Challenges and opportunities in providing palliative care services to children with a life-limiting illness: A systematic review.

Background Palliative care for children is an innovative approach that helps improve the quality of life of children suffering from life-limiting illnesses, and their family members. The WHO recognized palliative care as a part of universal health coverage. However, there is inadequate availability and inequitable distribution of palliative care services for children in most parts of the world. We reviewed the existing literature to assess (i) the challenges in providing palliative care services for children suffering from life-limiting illnesses and (ii) the strategies or opportunities to overcome these challenges. Methods We conducted systematic searches in the PubMed and Scopus databases to find articles published in the past 10 years (January 2011 to December 2020). The population, concept and context (PCC) framework was used to devise a search strategy in an electronic database. Results A total of 1562 articles were found by searching the database and other sources. Title and abstracts of articles were screened, and 206 articles were selected for full-text review. After scrutiny 28 articles met the inclusion criteria. Barriers to and opportunities in the provision of palliative care services for children were identified at policy, organizational, healthcare provider, and patient/family levels. Conclusion We found that the majority of barriers to provision of palliative care services for children with life-limiting illnesses can be addressed by adopting research-driven strategies. Adequate and equitable distribution of palliative care services is required for improving children and their family members' quality of life.

"Upgrading self-esteem: Effectiveness of cognitive enhancement package among psychiatric inpatients."

OBJECTIVE: To assess and compare the self-esteem before and after administration of cognitive enhancement package among psychiatric inpatients. DESIGN & METHOD: Quantitative approach, Non-Equivalent control group pre-test and post-test design under quasi experimental research design was used for study. Total 60 psychiatric inpatients whose scores came out to be 25 and less in Rosenberg Self-esteem scale were enrolled in the study. Samples were selected by using purposive sampling method. Total four sessions of intervention were provided with 80 to 100 min for overall tasks. Interventions comprised of total three sub-tasks and each task was followed by daily assessment of progression with the help of self-care activities checklist for self-care activities, Ferrara Group Experience scale for group interaction and Mini-Mental Status Examination for cognitive functioning. Post-test was taken on fifth day of intervention. RESULTS: The results showed that mean score of self-esteem (14.17 ± 2.00), self-care activities (3.83 ± 2.34) and group interaction (20.83 ± 7.42) along with cognitive functioning (18.23 ± 6.07) in pre-test were in lower level comparatively than in post-test after administration of Cognitive Enhancement Package which is self-esteem(20.17 ± 3.24), self-care activities (6.82 ± 2.31), group interaction (37.90 ± 5.71) and cognitive functioning (24.80 ± 4.12) at the 0.05 level of significance (p ≤ 0.05). However, the score remained same or decreased in case of comparison group who only received routine hospital care. CONCLUSION: All in all, present study concluded that different innovative psychological approaches like Cognitive Enhancement Package can be incorporated along with usual psychopharmacology in order to promote the overall wellbeing and better rehabilitation for the psychiatric inpatients.

Insulin Adherence in Adolescents with Type 1 Diabetes Mellitus.

Adherence to medication, especially insulin, is a key contributor to diabetes treatment outcomes. Lack of adherence is common among patients with type 1 diabetes mellitus (T1DM) ranging from 23% to 77%, with a higher frequency in developing countries. Poor adherence results in worse glycaemic control and increased mortality and morbidity due to diabetes complications. The objective of this study is to discuss insulin adherence among adolescents with T1DM. The review was conducted through search engines such as PubMed, Medline, Embase and Google Scholar. Search terms used were 'type 1diabetes mellitus', 'insulin dependent diabetes mellitus', 'Juvenile diabetes mellitus', 'adherence', 'compliance', 'non adherence', 'barriers', 'omission', 'medical adherence', 'adolescents', 'teenagers' and 'insulin'. T1DM is challenging for adolescents due to its lifelong treatment regimens. Educational programmes and specific interventions which can improve affordability, accessibility and administration of insulin should be implemented to improve insulin adherence among adolescents.

Registered nurses' experiences and perceptions of supervising international nursing students in a clinical setting - A qualitative study.

AIM: The aim of the study was to examine the experiences and perceptions of Indian RNs who supervise Norwegian undergraduate nursing students during their clinical practice in India. BACKGROUND: The globalization process has generated a need for registered nurses (RNs) to develop cultural competence. As a result, nursing education and policy need to respond to the challenging nature of global health and prepare RNs to work with diverse cultures by enhancing their cultural competence to help them encounter patients from different cultural backgrounds. Yet, the research investigating the experience of supervisors in non-western countries receiving students from western countries is sparse DESIGN: An exploratory descriptive design. METHODS: Eight individual semi-structured interviews were undertaken by Indian Registered nurses, supervising Norwegian nursing students. Three of the interviews were conducted in their workplace in India, while the rest were carried out using Zoom conference due to the COVID19 pandemic. The interviews were conducted between January - December 2020. Inductive qualitative content analysis was used to analyse the data. RESULTS: Thematic analysis elicited four main themes: 1) Preparation to receive international students, 2) The role of supervising international students, 3) Learning from the students, 4) Challenges of supervising international students CONCLUSIONS: Participants provided valuable insights into the role of supervising international nursing students in India. This insight is considered important since many students from Western countries go to non-Western countries for international exchanges. The study highlights the fact that the method of supervision is connected to the culture and is different in Western and non-Western countries. Even though they acknowledged several challenges with having international students, supervisors emphasized that having international students was a positive experience and that they learned from them.

Development and Validation of the Intravenous Infiltration and Extravasation Risk Assessment Tool (IIERAT) for Pediatric Patients.

OBJECTIVE: To develop and validate a new tool viz., Intravenous Infiltration and Extravasation Risk Assessment Tool (IIEART) for assessing risk of fluid extravasation in children. PARTICIPANTS: 120 children (aged 2-18 year) undergoing peripheral intravenous cannulation were recruited from four hospitals of Haryana to determine the IIEART scale's psychometric properties. METHODS: The tool was developed under four phases with Modified Delphi rounds among nine experts. After experts' confirmation of final draft, the reliability and validity of the tool was ascertained. RESULTS: The final IIERAT with 11 items showed good internal consistency (a=0.81) with inter-rater reliability of (k=0.88). To calculate predictive validity, sensitivity and specificity were assessed for 3 consecutive days from the day of cannulation. At a score >21, the sensitivity was 100% and specificity was 100% with area under curve of 1.0 (95% CI 1.0, 1.0) on second day of cannulation. CONCLUSION: The IIEART developed was found to be valid and reliable and can be used by healthcare personnel to predict pediatric patients at risk for intravenous infiltration and extravasation.

A Quality Improvement Initiative: Improving First-hour Breastfeeding Initiation Rate among Healthy Newborns.

INTRODUCTION: "No matter where a newborn takes his or her first breath, the desire to give that baby the best start in life is universal." The best gift a mother can give her baby is the gift of health. The gift of health can be given to the baby through early and adequate breastfeeding. Globally, only 2 out of 5 newborns are put to the breast within the first hour of life. Therefore, initiating breastfeeding is an evidence-based intervention for improving neonatal survival. METHODS: We aimed to improve the first-hour breastfeeding initiation rate from the existing 12%-80% over 3 months through a quality improvement (QI) process. The setting was antenatal, perinatal, and postnatal wards of the Maharishi Markandeshwar Institute of Medical Sciences And Research Hospital. The participants were postpartum mothers with stable newborns 35 weeks and older of gestation born by normal vaginal delivery. PROCEDURE FOR QI: A team of nurses and obstetricians was formed; we analyzed possible reasons for delayed initiation of breastfeeding by process cycle matrix chart and Fishbone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act cycles. The outcome measure is the proportion of eligible babies breastfed within 1 hour of delivery. RESULTS: After 3 months, the first-hour initiation of breastfeeding increased from 12% to 80%, without additional resources. CONCLUSIONS: A QI approach achieved an improvement in first-hour breastfeeding rates after normal vaginal delivery.

Efficacy of Lecture cum demonstration versus video-based teaching regarding active management of third stage of labor in terms of knowledge and skills of GNM students: An interventional study.

INTRODUCTION: Educational interventions have been associated with improved performance and significant changes, especially in perinatal outcomes. Teaching is one of the main components in educational planning which is a key factor in conducting educational plans through various teaching strategies such as simulation, demonstration and video teaching. AIM: The study aimed to assess lecture cum demonstration (LCD) versus video-based teaching (VBT) regarding active management of the third stage of labor (AMTSL) in terms of knowledge and skills of General Nursing Midwifery (GNM) students. METHODS: This was a quasi-experimental study conducted on 100 GNM third-year students selected by purposive sampling and randomly assigned to LCD (n = 50) and VBT (n = 50) groups. Sample characteristics performa, Structured Knowledge Questionnaire, and observational checklist were used to collect data from GNM students through self-report and observational technique. RESULTS: The study results showed that the mean posttest knowledge scores of LCD (17.32 ± 2.14) and VBT group (16.90 ± 2.41) were nearly equal and mean rank posttest skills score of LCD group (54.40) was slightly higher than VBT group (49.51), but computed " t " value of mean posttest knowledge and computed " Z " value of skill score of both LCD and VBT group (0.47, 0.54) were found to be statistically non-significant at 0.05 level of significance. CONCLUSION: It can be concluded that both LCD and VBT were found to be effective in improving knowledge and skills of GNM students regarding AMTSL.

Peer learning versus conventional teaching regarding antenatal assessment among nursing students in terms of knowledge, skills, and satisfaction: An interventional study.

INTRODUCTION: Eaching methods are the stimulation, guidance, direction, and encouragement for learning and also the means to achieve the desired educational objectives. AIM: This study aimed to assess peer learning (PL) versus conventional teaching (CT) regarding antenatal assessment in terms of knowledge, skills, and satisfaction among nursing students. METHODS: This was a quasi-experimental study conducted on 51 B.Sc.Nursing 3rd-year students who were selected by convenient sampling and randomly assigned to PL (n = 21) and CT (n = 30) group. Sample characteristics pro forma, structured knowledge questionnaire, observational checklist, and satisfaction rating scale wereused to collect data from nursing students through self-report and observational technique. RESULTS: The study results revealed that the mean posttest knowledge score (19.1 ± 0.75) in PL group was higher than that in CT group (17.0 ± 0.741) and the mean rank skill score of PL group (44.90) was higher than that in the CT group (20.30). There was no significant difference (t = 1.08, P > 0.05) in mean posttest knowledge score, whereas the significant difference was found in posttest skill score (Z = 5.00, P ≤ 0.01) among nursing students. Most of the nursing students were satisfied with the CT method. There was a mild positive correlation (r = 0.25) between knowledge and skills regarding antenatal assessment among nursing students. CONCLUSION: Based on the findings of the study, it can be concluded that both PL and CT groups were found to be equally effective in improving knowledge and skills of nursing students regarding antenatal assessment.

Effectiveness of Warm Compression on Lumbo-Sacral Region in Terms of Labour Pain Intensity and Labour Outcomes among Nulliparous: an Interventional Study.

Introduction: Childbirth is a distinctive and joyous moment in every mother's life. Giving birth is one of the powerful and vital event. This study aimed to assess and evaluate the effectiveness of warm compression (moist heat) on lumbo-sacral region in terms of labor pain intensity and labor outcomes Methods: An experimental research design was carried out on 88 nulliparous mothers with normal singleton term pregnancy (44 participants in each group) who were admitted in the labor room. Mothers who had high-risk pregnancy were excluded. Warm compression was given to nulliparous mothers of the experimental group with hydrochollator pack at 70◦C temperature for 20 minutes for 3 times with one-hour interval on lumbo sacral region starting from 4-5 cm of cervical dilatation. Labor pain intensity score, fetal heart rate, frequency and duration of uterine contractions were assessed before and immediately of warm compression and again after 30 minutes only labor pain was assessed. Results: Study results revealed that immediately after first, second and third time of warm compression labor pain intensity score in experimental group was lower than control group respectively ( t= 3.20; P< 0.001; t =4.45; P< 0.001; t= 6.18; P< 0.001). But no significant difference found in fetal heart rate and labor outcomes in terms of duration of labor, type of delivery, baby born alive/ not and cried immediately after birth. Conclusion: Warm compression was useful method to decrease the labour pain among nulliparous mothers in the first stage of labour and mothers reported satisfaction with intervention.

Knowledge and attitude regarding reproductive and sexual health among school teachers: a descriptive survey.

BACKGROUND: Adolescence is a time of evolving from the immaturity of childhood into the maturity of adulthood. This is a stage which requires extra care and protection. Physiologically and physically, adolescents go through a series of transformations as they grow and develop. METHOD: A descriptive study design was adopted with 70 teachers selected using a convenience sampling technique from five different government schools of the Ambala District, Haryana. Knowledge and attitude were assessed using a structured knowledge questionnaire and a 5-point Likert scale, respectively. The reliability coefficient of the structured knowledge questionnaire was found to be 0.67 by the Kuder-Richardson method and for the attitude scale, it was found to be 0.7 by Cronbach's α. RESULTS: More than one third (37.1%) of the teachers were between 31 and 35 years of age. Out of 70 the majority (75.7%) of the teachers were female. More than half (62.9%) of the teachers had an average level of knowledge and the majority (71.4%) of the teachers had moderately favorable attitudes regarding reproduction and sexual health. Furthermore, teachers had more knowledge about the reproductive organs and the concept of puberty followed by the concept of reproductive and sexual health and had the least knowledge in the area of contraception. CONCLUSION: This study highlights the need for special training and awareness programs regarding reproduction and sexual health among school teachers.

Improving quality of care during childbirth in primary health centres: a stepped-wedge cluster-randomised trial in India.

BACKGROUND: Low/middle-income countries need a large-scale improvement in the quality of care (QoC) around the time of childbirth in order to reduce high maternal, fetal and neonatal mortality. However, there is a paucity of scalable models. METHODS: We conducted a stepped-wedge cluster-randomised trial in 15 primary health centres (PHC) of the state of Haryana in India to test the effectiveness of a multipronged quality management strategy comprising capacity building of providers, periodic assessments of the PHCs to identify quality gaps and undertaking improvement activities for closure of the gaps. The 21-month duration of the study was divided into seven periods (steps) of 3 months each. Starting from the second period, a set of randomly selected three PHCs (cluster) crossed over to the intervention arm for rest of the period of the study. The primary outcomes included the number of women approaching the PHCs for childbirth and 12 directly observed essential practices related to the childbirth. Outcomes were adjusted with random effect for cluster (PHC) and fixed effect for 'months of intervention'. RESULTS: The intervention strategy led to increase in the number of women approaching PHCs for childbirth (26 vs 21 women per PHC-month, adjusted incidence rate ratio: 1.22; 95% CI 1.17 to 1.28). Of the 12 practices, 6 improved modestly, 2 remained near universal during both intervention and control periods, 3 did not change and 1 worsened. There was no evidence of change in mortality with a majority of deaths occurring either during referral transport or at the referral facilities. CONCLUSION: A multipronged quality management strategy enhanced utilisation of services and modestly improved key practices around the time of childbirth in PHCs in India. TRIAL REGISTRATION NUMBER: CTRI/2016/05/006963.

Intrinsic contributions of polar amino acid residues toward thermal stability of an ABC-ATPase of mesophilic origin.

The nucleotide-binding subunit of phosphate-specific transporter (PstB) from mesophilic bacterium, Mycobacterium tuberculosis, is a unique ATP-binding cassette (ABC) ATPase because of its unusual ability to hydrolyze ATP at high temperature. In an attempt to define the basis of thermostability, we took a theoretical approach and compared amino acid composition of this protein to that of other PstBs from available bacterial genomes. Interestingly, based on the content of polar amino acids, this protein clustered with the thermophiles.

Diagnostic dilemma: solitary fibrous tumor or hemangiopericytoma of the submandibular region in a patient with multiple odontogenic keratocysts.

Solitary fibrous tumors (SFTs) are rare spindle cell neoplasms that originate from mesothelial-lined surfaces, mainly the pleura and peritoneum. SFT is a distinctive mesenchymal neoplasm of the pleura but can be found in extrapleural sites. The treatment of SFT is simple excision or wide local resection. This is the case study of a 14-year-old girl who presented with a large diffuse swelling in the left submandibular region, ultimately diagnosed with SFT and surgically excised.