A qualitative study on factors affecting adherence to antidiabetic medication in patients approaching a health center in an urban area.

Aim: The aim of this study was to evaluate the factors affecting adherence to antidiabetic medication among diabetic patients in India. Setting and Design: A qualitative study was conducted among 40 diabetic patients aged >30 years, on treatment for more than a year without any complications in the Urban Health Centre of Dayanand Medical College and Hospital, Ludhiana, Punjab, India. Materials and Methods: A semistructured questionnaire was harnessed to congregate data by interviewing the patients for 30-40 min in person. The interviews were recorded in the form of audios by acquiring informed consent and transcribed verbatim. The factors were then divided into barriers and enablers which were further subdivided into themes and subthemes as a result of which four major themes were built including individual, social, organizational, and community levels. These major themes were further categorized into several subthemes to assess the nonadherence to antidiabetic medications. Results: The results of the interviews depicted that the lack of knowledge, financial problems, familial issues, misconceptions regarding the disease, and side effects of taking medications daily were the major altruist for nonadherence, whereas on the other hand, positive perception about the disease, family support, and getting medications on affordable prices by some health-care institutes played an important role in enabling medication adherence as about 50% patients were adherent to the medications. Moreover, various interventions were used to escort the patients regarding medication compliance and blood glucose level monitoring such as lifestyle modifications (diet and exercise), use of reminders for medication intake on time, encouraging them to visit health-care centers, or hospitals on time for regular check-ups and by educating them regarding the long-term effects of diabetes and its prevention.

Amiodarone-Induced Nystagmus and Ataxia: Case Report and Systematic Review of Case Reports.

Amiodarone is an antiarrhythmic drug with a significant adverse effect profile, including neurotoxicity. While ataxia, neuropathy, and tremors are more commonly seen forms of amiodarone neurotoxicity, very few cases of nystagmus are reported. We report the case of an 86-year-old man who presented with abrupt-onset ataxia, dizziness, and inability to ambulate, 10 days after initiating amiodarone for atrial fibrillation. His examination revealed gaze-evoked nystagmus along with features of cerebellar dysfunction. After excluding other etiologies, amiodarone was stopped. His nystagmus resolved, and his ataxia improved within 48 h of stopping amiodarone. Due to the rarity of this drug-induced adverse effect, we performed a systematic review of available case reports in the literature (PubMed and Scopus) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and presented our findings. Nystagmus is a rarely reported adverse effect of amiodarone, which can occur within days to months of starting the medication. Treatment includes stopping the drug and monitoring for resolution of nystagmus.

Questionnaire-based Evaluation of Factors Leading to Patient-physician Distrust and Violence against Healthcare Workers.

BACKGROUND: Rising incidents of aggression and violence against healthcare workers (HCWs) is widening the rift between the patients and their caregivers. So, aim of the study was to evaluate the perceptions of healthcare workers (HCWs) and patient's attendants about factors responsible for widespread violence and patient-physician distrust. MATERIALS AND METHODS: An anonymous, questionnaire-based, cross-sectional study was conducted over a period of one year in a tertiary care teaching institute. Performas, adapted from WHO published questionnaire and translated to local language, were administered separately to HCWs and attendants. Responses generated were collected and analyzed. RESULTS: Out of 295 HCWs, 11 (3.7%) HCWs faced physical violence, whereas verbal abuse was faced by 147 (50%) HCWs. A higher number of incidents of physical violence (91%) and verbal abuse (64%) were faced by HCWs in the age group of 20-30 years. Verbal abuse was faced by 49.3% of nurses, 53% of junior residents, 61% of senior residents and 36% of consultants. Out of 158 incidents of workplace violence (WPV), maximum occurred in ICUs (62.0%) and emergency (21%). Unexpected death, unexpected complication, extended hospital stay, staff shortage and unexpected bill were some of the factors perceived to be responsible for WPV. CONCLUSION: HCWs commonly face violence from patient's attendants resulting in stressful and fearful environment at the healthcare facility. Dedicated sessions on good communication and counseling for HCWs and better security arrangements at the hospitals are the need of the hour and also in the best interest of HCWs and patients. HOW TO CITE THIS ARTICLE: Sharma S, Gautam PL, Sharma S, Kaur A, Bhatia N, Singh G, et al. Questionnaire-based Evaluation of Factors Leading to Patient-physician Distrust and Violence against Healthcare Workers. Indian J Crit Care Med 2019;23(7):302-309.