Academic literature on the topic 'Indian patient'

Aim. To compare US, Russian and Indian primary care physicians attitudes, comfort and experiences providing palliative care. Design. Cross sectional survey. Settings. Iowa, USA; Leningrad Oblast, Russia; Mangalore, India. Participants. Primary care physicians. Methods. Chi-squared testing for dichotomous variables and t-tests for mean scores. Results. 66 US, 81 Russian and 95 Indian physicians completed the survey. More US physicians preferred end of life care at home (83% v 56% Russian and 29% Indian) p 0.001 and Indian physicians preferring hospitals (36% v 0% US and 1% Russian) p 0.001. 94% percent of US physicians preferred patient make their own decisions, 57% of Russian sample preferred physicians as decision makers, and Indian physicians preferred family members to patients themselves (44%) p 0.001. Patient should be informed (US vs Russia vs India) of terminal illness Always (74% vs 31% vs 33%) p 0.001, If Asked (9% vs 64% vs 12%) p 0.001 or Physicians Judgement (15%, 5%, 54%) p 0.001. US physicians reported higher comfort rates with managing symptoms at the end of life. In the last 6 months US physicians were more satisfied with provided care Often or Always (63% vs 36% Russian v 21% Indian) p 0.001. Conclusions. US sample was more concerned with patient autonomy and had more comfort and satisfaction in providing end of life care compared to Russian and Indian samples.

Background There is a dearth of studies from India evaluating the awareness of patient safety. This study was performed to gain insight into the Indian patients’ awareness about patient safety and evaluate their willingness in promoting the same. Methods In this cross-sectional study, online interactive sessions pertaining to patient safety and patient safety culture were arranged by clinical pharmacologists for 800 urban patients post-discharge from a tertiary care hospital in India. A validated questionnaire was used, and the responses were analysed using descriptive statistics. Results A total of 635 patients [mean age, 43.2 ± 10.3 years; 385 (60.6%) males] responded. A total of 93.4% of the patients were aware of the term “patient safety” and 35.3% faced situations where they felt that patient safety was compromised. Of these patients, 64.3% reported to higher authorities when faced with such situations, while the remaining either ignored the issue or had no idea about how to deal with the same. A total of 99.2% of the patients never participated in any patient safety program; nevertheless, 94.5% of them were willing to participate in the same. Accessibility to information about patient care was deemed essential by 58.3% of the patients. Conclusions Although the overall awareness about patient safety among urban Indian patients is high, there is a lack of awareness about ways of dealing with patient safety issues. Given the high level of interest in participating in patient safety programs, such programs should routinely include patients for optimizing the chances for safer provision of health care.

OBJECTIVE: To describe how clinical pharmacy is helping to improve medication use at a South Indian teaching hospital by addressing medication use problems, which are commonly encountered in India. SUMMARY: Clinical pharmacy is practiced in many countries and makes a significant contribution to improved drug therapy and patient care. India is a country with significant problems with medication use, but until recently Indian pharmacists have not been educated for a patient-care role. Postgraduate pharmacy practice programs have been established at 2 pharmacy colleges in South India as a result of a joint Indo-Australian program of cooperation. At a teaching hospital associated with the colleges, clinical pharmacy services such as drug information, medication counseling, drug therapy review, adverse drug reaction reporting, and the preparation of antibiotic guidelines are assisting clinicians to improve drug therapy and patient care. Seven hundred twenty-seven requests for drug information were received from July 1997 to February 2001, and 543 suspected adverse drug reactions were evaluated from November 1997 to February 2001. The most common drug classes causing adverse drug reactions were antibiotics, nonsteroidal antiinflammatory drugs, and antitubercular agents. Physician opinion and service utilization have also been surveyed: 82% of respondents had sought drug information from the Clinical Pharmacy Department and 71% of respondents had sought advice on individual patient management. The success of this program is raising awareness of clinical pharmacy among pharmacy educators elsewhere in India and has led to the introduction of clinical pharmacy services at other Indian hospitals.

AbstractIntroductionWithout a universal Emergency Medical Services (EMS) system in India, data on the epidemiology of patients who utilize EMS are limited. This retrospective chart review aimed to quantify and describe the burden of disease and patient demographics of patients who arrived by EMS to four Indian emergency departments (EDs) in order to inform a national EMS curriculum.MethodsA retrospective chart review was performed on patients transported by EMS over a three-month period in 2014 to four private EDs in India. A total of 17,541 patient records were sampled from the four sites over the study period. Of these records, 1,723 arrived by EMS and so were included for further review.ResultsA range of 1.4%-19.4% of ED patients utilized EMS to get to the ED. The majority of EMS patients were male (59%-64%) and adult or geriatric (93%-99%). The most common chief complaints and ED diagnoses were neurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease.ConclusionsNeurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease are the most common problems found in patients transported by EMS in India. Adult and geriatric male patients are the most common EMS utilizers. Emergency Medical Services curricula should emphasize these knowledge areas and skills.WijesekeraO, ReedA, ChastainPS, BiggsS, ClarkEG, KoleT, ChakrapaniAT, AshishN, RajhansP, BreaudAH, JacquetGA. Epidemiology of Emergency Medical Services (EMS) utilization in four Indian emergency departments. Prehosp Disaster Med. 2016;31(6):675–679.

ABSTRACT Pharmacovigilance is the pharmacological science relating to the detection, assessment, understanding, and prevention of adverse effects, particularly the long-term and short-term adverse effects of drugs or treatment. The World Health Organization (WHO) established pharmacovigilance Programme for International Drug Monitoring in response to the thalidomide disaster detected in 1961. India joined the WHO adverse drug reaction (ADR) monitoring program based in Uppsala, Sweden, in 1998. The Central Drugs Standard Control Organization (CDSCO), Directorate General of Health Services, under the aegis of the Ministry of Health and Family Welfare, Government of India, in collaboration with Indian Pharmacopoeia Commission, Ghaziabad, is a National Coordinating Centre (NCC). Adverse drug reaction monitoring centers (AMCs) under the Pharmacovigilance Programme of India (PvPI) play a vital role in the collection and follow-up of ADR reports from the patients, as drug trials in animals and humans (Phase I–III) do not predict accurately the adverse drug events. Patients with chronic kidney disease (CKD)/liver disease are at risk of enhanced drug-related events. These patients should be closely monitored for any adverse events and it should be reported. Thus, inculcating the habit of ADR reporting will help in generating data specific to Indian population and will contribute toward patient safety. This will also help in modifying the treatment given to the patients, as early identification of ADRs will help in reducing morbidity and mortality in patients. How to cite this article Sharma G, Kumar R, Singh J, Bhandari V, Singh N. Pharmacovigilance in India and its Impact in Patient Management. Curr Trends Diagn Treat 2017;1(1):27-33.

Abstract"Triaging for endoscopy" is the process to determine the most deserving patients after careful scrutiny amongst a pool of patients who report for Gastrointestinal (GI) Endoscopy diagnostic or interventional procedures that include Esophago-gastro-duodenoscopy (OGD), Colonoscopy, ERCP, EUS and Enteroscopy. The purpose of triaging at endoscopy is to prevent transmission of SARS-COV2 infection from suspected patient to the health care workers involved at endoscopy. The three professional Indian Gastroenterology bodies namely Society of Gastrointestinal Endoscopy of India (SGEI), Indian Society of Gastroenterology (ISG) & Indian Association for the study of the liver (INASL) have recently provided guidance of scheduling of endoscopic procedures in the current Covid-9 pandemic. Similar suggestions have been promulgated by other international bodies.

Background: The presently available hip prosthesis used in hip arthroplasty are designed based on the anthropometry of Western patients. These prosthesis do not replicate the exact anatomy of Indian patients, leading to postoperative complications and requiring revision surgery for correction. If the manufacturers keep in considering the anthropometric parameters of Indians while designing the prosthesis, this may lead to better clinical and functional outcome and higher patient satisfaction. So the present study was undertaken to understand the anthropometric variables of hip joint of Central Indian population and to compare these variables with the other Indian Ethnic groups and western population using computed tomographic images. Materials And Methods: We had included 200 patients and both the left and right side hip joints were analysed. The anthropometric variables included were Neck-Shaft Angle (NSA), Head Diameter (HD), Neck Width (NW), Acetabular Angle of sharp(AA), Horizontal Offset (HO), Vertical Offset (VO), Medullary Canal Diameter at the level of Lesser Trochanter (MDLT), and Acetabular Version (AV) were measured in all these individuals. Comparison of these parameters was done between the left and right side and among the males and females and compared with various populations and statistically analyzed Result: The mean values were NSA 132.53°, NW 25.11 mm, HD 43.94 mm, AA of sharp 43.11°, HO 43.76 mm, VO 56.37 mm, MDLT 23.00 mm, and AV 19.47°. We found a large variations in these parameters among the Indian ethnic groups and western population. Significant differences were seen between the males and females. Conclusion: This study indicates that there are significant differences in anthropometric parameters of proximal femur among the Central India population compared with Western population. Even within the Indian population, the anthropometric parameters vary from region to region.

Purposes/Aims: This study described the unique relationships that develop while providing cancer care to American Indian (AI) populations and the underlying meaning that nurses ascribed to these experiences. Rationale/Conceptual Basis/Background: The establishment of caring relationships in order to provide high quality cancer care is particularly challenging for nurses who engage with ethnic minority populations as they contend with cultural and contextual influences different from those found in the majority population. AIs represent an Indigenous minority group in the U.S. facing a considerable cancer care inequity. Nurses who care for AI patients frequently encounter population-specific issues that impact the caring dynamic, yet their experiences and the meaning they ascribe to them are largely unknown. Methods: This was an interpretive phenomenological study with iterative data collection and analysis. Nine cancer care nurses with a minimum of three years of experience working with AI patients participated by engaging in 2-3 exploratory, open-ended, reflective interviews over a period of 9 months. Thematic reduction was completed to explicate the fundamental structures of nurse-patient relationships during cancer care. Phenomenological and hermeneutical reflective writing resulted in linguistic transformation illuminating the essential meaning for nurses within this patient-nurse phenomenon. Results: Findings include individually-situated wholistic descriptions capturing the existential experiences of each of the participants. Reduction of individually-situated themes into seven shared meta-themes included From Task to Connection; Unnerving Messaging; We Are One; the Freedom of Unconditional Acceptance; Attuning and Opening; Atoning for the Past, One Moment at a Time; and Humanizing the Inhumane. Themes were explicated in a comprehensive general structural description followed by the reconstitution of the data and self-reflection into a deeply introspective essential description, suggesting that the meaning of the AI patient-cancer care nurse relationship was expressed in contradictory yet simultaneous patterns of joy and sorrow; ease and difficulty; obligation and vocation. From one moment to the next, nurses sought synchronicity with their patient as they danced to a life rhythm that revealed and concealed; enabled and limited; connected and separated. Being in relationship provided nurses great purpose within the universal human context of caring. Implications: Results contribute to the development of interventions designed to improve both the AI cancer care experience and the support and training of the nurses who serve this population. Refinement of our praxis will result in improved outcomes for both nurses and AI patients, reflecting the inseparability of the two entities within the cancer care relationship. The complimentary and mutually dependent nature of the patient-nurse relationship implies that strengthening and improving support for one entity may in turn positively impact the other. Further research into the AI patient’s perspective of their relationships with cancer care nurses is called for.

Type 2 diabetes is epidemic in the American Indian population. One problem health care providers face when working with the American Indian population is communicating about secondary complications, such as periodontal disease. From a public health standpoint, periodontal disease prevention is important not only to prevent unnecessary oral pain and tooth loss, but also to prevent other more serious systemic problems from occurring such as cardiovascular disease, strokes, and bacterial pneumonia. The purpose of this qualitative study was to examine the communication efforts of health care providers and understand if and how they discuss periodontal disease with their American Indian patients with type 2 diabetes. Structured interviews were conducted with health care providers at an American Indian community clinic using questions based on the model of communication competence. Data analysis consisted of an analysis of the interview transcripts looking for concepts, themes, and events to see if discussion of periodontal disease is occurring at diabetic visits. Results of the study showed that although all the providers knew about the link between diabetes and periodontal disease risk, not all the providers were discussing the risk with their patients, and time, perceived health literacy, and other priorities all played a role in the lack of communication. This finding has the potential to influence positive social change by being an impetus for change in current diabetic patient care policies in the areas of communication and education regarding American Indian patients with diabetes about periodontal disease risk.

This PhD thesis has two core objectives: 1) To critically analyse and compare the legal provisions relating to capacity assessment in England and Wales, Scotland and India; (2) To critically analyse and compare the legal provisions relating to decision-making on behalf of the incapable patient in England and Wales, Scotland and India. The methodology utilised to achieve these objectives is essentially a classic literature based comparative approach. This thesis provides an original contribution to knowledge by virtue of the fact that an in-depth tripartite comparative study of capacity law provisions in England and Wales, Scotland and India has yet to be undertaken within existing literature. The research undertaken in this thesis is timely given the implementation of capacity legislation in England and Wales and the relevant provisions of the Mental Capacity Act 2005 of England and Wales and the Adults with Incapacity (Scotland) Act 2000 are compared and critiqued as part of a discussion of the key ethical, legal and procedural concepts which underpin the law of capacity. In addition, the capacity law of England and Scotland is compared with the equivalent system in Indian law, which is at a nascent stage of development in comparison to the United Kingdom. The fact that India, despite being an Eastern country, also retains the influence of U.K law through its status as a Commonwealth country, means that the differences between the English, Scottish and Indian approaches to capacity can be attributed to issues of culture or development. The research undertaken for this thesis has shown that developmental issues are of greater impact, and while cultural issues are of some relevance, there are enough underlying commonalities between the three jurisdictions to suggest that India's capacity law is at a different point developmentally speaking.

In Australia, type 2 diabetes mellitus (T2DM) is a leading cause of morbidity and mortality with approximately 1.2 million people affected. Australia has a large number of migrants: as of June 2019, 7.5 million (29.7%) Australians were born overseas, and the Indian migrant population is 660,000 (2.6% of the total population). Evidence suggests that there is a very high prevalence of diabetes among Indian migrants (14.8%) compared to the Australian-born population (7.1%) along with a high rate of diabetes-related hospitalisation and complications. Indians are traditionally known for high use of ayurvedic medicines (AM), a component of complementary and alternative medicines (CAMs). Diabetes management's primary goal is to reduce symptoms, avoid the associated harms and improve quality of life. The patient can achieve these goals by adhering to treatment and lifestyle modifications. However, maintaining a normal blood sugar level can be challenging for Indian migrants because of several factors, such as an unhealthy diet, inadequate physical activity, poor adherence to medicines, religious factors, poor understanding of the health system, treatment costs, migration-related stress, seeking a job and other family-related issues. Ethno-racial and socio-cultural characteristics affect not only the susceptibility of individuals to diabetes, but also the day-to-day management of diabetes. While it is understood that Indian migrants are generally more at risk of developing diabetes than local Australians, the impact of Indian ethno-cultural traditions and religious and social norms on diabetes management is not well understood. The socio-cultural structure, traditions and ideologies of Indian migrants are complex and unique, and their impact on diabetes needs to be explored for a comprehensive understanding of, and interventions to improve, diabetes management for Indian migrants. Overall, this research aimed to gain an understanding of the factors that influence decision-making about medications and medication adherence in Indian migrants with type 2 diabetes (T2D), living in Australia. The research consisted of two stages: in-depth qualitative interviews and on-line survey using discreet choice experiments. The specific qualitative study objectives were: • To investigate Indian migrants’ awareness and understanding of, and access to, the healthcare system; how they feel it compares with their experience in India; and how they perceive this access influences their diabetes care. • To investigate Indian migrants’ medication-taking behaviour (with conventional medicines for diabetes) and factors that influence adherence at its three phases. • To explore the beliefs, decision-making process and experiences of patients with type 2 diabetes mellitus (T2DM) using AM, with a specific focus on the AM use pattern and disclosure to doctors, sources of information about AM and where AM is purchased. • To explore how Indian migrants cope with T2DM through religion and spirituality, and the impact of religion and fasting on insulin use. The specific discrete choice experiment (DCE) study objectives were: • To determine the preferences for conventional vs AM in Indian migrants with T2DM. • To identify the factors that may influence the preferences. Methods Qualitative study A qualitative study was designed consisting of face-to-face interviews. The study included Indian-born migrants (Australian citizen/permanent resident) aged 18 years or over; with T2DM; using at least one anti-diabetic medication; living in Greater Sydney or its surrounding suburbs, responsible for their own medications and fluent in English and/or Hindi. Twenty-three participants were interviewed; data saturation was reached after the 18th interview. The interview protocol was prepared after an extensive literature review, and comprised open-ended questions to enable participants to speak freely. The 40–45-minute interviews were audio recorded, transcribed verbatim and thematically analysed using a framework and an inductive approach to thematic analysis. Data analysis was performed manually using Microsoft Word. The consolidated criteria for reporting qualitative research (COREQ) was used to provide transparency in data reporting to improve the rigor, comprehensiveness and trustworthiness of the study. DCE research methods Participants completed an online survey with eight choice tasks and answered demographics questions. In the choice tasks, they chose their preferred medicine (conventional vs AM) or a 'no medicine' option. Paid and unpaid strategies were employed to recruit the participants, using Facebook and email. A D-efficient design was used to balance the attribute levels and to select a subset of the medication profiles. A total of 32 choice tasks were generated; however, to improve feasibility, the survey was blocked in 4 iterations, with each respondent completing 8 chosen tasks. Attributes and attribute-levels for the DCE were chosen systematically following a literature review and the qualitative research findings. Eight attributes (glycated haemoglobin, side effects, number of times medicine is taken (frequency), formulation, instructions to take with food, hypoglycemic events, weight change and cost of the medications) were selected. The levels chosen were widely spaced to encourage participants to maximise trade-off and increase the reliability of parameter estimates. Descriptive statistics (standard deviation, mean and frequency) for the socio-demographic characteristics of the sample and other parameters were reported. The DCE responses were analysed; a mixed multinomial logit (MMNL) model was used as it relaxes the assumption of identical distribution and accounts for heterogeneity in preferences between individuals. In DCE, parameter (β) estimates refer to the importance given by patients to an individual attribute-level, where a higher value indicates higher utility. The computer programme NLogit 6 was used for data analysis. Results Qualitative study Twenty-three participants were interviewed. The majority of participants were male (n=18) and followed Hinduism (n=17). Twelve participants had used AM at least once since they had been diagnosed with diabetes, and the remaining 11 had never used AM for diabetes (5 used AM for other conditions). Once diagnosed with T2DM, Indian migrants reported mixed emotions. Participants contemplated the need to restrict their diet, change their lifestyle and use lifelong medicines, and raised several issues related to their physical and mental health, which they felt were deteriorating. Consequently, they felt that they had to take further action to manage their diabetes: to maintain a normal blood sugar level, and to maintain well-being and inner or spiritual comfort. Controlling diabetes and associated health problems, such as co-morbid conditions and diabetes-related health issues, through the use of medications (either conventional or ayurvedic) was regarded as an important strategy. The findings show a limited knowledge of the healthcare system, and the use of informal sources (e.g., family, friends, social media) to learn about the healthcare system and the available services. Several barriers to decision-making in accessing health services were identified, such as socio-cultural beliefs, social impacts, preference for Indian healthcare professionals and the high cost of medications; these ultimately influenced diabetes management, which could lead to poor diabetes control. The study also identified some enablers encouraging people to improve their diabetes care, such as Health Cards (Medicare and NDDS card), which enable access to free GP consultations and laboratory tests and other diabetes products at a subsidised price. The findings suggest that religious beliefs influence diabetes management in this group. Participants believed that prayers gave them inner strength to manage their diabetes, and that prayers/blessings from religious leaders could help them manage their health conditions, including diabetes. Participants who held stronger religious beliefs were not in favour of using insulin or other medication derived from animal sources, and believed that fasting was an important religious obligation which could not be skipped due to diabetes. In contrast, some participants believed that animal-based medicines were permissible to consume and fasting could be skipped as it was detrimental to the health and well-being of people with diabetes. For the 12 participants that used AM, the decision-making process included evaluating AM benefits vs harms, and the positive opinions of others who used AM. Most participants expressed positive beliefs about AM (no side effects, can cure the condition and are effective), which influenced their decision to initiate AM. The decision to initiate AM was also influenced by other factors such as personals beliefs, social influence, and others’ experiences of using AM. They sought information from various sources such as family members, friends, multimedia, and from healthcare professionals in India. Participants believed that AM does not have side effects because it is obtained from a natural source (herbals), is effective and can cure diabetes. The use of AM was discontinued within months of initiation if there were no benefits. Participants used both ayurvedic and conventional medicines together as they believed that the combination of both medicines could better control blood sugar with no harmful effects. Most participants discontinued taking AM if they felt it was ineffective. Negative beliefs about AM centered on lack of scientific evidence to show effectiveness, and formulations. The majority of participants were initially prescribed oral antidiabetic medication and only two were started on insulin. From the time of diagnosis, patients made daily decisions about their diabetes disease control. The medication-taking behaviour among the participants changed at the three different phases of medication-taking (initiation, implementation, and discontinuation). Several factors influenced adherence at these three phases of adherence. At the initiation phase, most of the patients started conventional medication as soon as prescribed by GPs, while some postponed treatment initiation. The decision to initiate and continue the use of medications (adherence) was based on a balance between patient concerns and needs. The key motive was the desire to improve the diabetes outcome (control blood glucose level), and some participants were motivated to initiate treatment by advice/recommendations from GPs and the information they received about the medication. Fear of side effects delayed treatment initiation with conventional medications. Most participants reported taking their medication as prescribed. However, some reported forgetting their medication, especially when they were in a hurry for work or were out for family dinners or a party. In the implementation phase, patient benefits in (blood glucose levels) influenced people to adhere to conventional medications. Negative factors such as stigma and fear of side effects and drug dependence were identified barriers to adherence during the implementation phase. A few participants discontinued taking conventional medications once they started getting benefits and moved to AM; however, they restarted conventional medications if the desired results were not achieved with the ayurvedic medication. A few participants discontinued taking their medication due to fear of side effects. Overall, findings showed that negative beliefs and concerns about medications, such as fear of side effects, the stigma of diabetes and medications and fear of drug dependence, are common factors that influenced the initiation of medication. Decision to initiate the process was influenced by the balance between the desire to improve blood sugar levels and Hba1c outcomes (necessity beliefs) and negative medication beliefs (concerns). If the benefits were greater than the concerns, participants were more likely to initiate medications (either conventional or ayurvedic). DCE research The survey was completed by 141 participants. The average age was 49.7 years; most were male (n=92, 65.2%). The majority followed Hinduism (n=75, 53.2%). Many (n=80, 56.7%) respondents had co-morbid conditions, mainly cardiovascular disease. The majority (n=114, 80%) of participants used prescribed oral conventional medicine and 31.2% (n=44) used AM alone or with conventional medicines for their diabetes. Overall, the preference of respondents to initiate a medicine was negative for both medicines (conventional (β=−2.33164, p<0.001) and AM (β=−3.12181, p<0.001)); however, significant heterogenicity was noted in participants’ preferences (SD: 2.33122, p<0.001). Six attributes were identified to be a significant influence on medicine preferences: occurrence of hypoglycaemic events (relative importance, RI= 24.33%) was the most important, followed by weight change (RI=20.00%), effectiveness of the medicine (RI= 17.91%), instructions to take with food (RI= 17.05%), medicine side effects (RI=13.20%) and medicine formulation (RI= 7.49%). Another important finding was that participants expressed a desire to initiate a medicine despite the medicine having side effects, with the preference for initiation being higher with mild side effects compared with moderate to severe side effects. Conclusions This is the first qualitative study of Indian migrants with T2DM to explore their understanding of the Australian healthcare system; their medication-taking behaviour; and the impact of religious, cultural and other factors on diabetes management. The qualitative study revealed that Indian migrants had limited knowledge about the Australian healthcare system and relied on informal sources for information. Sociocultural beliefs, social influences, preferences for healthcare professionals, and high cost of medicine were barriers to accessing healthcare, while healthcare cards (Medicare and NDSS) were the main enablers. Religious beliefs play an important role in the self-management of diabetes among Indian migrants living in Australia. However, both positive and negative beliefs were identified regarding praying, using animal-based medicines, and the impact of fasting on the management of diabetes. Participants had a limited understanding of the rulings and teachings of their religion within the context of diabetes. Overall, Indian migrants usually use AM alone or with conventional medicine for diabetes self-management. Most took conventional medicines, though there were delays in initiation of the prescribed medicines. Side effects was a significant factor influencing medication adherence at all phases, whilst motivation to manage diabetes effectively was the key facilitator of medication taking. The quantitative findings demonstrated negative preferences for both conventional and ayurvedic medications; that is, Indian migrants were more likely to not start either conventional or ayurvedic medication to manage diabetes. Overall, if choosing between medications, they were more likely not to take ayurvedic medication compared to conventional medication. Preferences for conventional and ayurvedic medication were heterogenous and influenced by several factors. Experiencing hypoglycemic events was the most influential factor, followed by weight change, glycated haemoglobin, instructions for taking with food, side effects and formulation of medications. However, Indian migrants with T2DM indicated willingness to initiate medication to gain benefits despite mild and moderate side effects. This research has highlighted the importance of AM as a treatment option for T2D in Indian migrants living in Australia, and the range of factors influencing medication taking. The study findings point to the importance of healthcare professionals, particularly prescribers, to consider the range of factors that can impact medication taking when monitoring adherence, from initiation to persistence and discontinuation of therapy

The United States (US) is plagued by a high-cost health care system producing lower than desired patient quality outcomes. In 2012, the Patient Protection and Affordable Care Act was enacted to financially incentivize cost-effective models of care that improve the health of US citizens. One emerging solution is engaging patients with chronic conditions in self-management practices.

Guided by Krieger's Eco-Social Theory, this study used semi-structured interviews, scales and a questionnaire to detect factors that facilitate patient activation of self-management in patients with type 2 diabetes. Managed and unmanaged participants were equally represented in the study sample. White participants and participants from two American Indian tribes located in Northeast Wisconsin were included in this study. Findings indicated the establishment of routine behavior and the ability to identify healthy alternatives when routines were disrupted support patient activation of self-management. Experiencing success such as weight loss was also identified as a factor in facilitating patient activation. Social roles and responsibilities challenged unmanaged patients.

The study concluded that community, culture and environment have both a negative and positive influence on patient activation of self-management of type 2 diabetes. The current epidemics of obesity and diabetes create an apathetic response to the type 2-diabetes diagnosis that affects subsequent treatment and self-management in the communities studied. Aspects of local cultures such as unhealthy regional and tribal foods, lack of options for menu items low in carbohydrates and sugar in restaurants, high consumption of soda and alcohol and holidays/tribal events provide significant challenges for unmanaged patients. Workplace policies surrounding health insurance premiums had an impact on attendance at educational events but not on sustaining self-management behaviors. Positive aspects of the workplace include the imposition of structure and routine and the emotional support of colleagues. Warm seasons were also found to activate self-management by providing an opportunity for outdoor exercise and healthier modes of food preparation.

Consistent with a previous study, high rates of childhood trauma were found among the study groups. However, findings did not support the hypothesis that levels of childhood trauma were linked to self-management. While some evidence of historical grief and loss along with associated symptoms was found among the American Indian populations, there was no correlation between managed condition and level of grief and loss. Further examination of the connection between childhood and historical trauma to the current obesity and diabetic epidemics in these communities is recommended. Recommendations for changes to public health and health care policy are included.

Introduction - India is beginning to resemble the western worlds’ way of living and that leads to an increased risk of chronic diseases such as diabetes. Due to its very large population India has the world second largest number of people with diabetes; 61, 3 million people. Studies have shown that the awareness of diabetes is poor, especially in rural areas. Aim - To investigate nurses’ experience of applying professional competence in patient education with focus on diabetes type II in an Indian rural hospital. Method – Data was gathered through twelve qualitative interviews. The interviews were tape recorded, transcribed verbatim and then analyzed through content analysis. Result – Three main categories were identified; Acquired competence to meet the patients, Helping the patients manage their disease and Nurses’ ideas for quality improvements regarding diabetes care. Conclusion - This study identified different obstacles that could have a negative effect on the care and treatment of patients with diabetes type II. The nurses had many ideas for quality improvements which could raise the awareness of the disease among patients, improve clinical outcomes and the work environment for the nurses. The nurses are willing to get more education about the disease and implement quality improvements if the resources and equipment are provided by the hospital.

Britain's Asians are a young population and their socio-economic status is low, with racial disadvantage in housing, employment, education and health. Research on their health has usually not been conducted in its socio-economic and demographic context and there is little on their use of primary care. Three studies were conducted to investigate their relationship with primary care in Bradford. A study of general practice attenders of white/British, Pakistani and Indian origin confirmed the demographic and socio-economic differences between the groups. The former had higher rates of alcohol and cigarette consumption. For Pakistanis and Indians, fluency and literacy in English was poor. Ethnic and linguistic match between doctor and patient was more important in patients' choice of doctor than the doctor's sex. Differential employment status of Asian and white/British accounted for some of the differences in health. A study of general practice attendance showed similar rates of surgery consultations between Asians and Non-Asians; the latter made greater use of domiciliary services. Both these studies were conducted in an inner Bradford health centre with an Asian male, a white male and a white female doctor. Bradford GPs were found to perceive that Asian patients made greater use of surgery and domiciliary consultations; attended more often for trivial complaints; and had lower compliance rates than Non-Asians. These perceptions were not supported by objective data. Better qualified GPs had a smaller, and Asian doctors had a greater proportion of Asian patients on their lists. Research, and action on Asians' health, needs to take account of their poorer socio-economic status.
Yorkshire Regional and Bradford District Health Authority.

The American Indians population in Minneapolis, Minnesota has experienced limited health care access and threefold diabetes health disparity. The purpose of this study was to measure the extent to which collaborating marketplace clinics and community-based support groups expanded diabetes care and provided self-management education for this largely urban Indian neighborhood. The marketplace clinics located in nearby CVS, Walmart, Target, and Supervalu stores committed financial support, certified educators, and pharmacy staff for the community-based support group. The study was conducted within the patient activation measure (PAM) analytical framework to assess the participants' acquired knowledge, skills, and confidence for diabetes self-management. A case-control study and 3 years retrospective analysis of secondary data were used to test whether the Minneapolis marketplace clinics and the Phillips community diabetes support group participants (n = 48) had improved diabetes health outcomes relative to the control group (n = 87). The intervention group employed motivational interviewing and PAM in coaching diabetes self-care and behavioral modification. The control group received only basic self-management education. T test and Cohen's d effect size measurements were used to quantify the size of the health outcome variables' difference between the study intervention and comparison groups. The positive effects of marketplace clinics and community-based complementation were shown through improved blood sugar control (A1C), weight loss (BMI), and healthful lifestyle changes. Social change progress could be realized by incorporating PAM with diabetes prevention programs for 33 Urban Indian Health Organizations that are located in large cities throughout the United States.

AbstractOral and Maxillofacial surgery, like any surgical specialty, has two vital requirements. First, having the right armamentarium, and, second, acquiring appropriate skills and knowledge of the patients’ disease process, including comorbidities. With the changing demographic in India, the profile of Indian patient has undergone a sea change in the last few decades. From acute conditions that had little impact on subsequent health of the patient, we have arrived at a scenario where a large proportion of patients present with chronic disorders like diabetes, ischemic heart diseases, etc. that affect many elective procedures we undertake and require optimization of the overall physical status of the patient before proceeding with any surgery.Trainee surgeons need to be aware and updated and should be able to recognize, treat, or appropriately refer patients to the requisite specialty in case of complex conditions beyond their remit or ability. In this chapter, readers will get a very brief overview of the different organ systems that play crucial role in homeostasis and how to modify the treatment when there’s an imbalance in either of these systems.

India has the highest proportion of diabetes patients, and it is estimated that there will be 134 Million diabetics in India by 2045 as per IDF. Also, the disease burden is increasing to the young population between ages 25-40 as more of them are diagnosed positive according to JAMA recently. Moreover, there are only 4.8 Doctors per 10,000 population, and in villages, the ratio is the lowest possible in this country, according to the Indian Journal of Public Health. Therefore, screening & predicting Diabetes at an early stage remains a priority for clinicians. It reduces the risk of major complications and improves patients' quality of life with diabetes, and builds resilience and well-being amongst other citizens. With the advancement of Computer Science & Artificial Intelligence, it is now possible to predict diabetes and other such diseases through applying deep learning algorithms in high-quality data sets. This helps in a more accurate and faster diagnosis of Pre-diabetes, Diabetes & diabetes-related progressive eye diseases. In this study, a systematic review of the Pubmed repository for current practices to diagnose Diabetes based on AI intervention in the Indian context is carried out. Also, a critical analysis was done on various pioneered companies currently offering AI-based Diabetes diagnostic services in India. The study represents different concepts of AI tools used to predict the diseases currently available in India. Although most of the studies were carried out on Diabetic Retinopathy screening, future opportunities can be in several other areas such as Clinical Decision Support, Predictive Population Risk Stratification and Patient Self-Management Tools.

Introduction: The Evidence Based Medicine in oncological sciences is founded on many factors. Pathetic state of patient retrieval system and follow up are some of the inherent problems faced in developing countries. The absence of follow up seems to affect the patient survival, intervention in case of predictive recurrence, and it also fails to fortifies authenticity of research and survival data. Paper outlines histrionics, evolved/recommended methodologies, nationwide survey with regards to authenticity of Evidence Based Practices in Oncological research. It opens the facts sheet of awareness, practice of follow-up and obstacles faced in India institutions. Relevant for obstetricians adopting Gynec Oncology. Aims and Objective: (1) To Evaluate the Evidence based practice of Gynec Oncology, (2) To evaluate the effectiveness of follow up methodologies, (3) Compliance of institutions and oncologist with regards to follow-up of Gynec cancer patients. Materials and Methods: The follow up methodology propagated; 1–6 address system (IARC 3 Address System), 2-Postcarding, 3-SMS/Telephony, 4-Door to door patient retrieval, 5-Family Physician referrals/feedback, 6-Software Alert on follow up defaulters in the Hospital Based Cancer Registry. etc. A stock taking was started 10 years back with repeated circulars on dates of “The National Cancer Calendar” (one date every months) that were sent to some 10,000 E-mail address of personnel/institutions connected with oncological sciences. Over five years 150 postgraduate examinees and 50 faculty in various institutions were interviewed on their 1 - Practicing Evidence Based Gynec Oncology and 2 - Understanding of Follow up/patient retrieval system practices in Gynec cancers. As an inspector of a major medical accreditation institution 50 institutions were inspected and existence of their follow up methodologies were evaluated. 100 post graduate dissertations reviewed, were studied with regards to status of follow up in the study carried out or the existence of follow-up system in the institution. Undergraduate students and their text books were searched if they are educated about follow up and necessity of patient retrieval system and its significance in Medical sciences. Faculty/Specialist of Obs and Gyn departments were interviewed for the same. Observations and Results: Response to circulars on follow up in cancer patients was cold shouldered, 95 percent of examinee PG students did not know how to follow up the cancer patients, out which as many as 90 percent of their institutions did not have any follow up system in order. 99 percent of dissertation did not show any effort from the side of candidate for patient retrieval system in order to fortify the research data. Only 20 percent institutions had infrastructure and significant effort (including door to door retrieval) on following up the patients that are treated there. Non of the undergraduate text books had guidelines or teaching in follow up so were total blankness of concept of follow up with undergraduate students. The awareness of Evidence based practice of Gynec oncology in most of the faculty of Obs and Gyne Departments was abysmal and “Not Necessary or Not possible” issue. Conclusion: Death and prolongation of survival both in curable and not so curable gynec cancers is directly related to Patient retrieval through follow up that generates evidence on Indian patients. In order to improve the survival and timely therapeutic intervention, follow up has to be strengthen at under graduate and post graduate medical teaching. This also applies for the authenticity of oncological research data that is produced in large numbers in developing countries. This is especially significant in the large poor socio economic gynec cancer patient population with poor literacy levels and far off homes from cancer treatment centres.

Abstract Introduction The global threat caused by COVID-19 pandemic and the unprecedented lockdown imposed had created emotional stress among the breast cancer patients with dilemma regarding risk of progression of cancer due to interruptions of standard medical care and panic about acquiring the COVID-infection during their frequent visits to the hospital. Objectives We conducted a questionnaire-based study to assess the psychological impact in this situation affecting their quality of life and their perspective in this current situation. Materials and Methods Breast cancer patients who had been recently diagnosed, those who were on chemotherapy and visited our OPD in the month of July during the COVID-19 pandemic were assessed for their treatment-related perspectives with a questionnaire. Psychological status was analyzed with GAD-7 (generalized anxiety disorder questionnaire) and PHQ-9 (patient health questionnaire). Results A total of 202 breast cancer patients were included when lockdown was relaxed after a period of 3 months and COVID-19 status was still up trending. The clinical profile and patient-related information were collected from the medical records. Of them, 55.4% (112 patients) were within the city, 35.1% (71 patients) were from suburban areas of the city, and 9.4% (19 patients) were from adjacent districts/rural areas. Also, 56% were educated. Of these, 87% wanted to continue treatment and did not bother about the spread of the infection, while remaining patients’ main concern was to avoid infection than to get oncological management. Also, 76% were aware about the COVID-19 infection and sequelae. A total of 80% patients were aware of the consequences due to delay in cancer treatment. Of these patients, 51%, 42% and 7% had mild, moderate, and severe anxiety respectively and 69%, 25% and 6% had mild, moderate, and severe depression respectively. The severe anxiety and depression correlated with metastatic breast cancer and educated patients. Conclusion This study reflected that the breast cancer patients were more bothered to continue the treatment in spite of the existing pandemic.

Abstract Introduction Acute adverse drug reactions (ADRs) in day care chemotherapy are not uncommon and easily manageable many a time. However, sometimes they may lead to untoward events. It is of paramount importance to document and analyze such events in contemporary medical oncology practice for the best utilization and planning of available personnel and resources. Objectives This study was aimed to analyze the acute ADRs occurring in day care cancer chemotherapy setting. Materials and Methods All acute ADRs reported in day care cancer chemotherapy setting, during the administration of chemotherapy, at Basavatarakam Indo American Cancer Hospital, Hyderabad, Telangana, India, were included in the study from June 15, 2020 to September 30, 2020. The ADRs were classified in to anaphylactic, allergic, and gastrointestinal (nausea/vomiting/heart burns/chest tightness). All ADRs were graded according to CTCAE version 5.0. Suspected drugs, time to reaction, and corrective measures were analyzed. Results During the study period, a total of 8,600 sessions of day care chemotherapy were administered. ADRs were noticed in 83 cases (~1%). Among the reported ADRs, anaphylactic reactions were noted in 20 patients (24%); allergic reactions of grades 1 and 2 were noted in 41 patients (49%). Gastrointestinal ADRs were noted in 30 patients (36%). Adverse reactions are mostly seen in oxaliplatin (22.8%), rituximab (14.4%), paclitaxel (15.6%), carboplatin (13.2%), and docetaxel (7.2%). In grade-I (10%) and grade-II (63%) resections, supportive treatment was provided and chemotherapy was continued. Grade-III ADRs were noted in 21 patients (25%) out of whom, 3 patients required short-term intensive care, chemotherapy was withheld until the next cycle in one patient, and chemotherapy regimen was changed in 3 patients. No patient died of ADR. Conclusion Serious ADRs are rare in contemporary medical oncology practice during day care chemotherapy administration. Most acute ADRs were easily managed.

Cancer stigma may lead to delayed diagnosis and treatment, especially in low- and middle-income countries. This exploratory, pilot study was conducted in India to explore the degree to which cancer stigma is perceived, experienced, and internalized among adults living with cancer and their primary caregivers. We conducted a survey of cancer patients and their caregivers in two Indian cities. The survey assessed perceived, experienced, and internalized stigma; demographic characteristics; patient cancer history; mental health; and social support. A purposive sample of 20 cancer survivor and caregiver dyads was drawn from an ongoing population-based cohort study. Overall, 85 percent of patients and 75 percent of caregivers reported experiencing some level (i.e., yes response to at least one of the items) of perceived, experienced, or internalized stigma. Both patients (85 percent) and caregivers (65 percent) perceived that community members hold at least one stigmatizing belief or attitude toward people with cancer. About 60 percent of patients reported experiencing stigma, and over one-third of patients and caregivers had internalized stigma. The findings indicate that fatalistic beliefs about cancer are prevalent, and basic education about cancer for the general public, patients, and caregivers is required. Cancer-related stigma in India should continue to be studied to determine and address its prevalence, root causes, and influence on achieving physical and mental health-related outcomes.

Purpose: The aim of this study was to assess the ocular morbidity among the patients post SARS-CoV-2 infection. Methods: This is a prospective observational study conducted on patients post SARS-Co-V-2 infection, at a dedicated tertiary COVID-19 hospital in South India from June,2020 to August, 2021.A thorough history regarding the onset, duration, progression, nature of symptoms and its associated factors, medication history, treatment history were elicited and documented. Ocular examination was performed by an ophthalmologist with proper care. Further investigations including imaging were sought for, depending on clinical indications. A Results: total of 60 patients were examined. Of them, 41 (68.3%) were males and 19 (31.7%) were females, the age group ranged from 12 years to 62 years. On clinical examination, 45 (75%) developed ocular manifestations, of which 22 (48.8%) had features suggestive of Bilateral viral conjunctivitis solely,20(44.4%) had features suggestive of viral retinitis and 2(4.4%) had combined features of conjunctivitis and viral retinitis. 1 (2.2%) patient had developed Mucor mycosis. In our study, Viral retinitis was most common ocula Conclusion: r morbidity among the covid patients.This pandemic has changed our lives in many ways and various ocular morbidities were seen too, of which few cases recovered with timely diagnosis and management.

Review question / Objective: To evaluate the efficacy of herbal medicine in patients with herpes labialis. Condition being studied: Clinically diagnosed herpes labialis. Eligibility criteria: Inclusion:- All age - clinically diagnosed herpes labialis- topical or systemic herbal medicineExclusion:- traditional Chinese medicine- traditional Indian medicine- traditional Korean medicine- traditional Kampo medicine- highly diluted / homeopathic preparations.

Review question / Objective: To evaluate the effectiveness of topical and systemic herbal medicine in patients with psoriasis. Condition being studied: The study will focus on psoriasis. Eligibility criteria: Inclusion: - All age - (clinically) diagnosed psoriasis- topical or systemic herbal medicineExclusion:- traditional Chinese medicine- traditional Indian medicine- traditional Korean medicine- traditional Kampo medicine- highly diluted / homeopathic preparations.

Background and Objectives- Symptomatic Primary Hyperparathyroidism (PHPT) is common in India in comparison to the western population. But there is very little data on the inuence of age on the presentation of PHPT. In the present study we aimed to analyse the clinical and metabolic prole among different age groups of symptomatic primary hyperparathyroidism. Methods: This retrospective analysis was done in PHPT patients who attended Department of Endocrinology, Gauhati Medical college and Hospital. Thirty-one PHPT subjects who presented to us over a period of last ve years were divided into three different age groups i.e, children and adolescents <18yrs, adults ≥18-50 years, and older group >50years. All major clinical, metabolic and imaging parameters were compared among these groups. Appropriate statistical methods were used to compare different variables. The age distribution ranged from 13 to Results: 72 years with mean age of 38.6±16.3years and with equal female to male ratio. Bony deformity (Rickets) as initial manifestation was seen in three adolescents and bone pain was common in adolescents(p=0.05). Prevalence of renal stones were higher in adult group(p=0.002), gastrointestinal manifestations were higher in older group (p=0.02). There was no signicant difference in fracture rate(P=0.17), brown tumours(P=0.56) and other symptoms among different age groups. Alkaline phosphatase(p=0.006) and iPTH(p=0.01) were signicantly higher in adolescent group. There was no signicant difference in serum calcium, phosphate, 25(OH)Vitamin-D3 and haemoglobin levels among different age groups. Age has substantial inuence on PHPT presentation. Bone Interpretation & Conclusion: pain and deformity was common in adolescents, while renal stones and gastrointestinal manifestations were common in middle aged and elderly group respectively

The Population Council/Horizons (New Delhi and Washington, DC) and the Society for Service to Urban Poverty (New Delhi) are conducting an operations research study in three New Delhi hospitals. The study, entitled “Improving the hospital environment for HIV-positive clients in India,” is endorsed by the National AIDS Control Organization (NACO) of India. The main objective is to assess factors that affect the quality and type of care received by the general patient population, with special emphasis on patients with HIV. Another objective is to assess and address factors that affect staff safety with respect to infectious diseases. As part of the study, a practical checklist was developed that can be used by managers and others to identify institutional strengths, pinpoint problems, and set goals for improvement of services for people living with HIV/AIDS (PLHA) and staff safety. The PLHA-friendly Achievement Checklist is intended as a self-assessment tool for managers to use in gauging how well their facility reaches, serves, and treats HIV-positive patients. NACO plans to distribute the checklist to all government medical facilities throughout India.

Maharashtra was one of the first states to be affected by HIV in India. Results from the National Family Health Survey (NFHS-3) in 2005–06 indicate that 0.62 percent of men and women aged 15–49 years were infected with HIV, as compared to the national average of 0.28 percent. HIV sentinel surveillance data from sites across Maharashtra indicate that 1.3 percent of pregnant women receiving antenatal care (ANC) and 10.4 percent of patients receiving treatment for sexually transmitted infections in 2005 were infected with HIV. At the same time, Maharashtra ranks first nationally in the proportion of total migrants, and there is a growing consensus among policymakers and program managers that migration could be a major contributor in the spread of HIV in the state. However, empirical evidence to support or refute this conjecture is limited. To address this research gap, the Population Council studied the patterns and motivations related to the migration of male laborers and their linkages with HIV risk. The purpose of the research, as stated in this brief, was to document patterns of male migration and determine whether there was a relationship between migration and HIV prevalence.