Frequency and Perceived Authenticity of Social Determinants of Health Discussion by Medical Trainees

Introduction Social determinants of health (SDOH)—the conditions in which people live, learn, and work—play a vital, but often neglected role in shaping a community’s health. SDOH influence risk factors for disease and access to healthcare, consequently promoting health inequities among different populations. Examining how providers discuss SDOH with patients can identify opportunities to better integrate social context into care. Methods We analyzed standardized patient (SP) encounters of rising UofL M3 trainees to 1) determine whether SDOH are integrated into healthcare conversations, and 2) investigate what constitutes an authentic conversation to identify how trainees can better express interest in a patient. SP encounters (n=41) were randomly sampled from 139 video recordings of new patient histories. Discussions concerning SDOH categories were coded for content, patient response, and the perceived authenticity of each interaction. Results The most frequently discussed SDOH was employment (80.49% of encounters) while financial security (0%), healthcare access (2.44%), and discrimination (2.44%) were among the least discussed. Trainees appeared more engaged and interested when they empathized with patients, provided reassurance, established personal connections, and displayed a logical/organized flow of thought. Discussion Clinical skills around SDOH could be improved if students were provided more practice incorporating patients’ answers about SDOH into the health management plan. SDOH discussions can be used to get to know the patient holistically and foster strong doctor-patient relationships, both of which are crucial communication/clinical skills assessed by licensing exams. Emphasis on SDOH in medical education can help students advance these skills.https://ir.library.louisville.edu/uars/1039/thumbnail.jp

A Prospective Randomised Control Double blinded study comparing ultrasound guided transversus abdominis plane block vs ultrasound guided ilioinguinal block for postoperative analgesia in children undergoing elective hernia repair surgery

INTRODUCTION: This study aimed to compare the postoperative analgesia between two non neuraxial regional anesthesia techniques -US-guided ilioinguinal/iliohypogastric (II/IH) nerve block and USguidedtransversusabdominis plane (TAP) block for pediatric unilateral inguinal herniotomy. OBJECTIVES: Primary Objective: Duration of analgesia. Secondary Objectives: Intraoperative hemodynamics, Post operative hemodynamics. METHODS: A Prospective Randomised Double Blinded control study of 70 children ASA I or II scheduled to undergo unilateral herniotomy was conducted in the department of Pediatric Anesthesiology, Institute of Child Health, Madras Medical College after Institution Ethics Committee approval. they were randomised and allocated into two groups group I which received USG ilioinguinal nerve block using bupivacaine 0.25% 0.2 ml/kg and group B received USG TAP block 0.5 ml/kg of 0.25% bupivacaine after induction of general anesthesia Time to first rescue analgesia, pain scores(FLACC) and intraoperative and postoperative hemodynamics were recorded. RESULTS: Duration of analgesia was higher in the Ilioinguinal block group(7 hours) compared to the TAP blocl group (5 hours and 29 minutes) which was statistically significant.FLACC pain scores for analgesic requirement were better in the Ilioinguinal block group compared to the TAP block group, which was statistically significant. Post operative systolic, diastolic blood pressure and mean arterial pressure were higher in the TAP block group compared to the ilioinguinal block group, which was statistically significant. In both groups intraoperative hemodynamics were comparable and statistically insignificant. In both groups no adverse effects occurred. CONCLUSION: We found that the time to first rescue analgesia was longer and the duration of analgesia was more stable in the group that received ilioinguinal block as compared with group which received TAP block and concluded that ultrasound guided nerve block provided longer and more efficient postoperative analgesia compared with tap block

A comparative study of intraocular pressure changes in postmenopausal normotensive and hypertensive women

Background: Elevated intraocular pressure is a major modifiable risk factor for preventing glaucoma. Changes in intraocular pressure are directly and significantly associated with changes in blood pressure. Menopausal women with hypertension are at an increased risk of developing elevated intraocular pressure. Aim of current study was to compare the intraocular pressure changes in postmenopausal normotensive and hypertensive women.Methods: 35 normotensive and 35 hypertensive (based on JNC7 classification) postmenopausal women in the age group of 45-55 years participated in the study. Blood pressure was recorded in the sitting position with a mercury sphygmomanometer. Intraocular pressure was measured using Goldmann applanation tonometer.Results: Mean Intraocular Pressure in postmenopausal normotensive women was 13.01 ± 2.61 mmHg while that of postmenopausal hypertensive women was 15.15 ± 2.16 mmHg which was statistically significant. A statistically significant correlation was observed between IOP and systolic blood pressure and positive correlation was obtained between IOP and diastolic blood pressure in postmenopausal hypertensive women.Conclusion: Menopausal women are at an increased risk of developing hypertension due to age, hormonal changes and obesity which may lead to increased IOP. IOP is also directly and significantly related to systemic blood pressure hence postmenopausal women with systemic hypertension need periodic ophthalmologic examination. Detecting early IOP changes will help them in identifying the risk groups and formulating strategies for screening glaucoma.

The Influence of Rice Husk and Tobacco Waste Biochars on Soil Quality

Heavy metal pollution in agricultural land threatens soil and food quality. Soil pollution could be remediate using biochar, but the effectiveness of biochar on soil quality improvement is determined by types of feedstock and pyrolysis temperature. This study was aimed to explore the effect of different types of biochar on soil properties. Biochar from rice husk and tobacco waste was applied to soil contaminated with lead and mercury. This study was conducted at Sumber Brantas, Malang East Java, and used a completely randomized design with three replicates. Heavy metals content was measured using AAS. The results of measurements were analyzed using analysis of variance at 5% and 1% significance levels. The initial analysis of the soil properties at the research site showed that the soil nutrient status was low, i.e. N (0.2 %), K (0.50 cmol+/kg), and CEC (5.9 me/100g) respectively, but soil pH was neutral (6.8). The research site also has crossed the threshold of heavy metal content for Hg (0.5 ppm), Pb (25.22 ppm), Cd (1.96 ppm), and As (0.78 ppm). Biochar added had a positive influence on soil characteristics improvement. It could increase the content of organic C, i.e. 35.12% and 31.81% and CEC (cation exchange capacity), i.e.30.56 me/100g and 28.13 me/100 g for rice husk biochar and tobacco waste biochar, respectively. However, N, P, and K contents were low i.e. N ( 0.33 and 0.30 %); P2O5 (148.79 and 152 ppm); K (1.58 and 2.11 mg/100g) for rice husk biochar and tobacco waste biochar, respectively

Modified Goff Symptom Index : Simple triage tool for ovarian malignancy

Objectives: Ovarian cancer often goes undiagnosed or misdiagnosed in the early stages. The present study aimed to validate a modified version of the Goff Symptom Index (GSI) in an Indian population. Methods: This prospective case-control study was conducted between July 2010 and June 2012 in a university hospital in Manipal, Karnataka, India. A total of 305 inpatients admitted for ovarian pathology investigations and outpatients undergoing routine gynaecological check-ups were included in the study. The modified GSI (MGSI) was used to investigate the presence, severity, frequency and duration of 10 ovarian cancer symptoms on a scale of 1–5. Four additional symptoms were included with those of the original GSI (two symptoms from a previous MGSI and two new symptoms). Patients were regarded as positive for ovarian cancer if symptoms occurred >12 times per month and time since onset was <1 year. Histopathology confirmed the diagnosis of ovarian tumours. Results: A total of 13 patients were excluded. The final sample (n = 292) was divided into a test group (n = 74) and a control group (n = 218) based on histopathology. Within the controls, 144 women were found to have benign tumours. The MGSI was positive in 71.6% of the test group as opposed to only 11.5% of the control group. The addition of two symptoms (loss of appetite and weight) to the GSI increased the test’s sensitivity from 71.6% to 77% without compromising specificity (88.5%). Conclusion: Based on these findings, the addition of two new symptoms (loss of appetite and weight) to the GSI is proposed in order to increase the test’s sensitivity. However, the addition of urinary symptoms to the GSI requires further validation

Prescription pattern of patients admitted in the intensive care unit of a tertiary care hospital in Puducherry, India: a cross sectional study

Background: Patients with varied demographic characteristics, admission criteria and heterogeneous group are admitted to medical Intensive Care Unit (ICU) and are usually associated with co-morbid illnesses. Instituting rational pharmacotherapy is the need of the hour for saving the life of critically-ill patients while irrational drug use may be life threatening. Drug use patterns and prescribing behaviour are the essential tools to measure drug use in health care facilities.Methods: A record based, cross-sectional, observational study was done at medical ICU, IGMC and RI, Puducherry after obtaining IEC approval. Systemic random sampling was followed and data was collected for a period of one year. Data were analysed based on demographic characteristics, prescribing pattern and WHO drug use indicators.Results: The data of 151 patients were analysed. Mean age of the patients admitted in ICU was 52.9±17.7 years. Percentage of male patients (57.6) admitted in ICU were more when compared to female patients (42.4). Infective etiology was the most common factor for ICU admission followed by cardiac disorders. Diabetes mellitus and hypertension were the most common co-morbidities. The average length of stay in ICU was 4.11±2.99 days. Duration of stay in ICU ranged from 1-5 days (78.8% patients) to 15-20 days (0.1% patients). On an average 10.6±4.3 drugs were prescribed for each patient. Percentage of drugs prescribed by generic name was 45.8%. Majority of the drugs (87.4%) were from essential medicine list. Antibiotics in the prescription was 13.8% and 44.4% of drugs were administered in parenteral route. The prescription was complete in 145 case sheets (96%). Majority of the patients (68.9%) were discharged with improvement in the condition for which they were admitted.Conclusions: This drug utilization study has highlighted the strengths and shortcomings of the prescription pattern of patients who were admitted in the critical care setup. The information derived from this research work will be transmitted to the stakeholders for implementing the modifications wherever applicable for the betterment of the patient and the community

The Epics Reinterpreted: Highlighting Feminist Issues While Sustaining Deep Motif

This article explores revisionist works based on the Ramayana and Mahabharata twin epics and looks at the voices of female protagonists. The main emphasis has been on the way that authoritative texts are utilized to create cultural hegemony on purpose for a particular impact. The article also highlights the power of stories and demonstrates how the textual politics in the retelling is directed towards achieving different outlines, especially the modern ideals of liberty, equality, and individuality. By providing a thorough study of the social and psychological struggles of epic women, the view also strikes at the fact that women encounter similar issues for generations. The review explores how Indian society’s patriarchal framework and social construction mistreated the epic heroines and how these elements still have an adverse effect on women in the present era. Their resistance patterns are used to classify and organize them

Global Discontents

My creative project explores toys as means to express economic issues of globalization. By exploiting the educational and imaginative aspects of toys for adults and children, I intend to reflect on the impact and pressures of globalization on employment, technology and environment. In creating these toys I hope to make a visual statement concerning critical issues of human survival, sustainability and the divisive side of globalization