Monitoring the burden of COVID-19 and impact of hospital transfer policies on Australian aged-care residents in residential aged-care facilities in 2020.

BACKGROUND: Residential aged-care facilities in Australia emerged as the high-risk setting the COVID-19 outbreaks due to community transmission. The vulnerable aged-care residents of these facilities suffered due to low hospital transfers and high mortality and morbidity rates. This study aimed to monitor and report the burden of COVID-19 in residential aged-care facilities across Australia and the impact of hospital transfer policies on resident hospitalisation during the first year of the pandemic. METHODS: We conducted a retrospective cohort study by collecting data from weekly aged-care outbreak reports published by open sources and official government sources between 1st March and 20th November 2020. A comprehensive line list of outbreaks was created using open-source data. The line list included the name of the facility, location, COVID-19 cases among residents, & staff, resident hospitalisations, mode of transmission, number of resident deaths, and state policies involving resident hospitalisation. We also searched the websites of these facilities to collect data on their COVID-19 policies for the residents, staff, and visitors. Statistical analyses were performed on the data obtained. RESULTS: 126 aged-care COVID-19 outbreaks were identified in Australia during the study period. The incidence rate of COVID-19 infections among aged-care residents in Australia was (1118.5 per 100,000 resident population) which is 10 times higher than the general population (107.6 per 100,000 population). The hospitalisation rate for aged-care residents in Australia was 0.93 per 100,000 population. The hospitalisation rate of aged-care residents in Victoria was 3.14 per 100,000 population despite having the highest COVID-19 cases. Excluding South Australia, all states followed ad-hoc case-by-case hospital transfer policies for aged-care residents. CONCLUSION: This study documented a higher risk of COVID-19 infection for aged-care residents and workers but found low hospitalisation rates among residents across Australia. The hospitalisation rates in Victoria were higher than the national average but low when considering the COVID-19 infection rates in the state. The hospitalisation rates could have been impacted due to the state hospital transfer policies at that time. Immediate transfer of infected residents to hospitals may improve their survival and reduce the risk of infection to the other residents, as healthcare settings have more advanced infection control measures and are well-equipped with trained staff and resources.

Transformation of Mandatory Physiotherapy Internship into A Structured Competency-Based Program: A Pilot Study.

Introduction: Health professions education is challenging in terms of developing ways to construct and assess the amalgamation of knowledge, skills and attitudes that result in novice graduates to be self-aware and confident to practice without supervision. Currently, the Physiotherapy internship program in India does not have a comprehensive competency-based framework. With the current batch of interns facing the wrath of the COVID-19 pandemic during their undergraduate training, it is a matter of concern to ensure they have developed the required competencies to handle patients independently. Methods: This is a single-group interventional study using convenience sampling. A competency framework inclusive of a comprehensive assessment and training module was developed and introduced to 27 physiotherapy interns. Every intern underwent 10 training sessions along with 8 competency assessments during 6 months of internship training. A pre-post indigenous questionnaire was used to assess their self-perceived competency along with feedback questionnaire taken at the end of the module. Results: Implementation of the competency framework revealed a statistically significant difference in the self-perceived competency (pre=84.36±10.98, post=98.55±8.74, p≤0.000). Having uniformity in assessment techniques among the faculty, being exposed to challenging cases during assessment, having training module at the beginning of the internship were some of the suggestions given by the participants. Conclusion: Competency based education offers to be an effective technique in health professional program. Incorporating a competency-based training would help the learners to understand their strengths and weaknesses that would go a long way to develop competent health-care professionals. Developing such framework in curriculum will emphasize standardization of learning outcomes, thereby resulting in quality education, further enhancing patient care, and improving the health outcomes worldwide.

Safety and feasibility of pulmonary rehabilitation in patients hospitalized with post-COVID-19 fibrosis: A feasibility study.

BACKGROUND: Emerging data suggest a spectrum of pulmonary complications from COVID-19, ranging from dyspnea to difficult ventilator weaning and fibrotic lung damage. Prolonged hospitalization is known to significantly affect activity levels, impair muscle strength and reduce cardiopulmonary endurance. OBJECTIVE: To assess the feasibility and safety of inpatient pulmonary rehabilitation (PR) and to explore effects on functional capacity, physical performance, fatigue levels, and functional status. DESIGN: A prospective feasibility study. SETTING: Inpatient unit of a tertiary care hospital. PARTICIPANTS: Twenty-five hospitalized patients diagnosed with post-COVID-19 fibrosis referred for PR. INTERVENTION: Individualized PR intervention including breathing exercises, positioning, strengthening, functional training, and ambulation twice a day for 6 days a week. OUTCOME MEASURES: One-minute sit-to-stand test (STST), Short Physical Performance Battery (SPPB), Fatigue Assessment Scale (FAS), and Post-COVID-19 Functional Status Scale (PCFS). RESULTS: Twenty-five participants (19 males, 6 females) with a mean age of 54.2 ± 13.4 years were enrolled. Sixteen completed the two-point assessment after undergoing in-patient PR of mean duration 14.8 ± 9 days. PR led to a significant improvement in all functional outcomes that is, STST (from 7.1 ± 4.3 repetitions to 14.2 ± 2.1 repetitions, SPPB (from 5 ± 2.8 to 9.4 ± 1.5), FAS (from 33.3 ± 10.8 to 25.8 ± 4.7) at the p ≤ .001, and PCFS (from 3.6 ± 0.9 to 2.9 ± 1.2, p ≤ .05). CONCLUSION: Early initiation of PR for hospitalized patients with COVID-19 fibrosis was safe, well tolerated, and feasible and may improve functional status.

Inventory development to assess perceptions and metacognition of dental students toward learning in colleges in Pune, India.

BACKGROUND: Dental education is considered a challenging and taxing program as on successful completion one is required to attain unique and diverse competencies. There is an established perception that students do not enjoy their experiences in the dental institution and they always demand for certain amendments. Therefore, a dental education perceptions and metacognition assessment tool (DEPMAT) was developed for Indian undergraduate and postgraduate dental students for assessing their learning in Deemed University versus Maharashtra University of Health Sciences in Pune, Maharashtra. MATERIALS AND METHODS: This cross-sectional study was conducted among students of four dental colleges of two types of universities in Pune, India, using a 31-item DEPMAT based on Dundee Ready Education Environment Measure and metacognition awareness inventory using five subscales. Psychometric properties were also tested for this new tool. Data were analyzed using the SPSS software. RESULTS: Of 512 participants, 498 (96.88%) students had duly returned the questionnaire. Cronbach's alpha coefficient value for reliability was found to be 0.87 which indicated good internal consistency and test-retest reliability was found to be kw = 0.76, which indicated substantial agreement. Significant difference was found among undergraduates in domains regarding their perception toward academics, infrastructure and learning environment, and health and stress. CONCLUSION: This study suggested that the general perception toward learning among final year postgraduate students was positive in both the universities. However, the perception of final year undergraduates toward learning was negative and students have suggested certain amendments in both the universities. This study also suggested the new tool was effective in assessing the attitude of practice of both undergraduate and postgraduate students.

Extension for Community Healthcare Outcomes Based Telementoring of Physicians for Dementia-Effectiveness in India.

Objective: The study aimed to evaluate the effectiveness of a program based on the telementoring model [Extension for Community Healthcare Outcomes (ECHO)] for primary care physicians in diagnosing and treating patients with dementia. Method: The ECHO model was adapted through 12 live sessions of 2 h every 2 weeks consisting of a didactic presentation by the expert, peer-led new case discussions, and follow-up discussions. In addition, there were 10 h of self-paced e-learning and interim assignments. The impact was examined by noting participation, session ratings, monthly clinical reports, and comparing knowledge and competency scores before and after the course. Results: Among the 63 participants, 39.7% attended at least 80% of the sessions; completing the program successfully. The ratings for all sessions ranged from "good" to "excellent." The paired sample t-test revealed a statistically significant improvement (p < 0.001) in self-rated skills and confidence in diagnosing and treating dementia with an effect size of 1.25 and 1.37, respectively. No change in the knowledge score was observed throughout the course. A considerable increase in dementia-related clinical practice was observed during four monthly summary of clinical cases. Due to the limited data of monthly reports during the COVID pandemic, no statistical analysis was attempted. Conclusion: The ECHO model appears to have a positive immediate impact on the clinical ability of primary care physicians to diagnose and treat dementia. Its direct impact on patient health and at the community level should be aimed at in future studies.

Impact of Plantation Induced Forest Degradation on the Outbreak of Emerging Infectious Diseases-Wayanad District, Kerala, India.

The world has been facing a pandemic owing to COVID-19. We have also seen the geographic expansion and outbreaks of other emerging infectious diseases (EID) in recent years. This paper investigates the direct and indirect effects of land use land cover change (LULCC) on EID outbreaks in the context of Wayanad District of Kerala, India. Wayanad is in the vulnerable tropical forested region, and it is named as one of the four environmental change hotspots. The focus of this project is mainly three EIDs prevalent in this region: Kyasanur forest disease (KFD), Dengue and Leptospirosis. Our results, based on topographical map, remote sensing and extensive field work, show that the natural forest in Wayanad was replaced with agriculture and forest plantation during 1950-2018. This paper further suggests that encroachment of forest by forest plantation causes the human-animal conflict resulting in the outbreak of KFD cases. Our analysis reveals that a high number of Dengue cases is found in the forested regions of the district and over the adjacent human-made agriculture plantation areas. High and medium number of Leptospirosis cases contain a high portion of land area devoted to paddy cultivation and agricultural plantation. In summary, the results clearly show the linkage between the outbreak of above mentioned EIDs and LULCC in the context of Wayanad district, Kerala. We also discuss in detail the causal pathway involving human-environmental dynamics through which plantation leads to the outbreak of KFD. Replacing forests with plantations poses an alarming threat of disease outbreak in the community.

Gender Issues in the Care of Elderly: A Narrative Review.

Aging is an inevitable physiological process. A significant increase has been noted in the elderly population over the years. Aging population face challenges with physical health conditions, but also mental health problems. Care of the elderly is influenced by health conditions, health services, as well socio cultural factors. Gender plays an important role in the aging process with significant differences noted in the aging process, variations in health conditions as well care received. The current review addresses the role of gender in the aging process and its influence in the prevalence, clinical presentation and course of various mental and physical health conditions in the elderly. The review identifies gaps in understanding the gender perspectives related to long-term elderly care, legal and financial issues. The review emphasizes the necessity to address the gender perspective in aging to adequately meet the health demands of the elderly.

Postgraduate Physiotherapy Training in a Quandary - Ramifications of Corona virus pandemic Lockdown: A Survey-based Study.

INTRODUCTION: Coronavirus disease-2019 (COVID-19) has disrupted clinical services and postgraduate training across the world. Hence, this survey was conducted to understand the impact of pandemic on Physiotherapy post-graduate (PG) education. METHODS: It was a cross-sectional, observational study. A total of 254 Physiotherapy PG trainees were recruited through snowball sampling from Physiotherapy colleges across the state of Maharashtra. A 34-item structured questionnaire was developed, based on available literature, to evaluate the impact of COVID-19 pandemic on four domains: academic training, clinical training, research activities, and concerns faced by a PG trainee. The face validity of this questionnaire was assessed by six academicians and their suggestions were examined. Subsequently, it was piloted on five PG trainees before administering it to the participants. The validated questionnaire was then circulated via various social media platforms and personal contacts using Google form. Descriptive statistics were summarized as frequencies/ percentages. McNemar's test was used to determine the differences on a dichotomous dependent variable between the two related groups using SPSS software. RESULTS: Overall 131 trainees provided complete responses. Although 85% (n=111) of them claimed they attended PG teaching activities through online mode, almost 67% (n=101) disagreed to have achieved their learning objectives. A vast majority (91%, n=119) of them felt that their specialty related practical training was severely affected, and 98% (n=129) reported that reduced caseload had impacted their clinical learning. Also, 70% (n=54) of final year PGs had difficulty in recruiting new participants for their dissertation. Spread of infections to family (98%), commuting in public transport (98%), uncertainty about exam dates (91%), and competency development in specialty areas (96%) were some of their concerns. CONCLUSION: COVID-19 pandemic had impacted various domains of Physiotherapy PG program such as academic, clinical and research areas. Regulatory authorities should take serious consideration and devise strategies to overcome it.

Perceived barriers to evidence-based practice among Physiotherapy students.

BACKGROUND: Evidence-based practice (EBP) is the integration of clinical expertise, patient values, and best research evidence into the decision-making process for patient care. Identification of barriers that refutes the use of EBP in day-to-day practice will go a long way in designing programs for inculcating EBP among physiotherapy students. Therefore, the aim of this study was to identify perceived barriers to EBP among physiotherapy students. METHODS: A convenience sample of 429 participants were recruited from physiotherapy colleges affiliated to a State Health Science University as per the inclusion criteria. Participants were asked to fill the self-reported questionnaire that was developed by researchers based on possible items from previously developed surveys. Data collected were tabulated and analyzed by descriptive statistics. Response frequencies for the survey questions were determined and displayed in graphical formats. RESULTS: The study comprised of 182 final year students, 112 interns, and 135 postgraduate students having a mean age of 21.29 (0.85), 22.30 (0.77), and 24.34 (1.45) years, respectively. Majority of participants reported insufficient time, poor understanding of statistical analysis, lack of research skills, lack of formal training, lack of access to paid article, poor ability to critically appraise articles, and inadequate infrastructure facilities as barriers towards practicing EBP. CONCLUSION: Physiotherapy students perceived various organizational, training-related, and personal barriers toward the use of EBP. Effective education could prove to be the most powerful tool to overcome these barriers toward the use of EBP.

Prevalence and clinical correlates of intimate partner violence (IPV) in women with severe mental illness (SMI).

Women with severe mental illness (SMI) are a vulnerable population in whom varying rates of Intimate Partner Violence (IPV) have been reported with impact on their illness. The current study aimed to assess the prevalence and clinical correlates of IPV among women with SMI admitted to a tertiary care psychiatric hospital. The study was a cross sectional assessment of IPV among women with severe mental illness receiving inpatient care. The assessments included Indian Family Violence and Control Scale (IFVCS) for IPV, Brief Psychiatric Rating Scale (BPRS version 4) for psychopathology, The Suicide Behaviours Questionnaire Revised (SBQ-R) for suicidality, Physical Health Questionnaire (PHQ) for physical health, Scale for Assessment of Somatic Symptoms (SASS) for somatic symptoms and also semi structured schedule for their sociodemographic profile. A total of 100 women diagnosed with SMI with a cohabiting partner were assessed. The lifetime prevalence of IPV in the women with SMI was 22 %. Last 1-year prevalence of IPV in them was 20 %. Control and emotional violence were the most commonly reported form of violence, followed by physical violence, and sexual violence was the least reported. Significant association of IPV with suicidal behaviour, depression scores, physical health and somatic symptoms were found. IPV is prevalent in women with SMI and needs to be addressed. It is important to assess all types of IPV as it can impact the illness and the lives of these women, overall.

Efficacy of T. Cordifolia (Guduchi) against plaque and gingivitis-A clinico-microbiological study.

OBJECTIVES: The present study was conducted to assess the clinical efficacy (against plaque and gingivitis) and antimicrobial efficacy (against gram negative, gram positive and S. mutans counts) of T. cordifolia (Guduchi). METHODOLOGY: A nonrandomized before and after trial for 21 days of intervention was performed involving 17 participants. Plaque index, gingival index were recorded and saliva samples were collected at baseline, 13th day and 22nd day. Repeated measures ANOVA test was performed to compare the before and after results of the clinical parameters, i.e. score of plaque index and gingival index. Freidman's test was applied for comparison between the three intervals (for microbiological evaluation of colony counts). RESULTS: There was statistically significant reduction inplaque score, gingival score, and colony forming units of gram negative organisms and S. mutans from baseline to 22nd day (P = 0.001). There was no significant reduction with gram positive organisms. CONCLUSION: This clinico-microbiological study concluded that twice rinsing of T.cordifolia decoction as mouth rinse in adjunct to scaling and routine brushing of teeth for 21 days shows anti-plaque, anti-gingivitis, and antimicrobial action against gram negative organisms and S. mutans.

Acceptance of e-consult for Substance Use Disorders during the COVID 19 pandemic: A study from India.

OBJECTIVES: The COVID 19 pandemic has created challenges in providing timely care for patients and families with Substance Use disorders (SUDs). With the difficulties in face-to-face consultations because of social distancing measures, telepsychiatry services can be beneficial. The study proposes implementing an e-consult for SUD management and measuring its acceptability among the health care providers (HCPs) in India. METHODS: The mobile-based e-consult for SUD, connecting HCPs with addiction specialists, was implemented during the COVID lockdown period in India from 25 March to 31 May (71 days). A total of 153 HCPs, i.e., doctors, nurses, counselors, consulted for 110 cases of SUD. Sixty-eight provided feedback by filling the survey form derived from the Service User Technology Acceptability Questionnaire (SUTAQ). RESULT: More than 60% of HCPs reported overall high satisfaction. More than 98% providers reported high acceptability concerning"access to specialist care," "trusted to work appropriately", "saving time," "would like torecommend to others," easier to get touch with a specialist." The doctors reported significantly high acceptability about "access to specialist care," "satisfied with recommendations,"recommend to others" compared to other HCPs. CONCLUSION: During COVID 19 pandemic lockdown in India, e-consult was an acceptable tool in managing SUDs. The majority of HCPs could discuss their cases with addiction experts. There is a need to expand this further in other mental health conditions.

Survey of Musculoskeletal Disorders Among Indian Dancers in Mumbai and Mangalore.

Classical Indian dance has earned recognition across the globe; however, the health of dancers who are carrying forth this heritage has not received due attention. Therefore, this study aimed to explore musculoskeletal pain and injury prevailing among Indian dancers in Mumbai and Mangalore. A secondary aim was to compare pain tolerance levels between dancers and non-dancers. Fifty-one dancers trained in different traditional Indian and Western dance forms and 164 recreational dancers were recruited as participants. An indigenous questionnaire was designed and validated by physical therapists across various levels of experience and dancers across various training levels. The questionnaire recorded dance, pain, and injury profiles. Additionally, pain tolerance was evaluated using the Pain Sensitivity Questionnaire among dancers and healthy age- and gender-matched controls (N = 200). Descriptive statistical analysis was performed to present results of the site of current pain, site of past injury, perceived causes of injury, and exercise routine. The Student's t-test was used to compare Pain Sensitivity Questionnaire scores between dancers and non-dancers, and independent one-way ANOVA was used to compare scores among dancers practicing different dance forms. For both current pain and past injury, dancers reported the back (42.5%) followed by the knee (28.3%) and ankle (18.6%) as the most common sites. Stress was the most commonly perceived cause of injury (34.4%), followed by over work (24.7%), tiredness (17.2%), and falls (13.5%). Warm-up exercises were always performed by 43.30% of dancers, whereas only 20% performed stretching after dance. Almost 60% of dancers participated in forms of exercise other than dance, e.g., swimming, yoga, and aerobics. Pain sensitivity was not significantly different between dancers and non-dancers (p = 0.159). Level of training and gender did not influence pain.

Diagnostic Assessment of Cases with Chronic Kidney Disease with Diabetes Mellitus Type 2

Introduction: The currently available data in the publicdomain, is either from some specific regions in the countryor it doesn’t capture the prevalence of CKD specifically inT2DM population.9,14 Therefore, it was eminent to performa pan-India epidemiological study to get a clear cut idea onthe prevalence of CKD in T2DM patients. Hence, the presentstudy was conducted to assess the clinical spectrum of CKDpatients with type 2 diabetes mellitus.Material and Methods: This was a cross-sectional,observational, study to assess the clinical spectrum ofCKD among T2DM patients. The blood/plasma and urinesamples, were collected for estimation of hemoglobin A1c,microalbuminuria, serum creatinine, urine creatinine, androutine urine analysis.Results: When assessed blood pressures of the cases, weobserved that the mean systolic blood pressure was 138(12.4) mmHg, and mean diastolic blood pressure among thestudy subjects was 84 (6.4) mmHg. The mean HbA1C levelsobserved among the cases was 7.9 (1.27).Conclusion: Study reported higher prevalence of CKD whichwas driven by the ACR levels and majority of the patientshad reasonable eGFR. This can be a guide to select drug anddosage of diabetes drug as it depends on kidney function.

Study of Lipid Profile in Accelerated Hypertension in Tertiary Care Hospital in Western Maharashtra

Introduction: CVD is the leading cause of disability anddeath worldwide, and a great majority of CVDs are associatedwith dyslipidemia. Worldwide, there is broad variation inserum lipid profile levels among different population groups.Increased serum levels of TC, TG, LDL, and decreased HDLare known to be associated with major risk factors for CVD.The present study was conducted to assess the lipid levelsamong cases of accelerated hypertension presenting to atertiary healthcare institute.Material and methods: This study was done on 96 patientspresented with hypertensive emergencies admitted underdepartment of medicine, KIMS, Karad, from August 2018to December 2018 On admission, detailed history was takenand complete clinical examination was done. It was a hospitalbased cross sectional study.Results: Serum levels of TC, TG, HDL and LDL were 182±3.4,143.62±6.3, 49.68 and 95.83±7.8 mg/dL, respectively, inhypertensive subjects.Conclusions: Our results suggest that elevated BP may predictcertain disturbances in lipoprotein metabolism

Clinical Assessment of Cases Presented with Esophageal Varices and Portal Hypertension in a Tertiary Healthcare Institute: An Observational Study

Introduction: Portal hypertension (PHT) commonlyaccompanies cirrhosis of liver. Development of esophagealvarices is one of the major complications of PHT. A majorcause of PHT-related morbidity and mortality is thedevelopment of variceal hemorrhage, which occurs in 25-40% of patients. 1 Esophageal varices are diagnosed byendoscopy. Further follow-up should then relate to the initialsize of varices. In case of large varices, endoscopic follow-upis not necessary and primary prophylaxis with a nonselectiveβ-blocker should be started. Endoscopic band ligation isuseful in preventing variceal bleeding in patients with mediumor large varices. The present study was conducted to assess theclinical presentation of cases of portal hypertension presentedwith esophageal varices in tertiary healthcare institute.Material and methods: The present study was conductedat a tertiary healthcare teaching institute from July 2018 toOctober 2018 and 70 patients were studied. All the casespresented with PHT, which had been diagnosed clinically,biochemically, radiologically and endoscopically wereincluded in the present study.Results: Incidence of esophageal varices in patients withPHT is approximately 90-95%, but only 30-50% developvariceal bleeding, which is usually associated mainly withfatal outcome. Pallor (88%), ascites (80%) and splenomegaly(70%) were common signs followed by icterus (52%).Asymptomatic esophageal varices were found in 80% ofpatients, 20% had Grade 1, 26% had Grade 2 and 34% hadGrade 3 esophageal varices.Conclusions: Portal hypertension is largely a preventablecondition because the commonest etiology is alcoholism.Asymptomatic esophageal varices, which is quite common,can be easily diagnosed with invasive endoscopy or otherwisesuspected with noninvasive platelet/spleen size ratio in countrylike ours, where financial constraint is a main problem. It canbe very useful and applicable at small centers like communityhealth centers (CHCs) and primary health centers (PHCs) inour country with limited resources.

Assessment of Metabolic Syndrome as a Risk Factorfor Cardiovascular Diseases in Tertiary Care Hospital in Northern Maharashtra

Introduction: A wide range of traditional and nontraditionalcardiovascular risk factors that may promote and fosterthe development of atherosclerosis have been reportedin association with the metabolic syndrome, includingatherogenic dyslipidemia, prothrombotic and proinflammatorymilieu, and endothelial dysfunction. The present study wasconducted to study the cardiovascular risk factors amongthe cases presented with metabolic syndrome in a tertiaryhealthcare institute.Material and methods: It was a cross sectional observationalstudy conducted among 100 cases diagnosed with metabolicsyndrome attending outpatient department of departmentof medicine, KIMS. Written consents were taken from theparticipants.Results: Mean Waist Circumference in cm was 99.62 ± 9.2,Hip Circumference was 106.3 ± 8.67 cm. The W/H ratiowas 0.93 ± 0.79. These indices were higher as compared tothe controls. 7.5 % cases had peripheral vascular disease,8.2% cases had coronary artery disease, 4% had nephroticsyndrome, 6% had history of cerebrovascular disease.Conclusions: Evaluation of the parameters in metabolicsyndrome can be a simple clinical tool to assess potentialrisk for development of cardiovascular diseases and henceassessment of prognosis and to establish and prioritize theresources appropriately.