Care Around Birth Approach: A Training, Mentoring, and Quality Improvement Model to Optimize Intrapartum and Immediate Postpartum Quality of Care in India.

BACKGROUND: With the highest risk of maternal and newborn mortality occurring during the period around birth, quality of care during the intrapartum and immediate postpartum periods is critical for maternal and neonatal survival. METHODS: The United States Agency for International Development's Scaling Up Reproductive, Maternal, Newborn, Child, and Adolescent Health Interventions project, also known as the Vriddhi project, collaborated with the national and 6 state governments to design and implement the Care Around Birth approach in 141 high caseload facilities across 26 high-priority districts of India from January 2016 to December 2017. The approach aimed to synergize evidence-based technical interventions with quality improvement (QI) processes, respectful maternity care, and health system strengthening efforts. The approach was designed using experiential training, mentoring, and a QI model. A baseline assessment measured the care ecosystem, staff competencies, and labor room practices. At endline, the approach was externally evaluated. RESULTS: Availability of logistics, recording and reporting formats, and display of protocols improved across the intervention facilities. At endline (October-December 2017), delivery and newborn trays were available in 98% of facilities compared to 66% and 55% during baseline (October-December 2015), respectively. Competency scores (> 80%) for essential newborn care and newborn resuscitation improved from 7% to 70% and from 5% to 82% among health care providers, respectively. The use of partograph in monitoring labor improved from 29% at the baseline to 61%; administration of oxytocin within 1 minute of delivery from 35% to 93%; newborns successfully resuscitated from 71% to 96%; and postnatal monitoring of mothers from 52% to 94%. CONCLUSION: The approach successfully demonstrated an operational design to improve the provision and experience of care during the intrapartum and immediate postpartum periods, thereby augmenting efforts aimed at ending preventable child and maternal deaths.

Elements of stress relieving strategies amongst engineering students.

BACKGROUND: Stress relieving strategies (SRS) are quite significant to get rid of stress in engineering students. OBJECTIVE: The objective of this study is to determine the SRS factors in the engineering universities in Punjab state of India. This effort also aims to check the determinants of SRS. METHODS: The data is collected through a questionnaire survey conducted on engineering students of two different universities. The collected data out of 400 surveys is subjected to factor analysis and Anova. RESULTS: The factor analysis exposed various factors that influence the SRS. The study has projected the effects of SRS on gender, age, engineering streams, nature of universities. CONCLUSIONS: It is found that the SRS in students is partially influenced by engineering streams and gender of the engineering students.

Determinants of academic stress amongst engineering students.

BACKGROUND: Academic stress is one of the active research domains in engineering institutions. As it can result in ill health of students, it is important to monitor the level of academic stress in students. OBJECTIVE: The objective of this study was to determine the academic stress factors in the engineering universities in Punjab state of India. This study also aimed to check the determinants of academic stress. METHODS: The data was collected through a questionnaire survey conducted on engineering students of two different universities. The collected data out of 400 surveys is subjected to factor analysis and ANOVA. RESULTS: Factor analysis revealed various factors that influence the academic stress. It was also found that the academic stress in students is most influenced by Engineering Streams and Nature of Universities. CONCLUSIONS: The study projected the effects of Academic Stress on Gender, Age, Engineering Streams, Nature of Universities.

Respiratory failure in a cancer patient: pulmonary thrombotic microangiopathy.

The hypoxic patient with a normal chest X-ray can be a diagnostic challenge. This case illustrates the rational diagnostic process and describes a relatively rare but important complication of cancer metastasis. Thrombotic microangiopathy, like lymphangitis carcinomatosa, may cause respiratory failure and is a poor prognostic finding. However, unlike lymphangitis carcinomatosa, it may not have specific findings on cross-sectional imaging.

Gauging the effectiveness of music and yoga for reducing stress among engineering students: An investigation based on Galvanic Skin Response.

BACKGROUND: The purpose of this research is to examine the influence of music and yogic breathing for the management and control of stress. OBJECTIVE: To discover the most effective stimuli to handle stress by measuring the effect of types of musical drills and yogic breathing on engineering students using the Galvanic Skin Response Sensor Meter (GSRSM). METHODS: The present study attempts to study the effectiveness of music and yoga drills for relieving and managing stress. The study used a stratified random sampling method selecting engineering students from four streams. The GSRSM was used as a tool to record the responses after 300 seconds for the experimental and the control groups of 200 students each. Each group was comprised of 52 females (26%) and 148 males (74%). RESULTS: The experimental group reported reduction in mean value in Galvanic Skin Response (GSR) when they underwent deep yogic breathing, listened to religious hymns and listened to flute music. CONCLUSION: On the basis of the results, the researchers suggest that all three techniques i.e practicing yogic breathing, listening to religious hymns and listening to flute music were effective in reducing the stress level of engineering students. Listening to flute music emerged from these three drills, as the most effective stimulus for stress management.

Strengthening the Use of Partograph in High Caseload Public Health Facilities in India through an Integrated Quality Improvement Approach.

BACKGROUND: The effective implementation of evidence-based practices including the use of partograph to improve maternal and newborn outcomes is critical on account of increased institutional delivery. However, despite clear guidelines, partograph use in India is not widely practiced. MATERIALS AND METHODS: Quality improvement (QI) efforts along with training and mentoring were operationalized in a total of 141 facilities across 26 high priority districts of India. Assessments were conducted across baseline, intervention period, and end line. These included reviewing the availability of partograph and staff competency in filling them at baseline and end line, as well as reviewing monthly data for use and completeness of filling. The monthly data were tabulated quarter wise to study trends. Competency scores were tabulated to show the difference across assessments. RESULTS: An overall upward trend from 29% to 61% was seen in the practice of partograph use. Simultaneously, completeness in filling up the partograph increased from 32% to 81%. Staff competency in filling partograph improved considerably: proportion of staff scoring low decreased over the intervention period from 63% to 2.5% (P < 0.0001), and the proportion scoring high increased from 13% to 72% (P < 0.0001) from baseline to end line. CONCLUSION: The integrated approach of training, mentoring, and QI can be used in similar settings to strengthen partograph use.

India's RMNCH+A Strategy: approach, learnings and limitations.

Building on the gains of the National Health Mission, India's Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) Strategy, launched in 2013, was a milestone in the country's health planning. The strategy recognised the interdependence of RMNCH+A Interventions across the life stages and adopted a comprehensive approach to address inequitable distribution of healthcare services for the vulnerable population groups and in poor-performing geographies of the country. Based on innovative approaches and management reforms, like selection of poor-performing districts, prioritisation of high-impact RMNCH+A healthcare interventions, engagement of development partners and institutionalising a concurrent monitoring system the strategy strived to improve efficiency and effectiveness within the public healthcare delivery system of the country. 184 High Priority Districts were identified across the country on a defined set of indicators for implementation of critical RMNCH+A Interventions and a dedicated institutional framework comprising National and State RMNCH+A Units and District Level Monitors supported by the development partners was established to provide technical support to the state and district health departments. Health facilities based on case load and available services across the High Priority Districts were prioritised for strengthening and were monitored by an RMNCH+A Supportive Supervision mechanism to track progress and generate evidence to facilitate actions for strengthening ongoing interventions. The strategy helped develop an integrated systems-based approach to address public health challenges through a comprehensive framework, defined priorities and robust partnerships with the partner agencies. However, lack of a robust monitoring and evaluation framework and sub-optimal focus on social determinants of health possibly limited its overall impact and ability to sustain improvements. Guided by the learnings and limitations, the Government of India has now designed the 'Aspirational Districts Program' to holistically address health challenges in poor-performing districts within the overall sociocultural domain to ensure inclusive and sustained improvements.

Stress monitoring through non-invasive instrumental analysis of skin conductivity.

BACKGROUND: This paper envelops the notion of yogic breathing and its applications as one of the techniques for stress management through regulation of skin conductivity among Indian engineering students. Stress perturbs the normal physiological or psychological functioning of an individual. Thus, it is extremely vital to manage stress. OBJECTIVE: To explore the consequence of yogic breathing on skin conductivity using galvanic skin response sensor meter (GSRSM) on engineering students, of different universities. METHODS: The study uses stratified random sampling technique for the experimental study undertaken to measure skin conductivity. 471 Engineering students, in the age group of 18-22 years who gave informed written consent were screened, of which 71 (15%) dropped out and 400 students (84.9%) completed the study. The GSRSM was used to record skin conductivity (pre and post) among experimental (n = 200) and Control group (n = 200) each comprising of 52 females (26%) and 148 males (74%). The Experimental group underwent yogic breathing whereas the Control group did not do so. RESULTS: The experimental group reported reduction in mean value in skin conductivity after deep breathing for the time period (t = 300 sec) as compared to the control group, and this was significant (p < 0.01 and p < 0.05). CONCLUSION: It is recommended that, this uncomplicated and yet extremely effectual ancient technique of yogic breathing could be included in core curriculum to reduce and manage stress among engineering students. The paper thus highlights the use of yogic technique as an effective mode for Stress Management amongst Indian Engineering students.

An experimental analysis to monitor and manage stress among engineering students using Galvanic Skin Response meter.

BACKGROUND: This paper studies the impact of musical religious songs (hymns) for managing stress of Indian Engineering students through Galvanic Skin Response (GSR). OBJECTIVE: The objective of the paper is to find out, whether listening to hymns is able to reduce the value of GSR. METHODS: Sample students were selected through initial screening and the students who reported high mental stress during the interview were selected for the main drills. All the readings were taken using a GSR meter. Statistical t-test was used for the purpose of hypothesis testing. RESULTS: The study examines the relation between GSR and stress. The results indicated that listening to hymns had a significant effect on the value of GSR. The results highlight that GSR decreased at t = 300 seconds for the experimental group, who listened to hymns, as compared to control group (not exposed to the same). CONCLUSION: It is recommended that, this amazingly effortless and yet highly efficient traditional technique of listening to hymns be made a part of student's routine curriculum. The paper aims at spreading awareness of listening to hymns as one of the modes of Stress Management amongst Indian Engineering Students.

Stress management through regulation of blood pressure among college students.

BACKGROUND: This paper introduces the concept of Deep Breathing and its applications as one of the means towards stress management through regulation of blood pressure among Indian College Engineering students. The underlying concept of deep breathing is that the relation between emotions and breathing is two way, i.e. not only do emotions affect the breathing, but controlled deep breathing also has an effect on emotions. OBJECTIVE: The objective of the paper is to find out whether deep breathing technique is able to control blood pressure, and in turn, the level of stress. METHODS: Sample students had a selection through initial screening and the students who reported high mental stress during interview were selected for the main drills. All the readings are taken using a sphygmomanometer (digital blood pressure meter). Students' t test are used for the purpose of hypothesis testing. RESULTS: The results indicated that the deep breathing technique provided significant results. CONCLUSION: It is recommended that this amazingly simple and yet highly effective ancient technique of deep breathing become part of students' routine curriculum. The paper aims at spreading the awareness of this yogic technique as one of the modes of Stress Management amongst Indian college students.

Prevalence of and factors affecting post-obturation pain following single visit root canal treatment in Indian population: A prospective, randomized clinical trial.

AIM: This prospective randomized clinical study (1) investigated the prevalence of post-obturation pain after single visit root canal treatment and (2) evaluated the influence of factors affecting the pain experience. MATERIALS AND METHODS: One thousand three hundred and twenty eight (1328) patients were included in this study. Conventional single visit root canal treatment was carried out. The chemicomechanical preparation of root canals was done by a rotary protaper system with a combination of hand instruments. Post-operative pain was recorded by each patient by using visual analogue scale in well-defined categories at three time intervals, 12 h, 24 h, and 48 h. The data were analyzed using Fisher's exact test. RESULTS: The prevalence of post-obturation pain (severe) within 48 h after treatment was 4% (n = 54) but less as compared to the pain experienced after 12 h (9%) and 24 h (8.6%). The factors that significantly influenced post-obturation pain experience were: Age (Fishers exact test = 46.387, P = 0.0), gender (Fishers exact test = 23.730, P = 0.0), arch (Fishers exact test = 11.710, P = 0.001), and presence of pre-operative pain (Fishers exact test = 67.456, P = 0.0). CONCLUSION: The presence of post-operative pain was low (4%). The important prognostic determinants of post-obturation pain were: Old age, female, mandibular teeth, and presence of pre-operative pain. The vital condition of the tooth does not affect the intensity and frequency of post-obturation pain.

Mucinous metaplasia of the prepuce--a case report and review of literature--a case report.

Benign mucinous metaplasia of the prepuce is a rare and under recognized entity which can easily be mistaken for extramammary Paget's disease. It is characterized by the presence of benign mucin containing cells in the squamous epithelium. To the best of our knowledge only 6 such cases have been documented in the literature. We would like to report the first case in our country.

Di-n-butyltin(IV) complexes derived from heterocyclic beta-diketones and N-phthaloyl amino acids: preparation, biological evaluation, structural elucidation based upon spectral [IR, NMR (1H, 13C, 19F and 119Sn)] studies.

Stable, six coordinated Bu(2)SnLA type complexes have been prepared [where LH = RCOC:C(OH)N(C(6) H(5))N:CCH(3); R = -4-F-C(6)H(4)-(L(1)H), R = -4-Cl-C(6)H(4)-(L(2)H), R= -4-Br-C(6)H(4)-(L(3)H), R=-CF(3)(L(4)H) and AH = C(O)C(6) H(4) C(O)NCHR'COOH; R'= -H(A(1)H), -CH(3)(A(2)H), -CH(CH(3))(2)(A(3)H)] by the interaction of 1:1:1 molar ratios of di-n-butyltin(IV) dichloride with corresponding organic moieties in refluxing benzene using two moles of Et(3)N as a base. In these complexes LH and AH behave as bidentate and coordination is taking place through oxygen, this is inferred from IR and (13)C NMR studies. These complexes possess tin atoms in skew trapezoidal bipyramidal geometry with the C-Sn-C angles ranging from 149.88( degrees ) to 156.84( degrees ). Some of these complexes with their corresponding organic moieties (LH, AH) were tested for their antimicrobial activities.