Training need assessment of nursing personnel as super specialty tertiary care hospitals in Northern India

Background - Super specialty tertiary care hospital equips nurses with the requisite knowledge and skills to deliver high quality care in their practice areas. This has necessitated adopting a structured approach to the training needs assessment (TNA) to identify the development needs of the nursing workforce at a tertiary care centre. This study involves Micro Level – Task/Job analysis i.e. identifies and describes all the skills performed by employees in a particular job and the knowledge, skills, attitudes and other behaviours needed for successful job performance. Aim and objectives: The study explores the training needs of nursing personnel at super specialty tertiary care hospital in northern India by analyzing the areas of knowledge and skills deficit as perceived by the nurses and assessing the expectations of doctors, about the role of nurses and deficiencies in their current knowledge, skills Design: Structured questionnaire based descriptive cross sectional study Methods: A set of questionnaire were framed using core competencies of nurses listed by Massachusetts department of higher education and nursing council of Hongkong and A questionnaire based descriptive cross sectional study among nurses, faculty, senior residents and patients were done. Results: The total sample collected for the study was 274 which included 19 faculty, 44 senior résidents, 211 nurses. Training needs identified to be further developed for Grade II and grade I nurses both by nurses and doctors are maximum in patient care and research domain followed by managerial/administrative and communication domain. Training needs agreed to be promoted for ANS’s are maximum in managerial/ administrative and communication domain. Training needs recognized for DNS’s /NS/CNO are maximum in managerial/ administrative and research domain followed by communication domain Conclusion – This study reflects the training need assessment of nurses in a super specialty tertiary care hospita

To study the existing system of surgical safety for cataract surgery at tertiary care ophthalmic centre to implement WHO surgical safety checklist

Background: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, named after the first President of India, was established on the 10th of March, 1967 as a National centre for ophthalmic science, to provide state of the art patient care, expand human resources for medical education and undertake research to find solutions to eye health problems of national importance. Average numbers of cataract surgeries performed per month are 700 to 1000.Methods: Anticipating implementation in 50% cases hundred cases of cataract surgery were observed to study the existing system of surgical safety followed at Dr. R.P. Center and gap analysis done, against the WHO surgical safety checklist for cataract surgery. Modified WHO surgical safety checklist for cataract surgery was developed and implemented in the centre. Barriers in implementation of surgical safety checklist were also identified, and remedial measures suggested.Results: Significant improvement was noticed in all the parameters after introduction of modified checklist.  The additional points which were added in modified surgical safety checklist were implemented in almost all the cases by the nursing staff. Overall mean compliance percentage before implementation of modified surgical safety check list at Dr. R.P.C was 37%±10.1 (P=0.001).  While after introduction of modified surgical safety check list the mean compliance has improved to 62.7%±10.3, Wilcoxon rank sum test/Independent test is applied for each domain.Conclusions: Cataract procedure is the most common surgical procedure performed in the population in India. High volume and high turnover increase the potential for errors. Compliance to surgical safety check list before intervention was 32%. After intervention in form of a focus group discussion and introduction of modified surgical safety check list has resulted in increase in the compliance rate to 67%. This study revealed that changes or additional work is not happily accepted by the staff. After six months of intervention of modified surgical safety checklist compliance rate was still high, this suggests that constant supervision and monitoring by senior staff can sustain the compliance rate.

To study the preferred antihypertensive drugs in patients suffering from diabetes mellitus at a tertiary care hospital of Uttarakhand with an emphasis on compelling indications

Background: People with diabetes are more likely to also have high blood pressure. Hypertension can increase the risk of diabetes complications and is a powerful risk factor for development of a wide variety of cardiovascular, cerebrovascular and renal diseases. The treatment of hypertension in patients with diabetes thus becomes all the more important and may effectively prevent cardiovascular events. This study was thus planned with the aim to study the preferred antihypertensive drugs in patients suffering from diabetes mellitus and to teach UG students about the clinical importance of compelling indications in the treatment of hypertension.Methods: A total of 100 prescriptions of patients suffering from hypertension and diabetes mellitus were collected from diabetic hypertensive visiting the department of Medicine. Data was analysed in terms of percentage to find out the most and least preferred antihypertensive drugs in diabetes mellitus.Results: ACE inhibitors (30.95%) and ARBs (30.16%) were the most preferred, diuretics (19.84%), and CCBs (11.9%), and beta blockers (7.14%) were the least preferred antihypertensive drugs in diabetes patients. Three patients were on non-pharmacological treatment and among the remaining 97 prescriptions, monotherapy was the most common mode (70.1%) of therapy for hypertension, and drugs in combination were prescribed to 29.89% patients.Conclusions: ACE-I and ARBs were the preferred antihypertensive drugs prescribed in diabetic hypertensive. Treatment of hypertension should be individualized depending upon the compelling indications. This should be taught to undergraduate students in a practical way in collaboration with Medicine department

Analysis of waiting time for elective surgical procedures in neurosurgery department at a tertiary care teaching hospital in NCT, India

Background: Reported increases in waiting times for publicly-funded elective surgeries have intensified the need to decrease wait by healthcare providers and hence the study.Methods: Descriptive study done in neurosurgery department, to ascertain waiting times for its elective surgeries, included a retrospective analysis of admitted post-surgical patients and a prospective study using interviews with relevant stakeholders to do a process mapping.Results: Median time from decision of surgery to actual date of surgery was found to be 110.5 days. It was calculated that for optimum utilization of present available OTs, 19 extra beds are required and to address the existing load of patients waiting for their respective surgeries there is a need of 63 additional beds with 2 additional OTs functioning per day.Conclusions: The most common cause of waiting time was unavailability of vacant beds due to mismatch in demand-supply. The reason for postponement of surgery after admission was found to be lack of availability of theatre time followed by patient not being fit for surgery. Shortage of operating time was due to delayed start of operation theatre time. The study recommends improving admission process, restricting OPD time, standardized patient prioritization depending on relevant clinical criteria

Effect of non-genetic factors on voluntary and involuntary culling in Holstein Friesian crossbred cattle

The present study focused on analysis of annual disposal pattern and identification of non-genetic factors affecting the incidence of culling in Holstein Friesian crossbred cattle. Data on disposal pattern of 1988 Karan Fries (Holstein Friesian crossbred) cows, spread over a period of 34 years (1978 to 2012), were utilized for the study. Culling was classified into 2 groups viz. voluntary (low milk production) and involuntary culling. Reasons of involuntary culling were categorized into locomotory problem (LP), poor health and weakness (PHW), teat and udder problem (TUP) and reproductive problem (RP). Logistic regression analysis was conducted to assess the effect of various non-genetic factors viz. number of normal lactations completed (NLC), calving type (CT), season of calving (SC) and period of calving (PC) on incidence of culling in various parities. The analysis of annual disposal pattern of the Karan Fries cows, revealed that the average annual replacement index, annual culling rate and annual disposal rate in the herd was 1.46, 24.40 and 29.80% per annum, respectively. Odd ratio estimates indicated that young calvers which did not complete atleast one normal lactation were 1.83 times more prone to culling because of PHW and were 0.95 and 0.33 times lesser prone to culling due to RP and LMP, respectively. Moreover, receiver operating characteristic (ROC) analysis indicated that the role of non-genetic factors in prediction of culling increased with parities and the logistic regression was efficient in predicting the incidence of parity wise culling, due to different involuntary causes, in Karan Fries cattle

Alzheimer's disease-like perturbations in HIV-mediated neuronal dysfunctions: understanding mechanisms and developing therapeutic strategies

Excessive exposure to toxic substances or chemicals in the environment and various pathogens, including viruses and bacteria, is associated with the onset of numerous brain abnormalities. Among them, pathogens, specifically viruses, elicit persistent inflammation that plays a major role in Alzheimer's disease (AD) as well as dementia. AD is the most common brain disorder that affects thought, speech, memory and ability to execute daily routines. It is also manifested by progressive synaptic impairment and neurodegeneration, which eventually leads to dementia following the accumulation of Aβ and hyperphosphorylated Tau. Numerous factors contribute to the pathogenesis of AD, including neuroinflammation associated with pathogens, and specifically viruses. The human immunodeficiency virus (HIV) is often linked with HIV-associated neurocognitive disorders (HAND) following permeation through the blood-brain barrier (BBB) and induction of persistent neuroinflammation. Further, HIV infections also exhibited the ability to modulate numerous AD-associated factors such as BBB regulators, members of stress-related pathways as well as the amyloid and Tau pathways that lead to the formation of amyloid plaques or neurofibrillary tangles accumulation. Studies regarding the role of HIV in HAND and AD are still in infancy, and potential link or mechanism between both is not yet established. Thus, in the present article, we attempt to discuss various molecular mechanisms that contribute to the basic understanding of the role of HIV-associated neuroinflammation in AD and HAND. Further, using numerous growth factors and drugs, we also present possible therapeutic strategies to curb the neuroinflammatory changes and its associated sequels.Peer reviewe

Targeting eosinophils in respiratory diseases: Biological axis, emerging therapeutics and treatment modalities

Eosinophils are bi-lobed, multi-functional innate immune cells with diverse cell surface receptors that regulate local immune and inflammatory responses. Several inflammatory and infectious diseases are triggered with their build up in the blood and tissues. The mobilization of eosinophils into the lungs is regulated by a cascade of processes guided by Th2 cytokine generating T-cells. Recruitment of eosinophils essentially leads to a characteristic immune response followed by airway hyperresponsiveness and remodeling, which are hallmarks of chronic respiratory diseases. By analysing the dynamic interactions of eosinophils with their extracellular environment, which also involve signaling molecules and tissues, various therapies have been invented and developed to target respiratory diseases. Having entered clinical testing, several eosinophil targeting therapeutic agents have shown much promise and have further bridged the gap between theory and practice. Moreover, researchers now have a clearer understanding of the roles and mechanisms of eosinophils. These factors have successfully assisted molecular biologists to block specific pathways in the growth, migration and activation of eosinophils. The primary purpose of this review is to provide an overview of the eosinophil biology with a special emphasis on potential pharmacotherapeutic targets. The review also summarizes promising eosinophil-targeting agents, along with their mechanisms and rationale for use, including those in developmental pipeline, in clinical trials, or approved for other respiratory disorders

Albumin Nano-Encapsulation of Piceatannol Enhances Its Anticancer Potential in Colon Cancer Via Downregulation of Nuclear p65 and HIF-1 alpha

Piceatannol (PIC) is known to have anticancer activity, which has been attributed to its ability to block the proliferation of cancer cells via suppression of the NF-kB signaling pathway. However, its effect on hypoxia-inducible factor (HIF) is not well known in cancer. In this study, PIC was loaded into bovine serum albumin (BSA) by desolvation method as PIC-BSA nanoparticles (NPs). These PIC-BSA nanoparticles were assessed for in vitro cytotoxicity, migration, invasion, and colony formation studies and levels of p65 and HIF-1α. Our results indicate that PIC-BSA NPs were more effective in downregulating the expression of nuclear p65 and HIF-1α in colon cancer cells as compared to free PIC. We also observed a significant reduction in inflammation induced by chemical colitis in mice by PIC-BSA NPs. Furthermore, a significant reduction in tumor size and number of colon tumors was also observed in the murine model of colitis-associated colorectal cancer, when treated with PIC-BSA NPs as compared to free PIC. The overall results indicate that PIC, when formulated as PIC-BSA NPs, enhances its therpautice potential. Our work could prompt further research in using natural anticancer agents as nanoparticels with possiable human clinical trails. This could lead to the development of a new line of safe and effective therapeutics for cancer patients

Correction: Aljabali, A.A.A.; et al. Albumin Nano-Encapsulation of Piceatannol Enhances Its Anticancer Potential in Colon Cancer via down Regulation of Nuclear p65 and HIF-1α. Cancers 2020, 12, 113

The authors wish to make the following corrections to this paper [...]