Reasons for Hospitalisation among Patients with Diabetes in a Secondary Care Hospital in South India: A Retrospective Study.

Background: Type 2 diabetes mellitus is a rapidly emerging non-communicable disease in India. It is associated with many life-long complications and higher rates of hospitalisations. The characteristics and reasons for hospitalisation among individuals with diabetes have not been documented in India. Such a study would direct policy makers in implementing prevention and education strategies and economic changes as needed. Aim and Objectives: The study aimed to study the characteristics and causes of admission of patients with diabetes admitted to a secondary care unit in South India. Methods: Aretrospective observation study of inpatient records of patients with diabetes aged 18 years and above admitted between January to December 2019 in a secondary care unit was done. The details of patient demographics, reason and outcome of admission were retrieved manually from paper-based patient records. Descriptive analysis was done using SPSS version 23. The study was approved by the Institutional Review Board of the institution. Results: Among the 479 admissions of patients with diabetes during 2019, the mean age of the admitted patients was 57.75 years. The majority of them had only one admission, 15% had re-admissions in the same time period. Approximately 78% of the admitted patients had one or more co-morbidities, 44.6% had hypertension as a co-morbidity. The principal cause of admission was infections (45%), followed by metabolic and endocrine causes (13.5%), cardiovascular disease (10.9%) and renal disease (7.96%). More than 80% of the admissions had a favourable outcome and were discharged. Conclusion: This retrospective study demonstrated that the most common reason for admission among patients with diabetes to a secondary care unit in South India was infection. Many infections are preventable with effective treatment for diabetes and health education. Patients bear the costs of routine treatment for diabetes which is a fraction of the direct cost of hospitalisation and can drive them to huge economic losses. Therefore, interventions to promote standard treatment by primary and secondary care health professionals and self-awareness among patients need to be done to prevent hospitalisations.

Designing a curriculum for postgraduate training in family medicine in India.

CONTEXT: Family physicians, trained in handling primary care problems through the principles of family medicine (FM), were needed in India. The training required a comprehensive and detailed curriculum that could be implemented across the country. AIM: The aim was to create a document that includes rationale, goals, subject-based objectives, educational methods and assessment methods that align to the objectives. DESIGN AND METHODS: Kern's Six-Step-method was used to create a curriculum document. The six steps are (a) problem identification and general needs assessment, (b) targeted needs assessment, determining and prioritizing content, (c) writing goals and objectives, (d) selecting teaching/education strategies,(e) implementation of the curriculum and (f) evaluation and application of the lessons learnt. RESULTS AND CONCLUSIONS: Based on the given steps, a team of faculty identified needs, requirements and barriers, wrote goals and objectives along with aligned educational and assessment methods. The curriculum document was created for FM resident training. The first set of residents have been trained based on this curriculum and an evaluation is being planned.

Prevalence of multimorbidity among adults attending primary health care centres in Qatar: A retrospective cross-sectional study.

CONTEXT: Multimorbidity (MM) is a global concern following the increase in life expectancy, the conquering of major infectious diseases, and the advances in the management of chronic illnesses. It places a substantial burden on patients and healthcare systems. AIMS: This study aims to describe the prevalence and pattern of MM in adults among primary healthcare users in Qatar. SETTINGS AND DESIGN: A retrospective cross-sectional study design. METHODS AND MATERIAL: Data were extracted from the electronic health records of patients aged 18 years and above who registered for care with 27 primary health centres in Qatar from 1st January 2017 to 30th June 2020. The distribution of MM among age groups, gender and nationality was analysed. RESULTS: In the study population of 7,96,427, the prevalence of MM was found to be 22.1%. MM was more prevalent in females (51.2%) than males (48.8%). The prevalence of MM showed an increasing trend with increasing age, with a peak of 25.8% found in the 46-55 age group. Qatari nationals accounted for 32.7% of MM, Southeast Asians for 28.3%, North Africans for 16.7% and individuals from other Middle Eastern countries for 14.1%. The five most common long-term chronic conditions were type-2 diabetes mellitus, hypertension, dyslipidaemia, obesity and eczema, with the first three being the most prevalent disease clusters. CONCLUSIONS: Our findings confirm that MM is common in Qatar's primary care centres. While the prevalence of MM was found to increase with increasing age, the largest proportion of patients with MM were those aged 46-55 years. This information adds to the available data on MM and directs health policymakers towards tailoring the management for the same.

Antibiotic therapy for Shigella dysentery.

BACKGROUND: Shigella dysentery is a relatively common illness and occasionally causes death, worldwide. Mild symptoms are self-limiting but in more severe cases, antibiotics are recommended for cure and preventing relapse. The antibiotics recommended are diverse, have regional differences in sensitivity, and have side effects. OBJECTIVES: To evaluate the efficacy and safety of antibiotics for treating Shigella dysentery. SEARCH STRATEGY: In June 2009 we identified all relevant trials from the following databases: Cochrane Infectious Diseases Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, issue 4), MEDLINE, EMBASE, LILACS and the metaRegister of Controlled Trials (mRCT). We also checked conference proceedings for relevant abstracts, and contacted researchers, organizations, and pharmaceutical companies. SELECTION CRITERIA: Randomized controlled trials of antibiotics for Shigella dysentery. DATA COLLECTION AND ANALYSIS: Four authors, working in pairs, independently assessed trial eligibility, methodological quality, and extracted data. We calculated risk ratios (RR) with 95% confidence intervals (CI) for dichotomous data, and used the random-effects model for significant heterogeneity. We explored possible sources of heterogeneity, when present, in subgroup analyses of participant age and percentage of participants with confirmed Shigella infection. MAIN RESULTS: Sixteen trials (1748 participants), spanning four decades and with differing sensitivity to Shigella isolates, met the inclusion criteria. Seven were judged to be at risk of bias due to inadequate allocation concealment or blinding, and 12 due to incomplete reporting of outcome data. Limited data from one three-armed trial of people with moderately severe illness suggest that antibiotics reduce the episodes of diarrhoea at follow-up (furazolidone versus no drug RR 0.21, 95% CI 0.09 to 0.48, 73 participants; cotrimoxazole versus no drug RR 0.30, 95% CI 0.15 to 0.59, 76 participants).There was insufficient evidence to consider any class of antibiotic superior in efficacy in treating Shigella dysentery, but heterogeneity for some comparisons limits confidence in the results. All the antibiotics studied were safe. There was inadequate evidence regarding the role of antibiotics in preventing relapses. AUTHORS' CONCLUSIONS: Antibiotics reduce the duration of Shigella dysentery.Regularly updated local or regional antibiotic sensitivity patterns to different species and strains of Shigella are required to guide empiric therapy. More trials adhering to standard guidelines are required to evaluate the role of antibiotics in the treatment of severe forms of Shigella dysentery and in groups who are at high risk of complications.

Antibiotic therapy for Shigella dysentery.

BACKGROUND: Shigella dysentery is a relatively common illness and occasionally causes death, worldwide. Mild symptoms are self-limiting but in more severe cases, antibiotics are recommended for cure and preventing relapse. The antibiotics recommended are diverse, have regional differences in sensitivity, and have side effects. OBJECTIVES: To evaluate the efficacy and safety of antibiotics for treating Shigella dysentery. SEARCH STRATEGY: In June 2009 we identified all relevant trials from the following databases: Cochrane Infectious Diseases Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, issue 4), MEDLINE, EMBASE, LILACS and the metaRegister of Controlled Trials (mRCT). We also checked conference proceedings for relevant abstracts, and contacted researchers, organizations, and pharmaceutical companies. SELECTION CRITERIA: Randomized controlled trials of antibiotics for Shigella dysentery. DATA COLLECTION AND ANALYSIS: Four authors, working in pairs, independently assessed trial eligibility, methodological quality, and extracted data. We calculated risk ratios (RR) with 95% confidence intervals (CI) for dichotomous data, and used the random-effects model for significant heterogeneity. We explored possible sources of heterogeneity, when present, in subgroup analyses of participant age and percentage of participants with confirmed Shigella infection. MAIN RESULTS: Sixteen trials (1748 participants), spanning four decades and with differing sensitivity to Shigella isolates, met the inclusion criteria. Seven were judged to be at risk of bias due to inadequate allocation concealment or blinding, and 12 due to incomplete reporting of outcome data. Limited data from one three-armed trial of people with moderately severe illness suggest that antibiotics reduce the episodes of diarrhoea at follow-up (furazolidone versus no drug RR 0.21, 95% CI 0.09 to 0.48, 73 participants; cotrimoxazole versus no drug RR 0.30, 95% CI 0.15 to 0.59, 76 participants).There was insufficient evidence to consider any class of antibiotic superior in efficacy in treating Shigella dysentery, but heterogeneity for some comparisons limits confidence in the results. All the antibiotics studied were safe. There was inadequate evidence regarding the role of antibiotics in preventing relapses. AUTHORS' CONCLUSIONS: Antibiotics reduce the duration of Shigella dysentery.Regularly updated local or regional antibiotic sensitivity patterns to different species and strains of Shigella are required to guide empiric therapy. More trials adhering to standard guidelines are required to evaluate the role of antibiotics in the treatment of severe forms of Shigella dysentery and in groups who are at high risk of complications.

Prevalence of Cervical Cancer Screening and Awareness among Women in an Urban Community in South India-A Cross Sectional Study.

Background: Although the incidence of cervical cancer has declined in developed countries, cervical cancer remains a major problem in those that are developing. Past studies suggest that Indian women, who account for at least one-fourth of the global disease burden, are not routinely screened. Objectives: Among the women living in our low-income urban community in South India, we sought to determine the prevalence of screening and to assess women's knowledge of cervical cancer. Methods: We conducted a community-based cross-sectional survey evaluating cancer screening prevalence among women aged 25-65 living in the communities served by our clinic. We also assessed knowledge of cervical cancer, screening and the HPV vaccine in a subset of 175 women in the same age range. Findings: Prevalence data was available for 1033 women. Of these,14.3% had at least one lifetime pelvic exam and 7.1% had undergone cervical cancer screening. Women who were married below the age of 18, who belonged to non-Hindu religion, and who were from a higher socioeconomic status were more likely to be screened. Women who were single did not undergo screening. With regard to knowledge of cervical cancer, 84.6% of women had poor knowledge, 10.3% had moderate knowledge, and 5.1% had good knowledge. Women aged 41 years or younger had better knowledge of the disease. Conclusions: Very few women are screened for cervical cancer and few have adequate knowledge of the disease within this South Indian community. These findings suggest opportunities for a community-based education and screening campaign to reduce the prevalence of cervical cancer within this population.

Effect of BATHE interview technique on patient satisfaction in an ambulatory family medicine centre in South India.

OBJECTIVE: The objective of the study is to determine the effect of background, affect, trouble, handling and empathy (BATHE) versus usual interview technique on patient satisfaction during regular consultation with family physicians in ambulatory care. DESIGN: The research design was a prospective, randomised control trial. SETTING: The trial took place in a family practice unit in South India, which was one of the clinical service units of the academic Department of Family Medicine of a tertiary hospital. PARTICIPANT: The eligible participants were adults above the age of 18 years, who did not have any acute presenting illness. The participants should have given consent and also not have any cognitive disability. A total of 138 participants took part in the trial, 70 in BATHE group and 68 in the non-BATHE group. All participants entering the trial completed the questionnaire. RESULT: The BATHE group had a significantly higher mean score for questions grouped under professional satisfaction. This included questions on whether the patient felt that the physician treated them as a person and also whether they felt the appropriate clinical examination was communicated to them. The questionnaire used for scoring satisfaction had 18 questions with a maximum possible score of 90. When taking a cut-off of 75% (68) from the total possible score of 90, 72.9% (51) of the participants for whom the BATHE consultation technique was used were satisfied as compared with only 55.9% (30) for whom the routine consultation was carried out. This was statistically significant (χ2=11.15, p value=0.0006) CONCLUSION: The study suggests that using BATHE in this family practice centre is beneficial in improving the perception of person centeredness in the consultation. However, further studies ruling out all possible bias are needed in our setting before the range of probable benefits of the BATHE technique can be fully gauged.

Antibiotic therapy for Shigella dysentery.

BACKGROUND: Shigella dysentery is a relatively common illness and occasionally causes death, worldwide. Mild symptoms are self-limiting but in more severe cases, antibiotics are recommended for cure and preventing relapse. The antibiotics recommended are diverse, have regional differences in sensitivity, and have side effects. OBJECTIVES: To evaluate the efficacy and safety of antibiotics for treating Shigella dysentery. SEARCH STRATEGY: In June 2009 we identified all relevant trials from the following databases: Cochrane Infectious Diseases Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, issue 4), MEDLINE, EMBASE, LILACS and the metaRegister of Controlled Trials (mRCT). We also checked conference proceedings for relevant abstracts, and contacted researchers, organizations, and pharmaceutical companies. SELECTION CRITERIA: Randomized controlled trials of antibiotics for Shigella dysentery. DATA COLLECTION AND ANALYSIS: Four authors, working in pairs, independently assessed trial eligibility, methodological quality, and extracted data. We calculated risk ratios (RR) with 95% confidence intervals (CI) for dichotomous data, and used the random-effects model for significant heterogeneity. We explored possible sources of heterogeneity, when present, in subgroup analyses of participant age and percentage of participants with confirmed Shigella infection. MAIN RESULTS: Sixteen trials (1748 participants), spanning four decades and with differing sensitivity to Shigella isolates, met the inclusion criteria. Seven were judged to be at risk of bias due to inadequate allocation concealment or blinding, and 12 due to incomplete reporting of outcome data. Limited data from one three-armed trial of people with moderately severe illness suggest that antibiotics reduce the episodes of diarrhoea at follow-up (furazolidone versus no drug RR 0.21, 95% CI 0.09 to 0.48, 73 participants; cotrimoxazole versus no drug RR 0.30, 95% CI 0.15 to 0.59, 76 participants).There was insufficient evidence to consider any class of antibiotic superior in efficacy in treating Shigella dysentery, but heterogeneity for some comparisons limits confidence in the results. All the antibiotics studied were safe. There was inadequate evidence regarding the role of antibiotics in preventing relapses. AUTHORS' CONCLUSIONS: Antibiotics reduce the duration of Shigella dysentery.Regularly updated local or regional antibiotic sensitivity patterns to different species and strains of Shigella are required to guide empiric therapy. More trials adhering to standard guidelines are required to evaluate the role of antibiotics in the treatment of severe forms of Shigella dysentery and in groups who are at high risk of complications.