Reasons for Hospitalisation among Patients with Diabetes in a Secondary Care Hospital in South India: A Retrospective Study.

Background: Type 2 diabetes mellitus is a rapidly emerging non-communicable disease in India. It is associated with many life-long complications and higher rates of hospitalisations. The characteristics and reasons for hospitalisation among individuals with diabetes have not been documented in India. Such a study would direct policy makers in implementing prevention and education strategies and economic changes as needed. Aim and Objectives: The study aimed to study the characteristics and causes of admission of patients with diabetes admitted to a secondary care unit in South India. Methods: Aretrospective observation study of inpatient records of patients with diabetes aged 18 years and above admitted between January to December 2019 in a secondary care unit was done. The details of patient demographics, reason and outcome of admission were retrieved manually from paper-based patient records. Descriptive analysis was done using SPSS version 23. The study was approved by the Institutional Review Board of the institution. Results: Among the 479 admissions of patients with diabetes during 2019, the mean age of the admitted patients was 57.75 years. The majority of them had only one admission, 15% had re-admissions in the same time period. Approximately 78% of the admitted patients had one or more co-morbidities, 44.6% had hypertension as a co-morbidity. The principal cause of admission was infections (45%), followed by metabolic and endocrine causes (13.5%), cardiovascular disease (10.9%) and renal disease (7.96%). More than 80% of the admissions had a favourable outcome and were discharged. Conclusion: This retrospective study demonstrated that the most common reason for admission among patients with diabetes to a secondary care unit in South India was infection. Many infections are preventable with effective treatment for diabetes and health education. Patients bear the costs of routine treatment for diabetes which is a fraction of the direct cost of hospitalisation and can drive them to huge economic losses. Therefore, interventions to promote standard treatment by primary and secondary care health professionals and self-awareness among patients need to be done to prevent hospitalisations.

Designing a curriculum for postgraduate training in family medicine in India.

CONTEXT: Family physicians, trained in handling primary care problems through the principles of family medicine (FM), were needed in India. The training required a comprehensive and detailed curriculum that could be implemented across the country. AIM: The aim was to create a document that includes rationale, goals, subject-based objectives, educational methods and assessment methods that align to the objectives. DESIGN AND METHODS: Kern's Six-Step-method was used to create a curriculum document. The six steps are (a) problem identification and general needs assessment, (b) targeted needs assessment, determining and prioritizing content, (c) writing goals and objectives, (d) selecting teaching/education strategies,(e) implementation of the curriculum and (f) evaluation and application of the lessons learnt. RESULTS AND CONCLUSIONS: Based on the given steps, a team of faculty identified needs, requirements and barriers, wrote goals and objectives along with aligned educational and assessment methods. The curriculum document was created for FM resident training. The first set of residents have been trained based on this curriculum and an evaluation is being planned.

Prevalence of multimorbidity among adults attending primary health care centres in Qatar: A retrospective cross-sectional study.

CONTEXT: Multimorbidity (MM) is a global concern following the increase in life expectancy, the conquering of major infectious diseases, and the advances in the management of chronic illnesses. It places a substantial burden on patients and healthcare systems. AIMS: This study aims to describe the prevalence and pattern of MM in adults among primary healthcare users in Qatar. SETTINGS AND DESIGN: A retrospective cross-sectional study design. METHODS AND MATERIAL: Data were extracted from the electronic health records of patients aged 18 years and above who registered for care with 27 primary health centres in Qatar from 1st January 2017 to 30th June 2020. The distribution of MM among age groups, gender and nationality was analysed. RESULTS: In the study population of 7,96,427, the prevalence of MM was found to be 22.1%. MM was more prevalent in females (51.2%) than males (48.8%). The prevalence of MM showed an increasing trend with increasing age, with a peak of 25.8% found in the 46-55 age group. Qatari nationals accounted for 32.7% of MM, Southeast Asians for 28.3%, North Africans for 16.7% and individuals from other Middle Eastern countries for 14.1%. The five most common long-term chronic conditions were type-2 diabetes mellitus, hypertension, dyslipidaemia, obesity and eczema, with the first three being the most prevalent disease clusters. CONCLUSIONS: Our findings confirm that MM is common in Qatar's primary care centres. While the prevalence of MM was found to increase with increasing age, the largest proportion of patients with MM were those aged 46-55 years. This information adds to the available data on MM and directs health policymakers towards tailoring the management for the same.

Effect of BATHE interview technique on patient satisfaction in an ambulatory family medicine centre in South India.

OBJECTIVE: The objective of the study is to determine the effect of background, affect, trouble, handling and empathy (BATHE) versus usual interview technique on patient satisfaction during regular consultation with family physicians in ambulatory care. DESIGN: The research design was a prospective, randomised control trial. SETTING: The trial took place in a family practice unit in South India, which was one of the clinical service units of the academic Department of Family Medicine of a tertiary hospital. PARTICIPANT: The eligible participants were adults above the age of 18 years, who did not have any acute presenting illness. The participants should have given consent and also not have any cognitive disability. A total of 138 participants took part in the trial, 70 in BATHE group and 68 in the non-BATHE group. All participants entering the trial completed the questionnaire. RESULT: The BATHE group had a significantly higher mean score for questions grouped under professional satisfaction. This included questions on whether the patient felt that the physician treated them as a person and also whether they felt the appropriate clinical examination was communicated to them. The questionnaire used for scoring satisfaction had 18 questions with a maximum possible score of 90. When taking a cut-off of 75% (68) from the total possible score of 90, 72.9% (51) of the participants for whom the BATHE consultation technique was used were satisfied as compared with only 55.9% (30) for whom the routine consultation was carried out. This was statistically significant (χ2=11.15, p value=0.0006) CONCLUSION: The study suggests that using BATHE in this family practice centre is beneficial in improving the perception of person centeredness in the consultation. However, further studies ruling out all possible bias are needed in our setting before the range of probable benefits of the BATHE technique can be fully gauged.

Prevalence of Cervical Cancer Screening and Awareness among Women in an Urban Community in South India-A Cross Sectional Study.

Background: Although the incidence of cervical cancer has declined in developed countries, cervical cancer remains a major problem in those that are developing. Past studies suggest that Indian women, who account for at least one-fourth of the global disease burden, are not routinely screened. Objectives: Among the women living in our low-income urban community in South India, we sought to determine the prevalence of screening and to assess women's knowledge of cervical cancer. Methods: We conducted a community-based cross-sectional survey evaluating cancer screening prevalence among women aged 25-65 living in the communities served by our clinic. We also assessed knowledge of cervical cancer, screening and the HPV vaccine in a subset of 175 women in the same age range. Findings: Prevalence data was available for 1033 women. Of these,14.3% had at least one lifetime pelvic exam and 7.1% had undergone cervical cancer screening. Women who were married below the age of 18, who belonged to non-Hindu religion, and who were from a higher socioeconomic status were more likely to be screened. Women who were single did not undergo screening. With regard to knowledge of cervical cancer, 84.6% of women had poor knowledge, 10.3% had moderate knowledge, and 5.1% had good knowledge. Women aged 41 years or younger had better knowledge of the disease. Conclusions: Very few women are screened for cervical cancer and few have adequate knowledge of the disease within this South Indian community. These findings suggest opportunities for a community-based education and screening campaign to reduce the prevalence of cervical cancer within this population.

Management of diabetic ketosis and ketoacidosis with intramuscular regular insulin in a low-resource family medicine setting.

BACKGROUND: India is facing an epidemic of diabetes mellitus (DM). Effective management of complications of DM is a challenge in resource-poor areas of India. This study addresses the need to explore low-cost methods to manage diabetic ketosis (DK) and diabetic ketoacidosis (DKA). OBJECTIVES: To demonstrate the use of intramuscular (IM) regular insulin as a safe alternative method to control DK and DKA in a family practice setting. MATERIALS AND METHODS: A retrospective chart review was done for 34 patients admitted with DK and DKA in a family medicine unit for the urban poor over 5 years. Data on age, sex, precipitating factors, blood pressure, number of days of hospitalization, amount of insulin, and time required to control blood glucose (BG) and to correct acidosis were entered into EpiData version 3.1 and analyzed using SPSS software version 17. RESULTS: Administration of IM regular insulin was effective in reducing the BG to < 250 mg/dL in patients with DK and DKA. The mean time required for this in the ketosis group was 3.8 h and in the ketoacidosis group was 3.9 h. The mean amount of insulin required for correction of acidosis in the ketoacidosis group was 72.3 units and the mean time to achieve this was 33 h. Of the 34 patients, only one in the ketoacidosis group had hypoglycemia. There was no fatality or referral of any patient. CONCLUSION: This study demonstrates that IM regular insulin is a safe alternative method in managing DK and DKA in a family medicine setting.

Quality of Antenatal Care Provided by Nurse Midwives in an Urban Health Centre with Regard to Low-Risk Antenatal Mothers.

BACKGROUND: India contributes to 19% of the global maternal deaths. Good quality antenatal care can prevent maternal deaths by early detection of complications and maintaining maternal health. There are few studies documenting quality of antenatal care in India. This study aimed to document the antenatal services provided by nurse midwives to low-risk pregnant mothers from an urban population. AIMS: The primary objective was to describe the quality of the antenatal care provided by nurse midwives of an urban health centre with regard to low-risk mothers. The secondary objective was to document the maternal and early neonatal outcomes of the enrolled mothers during the period of study. METHODS: This prospective cohort study was done on 200 pregnant women who had antenatal care by nurse midwives between April 2014 and November 2014. The quality of care was assessed by a checklist adapted from World Health Organization (WHO). RESULTS: We report that the quality of antenatal care for all domains was above 90% except for the health education domain, which was poor with regard to breastfeeding and family planning in the enrolled 200 pregnant women. CONCLUSION: Our study concluded that trained nurse midwives when regularly monitored, audited and linked with reliable referral facilities can deliver good quality antenatal care.

Satisfaction of antenatal mothers with the care provided by nurse-midwives in an urban secondary care unit.

BACKGROUND: The satisfaction of antenatal women to antenatal services has rarely been studied in India. In a nation with a maternal mortality ratio of 178/100,000 live births, it is crucial to explore all avenues to reduce it. AIMS: Our study aims to assess the pregnant women's satisfaction with regard to antenatal care services provided by nurse-midwives in an urban health center in South India. METHODS: We administered a satisfaction of care questionnaire to 200 consecutive antenatal women attending the nurse run antenatal clinics from April 2014 to November 2014. The date entry was done using Epi-Data system and the analysis by SPSS version 16. STATISTICAL ANALYSIS USED: The absolute distribution of each of the question in the satisfaction of care questionnaire was calculated as proportions. The relationship between satisfaction of care and parity, number of visits, years of experience of the care provider and mother's education was tested using Mann-Whitney test for two independent groups. RESULTS: The mean age of the mothers was 23.5 years. More than 95% of the mothers expressed satisfaction with the number of antenatal visits components of antenatal care. Only 31.8% of the mothers were satisfied with the health education on family planning. There was no significant relationship between satisfaction of care and parity of mothers or years of experience of care provider. CONCLUSIONS: Pregnant women attending a nurse run antenatal care service have positively expressed satisfaction of care provided therein.

Role of Family Medicine Education in India's Step Toward Universal Health Coverage.

India's commitment to universal health coverage has grown stronger with the submission of High Level Expert Group report by the Planning Commission in 2012. With this report comes the commitment to increase the primary health-care workforce to meet the population needs. However, the focus should not be just to increase the number of health workers, but to produce better health workers. Doctors, nurses and community health workers trained in primary and secondary health-care facilities can make a significant contribution in responding to the needs of the local community. The role of family medicine education is worth exploring in this context to equip the primary care health workers with the competencies of providing person-centered, comprehensive and continuous care.

Primary hypoparathyroidism presenting with new adult onset seizures in family practice.

Hypoparathyroidism commonly presents with paresthesias, fatigue, anxiety, muscle cramps and infrequently with seizures due to hypocalcaemia. Here, we present a case of 27-year-old adult female presenting with new onset convulsions who was subsequently diagnosed to have primary (congenital) hypoparathyroidism.

International classification of primary care: an Indian experience.

BACKGROUND: India is in the process of transition to universal health coverage for Indian citizens. The focus is to strengthen the primary and secondary level services. Coupled with this national scenario, the development of Family medicine as a distinct discipline is in a crucial stage. There is a nation-wide urge to build family medicine training units and service centers across the country to fulfill the unmet health needs of the population. OBJECTIVES: This study aimed to bring out reasons for encounter (RFE) and morbidity pattern of patients seen in a family physician run urban health center in South India. METHODS: The study was conducted in an urban health center of a tertiary care hospital. Clinicians entered the data using International Classification of Primary Care (ICPC) codes. Data included were demographics, 3 RFE, 3 diagnoses, 3 outcomes of care that include prescriptions, investigations, procedures, and referrals made. RESULTS: During 47,590 patient encounters, 59,647 RFE, 62,283 diagnoses and 68269 outcomes of care were recorded. The majority of RFEs and diagnoses are in the following ICPC chapters: Endocrinology (38.6%), cardiovascular (35.91%), respiratory (20.26%), digestive (7.68% and musculo-skeletal (6.8%). The most frequent outcome of care was prescriptions, followed by counseling and nebulization. CONCLUSION: This study is the first to report on the RFE in India. This study demonstrated the breadth of clinical conditions seen by family physicians across all ages and in both genders. This study attempts to highlight the need for family physician based services as a training ground for trainees.

Meningococcal meningitis C in Tamil Nadu, public health perspectives.

Meningococcal meningitis has rarely been reported in Tamil Nadu. We report here two children diagnosed with meningococcal meningitis in Vellore, Tamil Nadu, on May 2014. The causative strain was Neisseria meningitidis serotype C. The role of the primary care physician in early diagnosis, appropriate referral, and preventive measures of this disease to the immediate family and community is stressed.

Early diagnosis of a large vesical calculus complicating pregnancy.

Vesical calculus-complicating pregnancy is rare. This is a case report of a large vesical calculus-complicating pregnancy. The early diagnosis and appropriate surgical management of the large vesical calculus prevented complications like recurrent urinary tract infections and obstructed labor. It enabled the mother to have an uneventful vaginal delivery.

Morbidity Profile of Inpatients in a Secondary Care Center Run by Family Physicians.

BACKGROUND: There is a scarcity of records of morbidity pattern in secondary care centers. Reliable morbidity data will help in proper allocation of human resources. MATERIALS AND METHODS: A retrospective study of inpatient admission records of an urban secondary health center run by family physicians was done between April 2010 and March 2011. RESULTS: Pneumonia and other respiratory illnesses (represented by ICD code J) was the most common diagnosis. This was followed by infectious and viral diseases, circulatory diseases like hypertension, ischemic heart disease and endocrine diseases like non-insulin dependent diabetes mellitus. CONCLUSION: Physicians working in secondary care centres need to be experts in managing respiratory diseases, viral diarrheal illnesses, hypertension, ischemic heart disease and diabetes mellitus and patients with co-morbidities. They also need to be able to manage common obstetrics and neonatal emergencies. As the discipline of family medicine specializes in management of common ailments and multiple co-morbidities with an attitude of patient centeredness, family physicians would be the best managers of such centers. Inclusion of family physicians as specialist in secondary care centers will help in covering the manpower shortage in such centers.

Antibiotic therapy for Shigella dysentery.

BACKGROUND: Shigella dysentery is a relatively common illness and occasionally causes death, worldwide. Mild symptoms are self-limiting but in more severe cases, antibiotics are recommended for cure and preventing relapse. The antibiotics recommended are diverse, have regional differences in sensitivity, and have side effects. OBJECTIVES: To evaluate the efficacy and safety of antibiotics for treating Shigella dysentery. SEARCH STRATEGY: In June 2009 we identified all relevant trials from the following databases: Cochrane Infectious Diseases Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, issue 4), MEDLINE, EMBASE, LILACS and the metaRegister of Controlled Trials (mRCT). We also checked conference proceedings for relevant abstracts, and contacted researchers, organizations, and pharmaceutical companies. SELECTION CRITERIA: Randomized controlled trials of antibiotics for Shigella dysentery. DATA COLLECTION AND ANALYSIS: Four authors, working in pairs, independently assessed trial eligibility, methodological quality, and extracted data. We calculated risk ratios (RR) with 95% confidence intervals (CI) for dichotomous data, and used the random-effects model for significant heterogeneity. We explored possible sources of heterogeneity, when present, in subgroup analyses of participant age and percentage of participants with confirmed Shigella infection. MAIN RESULTS: Sixteen trials (1748 participants), spanning four decades and with differing sensitivity to Shigella isolates, met the inclusion criteria. Seven were judged to be at risk of bias due to inadequate allocation concealment or blinding, and 12 due to incomplete reporting of outcome data. Limited data from one three-armed trial of people with moderately severe illness suggest that antibiotics reduce the episodes of diarrhoea at follow-up (furazolidone versus no drug RR 0.21, 95% CI 0.09 to 0.48, 73 participants; cotrimoxazole versus no drug RR 0.30, 95% CI 0.15 to 0.59, 76 participants).There was insufficient evidence to consider any class of antibiotic superior in efficacy in treating Shigella dysentery, but heterogeneity for some comparisons limits confidence in the results. All the antibiotics studied were safe. There was inadequate evidence regarding the role of antibiotics in preventing relapses. AUTHORS' CONCLUSIONS: Antibiotics reduce the duration of Shigella dysentery.Regularly updated local or regional antibiotic sensitivity patterns to different species and strains of Shigella are required to guide empiric therapy. More trials adhering to standard guidelines are required to evaluate the role of antibiotics in the treatment of severe forms of Shigella dysentery and in groups who are at high risk of complications.