Ayurvedic, Allopathic & Integrated Treatment of Diabetes in Northern India: Practitioner Perceptions

This study is based on a research of diabetic treatment and medical integration in Uttarakhand, North India. It explores ayurvedic, allopathic, and integrated diagnoses and treatment of diabetes with a focus on adult-onset (Type II) diabetes. Not only is India ranked second in the world in diabetes prevalence, but it is also the host of the two prevailing systems of medicine described in this study: Ayurveda and Allopathy. Considering the shortcomings of modern medicine to prevent and treat chronic illness, there has been much discourse about the value of integrating Ayurveda and Allopathy. This study seeks to answer how ayurvedic and allopathic physicians compare in their philosophies underlying the treatment of Type II diabetes, their perceptions of Ayurveda and Allopathy, and in their views of their own integrative practices as well as in the value and existence of integration. The research for this study was done in the spring of 2014. The data are derived from semi-structured interviews with eleven physicians in the cities of Dehradun, Rishikesh, and Palampur. The interpretivist and critical medical anthropology theoretical approaches serve as a guide to the methodology of this study. Findings suggest that allopathic and ayurvedic physicians have many differences in their descriptions, classifications, and treatments of Type II diabetes, as well as a few similarities. The ayurvedic and allopathic physicians of this study are well matched in their knowledge of the strengths and benefits of the other pathy. The knowledge that physicians have about the other system either prompts or discourages their ability and desire to integrate. Ayurvedic and allopathic physicians share both positive and negative views about integration. Although not all interviewed physicians support integration, many of them list particular circumstances in which it should occur. Scholarly implications of this study include a need for a closer analysis and quantification of the ways that unstructured integration is occurring. In light of the potentially harmful effects of unstructured integration and the valuable outcomes of structured integration, practical implications include a need for more dually trained physicians

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Epidemiology of Patients with Head Injury at a Tertiary Hospital in Rwanda

Introduction: Traumatic injuries disproportionately affect populations in low and middle-income countries (LMIC) where head injuries predominate. The Rwandan Ministry of Health (MOH) has dramatically improved access to emergency services by rebuilding its health infrastructure. The MOH has strengthened the nation’s acute emergency response by renovating emergency departments (ED), developing the field of emergency medicine as a specialty, and establishing a prehospital care service: Service d’Aide Medicale Urgente (SAMU). Despite the prevalence of traumatic injury in LMIC and the evolving emergency service in Rwanda, data regarding head trauma epidemiology is lacking.Methods: We conducted this retrospective cohort study at the University Teaching Hospital of Kigali (UTH-K) and used a linked prehospital database to investigate the demographics, mechanism, and degree of acute medical interventions amongst prehospital patients with head injury.  Results: Of the 2,426 patients transported by SAMU during the study period, 1,669 were found to have traumatic injuries. Data from 945 prehospital patients were accrued, with 534 (56.5%) of these patients diagnosed with a head injury. The median age was 30 years, with most patients being male (80.3%). Motor vehicle collisions accounted for almost 78% of all head injuries. One in six head injuries were due to a pedestrian struck by a vehicle. Emergency department interventions included intubations (6.7%), intravenous fluids (2.4%), and oxygen administration (4.9%). Alcohol use was not evaluated or could not be confirmed in 81.3% of head injury cases. The median length of stay (LOS) in the ED was two days (interquartile range: 1,3). A total of 184 patients were admitted, with 13% requiring craniotomies; their median in-hospital care duration was 13 days. Conclusion: In this cohort of Rwandan trauma patients, head injury was most prevalent amongst males and pedestrians. Alcohol use was not evaluated in the majority of patients.  These traumatic patterns were predominantly due to road traffic injury, suggesting that interventions addressing the prevention of this mechanism, and treatment of head injury, may be beneficial in the Rwandan setting.&nbsp