Improvement in Care and Maintenance of Port-A-Cath Following the Introduction of Care" Bundle.

Background: Port-a-cath is a type of indwelling central venous catheter used to manage pediatric patients who require long-term intravenous therapy. Objectives: The objective of this study was to improve the care and maintenance of port-a-cath among the nursing staff by introducing a care bundle. Materials and Methods: Pretraining and posttraining designs using PDSA (Plan, Do, Study, Act.) model were followed. We observed two sets of 30 procedures for accessing of port-a-cath by the nursing staff. Following the initial 30 observations of port-a-cath handling, a "care bundle" was designed as per the set standards of the maintenance of port-a-cath. It involved education and training and live audio-visual sessions. Two months after the initiation of the care bundle, the second set of 30 procedures was observed. Results: Following the introduction of the care bundle, the observed efficacy on obtaining verbal consent improved to 100% from 83%, arrangement of drugs and instruments before insertion to 100% from 90%, not touching the needle while inserting from 60%, administration of adequate amount saline flush from 83.3% (25/30), heparin administration from 71.1%, and looking out for signs of extravasation to 100% from 80%. Two nursing staff involvement improved from 23% to 63%. A 100% efficacy in the management of nonbleeding back scenarios was observed. The cross-checking of drug expiry improved from an initial 26.6% to 89.3%. The port-a-cath infections have significantly come down (3 vs. 0) (P < 0.05). Conclusion: Implementation of a "care bundle" has significantly improved the quality of handling of port-a-cath and reduction in infections.

Frozen in Time: Intraoperative Diagnosis and Management of Malignant Transformation in Mature Cystic Teratoma.

Malignant transformation (MCT) of ovary is rare complications affecting elderly, squamous cell carcinoma being the most common. The prognosis worsens with extraovarian spread. We present two cases of MCT-derived SCC. Patients exhibited abdominal lump, pain, bowel symptoms, sometimes with weight loss; imaging revealed MCT. Age (51-60), postmenopausal status, large size (>20 cm), bilaterality, and complex ovarian lesions raised suspicion of malignancy. Elevated tumor markers (e.g., cancer antigen-125 and lactate dehydrogenase) were noted in one case. Intraoperative frozen section confirmed malignancy, guiding staging laparotomy. One case was advanced stage on histopathology. Intraoperative frozen section aids optimal staging.

Locked Down: Experiences of Domestic Violence in Central India.

INTRODUCTION: The National Family Health Survey (NFHS-4) data show that 31.1% of women faced domestic violence in 2015-2016, with no reduction since 2005-2006. Emerging data show that since the outbreak of the coronavirus disease (COVID-19), reports of intimate partner violence have increased worldwide because of mandatory lockdowns to curb the spread of the virus. The nature of the current pandemic, which has forced women to spend time with their abusers and restricted their mobility, has made them more vulnerable to abuse. We aimed to determine the proportion of domestic violence among Indian women during the lockdown period. METHODS: This is a cross-sectional study, conducted in June-August 2020 on married, Indian women of reproductive age who attended the obstetrics-gynecology outpatient department during the COVID-19 pandemic. The Abuse Assessment Screening questionnaire validated during NFHS-4 (2015-2016) was used as a data collection tool. Our primary objective was to determine the proportion of women presenting to the hospital who were exposed to domestic violence during the lockdown period. Analysis was done using SPSS Statistics V22.0. RESULTS: A total of 412 women were recruited for the study. The mean age was 23 years (range 19-52 years). The prevalence of domestic violence in any form was found to be 32.5%, with the majority being verbal abuse in the form of insults, threats of physical violence, or public humiliation. CONCLUSION: The results of this study indicated a high proportion of women with a history of domestic violence during the pandemic. Thus, health care policy makers and experts involved in women's care-particularly during crisis conditions such as the COVID-19 pandemic-should be aware of the extent of this problem and take measures to properly address it.

The socioeconomic apprehensions of a pregnant woman around COVID-19 - Do we need to be worried?

Introduction: Coronavirus 2019 (COVID-19) pandemic has become the most severe intercontinental health challenge and pregnant women are deemed to be a special population group. The COVID-19-related restrictions on visiting the hospital for antenatal check-up and procedures may be distressing for them. The present study aims at assessing the level of anxiety and risk perception of pregnant women during the pandemic. Materials and Methods: This cross-sectional observational study included all pregnant women who were above 18 years of age, irrespective of their gestational age. They were administered the pre-designed, pre-tested questionnaire via face-to-face interview. The effect of the COVID-19 pandemic and its influence on women's experience including her worries were collected. Data analysis was done using SPSS software version 22. Results: A total of 130 pregnant women with a mean maternal age of 26.1 ± 6.5 years were enrolled in the study. The mean gestational age of the women was 19 ± 4.7 weeks and most of them were in the second trimester (48.5%). Most of the pregnant women encountered the adverse socioeconomic influence of COVID-19 on their daily life (55.6% somewhat, 9.1% moderately so, 1.1% very much). Majority of them reported that they had limited their social activities (78.5%) and amorous relationship with their partner (30.8%). Also, around 59.2% of antenatal women experienced a moderate level and 40.7% had a mild level of anxiety. Conclusion: It is essential for obstetric providers to do prompt identification of mental health concerns in perinatal women and to liaise with mental health professionals to provide relevant interference.

Maternal Mortality in the Remote Islands of India-Unraveling the Conundrum.

Introduction: Reduction in maternal mortality has been a top priority in low- and lower middle-income countries of Asia-Pacific region. India, being one of them, has a major responsibility of reducing maternal mortality especially in light of the commitment on the part of the Sustainable Development Goals. Despite massive efforts and availability of technology needed to avert maternal deaths, the maternal mortality ratio (MMR) in India continues to be high especially in remote areas. This study aims at collecting the MMR data and analyzing in the context of island infrastructure. Material and Methods: This was a hospital-based cross-sectional study. The records of maternal deaths from January 2010 to December 2019 were collected from the medical record section and analyzed. Results: The MMR was estimated to be 95.63 per 100,000 live births. Majority of the patients were multigravida (82%) in the age group of 21 to 30 years (75%). Around 64% of them were referred cases. Majority (86%) of the deaths occurred in the postpartum period. Hemorrhage was the leading direct cause of maternal deaths (35.7%) followed by hypertensive disorders of pregnancy (HDP) (21.4%). Conclusion: Most maternal deaths are preventable. Early detection of high-risk pregnancies and early referral of such patients to a well-equipped center is the key to curb the catastrophe of mortality. Adopting methods like qSOFA (quick sequential organ failure assessment) for identifying patients requiring intensive care and miniPIERS (Preeclampsia Integrated Estimate of RiSk) model for predicting adverse outcome in HDP is the need of hour. More efforts should be made to retain the specialists in the islands.

Exploring the perspective of nursing staff or caregivers on birthing positions in Central India.

INTRODUCTION: Maternal birthing positions refer to the various physical postures a pregnant mother may assume at the time of delivery. The World Health Organisation recommends that woman should be given an opportunity to make a choice on the type of position to use during labour. Alternative birth positions are associated with lower incidence rates of performing episiotomy, less perineal tears and less use of instrumental deliveries. Nurses' perspective on women's positions has rarely been explored in India. Present study aims at assessing the knowledge regarding alternative birth positions among nursing officers. MATERIALS AND METHODS: This cross-sectional observational study was conducted on 52 nursing officers who were posted in the labour room. A pretested questionnaire was administered to them. Data analysis was done using SPSS software version 22. RESULTS: Majority (82.7%) of nursing officers felt that there is a need of giving a choice to the woman regarding alternate birth position. 76.9% of them were aware of position other than lithotomy. Around 48.1% would recommend squatting position to a woman in labour. Ease and convenience in conducting the delivery was the foremost reason chosen in advocating a birth position. Whereas overcrowding in the labour room, ignorance about alternate positions and difficulty in converting to instrumental delivery were cited as reasons of not recommending these positions. CONCLUSION: Educating nursing officers about emerging evidence regarding birthing positions will enable them to give accurate information to women.