management Act, Disaster manual, Hospital administration, Stakeholders, Mock drills     

Paradoxical structural effects in the unilaterally denervated spontaneously hypertensive rat kidney

OBJECTIVE: To determine the effects of chronic denervation on renal vascular structure and function in young adult spontaneously hypertensive rats (SHRs). DESIGN: Unilateral renal denervation (SHRUDx) or sham-operation (SHRS) was performed in SHRs at 6 weeks of age. At 10 weeks, rats were allocated to one of three procedures designed to examine renal vascular structure and function. A further group underwent bilateral renal denervation. METHODS: In SHRUDx or SHRS groups, either the kidneys were perfusion-fixed for stereological estimates of artery wall and lumen dimensions or for vascular casting to determine arteriole lumen diameters, or the rats were anaesthetized for estimation of glomerular capillary pressure. RESULTS: Chronic unilateral renal denervation had no significant effect on the development of hypertension between 6 and 10 weeks of age, as previously reported, but resulted in luminal narrowing of the interlobular artery (denervated group 52 +/- 2 mum, sham-operated group 64 +/- 1 mum; P < 0.01 for interaction between strain and treatment), without alterations in interlobular or arcuate artery wall dimensions. There were no significant effects on either afferent or efferent arteriole lumen diameters. Estimated glomerular capillary pressure was significantly lower in the denervated kidneys of SHRUDx (47 +/- 1 mmHg) compared with kidneys of the SHRS (50 +/- 1 mmHg; P < 0.04). Mean arterial pressure was approximately 12 mmHg lower in the bilaterally denervated SHRs than in the sham-operated SHRs. CONCLUSIONS: Although bilateral denervation attenuated the development of hypertension in SHRs, unilateral denervation did not, indicating that one neurally intact kidney was sufficient to drive the normal development of SHR hypertension, but only with apparent prohypertensive compensatory changes in the denervated kidney.     

Incidence,Predictors, and Prognostic Value of Acute Kidney Injury Among Patients Undergoing Left Atrial Appendage Closure

Objectives

The aims of this registry were to determine the incidence, predictors, and prognostic value of periprocedural acute kidney injury (AKI) after left atrial appendage closure (LAAC).

Prophylactic antibiotics for simple hand lacerations: Time for a clinical trial?

BackgroundSimple hand lacerations (not involving bones, tendons, nerves, or vessels) are a common emergency department (ED) complaint. Whilst the practices of irrigation, debridement, foreign body removal, and suture repair are well accepted, the use of prophylactic antibiotics is not. Without evidenced-based guidelines, practice is left to physician preference.ObjectivesThe aim of this study was to assess the need for, and the feasibility to perform, a randomised controlled trial to evaluate the role of prophylactic antibiotics in simple hand lacerations.MethodsThe study was done in three phases: (1) estimation of the national ED burden of simple hand lacerations and the use of antibiotic prophylaxis; (2) assessment of indications for antibiotic prophylaxis and (3) investigation of patient willingness to enrol in a randomised controlled trial and their preferred outcomes from simple hand lacerations. For Phase 1, we analysed the 2007 National Hospital Ambulatory Medical Care Survey. For Phase 2, we surveyed ED physicians in three urban teaching institutions (two in Brooklyn, NY and one in Washington, DC). For Phase 3, we surveyed ED patients at the same three institutions.ResultsPhase 1: out of 116.8 million ED visits nationally in 2007, 1.8 million (1.6%) were due to simple hand lacerations, of which 1.3 million (71%) required repair. Of those repaired, 27% (95% CI, 19–35%) were prescribed prophylactic antibiotics, most commonly cephalexin (73%). Phase 2: out of 108 providers surveyed, 69 (64%) responded. 16% (95% CI, 9–27%) reported prescribing prophylactic antibiotics routinely, most commonly cephalexin (84%, 95% CI, 67–93%). The degree of contamination was the most important factor (91%, 95% CI, 82–96%) in the physicians’ decision to prescribe antibiotics. Phase 3: of the 490 patients surveyed, 64% (95% CI, 60–68%) expressed interest in participating in a study to evaluate the use of prophylactic antibiotics. Their primary concern was prevention of infection (77%, 95% CI, 73–81%).ConclusionSimple hand lacerations represent a substantial number of ED visits in the United States. Absence of clear guidelines, disparity in physician practice, and patient interest in infection prevention all support performing a prospective randomised controlled trial to establish the role of antibiotic prophylaxis in simple hand lacerations.     

Nutrition Research in India: Underweight,Stunted, or Wasted?

India has experienced dramatic economic growth in the past 2 decades accompanied by a rising burden of noncommunicable diseases, which coexists with the unfinished agenda of undernutrition. Tackling these dual challenges requires strong investment in nutrition research. We compared India's research output with another rapidly developing country (China) and an established developed country (USA). We analyzed trends for each country between the periods 2000 to 2005 and 2006 to 2010, in terms of quantity and quality of the publications. India produced 2,712 articles (1.9% of the global total) in the 2000 to 2005 period and 3,999 articles (2.1%) in the 2006 to 2010 period, and the country impact factor was 191 and 174, respectively. The contributions to the top 10 nutrition journals during 2006 to 2010 was 1%. India must increase investment in and attention towards quality nutrition research and address potential barriers to publish.     

Modulation of glycemic response by protein, fat and dietary fibre

Five healthy young male volunteers were given isocaloric meals composed of glucose alone or in combination with protein, fat, or dietary fiber. Glycemic response was blunted in case of all mixed meals, the glucose level at 2.0 h and the area under the 2-h glucose curve being significantly lower (p<0.05) as compared to the glucose-only meal. Insulin responses to various meals were not significantly different from one another. The data point to an improved efficiency of insulin when nutrients other than carbohydrate are incorporated in a glucose meal.     

Effect of cellulose and ispaghula husk on fasting blood glucose of developing rats

Fasting blood sugar was measured at the beginning and end of a 4-wk dietary period during which weanling rats were fed either a fibre-free diet, or a similar diet containing cellulose or ispaghula husk. The fibre-free group showed no significant change, but the groups fed cellulose or ispaghula showed a significant fall in fasting blood sugar.     

A brief but comprehensive lifestyle education program based on yoga reduces risk factors for cardiovascular disease and diabetes mellitus

OBJECTIVES: The objective of the study was to study the short-term impact of a brief lifestyle intervention based on yoga on some of the biochemical indicators of risk for cardiovascular disease and diabetes mellitus. DESIGN: The variables of interest were measured at the beginning (day 1) and end (day 10) of the intervention using a pre-post design. SETTING: The study is the result of operational research carried out in our Integral Health Clinic (IHC). The IHC is an outpatient facility which conducts 8-day lifestyle modification programs based on yoga for prevention and management of chronic disease. A new course begins every alternate week of the year. SUBJECTS: The study is based on data collected on 98 subjects (67 male, 31 female), ages 20-74 years, who attended one of our programs. The subjects were a heterogeneous group of patients with hypertension, coronary artery disease, diabetes mellitus, and a variety of other illnesses. INTERVENTION: The intervention consisted of asanas (postures), pranayama (breathing exercises), relaxation techniques, group support, individualized advice, lectures and films on the philosophy of yoga and the place of yoga in daily life, meditation, stress management, nutrition, and knowledge about the illness. OUTCOME MEASURES: The outcome measures were fasting plasma glucose and serum lipoprotein profile. These variables were determined in fasting blood samples, taken on the first and last day of the course. RESULTS: Fasting plasma glucose, serum total cholesterol, low-density lipoprotein (LDL) cholesterol, very- LDL cholesterol, the ratio of total cholesterol to high density lipoprotein (HDL) cholesterol, and total triglycerides were significantly lower, and HDL cholesterol significantly higher, on the last day of the course compared to the first day of the course. The changes were more marked in subjects with hyperglycemia or hypercholesterolemia. CONCLUSIONS: The observations suggest that a short lifestyle modification and stress management education program leads to favorable metabolic effects within a period of 9 days.     

Acute toxicity of textile dye wastewaters (untreated and treated) of Sanganer on male reproductive systems of albino rats and mice

This study reports on the toxic effects of 15-days oral administration of untreated (Influent) and treated (Effluent) textile dye wastewaters on male reproductive systems of adult Swiss albino rats (age: 85–90 days) and mice (40–50 days). Textile dye wastewaters decreased body weight (7–25%) and reproductive organ weight (testis, epididymis, prostate gland and seminal vesicle, 2–48%). Similar trends were noted for total protein (14–70%), cholesterol (14–91%) and total lipid (10–30%) content of reproductive organs and spermatozoa, and for fructose levels in seminal vesicle (18–44%). Acid phosphatase activity in prostate however, was increased (11–44%) in the wastewater-exposed animals. Histopathological studies of treated animals revealed altered spermatogenesis, with higher sperm abnormalities, reduction in sperm counts (10–59%), and altered motility (14–56%). The magnitude of these abnormalities was stronger in rats versus mice, while among treatments, it was stronger in the Influent animals. Adverse effects improved when treated rats were allowed to recover 45 days in the control condition. Only recovered Effluent rats were capable of fertilizing normal females indicating that treated wastewater was less toxic; however, in comparison to control rats, litter size and body weight gains of F₁ and F₂ generations were adversely affected. Thus, the present study has established toxicity of both untreated and treated textile dye wastewater on reproductive biology of male Albino mice and rats.