A critical evaluation of pictogram based patient information leaflet on hypothyroidism patients with metabolic syndrome: a visual approach to enhance health literacy.

INTRODUCTION: Hypothyroidism is a condition with an underactive thyroid gland. Since thyroid hormones play a significant role in metabolism, hypothyroidism is often associated with metabolic syndrome. Thus, the patient's awareness regarding metabolic syndrome is crucial. OBJECTIVES: To develop and evaluate a Pictogram-based Patient Information Leaflet (P-PIL) for hypothyroidism with metabolic syndrome. MATERIALS AND METHODS: This is a quasi-experimental study without a control group. The P-PIL was developed and validated using the Lawshe Method, translated, and evaluated with 72 patients (24 patients each for English and regional languages, Kannada and Malayalam). RESULTS: The leaflet's Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) scores were 62.0 and 7.1, respectively. The Baker Able Leaflet Design (BALD) index of English, Kannada, and Malayalam versions of the P-PIL were 28, 27, and 27, respectively. The user testing of the P-PIL was assessed in 72 patients. The overall mean knowledge assessment scores significantly improved from 52.92 ± 6.90 to 77.92 ± 9.31. The majority of patients, precisely 84.72%, expressed a positive opinion regarding the design and layout of the P-PIL. CONCLUSION: The evaluation results strongly suggest that this P-PIL can be an effective educational tool for hypothyroidism patients with metabolic syndrome.

Health Education for Chronic Kidney Disease Patients Not on Dialysis Through the Pictorial Patient Information Leaflet.

Background: Educating the patient with patient information leaflets is helpful to increase understanding and awareness about chronic kidney disease. Various educational materials are available online, but their quality is mixed. The content was found to be unreliable or incomprehensible. Objective: The study aimed to develop, validate, test the readability, translation, and design of the patient information leaflet and focused on assessing patients' knowledge levels using questionnaires after providing the validated patient information leaflet. Methods: A prospective study was conducted among chronic kidney disease patients who were not on dialysis. The patient information leaflet was prepared based on experts' opinions and a thorough review of various resources. Experts validated the content of the patient information leaflet through the content validity index. After being validated, the Baker Able leaflet design scale was used to evaluate the layout and design. Knowledge assessment questions were validated using item-content validity index scores to assess patient knowledge before and after providing the patient information leaflet. Results: A total of 60 randomly selected chronic kidney disease patients were enrolled. The content validity index of the patient information leaflet was found to be 0.9. The Baker Able leaflet design score was found to be 25. Knowledge was assessed and it showed that score had increased from 42 ± 6.95 to 73.5 ± 6.70, respectively, with a P-value <0.000. Conclusion: This study concluded that the patient information leaflet was developed based on standard procedures. Significant improvement was seen in patients' knowledge after utilizing a validated patient information leaflet.

Development of evidence-based indicators for the detection of drug-related problems among ovarian cancer patients.

Background: Antineoplastic drugs produce serious drug-related problems and their management is challenging. DRPs are critical, for saving on therapeutic costs, particularly in resource poor settings within low-middle-income countries such as India. Indicators are clues that helps to detect DRPs within the healthcare organization and minimize overall harm from medications. Indicators enable healthcare professionals to determine the future therapeutic course. And enable healthcare professionals to take a proactive stand, and stay informed and empowered to both prevent and manage DRPs. This study aims to develop evidence-based indicators for detecting potential drug-related problems in ovarian cancer patients. Patients and Methods: A retrospective study was conducted in the Department of Oncology of a tertiary care teaching hospital in South India. Based on literature search, we developed a list of indicators, which were validated by a Delphi panel of multidisciplinary healthcare professionals (16 members). Based on 2 years of ovarian cancer data, we performed a feasibility test retrospectively and classified the DRPs according to the Pharmaceutical Care Network Europe classification of DRPs version-9.1. Results: The feasibility test identified 130 out of 200 indicators. A total of 803 pDRPs were identified under four main categories: drug selection problem, drug use problem, adverse drug reaction and drug-drug interaction The most frequently observed were ADR 381 (47.45%), DDIs 354 (44.08%), and drug selection problems 62 (7.72%). Conclusion: Indicators developed by us effectively identified pDRPs in ovarian cancer patients, which can potentially help healthcare professionals in the early detection, timely management, and attenuating severity of DRPs. Identifying the pDDIs can potentially improve interdisciplinary involvement and task sharing, including enhanced pharmacists' participation within the healthcare team.

Factors determining family and social support among pulmonary tuberculosis patients in East Khasi Hills, Meghalaya: a cross-sectional study.

INTRODUCTION: Family support plays a vital role in the outcome of individuals with tuberculosis (TB). OBJECTIVES: To determine the family and social support among individuals with pulmonary TB during treatment. METHODS: A cross-sectional survey was conducted among 237 pulmonary TB patients currently in the continuous phase of treatment. Bivariate and multivariate analyses were conducted to determine the association and predictors for family and social support. P-value < 0.05 was considered statistically significant. RESULTS: The mean age of the respondents was 31.97 ± 12.51 years, and a majority (58.2%) of the respondents with TB disease were 18 to 38 years old, and 59.9% were males. Around 49.7% of the pulmonary TB patients received a high level of family support, whereas 73% received a high level of social support. The determinants like age, average monthly income, the educational level of the head of the family and the occupational level of both the patients and the head of the family are associated with family support. CONCLUSION: This study recommends a coordinated strategy to treat TB that involves not only professional services but also the vital social support network of family and community that is required throughout therapy.

Evaluation of psychometric properties of a leaflet developed for schizophrenia.

BACKGROUND: Patients with severe mental illnesses like schizophrenia may benefit from a variety of patient education materials. Despite the availability of various resources, it is essential to assess the extent to which patients can comprehend the materials provided. OBJECTIVE: This study aims to evaluate the reliability and readability of the patient information leaflet (PIL) for schizophrenia. METHOD: A quasi-experimental study was conducted for a period of 6 months in the departments of psychiatry. Patients with a diagnosis of schizophrenia were recruited for the study. A user-testing questionnaire was developed and validated with the help of an expert committee to assess reliability. Later, translated versions of the questionnaire were then administered to the patients based on their language preference and evaluated by test-retest analysis. The readability was assessed using pre-validated and translated versions of the PIL. Initially, baseline scores of patient knowledge were assessed using a reliable user-testing questionnaire. Later, their responses were reassessed again using the same questionnaire after reading the PIL. RESULTS: A total of 45 patients participated in the study. From the total sample, 20 participants were randomly selected for reliability assessment. Intraclass-correlation coefficient (ICC), a statistical tool of reliability, give .6 for Kannada, .7 for Malayalam and 1 for the English version of the questionnaire. The overall patient's knowledge was found to be improved from 50.4 to 76.4 after reading the PIL. CONCLUSION: Patients with schizophrenia were able to comprehend the information available on the PIL. Therefore, further research is needed to determine its efficacy in a larger population.

Bacteriological profile and antimicrobial resistance pattern among patients with sepsis: A retrospective cohort study.

BACKGROUND: As the susceptibility pattern of different pathogens varies among different settings, the evaluation of appropriate clinical diagnosis and timely initiation of the empirical antibiotic treatment based on the local susceptibility data is crucial in the management of sepsis. METHODS: A retrospective study was conducted among adult patients with sepsis at a charitable hospital in Mangaluru. The essential details such as patient demographics, culture specimens, organisms, resistance/susceptibility pattern, laboratory data, empirical therapy and clinical outcomes were collected from the medical records. Descriptive statistics were used in analysing the data. RESULTS: A total of 425 patients diagnosed with sepsis during the study period were screened to meet the sample size of 373 positive cultures, among which 367 (91.3%) samples yielded the bacterial isolates, of which 250 (68.1%) and 117 (31.9%) were gram-negative and gram-positive organisms, respectively. The most common gram-negative organisms isolated were K pneumoniae (19.9%), A baumannii (19.6%) and E coli (12.8%); while Coagulase-negative staphylococcus (14.4%) and S aureus (8.4%) were the predominant gram-positive organisms. The isolated pathogens showed a resistance rate of >50% to the most commonly used antibiotics. CONCLUSION: The present study provides information on the prevalence of the most common pathogens and their resistance pattern to different antibiotics, which plays a vital role in the selection and timely initiation of the appropriate empirical antibiotic therapy.

Experience of SARS-CoV-2 infection in two kidney transplant recipients living with HIV-1 infection.

There is still no consensus on the optimal management of COVID-19 within the general population due to the emerging evidence base. High-risk groups, including kidney transplant recipients living with HIV present unique additional challenges. Here we discuss two kidney transplant recipients living with HIV with SARS-CoV-2 infection and their clinical course, and review the existing literature for this subset of challenging patients.

Outcomes of Renal Transplant Recipients With SARS-CoV-2 Infection in the Eye of the Storm: A Comparative Study With Waitlisted Patients.

BACKGROUND: Patients with chronic kidney disease stage 5 and those on immunosuppression are particularly vulnerable and are shielded as per public health strategy. We present our experience of coronavirus disease 2019 (COVID-19) transplant patients in one of the most affected parts of the UK with direct comparison to waitlisted patients. METHODS: A single-center prospective study of symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive waitlisted and transplant patients was undertaken to compare these groups and assess clinical outcomes. RESULTS: A total of 60 consecutive symptomatic SARS-CoV-2 positive patients were identified with 32 active waitlisted patients and 28 functioning renal transplants. Demographics were similar. The incidence of symptomatic COVID-19 in the waitlisted group was 9.9% compared to 1.9% in renal transplant patients (P < 0.001). Immunosuppression did not influence initial symptomology. Fifteen percent of patients in the waitlisted and 32% in the transplant groups died (P = 0.726). Mortality as proportion of total waitlisted (321 patients) and transplant population (1434 patients) of our centre was 1.5% and 0.6% (P < 0.001), respectively. C-reactive protein (CRP) at 48 h and peak CRP were associated with mortality in both groups while quick sequential organ failure assessment score at 48 h (P = 0.036) was associated with mortality for transplant patients. CONCLUSIONS: Incidence of COVID-19 is higher in the waitlisted population but transplant patients have more severe disease, reflected by higher mortality. CRP at 48 h can be used as a predictive tool. In the absence of effective treatments, the current strategy of shielding is arguably the most important factor in protecting patients while resuming transplantation.

Primary Renal Lymphoma - A Case Report and Review of Literature.

Primary Renal Lymphoma (PRL) is rare and its existence has been called into question due to the absence of lymphatic tissue within renal parenchyma. Non-specific abdominal pain with mass in the lumbar region and otherwise unexplained renal failure is the most common presentation. Almost all patients eventually develop extrarenal lymphomatous disease and few patients survive beyond one year. Surgical treatment is rarely feasible as primary modality of treatment since the tumour often encases major vessels and surrounding organs necessitating major resection. Instead, an attempt can be made to downstage the tumour with chemotherapy before attempting surgery. Here we present a case of primary renal Non-Hodgkins Lymphoma (NHL) which was treated with chemotherapy but the patient succumbed to disease before the third cycle.

Medical Symbols in Practice: Myths vs Reality.

BACKGROUND: The caduceus is the popular symbol of medicine. However, premier health organizations and regulatory bodies such as the World Health Organization and the Medical Council of India use a different symbol- the rod of Asclepius in their logo. There is an increasing awareness and recognition that the caduceus is a false symbol and has no historical substantiation as an emblem of medicine. Many academic and health institutions in the western hemisphere have changed their logo as a consequence. There are other symbols of medicine which are similarly misunderstood. OBJECTIVES: The purpose of the study is to assess the knowledge of common medical symbols among doctors and medical students. MATERIALS AND METHODS: Three hundred doctors and medical students were assessed on their knowledge about the Rx symbol, the Red Cross emblem and the true representative emblem of medicine. Logos and emblems of elite medical colleges and medical associations were also studied. RESULTS: Only 6% of doctors were aware that the Rod of Asclepius is the true symbol of healing. Knowledge of the significance of the Rx symbol and the origin of the Red Cross emblem was 55% and 39 %. CONCLUSION: There is very little awareness about the rod of Asclepius and most institutions have adopted a logo based on the caduceus. Awareness of the true origins and the symbolism of the emblems is lacking in the medical fraternity.

Attitudes and Practices of Surgeons towards Spilled Gallstones during Laparoscopic Cholecystectomy: An Observational Study.

The sequelae of spilled gallstones after Laparoscopic cholecystectomy (LC) and the occurring complications may go unnoticed for a long time and can be a diagnostic challenge. The aim of this survey was to study the knowledge, attitude, and practices of surgeons regarding spilled gallstones during LC. An observational, cross-sectional survey, using a questionnaire based on 11 self-answered close-ended questions, was conducted among general surgeons. Of the 138 respondents only 29.7% had observed a complication related to gallstone spillage during LC. There was varied opinion of surgeons regarding management of spilled gallstones, documenting the same in operative notes and consent. It was observed that there is lack of knowledge regarding the complications related to gallstone spillage during LC. There is need to educate surgeons regarding safe practices during LC to avoid gallstone spillage, early diagnosis, and management of complications. There is need to standardize practice to retrieve lost gallstones to reduce complication and legal consequences.

A case of heterotopic pregnancy with tubal rupture.

Heterotopic Pregnancy (HP) is the simultaneous development of an intra-uterine pregnancy and ectopic pregnancy. In natural cycle, it is a very rare event. With the increasing popularity of ovulation induction performed during assisted reproductive techniques, its incidence has significantly increased. However, diagnosis is often delayed because of its rarity and difficulty. Heterotopic pregnancy is an important differential diagnosis to consider in patients with intra-uterine pregnancies presenting with acute abdominal pain and hemoperitoneum. Here we are reporting a case of heterotopic pregnancy in a 26-year-old woman presented with symptoms and signs of ruptured tubal pregnancy with live intra-uterine gestation at 8 weeks of amenorrhea.