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Objective: Healthcare services using mobile-phone based telemedicine provide simple technology that does not require sophisticated equipment. This study assessed community health workers’ knowledge, attitude, and practice (i.e., their readiness) at the village level for uptake of mobile-phone based telemedicine.Materials and Methods: This cross-sectional study was conducted among 80 community health workers, including Auxiliary Nurse Midwives, Multipurpose Health Workers and Accredited Social Health Activists working in a rural health block of India. A pre-tested, semi-structured, interviewer-assisted, self-administered questionnaire was used to assess their mobile-phone based telemedicine readiness.Results: Sixty (75.0%) health workers owned mobile phones. The median readiness score for mobile-phone based telemedicine was 109.0. The Accredited Social Health Activists showed a better attitude toward mobile-phone based telemedicine than others. There was a significant moderate positive correlation (r=0.67) between knowledge and practice domains. Community health workers who had smartphones showed a significantly better attitude than those who did not.Conclusion: Training programs on telemedicine service delivery, focused on Auxiliary Nurse Midwives/ Multipurpose Health Workers, can improve their attitudes towards telemedicine. A better attitude of the Accredited Social Health Activists must be leveraged to initiate mobile-phone based telemedicine services on a pilot basis initially and later scaled up in other settings.
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Objectives@#During the coronavirus disease 2019 (COVID-19) pandemic, countries around the world framed specific laws and imposed varying degrees of lockdowns to ensure the maintenance of physical distancing. Understanding changes in temporal and spatial mobility patterns may provide insights into the dynamics of this infectious disease. Therefore, we assessed the efficacy of lockdown measures in 16 countries worldwide by analyzing the relationship between community mobility patterns and the doubling time of COVID-19. @*Methods@#We performed a retrospective record-based analysis of population-level data on the doubling time for COVID-19 and community mobility. The doubling time for COVID-19 was calculated based on the laboratory-confirmed cases reported daily over the study period (from February 15 to May 2, 2020). Principal component analysis (PCA) of six mobility pattern-related variables was conducted. To explain the magnitude of the effect of mobility on the doubling time, a finite linear distributed lag model was fitted. The k-means clustering approach was employed to identify countries with similar patterns in the significant co-efficient of the mobility index, with the optimal number of clusters derived using Elbow’s method. @*Results@#The countries analyzed had reduced mobility in commercial and social places. Reduced mobility had a significant and favorable association with the doubling time of COVID-19—specifically, the greater the mobility reduction, the longer the time taken for the COVID-19 cases to double. @*Conclusions@#COVID-19 lockdowns achieved the immediate objective of mobility reduction in countries with a high burden of cases.
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INTRODUCTION:Because patients covered by medical insurance are being denied legitimate claims, doctors are working shoulder to shoulder with them and have garnered significant experience in this matter. We, therefore, decided to a systematic survey under the Medic LAWgic banner and presented the data.METHODS:A short, 8-question multiple-choice survey was conducted online among doctor clinicians. Duplicate replies were removed. The remaining replies were evaluated, interpreted, and the data are being presented here.RESULTS:A total of 377 doctors responded. The majority (208, 55%) had faced problems with medical insurance claims in more than 10% of their patients. Almost half of them (48%) had outright rejection of the claims in more than 10% of their patients. Reduction in claim amounts was faced in more than 10% instances by 262 (70%). The five most common causes for refusal or rejection of claims included failure of patient to disclose pre-existing illness (234, 62%), other insurance policy terms related issues (157, 42%), oral medication (199, 53%), treatment without admission (155, 41%), and treatment with new modes of therapy (152, 40%). As many as 301/377 (80%) doctors had written letters to the insurance companies for supporting their patients’ claim. Such supporting letters from the treating doctors resulted in the claim being accepted or approved in 216 instances (57%).DISCUSSION:Mediclaim denial is a major and growing problem. People who need financial assistance the most are also the most vulnerable to denial. In the USA, such denial rates ranged from 1% to 45% of in-network claims in the year 2017. Unfortunately, <0.5% of patients appealed such claim denial. The insurance regulatory and development authority of India (IRDA) have issued guidelines that all claims need to be settled within 30 days and that insurance companies must fulfill their contractual commitment for genuine claims, even if timely intimation was not possible. Insurance companies are running a business for profit. Hence, even the most expensive plans will have a list of exclusions, in the fine print. Indian patients need to be proactive in following up when claims are rejected or reduced. Doctors are their pillar of support, whose advantage needs to be taken by them. IRDA and consumer courts are also looking after patients’ rights in this matter.CONCLUSION:Patients are increasingly facing challenge of medical insurance companies denying legitimate claims. Doctors help by writing to the insurance companies supporting their patients claim and such letters help in the majority of instances. Patients and their families need to follow up aggressively when their claims are not approved, rejected or reduced. They should also request the help of their doctors when facing such challenges.
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We compared three angiotensin-converting enzyme (ACE) inhibitors, captopril, perindopril, and ramipril, in the presented prospective study for their effectiveness in patients having left ventricular (LV) systolic dysfunction and undergoing coronaryartery bypass grafting (CABG). We enrolled 27 patients in captopril, 43 patients in perindopril, and 70 patients in ramipril group. There was about 25%–36% rise in LVEF after 3 and 6 months of ACE inhibitor administration in all three groups. The reduction in LV diameters did not differ significantly amongst the three groups. There was a significant decrease (p < 0.05) in LV end-diastolic diameter from baseline levels in captopril and perindopril groups after 3 months that got increased after 6 months but remained below pretreatment levels in both the groups. In ramipril group, there was no much change in this parameter from baseline levels at 3 and 6 months of treatment. After 6 months of treatment, the percent reduction in LV end-systolic diameter was also sustained in perindopril-treated patients. The percent reduction was greater in the perindopril group (3 and 6 months: 7.39 ± 5.94 and 7.73 ± 3.43, respectively) as compared to that observed in captopril group (3 and 6 months: 5.67 ± 1.05 and 2.52 ± 3.11, respectively) and ramipril group (3 and 6 months: 7.30 ± 2.75 and 4.93 ± 3.22, respectively). Mitral-valve regurgitation was greatly reduced in the captopril group at 3 as well 6 months of ACE inhibitor administration. However, the percent reduction from baseline levels was not statistically significant amongst the three groups. The percent improvement in functional status was significantly greater in the ramipril treatment group (36.46 ± 3.14) after 6 months of treatment as compared to that of captopril (6.67 ± 10.64) and perindopril (4.17 ± 2.73) group. In conclusion, our data show equal beneficial effects with all three ACE inhibitors under investigation in CABG patients with LV systolic dysfunction, with marginal superiority for perindopril.
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Background: - Risk factors for cancer are also risk factors for other non-communicable diseases. The studies were done for knowledge, attitude & practice on risk factors of oral cancer, breast cancer and risk factors of cervical cancer and early diagnostic techniques for oral cancer, breast cancer and cervical cancer. Objectives:(1) To assess the knowledge of administrative staffs of New Sachivalaya, Gandhinagar regarding the risk factors for cancer and the awareness level among them on cancer prevention and treatment. (2)To assess their attitude towards cancer risk factors identification and early self diagnostic techniques. (3)To assess their behaviour towards practicing regarding self examination technique of oral cavity, self breast examination and cervical screening. Methods:- Detail list of all administrative staffs were obtained from General Administrative Department after the permission letter from Commissioner of Health & Secretariat of General Administrative Department of Sachivalaya. All 3429 staffs of New Sachivalaya were included in Simple random technique. Out of them 350 (10%) participants were taken for this study by their consent. Results: Study result showed knowledge were mix type of because 79.7% (n=279) had answer lump in breast or bleeding from nipple of breast were early signs for breast cancer, but 48.9% had answer on painful lump in breast is an early signs for diagnosis. 64.4% were had belief on cancer that cancer is a deadly diseases and cancer means cancel. Only 34.6% had belief as cancer can be prevented if early diagnosed. Knowledge level was different as they were on different position but the attitude and the practice to cancer risk factors identification and early diagnostic signs were almost same. They had more attitude and practice towards hospital visit rather than doing Self-Examination technique 93.7% (n=328) were willing to create awareness on cancer risk factors and its screening tests and early diagnostic signs for early identification of cancer.
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BACKGROUND: Several studies in the last few years have shown that the standard 250 micro g dose used in ACTH stimulation test may be very high and have suggested that a dose of 1 micro g may be sufficient for evaluating hypothalamo-pituitary adrenal (HPA) axis. AIMS: To evaluate the role of low dose ACTH stimulation test in patients with suspected Secondary Adrenal Insufficiency (SAI). SUBJECTS AND METHODS: Thirty-one patients of suspected SAI with a documented pituitary lesion and seven normal healthy controls were included in the study. All the subjects underwent ACTH stimulation test with standard high dose (HD= 250 microg) and low dose (LD= 1 microg) ACTH. Insulin Induced Hypoglycaemia (IIH) test was done in 7 out of 9 patients in whom the results of the two tests were discordant. The cut off for normal HD stimulation test was taken as peak cortisol response > 18 microg/dl and for LD test, either a cortisol response of > 18 microg/dl or an increment of more than 7 micro g/dl over the basal value at any time during the test, on the basis of response observed in controls. RESULTS: 22/31 patients (74%) in SAI group showed concordant results with both tests, whereas nine patients had discordant results. These nine patients showed AI with LD ACTH, but HD ACTH test showed a normal response. In 7 of these 9 patients who underwent IIH, AI was confirmed in 6. CONCLUSION: The LD ACTH stimulation test seems to be better than HD ACTH stimulation test for evaluating HPA axis in patients with suspected SAI. When basal cortisol is normal, LD ACTH stimulation test detects subtle SAI.