Effectiveness of a Disease Management Program (DMP) in controlling the progression of Chronic Kidney Disease among hypertensives and diabetics. [version 3; peer review: 2 approved]

Background The occurrence rate of stage 5 chronic kidney disease (CKD) will be 151 per million population in India in the coming years. Comorbidities like diabetes mellitus and hypertension are the usual triggers of CKD. Hence this study aimed to control the progression of CKD and to note the effectiveness of a structured education program that would help in the prevention of complications related to diabetes and hypertension. Methods This quasi-experimental study was conducted among 88 participants who had hypertension, diabetes mellitus, or both for five or more years. The study objective was to find the effect of a Disease Management Program on delaying progression of CKD in patients with hypertension or diabetes mellitus. The baseline data were obtained from demographic proforma, and the clinical data collected were the blood pressure, serum creatinine, and random blood sugar (RBS) of the participants. The management of hypertension and diabetes mellitus was taught to them. In the fourth and the eighth month, blood pressure and blood sugar were reassessed. At one-year blood pressure, blood sugar, and serum creatinine were tested. Baseline and one-year follow-up blood pressure, blood sugar, and estimated Glomerular Filtration Rate were compared. Descriptive statistics and "Wilcoxon signed-rank test" were used to analyze the data. Results In one year, the mean systolic blood pressure reduced by six mm of Hg and mean blood sugar by 24 mg/dl. The prevalence of CKD stage three and above (< 60 ml/min/m2) was nine (10.22%). The median decline in eGFR was 5 ml/min/m2 (Z= 5.925, P< 0.001). Conclusion The Disease Management Program led to improvements in blood pressure and diabetes control and median progression of CKD was estimated at five ml/min/m2/year

Kinetics and kinematics of diabetic foot in type 2 diabetes mellitus with and without peripheral neuropathy: a systematic review and meta-analysis.

Diabetes mellitus patients are at increased risk of developing diabetic foot with peripheral neuropathy, vascular and musculoskeletal complications. Problems develop with a relatively high risk of infection, gangrene and amputation. In addition, altered plantar pressure distribution is an important etiopathogenic risk factor for the development of foot ulcers. The purpose of this systematic review is to understand the biomechanical changes involved through studies of foot kinematic and kinetic in type 2 diabetes mellitus. Scientific articles were identified using electronic databases including Science Direct, CINAHL, Springer Link, Medline, Web of Science, and Pubmed. The selection of articles to include in the systematic review was narrorwed after reading the full text, focusing on studies that used experimental designs relating to the biomechanics of diabetic foot. The meta-analysis report on gait velocity (neuropathy = 128 and non-diabetes = 131) showed that there was a significantly lower gait velocity in neuropathy participants compared to non-diabetes age-matched participants at a high effect level (-0.09, 95% CI -0.13 to 0.05; p < 0.0001). Regarding knee-joint flexion range, there was a significant difference between neuropathy and non-diabetes groups (4.75, 95% CI, -7.53 to 1.97, p = 0.0008). The systematic review found significant differences in kinematic and kinetic variables among diabetic with neuropathy, diabetic without neuropathy and non-diabetic individuals. The review also found that the sample sizes used in some studies were not statistically significant enough contribute reliably to the meta-analysis, so further studies with higher sample sizes are required

Formative Assessment Practice in Health Science Education

To explore the extent of practices of formative assessment in health science education, a self-report questionnaire was administered to faculty members of nursing and allied health sciences of a south India university. Simple percentages were computed to explore the extent of practice of formative assessment and the ways in which it is currently used to help students learn in nursing and allied health science courses. The study revealed that there is room for improvement in the way formative assessment is practiced currently in health science education

Quality of life in patients with alcohol use disorders admitted to de-addiction centers using WHOQOL-BREF scale—A cross-sectional study

BACKGROUND: Alcohol use disorders (AUDs) adversely affect a person's general health and the lives of their family and friends. These disorders are also the most undertreated mental illness with severe implications for public health. Hence, the present study aimed to employ the WHOQOL-BREF to assess the quality of life (QoL) of AUDs patients seeking treatment at de-addiction centers and identify the demographic variables associated with the QoL dimension scores. MATERIALS AND METHODS: A cross-sectional study was conducted among alcohol dependents taking treatment in de-addiction centers in Dakshina Kannada District, Karnataka. The WHOQOL-BREF questionnaire was administered to 124 subjects. Multiple regression analysis was carried out to identify the demographic variables associated with the QoL dimension scores. RESULTS: The domain mean scores were between 50 and 60 on the 0 to 100 scale. Age, social class, residential area, marital status, and years of drinking were the demographic variables found to be significantly associated with the dimension scores. CONCLUSIONS: Physicians should monitor the effect of alcoholism on QoL, and a multidisciplinary treatment plan with elements from the medical, social, and psychiatric fields should be used. The demographic variables should be considered while managing patients with AUDs

Caregiver Burden among Caregivers of Mentally Ill Individuals and Their Coping Mechanisms

Background: During a given year, almost 30% of the people around the world are affected by mentally ill health. In India, it accounts for about 20%. Caregivers face a lot of strain, ill health, and disrupted family life, with literature suggesting an increasing concern about their ability to cope up. The needs of caregivers of the mentally ill are given low priority in the current health-care setting in India. Aim: The aim of the study was to assess the burden of caregivers of mentally ill individuals and their coping mechanisms. Methods: A cross-sectional study was employed with a quantitative approach. A convenient sample of 320 caregivers was taken from two private tertiary care centers and one public secondary care center in Udupi taluk. This study was conducted using the Burden Assessment Schedule (BAS) and Brief Cope Scale (BCS). Statistical analysis was done on categorical variables, and they were expressed as frequencies and percentages. Continuous variables were measured using mean and standard deviation. Univariate and multivariate analysis using binomial logistic regression was done. SPSS version 15 was used to analyze the data. Results: According to BAS, severe burden accounted for 40.9% and moderate for 59.1%. The highest amount of burden was seen in the areas of physical and mental health, spouse related, and in areas of external support. The BCS showed that the most frequently used coping styles were practicing religion, active coping, and planning. Conclusion: This study concluded that caregivers of the mentally ill individuals do undergo a lot of burden. Hence, there is a need to develop strategies that can help them such as providing them with a support structure as well as counseling services

Learning Approaches, Learning Difficulties and Academic Performance of Undergraduate Students of Physiotherapy

A locally developed ‘Approaches to Learning Inventory (ALI)’ was administered to explore the learning difficulties and learning approaches of undergraduate students of Bachelor of Physiotherapy, College of Allied Health Sciences, Manipal. University examination marks of these students were also collected. Learning approach and learning difficulties were summarized by computing mean, standard deviation and percentage of students experiencing some of the academic and non-academic problems. Spearman’s correlation was computed between standardized scores of examination marks, learning approach and learning difficulty scale scores. Academic performance has shown significant negative correlation with surface approach and various problems of learners like fear of failure and lack of confidence, non-academic distracters and poor English language ability. This study demonstrated significant positive association between surface approach and various problems of the learners. The students have also reported a number of academic and non-academic problems

Knowledge and awareness of dental implants as a treatment choice in adult population in South India: A hospital-based study

Context: Implant-supported prosthesis improves the self-confidence and quality of life of the patient by giving them masticatory comfort and a high level of satisfaction. For any professional community, it is essential to know whether patients feel well informed and whether what they know reflects on the current advances in dental health care. The aim of this study was to assess the knowledge and awareness of dental implants as a treatment choice in patients visiting a dental college situated in Mangalore, Karnataka, India. Materials and Methods: A questionnaire consisting of 13 close-ended questions was used to assess the level of knowledge and awareness among patients visiting prosthodontics outpatient department regarding dental implants as a treatment option for replacing missing teeth. A total of 242 participants were interviewed to collect the required data. Chi-square test was used to study the association between demographic variables and awareness about implantation. Results: Only 17.8% of the population with missing teeth knew about dental implants as a treatment choice. For 69.8% of the population, the source of information regarding prosthetic options was through friends and relatives, and for 28.1%, it was from dentists. Awareness percentage was significantly higher among males (P = 0.024) and among those whose education level was graduation and above (P < 0.001). Conclusion: This study showed that knowledge and awareness regarding dental implants was disturbingly low. The patients had a very minimal and superficial knowledge regarding prosthetic options. Emphasis is placed on the need for conducting and implementing various public awareness campaigns and for establishing counseling centers

Research Design and Statistical Methods in Indian Medical Journals: A Retrospective Survey

<div><p>Good quality medical research generally requires not only an expertise in the chosen medical field of interest but also a sound knowledge of statistical methodology. The number of medical research articles which have been published in Indian medical journals has increased quite substantially in the past decade. The aim of this study was to collate all evidence on study design quality and statistical analyses used in selected leading Indian medical journals. Ten (10) leading Indian medical journals were selected based on impact factors and all original research articles published in 2003 (N = 588) and 2013 (N = 774) were categorized and reviewed. A validated checklist on study design, statistical analyses, results presentation, and interpretation was used for review and evaluation of the articles. Main outcomes considered in the present study were – study design types and their frequencies, error/defects proportion in study design, statistical analyses, and implementation of CONSORT checklist in RCT (randomized clinical trials). From 2003 to 2013: The proportion of erroneous statistical analyses did not decrease (<i>χ^²</i>=0.592, <i>Φ=</i>0.027, <i>p</i>=0.4418), 25% (80/320) in 2003 compared to 22.6% (111/490) in 2013. Compared with 2003, significant improvement was seen in 2013; the proportion of papers using statistical tests increased significantly (<i>χ²</i>=26.96, <i>Φ=</i>0.16, <i>p</i><0.0001) from 42.5% (250/588) to 56.7 % (439/774). The overall proportion of errors in study design decreased significantly (<i>χ²</i>=16.783, <i>Φ=</i>0.12 <i>p</i><0.0001), 41.3% (243/588) compared to 30.6% (237/774). In 2013, randomized clinical trials designs has remained very low (7.3%, 43/588) with majority showing some errors (41 papers, 95.3%). Majority of the published studies were retrospective in nature both in 2003 [79.1% (465/588)] and in 2013 [78.2% (605/774)]. Major decreases in error proportions were observed in both results presentation (<i>χ²</i>=24.477, <i>Φ=</i>0.17, <i>p</i><0.0001), 82.2% (263/320) compared to 66.3% (325/490) and interpretation (<i>χ²</i>=25.616, <i>Φ=</i>0.173, <i>p</i><0.0001), 32.5% (104/320) compared to 17.1% (84/490), though some serious ones were still present. Indian medical research seems to have made no major progress regarding using correct statistical analyses, but error/defects in study designs have decreased significantly. Randomized clinical trials are quite rarely published and have high proportion of methodological problems.</p></div

Percentage of errors in major statistical methods.

<p>This figure shows the percentage of errors present in major statistical methods in the years 2003 and 2013.</p

Effect of limited access dressing on hydroxyproline and enzymatic antioxidant status in nonhealing chronic ulcers

Background: Healing ability of nonhealing chronic ulcers can be assessed by estimating hydroxyproline, total protein and enzymatic antioxidants such as glutathione peroxidase (GPx), glutathione S-transferase (GST) in the granulation tissue. Materials and Method: A total of 34 patients were analysed from two groups: Limited access dressing (LAD) group (n = 17) and conventional dressing group (n = 17). Results: Patients treated with LAD that exerts combination of intermittent negative pressure and moist wound-healing had shown a significant increase in the hydroxyproline (P = 0.026), total protein (P = 0.004), GPx level (P = 0.030) and GST level (P = 0.045). Conclusion: Patients treated with LAD indicated significantly better anabolic effect on wound-healing compared to that of patients treated with conventional dressing