END OF LIFE CARE DECISIONS AND THE HOSPICE MOVEMENT

Inspite of spectacular technological advances made in the recent years, modern medicine has not been able to deny the inevitability of death. Slowly but surely, the approach towards death is changing with increasing emphasis on various end of life care decisions. Many of these decisions are being actively discussed, debated and practised all over the world. Palliative care in hospice has become an accepted mode of management of terminally ill patients, for whom the prognosis is limited. Increase in life expectancy of the Indian people and a strong movement to authorise ex-servicemen for treatment of malignant and other chronic diseases in service hospitals, requires the Armed Forces to consider these end of life care decisions and plan for terminal care in hospice.KEY WORDS: End of Life Care Decision, Hospice, Palliative Care     

COSTING A HOSPITAL SERVICE PRODUCT: MARGINAL Vs ABSORPTION COSTING

Costing a service product is a challenging but important tool for cost control. Different methods used for costing may provide varying costs and the choice of the method used becomes important. Use of absorption costing and marginal costing method and treatment of labour cost as variable and fixed cost provided different results in the present study of the cost of below knee patellar tendon bearing prosthesis. The study shows that marginal costing should also be done along with the absorption cost as it provides better indicator for cost control.Key Words: Absorption Costing, Cost Control, Marginal Costing, Prosthesis     

TOTAL QUALITY MANAGEMENT - THE NEW PARADIGM IN HEALTH CARE MANAGEMENT

Hospitals are by nature complex organisations and the complexity is compounded in service hospitals with perceived notion of service deficiencies. Quality has emerged as a major issue in health care sector and TQM has been accepted as a major long-term strategic initiative towards continuously improving quality of health care. Key concepts of TQM start with top management leadership with emphasis on process and customer focus. Implementation of TQM in service hospitals will require Quality Management awareness, training and framework development as well as development of customer awareness. TQM has been widely applied in clinical field with successful outcome. TQM is not a short-term solution, it has to be understood and practised as a long-term strategic commitment.Key Words: Quality in Health Care, Total Quality Management(TQM)     

Paraplegia treated with blood transfusion

Extramedullary hematopoiesis is a compensatory response in patients with thalassemia and other chronic anemia and can result in compressive myelopathy, if untreated. Two young adults with history of thalassemia presented with symptoms of spinal cord compression. Presence of extramedullary hematopoiesis was confirmed by magnetic resonance imaging. Both the patients were treated with blood hypertransfusion and showed improvement clinically and radiologically. Although there are various options in the management of such condition, including decompression surgery and radiation treatment, hypertransfusion can be very effective even in severe compression of the spinal cord. Hypertransfusion should be tried as the first line of management in patients with thalassemia presenting with compressive myelopathy to decrease the bulk of extramedullary hematopoietic tissue.     

BEHAVIOURAL AND EMOTIONAL PROBLEMS IN SCHOOL GOING ADOLESCENTS

Background

Adolescents are highly vulnerable to psychiatric disorders. This study aimed to explore the prevalence and patterns of behavioural and emotional problems in adolescents. It was also aimed to explore associations between socioenvironmental stressors and maladaptive outcomes.

Method

A school based cross-sectional study was conducted between January and July 2008. A stratified random sampling was done. 1150 adolescents in 12 to 18 year age group in grades 7 to 12 in 10 co-educational schools (government run and private) were the subjects of the study. Behavioural and emotional problems were assessed using Youth Self-Report (2001) questionnaire. Family stressors were assessed using a pre-tested 23 item questionnaire. Univariate and multivariate analysis were performed. Multiple logistic regression analysis was also done.

Results

Prevalence of behavioural and emotional problems in adolescents was found to be 30%, with girls exceeding boys in all age groups. Internalizing syndrome was the most common (28.6%) psychiatric problem. On stepwise regression analysis, a perceived lack of emotional proximity to mother had the highest odds (3.489) followed by addiction in father (2.642) and marital discord in parents (1.402). Type of school, type of family, socioeconomic status, relationship with father, mother&s employment and educational status were not found to be significantly associated

Conclusion

An alarming number of our adolescents suffer from emotional and behavioural problems which have their roots in the family environment. These data suggest urgency in establishing a school based mental health service.     

Investigation of DNA damage response and apoptotic gene methylation pattern in sporadic breast tumors using high throughput quantitative DNA methylation analysis technology

Background-  

Sporadic breast cancer like many other cancers is proposed to be a manifestation of abnormal genetic and epigenetic changes. For the past decade our laboratory has identified genes involved in DNA damage response (DDR), apoptosis and immunesurvelliance pathways to influence sporadic breast cancer risk in north Indian population. Further to enhance our knowledge at the epigenetic level, we performed DNA methylation study involving 17 gene promoter regions belonging to DNA damage response (DDR) and death receptor apoptotic pathway in 162 paired normal and cancerous breast tissues from 81 sporadic breast cancer patients, using a high throughput quantitative DNA methylation analysis technology.     

Chemotherapy of leishmaniasis part-VIII: synthesis and bioevaluation of novel chalcones

Some novel dihydro-alpha-ionone based chalcones have been synthesized and evaluated for their in vitro antileishmanial activity in promastigote and amastigote model. Some of the compounds showed 100% inhibition at 5 and 2 microm/ml concentration.     

Conventional MRI at presentation does not predict clinical response to radiation therapy in children with diffuse pontine glioma

BACKGROUND： Diffuse pontine glioma is a pediatric brain tumor with a median survival time of 1 year and few long-term survivors. Conventional MRI has not been shown to predict overall survival. With this dismal prognosis, clinical improvement after radiation therapy might be a more relevant issue. OBJECTIVE： To determine whether initial imaging would predict clinical response. MATERIALS AND METHODS： We performed a retrospective review of children with diffuse pontine glioma treated at The Children＇s Hospital, Denver, and the University of Colorado-Denver from 1995 to 2008. The 30 children were divided into two groups based on acute clinical response to radiation therapy.     

Mediastinal histoplasmosis granuloma: evaluation with CT

Mediastinal granuloma secondary to histoplasmosis was described in three patients. Computed tomographic scans in each patient demonstrated a large, low-attenuation mediastinal mass crossed by enhancing septae. Other granulomatous diseases may produce similar abnormalities. The differential diagnosis of such lesions was discussed.