Risk Assessment in Discharge Process using PFMEA Tool in a Multi-Specialty Hospital

Introduction: ‘Quality’ is an inseparable component of healthcare. It focuses not only on care parameters but also in identifying the potential failures/ risks associated with the care process; thereby addressing them pro-actively before the occurrence of the loss. There are several quality tools available such as Process Failure Mode Effect Analysis (PFMEA) that helps in analyzing a process for identification of possible failures. This helps to find ways to avoid the occurrence of the failure or have a strategy to eliminate or minimize the risk. Thus, the current study was undertaken on identifying the risks involved in the discharge process using PFMEA tool. Objectives: To identify the potential risks in patient discharge process and suggest measures to address the failures. Methodology: The study was conducted for a period of 2 months in a multi-specialty hospital. In-patient discharge process was observed in detail and potential failures in the process were identified with the help of a multidisciplinary team constituted for the same purpose. Brainstorming sessions were conducted with the team members to identify possible failures, its causes and effects. Basing on the severity, occurrence and detectability, failure was ranked on a scale of 1 to 10 and Risk Priority Numbers (RPN) were assigned to each of the potential risks in the process. Results: A total of 23 possible failures were identified which included inadequate explanation of discharge summary, missing diagnostic reports, delay in discharge medication initiation and unattended patient queries. RPN values have ranged from 60-320; depicting severity, occurrence and detectability of respective failures. Conclusion: Identifying the potential failures in the patient care process is very crucial for patient, provider and healthcare facility as it helps in the optimization of resources, adds value to patient care, leads to patient satisfaction thereby enhancing quality

ANALOGIZING OF METABOLIC SYNDROME IN SIDDHA SYSTEM OF MEDICINE-A LITERATURE REVIEW

Background: In worldwide, 20-25% of the population have the Metabolic Syndrome (MetS). The highest prevalence rate reported in South Asia of MetS in the Punjabi community in India by Adult Treatment Panel III criteria. The metabolic syndrome (MetS) is a major and escalating public-health and clinical challenge worldwide in the wake of rapid urbanization, surplus energy intake, increasing obesity, and sedentary life habits. Nowadays, the use of Complementary and Alternative Medicine (CAM) is increasing rapidly due to the inadequate solution for the newly developed health issues. Method: In this study, the International Diabetic Federation (IDF) criteria were used as a standard tool for comparison. A total of 9 sources (4 Siddha classical textbooks, e-data such as pub-med, Google scholar, AYUSH research portal, NAMSTP) were searched to identify the appropriate analog for MetS. Results: 13 Terms related to MetS were identified from the 4 Siddha classical literature, whereas the e-data did not provide any term related to MetS. In those 13 terms, 3 terms which were closely relevant to MetS signs and symptoms were Aiya Migu Kunam, Paci Aiya Noi, and Megam. As a final point, this paper identified the Siddha analog for MetS as Aiyamigukunam. Conclusion: This paper ended up with analog to MetS as Aiyamigukunam and made a comparison with the standard IDF criteria for MetS

Propagation of pure fetal and maternal mesenchymal stromal cells from terminal chorionic villi of human term placenta

Long term propagation of human fetal Mesenchymal Stromal Cells (MSC) in vitro has proven elusive due to limited availability of fetal tissue sources and lack of appropriate methodologies. Here, we have demonstrated the presence of fetal and maternal cells within the tips of Terminal Chorionic Villi (TCV) of normal human term placenta and we have exploited inherent differences in the adhesive and migratory properties of maternal vs. fetal cells, to establish pure MSC cultures of both cell types. The origin and purity of each culture was confirmed by X-Y chromosome-specific Fluorescence In Situ Hybridization (FISH) and Short Tandem Repeat (STR) genotyping. This is the first demonstration of fetal and maternal cells in the TCV of human term placenta and also of deriving pure fetal MSC cultures from them. The concomitant availability of pure cultures of adult and fetal MSC from one tissue provides a good system to compare genetic and epigenetic differences between adult and fetal MSCs and also to generate new models of cell based therapies in regenerative medicine

Mutational analysis of the betaglycan gene-coding region in susceptibility for ovarian

Background: Elevation of FSH is frequently a consequence of impaired ovarian follicle growth. Down-regulation of the FSH levels by inhibins is mediated through its receptor betaglycan in the gonadotrophs. Understanding of germline status of the betaglycan gene (TGFBR3) is essential for ovarian failure pathophysiology. Methods: Sequence analysis was performed for the coding region of TGFBR3 gene in a cohort of 196 ovarian failure cases that include 133 premature ovarian failure (POF) cases, 63 primary amenorrhoea (PA) cases compared with 200 controls. Results: Forty-six variants including six novel exonic variants and 16 novel intronic variants were revealed. Two variants were missense: (i) p.Iso184Val in a control and (ii) p.Pro775Ser in a POF case. Genotypic distribution of three variants (c.382-81C>T, c.382-77T>C and c.1200G>A) was significantly different in the patients as compared with the controls. Five variants c.382-81C>T, c.382-77T>C, c.566-216G>A, c.1200G>A and c.2022T>C were chosen for haplotyping. The CCAAT haplotype was significantly higher in the patient population as compared with the controls (P=0.00007). Conclusion: This study establishes the first mutational report of the TGFBR3 gene in correlation with ovarian failure. Significant diversity of genotype distribution and haplotype analysis suggested susceptibility of the TGFBR3 gene for ovarian failure aetiology

Traditional methods of purification (detoxification process) for Schedule E poisonous drugs

Medicinal plants have different types of active phytochemicals, which are still in use, either in their crude form or after proper processing. Though most of the plant drugs are safe, few are poisonous and may cause immediate toxic effect or cumulative toxic effect for human health. There are 25 poisonous or toxic plants in Siddha texts listed in the Schedule E of Drugs and Cosmetics Act 1940. The concept of Suthimuraigal in Siddha not only covers the process of purification and detoxification of physical and chemical impurities but also minimizes the side effects and improves the potency/therapeutic efficacy of the purified drugs. The aim of this review is to perceive the importance of the Schedule E drugs through their immense uses to treat diseases and to flourish the knowledge of purification processes to detoxify the poisonous elements, thus enhancing and utilizing them in curing challenging diseases. The distinct purification methods mentioned in Ayurvedic journals have also been reviewed for possible information. Methods of Suthi are variable and some of the important Siddha Suthimuraigal are reviewed in this paper. The traditional methods of purification may combat the toxic effects like ulceration, swelling, giddiness, skin rashes, pruritis also, thus enhancing the efficacy of the drugs in healing various ailments. Since these poisonous plants have very high potential to treat diseases, the chemical changes which transpired during the Suthi are to be revealed in further studies such as quantitative and qualitative analysis after their purification before they are applied in medicines

Traditional methods of purification (detoxification process) for Schedule E poisonous drugs

740-748Medicinal plants have different types of active phytochemicals, which are still in use, either in their crude form or after proper processing. Though most of the plant drugs are safe, few are poisonous and may cause immediate toxic effect or cumulative toxic effect for human health. There are 25 poisonous or toxic plants in Siddha texts listed in the Schedule E of Drugs and Cosmetics Act 1940. The concept of Suthimuraigal in Siddha not only covers the process of purification and detoxification of physical and chemical impurities but also minimizes the side effects and improves the potency/therapeutic efficacy of the purified drugs. The aim of this review is to perceive the importance of the Schedule E drugs through their immense uses to treat diseases and to flourish the knowledge of purification processes to detoxify the poisonous elements, thus enhancing and utilizing them in curing challenging diseases. The distinct purification methods mentioned in Ayurvedic journals have also been reviewed for possible information. Methods of Suthi are variable and some of the important Siddha Suthimuraigal are reviewed in this paper. The traditional methods of purification may combat the toxic effects like ulceration, swelling, giddiness, skin rashes, pruritis also, thus enhancing the efficacy of the drugs in healing various ailments. Since these poisonous plants have very high potential to treat diseases, the chemical changes which transpired during the Suthi are to be revealed in further studies such as quantitative and qualitative analysis after their purification before they are applied in medicines

Providing Diabetes Education through Phone Calls Assisted in the Better Control of Hyperglycemia and Improved the Knowledge of Patients on Diabetes Management

Purpose: A recent single-arm pilot study from our group showed a significant decrease in HbA1C in Type-2 diabetes individuals provided with SMS and phone call-based education on glycemic control. Considering the preference of participants to phone call-based education, a randomized control trial (RCT) with parallel design was conducted to determine the impact of phone call-based diabetes educational intervention on the control of hyperglycemia and improvement in the knowledge about diabetes management. Objectives: To determine the impact of phone call-based educational intervention on the control of hyperglycemia and improvement in the knowledge about diabetes management. Methodology: The study was conducted for a period of 12 months on a total of 273 Type-2 diabetic patients (interventional group (n = 135); non-interventional group (n = 138)) who had provided consent to participate. Subjects in the case group received weekly phone calls on diabetes education; whereas the control group received no education. HbA1C investigations were carried out at baseline and at every fourth month until the completion of the study period for the subjects in both the groups. The impact of phone call-based education was measured by comparing HbA1C values as well as by measuring the questionnaire-based knowledge scores on diabetes management. Results: At the end of the study period, there was a significant reduction in HbA1C in 58.8% participants (n = 65) and a manifold (2–5-fold) increase in knowledge on diabetes management among participants in the case group (n = 110). However, no significant difference in HbA1C and knowledge score was observed in participants from the control group (n = 115). Conclusion: Phone call-based diabetes education is a viable option to empower patients for better management of Type-2 diabetes

Intervention through Short Messaging System (SMS) and phone call alerts reduced HbA1C levels in ~47% type-2 diabetics-results of a pilot study.

PurposeDespite extensive research and newer methods of interventions, the incidence and prevalence of diabetes is increasing at an alarming rate. Currently, according to world health organization (WHO) statistics, 422 million individuals are suffering from diabetes worldwide. In India, recent estimates have reported a significant increase in the number of diabetics in the last decade. Poor dietary habits, minimal adherence to treatment regimens, lack of timely education are some of the contributing factors for increasing incidence and huge economic burden; which can be handled by life style behavior modifications backed up by hand holding through continuous education. Prior studies have demonstrated the efficacy of various self-management tools and educational programs in better disease management behaviors among individuals with diabetes. Among various self-management tools, educating the individuals and alerting them using mobile phone calls and short messaging system (SMS) are widely accepted due to (a) the increasing mobile phone users and (b) availability of short messaging systems in local languages in the recent years. Therefore, a pilot study was conducted to determine the benefit of educating patients through phone calls and SMS in the self-management of diabetes.ObjectivesThe objective of the study is to determine the feasibility and utility of SMS and phone call-based interventions in the management of diabetes by comparing the HbA1c values.MethodologyThe study was conducted for a period of 14 months from December 2017 till Feb 2019. Out of 380 individuals initially enrolled into the study, 120 had completed the 14-months period. Diabetes education through SMS and phone calls was provided on regular basis, and HbA1C levels at baseline, 8-months and 14-months quantified. In addition, feedback on patients' satisfaction and utility of the SMS / Phone calls was collected using questionnaires.ResultsData from our study demonstrated that after 8-months of intervention through phone calls, a significant increase in the number of individuals with HbA1c in the range of 5.1 to 7.0 was observed (from 27 individuals at base line to 37 individuals after 8-months intervention). Much more significant improvement in the number of individuals with lower HbA1c was observed at 14-months of intervention, indicating the benefit of regular phone call-based system in managing diabetes. A Chi square (χ2) test was performed to examine if the frequencies in the cells varied at baseline and at 8 and 14 months.ConclusionChronic diseases like diabetes needs awareness and education to patients in adopting disease self-management practices. As mobile phone users are increasing in number, providing diabetes management education through mobile phone intervention could be a viable strategy for controlling diabetes

Effect of some toxic metals on selected phytoplankton of Kerala water

The extraction and use of metals has been the mainstay for the sustained development and progress of a nation. Metals, though fairly stable in the natural environment are found in trace quantities in water bodies. Attention has therefore been focused to identify the metals that impair the water quality. In the last few decades the concern about the fate of these metals in the aquatic system has been gaining momentum, particularly in the industrial belts. The disasters caused by metal poisoning in recent times have prompted an indepth study of the interaction of metals with aquatic biota. Kerala, basically an agriculture oriented state has witnessed the upsurgence of various industries as a part of the nationwide economic development programme. Cochin has been identified as the industrial capital of the state.The present study is an attempt towards a better understanding of the metal-phytoplankton interactions with special reference to the physiological changes in the species. various parameters such as temperature, salinity, pH, nutrients, number of cells, photosynthetic pigments, carbohydrates, protein and lipid are studied to highlight the complexity of metal..phytoplankton interactionCochin University of Science and TechnologySchool of Environmental Studies, Cochin University of Science and Technolog

CYP1A1, GSTM1 and GSTT1 genetic polymorphism is associated with susceptibility to polycystic ovaries in South Indian women

Polymorphic variants in the phase I enzyme, cytochrome P450 gene, may lead to increased toxification, whereas polymorphisms in the phase II enzyme, glutathione S-transferase genes, may result in impaired detoxification. Alterations in the activities of phase I drug metabolizing enzymes and phase II detoxification enzymes may cause abnormal functioning and formation of follicular cysts in the ovaries and thus causing an imbalance in the hormone profiles. This study aimed to investigate the relationship between genetic polymorphisms of CYP1A1 (T6235C), GSTM1 and GSTT1 in South Indian women with polycystic ovaries (PCO) using polymerase chain reaction-restriction fragment length polymorphism. The frequencies of variants of these genes were studied in 180 women with confirmed PCO and in 72 healthy fertile women with successful pregnancy record. No significant difference was found between the frequencies of GSTM1 and GSTT1 null genotypes in PCO cases and healthy controls. However, CYP1A1 Msp I homozygous mutants were strongly associated (P=0.0139) with increased susceptibility to PCO. Three genotype combinations, CYP1A1(mt/mt) with GSTM1[-] and GSTT1[−], CYP1A1(wt/mt) with GSTM1[−] and GSTT1[−] and CYP1A1(mt/mt) with GSTM1[−], GSTT1[+], were also observed in women with PCO. In conclusion, the presence of hyperinducible CYP1A1 (T6235C) mutant genotype and its mutants in combination with GSTM1 and GSTT1 null genotypes might cause an imbalance between phase I and phase II enzymes, and therefore may represent a risk factor for PCO