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     

Improving Outcome of Thalassemia with Hematopoetic Stem Cell Transplantation: An Experience of Gujarat Cancer Research Institute

Total 26 children of thalassemia underwent hematopoetic stem cell transplantation from September 2006 to December 2014. Out of these 17 were matched sibling transplantation (MST) and 9 were unrelated umbilical cord blood transplantation (UCT). Median age was 4 years. At a median follow up of 46.5 months, 12 of 17 (70 %) MST and 3 out of 9 (33.33 %) UCT were cured of thalassemia. Three (11.53 %) patients died due to transplant related mortality. Average cost of MST was 6 lakhs and that of UCT was 20 lakhs.     

Remissions in maternal depression and child psychopathology: a STAR*D-child report

Context  Children of depressed parents have high rates of anxiety, disruptive, and depressive disorders that begin early, often continue into adulthood, and are impairing. Objective  To determine whether effective treatment with medication of women with major depression is associated with reduction of symptoms and diagnoses in their children. Design  Assessments of children whose depressed mothers were being treated with medication as part of the multicenter Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial conducted (between December 16, 2001 and April 24, 2004) in broadly representative primary and psychiatric outpatient practices. Children were assessed by a team of evaluators not involved in maternal treatment and unaware of maternal outcomes. Study is ongoing with cases followed at 3-month intervals. Setting and Patients  One hundred fifty-one mother-child pairs in 8 primary care and 11 psychiatric outpatient clinics across 7 regional centers in the United States. Children were aged 7 to 17 years. Main Outcome Measures  Child diagnoses based on the Kiddie Schedule for Affective Disorders and Schizophrenia; child symptoms based on the Child Behavior Checklist; child functioning based on the Child Global Assessment Scale in mothers whose depression with treatment remitted with a score of 7 or lower or whose depression did not remit with a score higher than 7 on the Hamilton Rating Scale for Depression. Results  Remission of maternal depression after 3 months of medication treatment was significantly associated with reductions in the children's diagnoses and symptoms. There was an overall 11% decrease in rates of diagnoses in children of mothers whose depression remitted compared with an approximate 8% increase in rates of diagnoses in children of mothers whose depression did not. This rate difference remained statistically significant after controlling for the child's age and sex, and possible confounding factors (P = .01). Of the children with a diagnosis at baseline, remission was reported in 33% of those whose mothers' depression remitted compared with only a 12% remission rate among children of mothers whose depression did not remit. All children of mothers whose depression remitted after treatment and who themselves had no baseline diagnosis for depression remained free of psychiatric diagnoses at 3 months, whereas 17% of the children whose mothers remained depressed acquired a diagnosis. Findings were similar using child symptoms as an outcome. Greater level of maternal response was associated with fewer current diagnoses and symptoms in the children, and a maternal response of at least 50% was required to detect an improvement in the child. Conclusions  Remission of maternal depression has a positive effect on both mothers and their children, whereas mothers who remain depressed may increase the rates of their children's disorders. These findings support the importance of vigorous treatment for depressed mothers in primary care or psychiatric clinics and suggest the utility of evaluating the children, especially children whose mothers continue to be depressed.      

In-vitro evaluation of the effect of canal curvature on adaptation of gutta-percha in canals obturated with HEROfill system by CBCT

A hermetic seal of the root canal space following canal preparation is important in endodontics. This study evaluated the effect of canal curve on adaptation of gutta-percha to dentinal walls of canals obturated using the Herofill system. For this in vitro study, 80 mesial roots of mature human first molars with length of 16 mm, curve between 5° and 45°, and no caries or resorption of the root surface were selected. A cone beam computed tomography system was used to evaluate the presence or absence of a gap in the samples. Photographs were taken in three sections: 2 mm above the curve, at the curve and 2 mm below the curve. The gap area was identified using Photoshop and AutoCAD software. Kruskal Wallis and Mann-Whitney tests were used to analyze the data mounted in a castcurve. There were significant differences between the two lateral condensation groups with various curves; roots with more curve had more gaps. When the Herofill and lateral condensation groups were compared without considering the sections and curve, there was a significant difference between these groups and the Herofill group had less gaps. The Herofill system is an alternative to the lateral condensation technique in severely curved canals.     

Potentially inappropriate prescribing in elderly: assessing doctor knowledge,confidence and barriers

Introduction Inappropriate medication prescribing by doctors is an important preventable cause of morbidity and mortality in the elderly. This study investigates doctor knowledge about potentially inappropriate prescribing (PIP) in elderly, their confidence in prescribing for the elderly and explores perceived barriers. Methods Family and Internal Medicine resident and attending doctors at three teaching hospitals were asked to complete a survey. Six clinical vignettes based on the 2003 Beers criteria were used to evaluate doctor knowledge about medications to avoid in the elderly. Confidence in prescribing for the elderly and perceived barriers to appropriate prescribing in elderly was assessed using a 5‐point Likert scale. Results Eighty‐nine doctors completed the survey, for a response rate of 45%. Forty‐four per cent of surveyed doctors estimated that over 25% of their practice consisted of patients 65 years or older. When knowledge of PIP was assessed via vignettes, the mean correct response was 3.9 (SD: 1.1, min = 1, max = 6). Only 14% of those doctors scoring ≤4 vignettes correctly had used the Beers criteria for prescribing; 31% of the doctors answering ≥5 vignettes correctly had used the Beers criteria (P = 0.08). Overall, 75% of doctors felt confident about their prescribing irrespective of their knowledge scores. Seventy per cent of surveyed doctors cited at least seven different barriers to appropriate prescribing in elderly. Conclusions Many primary care doctors possess a poor knowledge of PIP and are unaware of prescribing guidelines such as the Beers criteria. Our survey indicates that doctor usage of the Beers criteria might correlate with improved judgement in prescribing for the elderly. Most doctors report multiple barriers to appropriate prescribing in the elderly. Lack of formal education about prescribing guidelines was the only barrier that correlated with the doctors' level of training.     

Oesophagitis dissecans superficialis complicating repeated rigid oesophagoscopy and dilatation

Oesophagitis dissecans superficialis is an extremely rare and benign condition where the mucosal epithelium of the oesophagus sloughs off along the whole length of the oesophagus and is expelled as an oesophageal cast. This condition has been reported in association with various aetiological factors. We report a case of an oesophageal cast in a patient who underwent repeated oesophagoscopy and dilatation for a postcricoid web. We discuss the possible relationship between trauma to the upper oesophagus and the development of oesophagitis dissecans superficialis.     

Orphanin FQ/nociceptin analgesia in the rat

The heptadecapeptide orphanin FQ or nociceptin (OFQ/N), the endogenous ligand for the orphan opioid receptor, has a complex pharmacology in mice, eliciting either an anti-opioid/hyperalgesic action or analgesia depending upon the dose and testing paradigm. Unlike mice, orphanin FQ/nociceptin fails to elicit hyperalgesia in the rat following intracerebroventricular injection. Both OFQ/N and a truncated version, OFQ/N(1-11), produce a robust analgesic response. OFQ/N analgesia is readily antagonized by the opioid antagonists naloxone or diprenorphine, despite their very poor affinity for the cloned orphan opioid receptor. Antisense studies revealed that probes targeting the second and third coding exon of the orphan clone significantly attenuate OFQ/N analgesia, while the exon 1 probe was inactive. These results indicate that OFQ/N elicits a naloxone-sensitive analgesia in rats similar to that previously reported in mice.     

Enhancing the effectiveness of the Health Star Rating via presentation modifications

Objective : Research demonstrates the superiority of highly interpretive front‐of‐pack nutrition labels. The aim of this study was to assess the potential to enhance the Health Star Rating (HSR) by increasing its ‘interpretiveness’ through the addition of colour and the exclusion of the nutrient icons. Methods : An online survey was administered to 1,033 Australian adults who were randomly allocated to one of four conditions: black and white (B&W) full HSR, colour full HSR, B&W star rating only, and colour star rating only. Each respondent viewed four packs of breakfast cereal of varying levels of healthiness as indicated by the displayed HSRs. Respondents nominated the product option they would prefer to buy and then the one they understood to be healthiest. Results : Coloured HSR variations scored better than their B&W counterparts and the star‐only versions scored better than the corresponding versions displaying nutrient icons. Overall, the coloured star‐only HSR performed significantly better than the B&W full HSR for both choice and understanding. Conclusions : Increasing the interpretive nature of the HSR could enhance its effectiveness. Implications for public health : Policy makers should consider the evolution of the HSR towards a more interpretive presentation that includes colour and excludes the nutrient icons.     

Production of Monocyte Chemotactic Protein-1 (MCP-1/JE) by Bone Marrow Stromal Cells: Effect on the Migration and Proliferation of Hematopoietic Progenitor Cells

Recombinant chemotactic cytokines (chemokines) have been shown to modulate in vitro proliferation of hematopoietic progenitor cells. Whether bone marrow stromal cells produce chemokines and the physiological role they may have in the regulation of hematopoiesis has largely remained unexamined. We have examined the expression of monocyte chemoattractant protein-1 (MCP-1/JE) in bone marrow stromal cells and its effect on the migration and proliferation of murine hematopoietic progenitor cells. Freshly derived murine bone marrow stromal cells were found to secrete abundant amounts of MCP-1/JE, which was further increased upon stimulation of stromal cells with pro-inflammatory agents LPS, IL1-α, IFN-γ, or TNF-α. Although culture supernatant conditioned by stromal cells exhibited chemotactic activity toward hematopoietic progenitor cells, the chemotactic activity was not due to MCP-1/JE. Furthermore, rMCP-1/JE also failed to induce migration of progenitor cells. MCP-1/JE, however, caused 20 to 30% increase in the clonal expansion of progenitor cells. Thus, although MCP-1/JE does not chemoattract hematopoietic progenitor cells it may have a role in their proliferation and clonal expansion.