Referral chain of patients with obstetric emergency from primary care to tertiary care: A gap analysis.

BACKGROUND: The referral system plays a crucial role in antenatal care and childbearing by providing access to emergency obstetric care. Excess referral from primary care and bypassing secondary levels of care leads to overcrowding of high risk and normal mothers in tertiary centers. Hence, this study aims to assess the gaps in the referral of patients with obstetric emergency from primary care to tertiary care. METHODOLOGY: In this hospital-based descriptive study, all obstetric patients referred to the Obstetric emergency facility and admitted in postnatal wards during the study period were included. They were interviewed using a pretested questionnaire. Data entry was performed using EpiData version 3.1 and analysis was done using SPSS version 22 software. RESULTS: Of the 505 eligible women who attended the facility, 286 (56%) were referred from other institutions, while 44% were self-referred. Among those referred, one-third were from tertiary level facility and 40% from primary care facility. More than half of the referral was through verbal communication to the patient (60%); only one-third had referral slips. Around 40.4% chose bus and private vehicles (37.6%) as their means of transport; only around 10% traveled in 108 ambulances. CONCLUSIONS: Measures to improve the capacity building at primary setting, hierarchy of referral, quality of documentation, and emergency transport mechanism for obstetric patients are vital. The deficits identified in the existing referral system will be useful to give feedback to the health systems of the neighboring regions on emergency obstetrics referrals and to propose referral guidelines.

A community-based cross-sectional study on hypertension screening in Puducherry, India.

Background & objectives: Hypertension is a health problem of global priority. Screening and early diagnosis is important to plan appropriate interventions. The present study objectives were to screen the urban population aged 30 yr and above and diagnose for hypertension and to identify the factors associated with poor screening for hypertension, if any. Methods: A community-based descriptive cross-sectional study was conducted in urban field practice area of a tertiary care hospital in Puducherry, India, among individuals aged 30 yr and above. Individuals were asked if they have tested themselves for hypertension in the past two years. Pretested questionnaire was used for data collection. Data collection was done during regular working time of the health centre. All eligible participants from consecutive households were included till the required sample size of 394 was achieved. Results: Of the 394 individuals interviewed, 252 (64%) had undergone screening for hypertension. The prevalence of self-reported hypertension among those screened was 26.2 per cent with no significant gender-wise differences. Screening for hypertension was better among females (71.6%) as compared to males (55.2%). Population who were at a higher risk of not getting screened for hypertension were relatively younger (30-44 yr) individuals and males. Interpretation & conclusions: The prevalence of self-reported hypertension among those screened was 26.2 per cent [95% confidence interval (21.1-31.9)]. Screening needs to be targeted more towards males and younger population.

Effects of vitamin D and calcium supplementation on side effects profile in patients of breast cancer treated with letrozole.

BACKGROUND: Vitamin D deficiency (<10ng/mL) and insufficiency (10-30ng/mL) may contribute to musculoskeletal symptoms observed in patients taking letrozole. This study was undertaken to assess the vitamin D status in breast cancer patients who received letrozole for >2months and to see the effects of vitamin D3 and calcium supplementation on them. METHODS: Eighty-two breast cancer patients were included. Baseline serum 25-hydroxy vitamin D concentrations were assayed and standard questionnaire was completed. They were given vitamin D3 and calcium supplementation (2000IU/1000 mg and 4000IU/1000mg) based on their baseline serum 25-hydroxy vitamin D concentration for 12weeks. RESULTS: Baseline serum 25-hydroxy vitamin D concentrations showed that 13.4% of patients were deficient and 73.2% of patients were insufficient in 25-hydroxy vitamin D. There was an increase in the concentrations of calcium, phosphorus and decrease in the concentrations of parathyroid hormone, alkaline phosphatase as the concentration of serum 25-hydroxy vitamin D increases. Patients who received letrozole for a longer duration had a low concentration of serum 25 (OH) vitamin D. Vitamin D3 and calcium supplementation increased the concentrations of calcium, phosphorous and decreased the concentrations of parathyroid hormone and alkaline phosphatase. Patients who had low serum 25-hydroxy vitamin D concentrations had more musculoskeletal symptoms which was improved following supplementation (9.14 vs 8.10 p=0.000). CONCLUSION: Vitamin D3 supplementation significantly improved serum 25-hydroxy vitamin D concentrations and decreased letrozole-induced arthralgia.