Harshad Thakur

Optimal bearing surfaces for total hip replacement in the young patient: a meta-analysis

Although there is general consensus about the efficacy of total hip replacement (THR) in young patients, the most appropriate bearings in young patients remain highly debated. The three most popular bearings in use include metal-on-polyethylene (MOP), metal-on-metal (MOM) and ceramic-on-ceramic (COC). We conducted a systematic review and meta-analysis of literature to summarise the best available evidence on relative success of the three most popular bearings used in THR in young active patients. Our findings support the use of MOM bearings in the management of the young arthritic hip. These findings, largely based upon observational studies, should be taken in the context of the limitations of such non-randomised study designs.

Comparison of glucosamine sulfate and a polyherbal supplement for the relief of osteoarthritis of the knee: a randomized controlled trial (ISRCTN25438351)

BackgroundThe efficacy and safety of a dietary supplement derived from South American botanicals was compared to glucosamine sulfate in osteoarthritis subjects in a Mumbai-based multi-center, randomized, double-blind study.MethodsSubjects (n = 95) were screened and randomized to receive glucosamine sulfate (n = 47, 1500 mg/day) or reparagen (n = 48, 1800 mg/day), a polyherbal consisting of 300 mg of vincaria (Uncaria guianensis) and 1500 mg of RNI 249 (Lepidium meyenii) administered orally, twice daily. Primary efficacy variable was response rate based on a 20% improvement in WOMAC pain scores. Additional outcomes were WOMAC scores for pain, stiffness and function, visual analog score (VAS) for pain, with assessments at 1, 2, 4, 6 and 8 weeks. Tolerability, investigator and subject global assessments and rescue medication consumption (paracetamol) were measured together with safety assessments including vital signs and laboratory based assays.ResultsSubject randomization was effective: age, gender and disease status distribution was similar in both groups. The response rates (20% reduction in WOMAC pain) were substantial for both glucosamine (89%) and reparagen (94%) and supported by investigator and subject assessments. Using related criteria response rates to reparagen were favorable when compared to glucosamine. Compared to baseline both treatments showed significant benefits in WOMAC and VAS outcomes within one week (P < 0.05), with a similar, progressive improvement over the course of the 8 week treatment protocol (45–62% reduction in WOMAC or VAS scores). Tolerability was excellent, no serious adverse events were noted and safety parameters were unchanged. Rescue medication use was significantly lower in the reparagen group (p < 0.01) at each assessment period. Serum IGF-1 levels were unaltered by treatments.ConclusionBoth reparagen and glucosamine sulfate produced substantial improvements in pain, stiffness and function in subjects with osteoarthritis. Response rates were high and the safety profile was excellent, with significantly less rescue medication use with reparagen. Reparagen represents a new natural productive alternative in the management of joint health.Trial registrationCurrent Controlled Trials ISRCTN25438351.

Knowledge, Practices, and Restrictions Related to Menstruation among Young Women from Low Socioeconomic Community in Mumbai, India

The main objective was to assess knowledge, practices, and restrictions faced by young women regarding their menstrual hygiene. The views of adult women having young daughters were also included and both views were compared. In addition, the factors influencing the menstrual hygiene practices were also studied. The study was carried out during 2008 in Mumbai, India. The mixed methods approach was followed for the data collection. Both qualitative and quantitative methods were used to collect the data. For quantitative survey, totally 192 respondents (96 adult and 96 younger women) were selected. While young women were asked about questions related to their menstruation, adult women were asked questions to find out how much they know about menstrual history of their daughters. The qualitative data helped to supplement the findings from the quantitative survey and to study the factors affecting menstrual practices in young women. The mean age at menarche reported was 13.4 years and 30–40% of young girls did not receive any information about menstruation before menarche. It is thus seen that very few young girls between the age group 15 and 24 years did receive any information before the onset of menstruation. Among those who received some information, it was not adequate enough. The source of information was also not authentic. Both young and adult women agreed on this. Due to the inadequate knowledge, there were certain unhygienic practices followed by the young girls resulting in poor menstrual hygiene. It also leads to many unnecessary restrictions on young girls and they faced many health problems and complaints, which were either ignored or managed inappropriately. The role of health sector was almost negligible from giving information to the management of health problems of these young girls. This paper reemphasizes the important, urgent, and neglected need of providing correct knowledge to the community including adolescent girls.

Developing clinical indicators for the secondary health system in India

QUALITY PROBLEM OR ISSUE One of the prime goals of any health system is to deliver good and competent quality of healthcare. Through World Bank-assisted Maharashtra Health Systems Development Project, Government of Maharashtra in India developed and implemented clinical indicators to improve quality. INITIAL ASSESSMENT During this, clinical areas eligible for monitoring quality of care and roles of health staff working at various levels were identified. CHOICE OF SOLUTION Brainstorming discussion sessions were conducted to refine list of potential clinical indicators and to identify implementation problems. IMPLEMENTATION It was implemented in four stages. (a) Self-explanatory tool of record, standard operating procedures and training manual were prepared during tools preparation stage. (b) Pilot implementation was done to monitor the usefulness of indicators, document the experiences and standardize the system accordingly. (c) The final selection of indicators was done taking into consideration points like data reliability, indicator usefulness etc. For final implementation, 15 indicators for district and 6 indicators for rural hospitals were selected. (d) Transfer of skills was done through training of various hospital functionaries. EVALUATION AND LESSONS LEARNED Selection and prioritization of clinical indicators is the most crucial part. Active participation of local employees is essential for sustainability of the scheme. It is also important to ensure that data recorded/reported is both reliable and valid, to conduct monthly review of the scheme at various levels and to link it with the quality improvement programme.

Study of Awareness, Enrollment, and Utilization of Rashtriya Swasthya Bima Yojana (National Health Insurance Scheme) in Maharashtra, India

Introduction Government of India launched a social health protection program called Rashtriya Swasthya Bima Yojana (RSBY) in the year 2008 to provide financial protection from catastrophic health expenses to below poverty line households (HHs). The objectives of the current paper are to assess the current status of RSBY in Maharashtra at each step of awareness, enrollment, and utilization. In addition, urban and rural areas were compared, and social, political, economic, and cultural (SPEC) factors responsible for the better or poor proportions, especially for the awareness of the scheme, were identified. Methods The study followed mixed methods approach. For quantitative data, a systematic multistage sampling design was adopted in both rural and urban areas covering 6000 HHs across 22 districts. For qualitative data, five districts were selected to conduct Stakeholder Analysis, Focused Group Discussions, and In-Depth Interviews with key informants to supplement the findings. The data were analyzed using innovative SPEC-by-steps tool developed by Health Inc. Results It is seen that that the RSBY had a very limited success in Maharashtra. Out of 6000 HHs, only 29.7% were aware about the scheme and 21.6% were enrolled during the period of 2010–2012. Only 11.3% HHs reported that they were currently enrolled for RSBY. Although 1886 (33.1%) HHs reported at least one case of hospitalization in the last 1 year, only 16 (0.3%) HHs could actually utilize the benefits during hospitalization. It is seen that at each step, there is an increase in the exclusion of eligible HHs from the scheme. The participants felt that such schemes did not reach their intended beneficiaries due to various SPEC factors. Discussion and conclusion The results of this study were quite similar to other studies done in the recent past. RSBY might still be continued in Maharashtra with modified focus along with good and improved strategy. Various other similar schemes in India can definitely learn few important lessons such as the need to improve awareness, issuing prompt enrollment cards with proper details, achieving universal enrollment, ongoing and prompt renewal, and ensuring proper utilization by proactively educating the vulnerable sections.

Usage of Complementary and Alternative Medicine among Severe Hemophilia A Patients in India

Documented evidence of the usage of complementary and alternative medicine among patients with rare disease such as hemophilia is limited. Therefore, we explored the types of complementary and alternative medicines used, the associated sociodemographic and clinical factors, and the cost and reasons for usage among severe hemophilia A patients in India. Our study demonstrates an increased usage of complementary and alternative medicine (42.3%) among hemophiliacs. Significant factors associated with usage of these therapies were economic status, comorbidity status, and education of head of households. Among users of complementary and alternative medicine, cost of these therapies was found to be higher (17.22%) compared with hemostatic drugs (5.63%) from the average cost of treatment (Rs 29 029). The findings of this study warrant multicenter research to explore different dimensions of complementary and alternative medicine and also incorporate it in comprehensive hemophilia care programs to address issues of treatment gap and quality of life of hemophiliacs.

The ''Shetty test'' in ankle injuries: validation of a novel test to rule out ankle fractures

Ankle sprains are by far the commonest ankle injuries. The traditional clinical approach, to any ankle injury, is a clinical examination followed by radiological examination. We have developed a simple clinical test to rule out fractures in ankle injuries and thereby eliminating the necessity for radiological examination. Our test is simple, reproducible, economic, time saving and avoids potential radiation exposure risks.

Characteristics of childhood tuberculosis patients registered under RNTCP in Varanasi, Uttar Pradesh

Childhood tuberculosis (TB) reflects on-going transmission. Data on childhood TB from TB registers under Revised National Tuberculosis Control Program of 2008 and 2009 in Varanasi district was analyzed. Proportion of childhood TB was 8.3% of total registered cases 12,242. It was lower than estimated 10-20% in endemic areas. In rural Tuberculosis Units childhood case detection was poor. Case detection in ≤5 years was very less. The childhood cases were detected mainly in adolescent age group. Thus, childhood TB is remaining a under diagnosed/under reported disease in India. It needs attention to increase the detection of childhood TB cases to control TB in general population.

Institutionalizing Patient Safety Culture: A Strategic Priority for Healthcare in India

Fledgling steps in the form of policy measures, surveillance mechanisms and safety initiatives have been taken in the Indian healthcare context to address the increasing evidence base of patient safety events. The paper examines whether structural and processual measures alone would contribute to safer care. The article posits that healthcare organisations in India need to look beyond the structural-procedural efforts and evaluate an essential component of healthcare which serves to bind these efforts; that of safety culture. The paper draws on literature from health services and safety culture research as well as news articles in order to examine adverse incidents in care, safety theories and assess whether structural and procedural efforts would alone contribute to safer care. The review examines the current burden of adverse events in care as well as patient safety initiatives in the Indian context. An emergent strategy comprising policy, regulatory and structural measures has evolved over a period of time to address various facets of patient safety. Global research evidence over the years suggests that such structural-processual measures alone have not been able to address the burden of adverse events in care. Safety culture has emerged as an important concept binding quality and performance measures in most high-risk organizations including healthcare. Institutionalizing safety culture has become a strategic priority in most health care organisations globally. Taking a complex adaptive system perspective, the paper argues that synergizing policy, regulatory and structural-processual measures with safety culture engineering at multiple levels would fetch greater dividends in the Indian patient safety landscape.

User Fee Management in India

Background: There have been a number of studies conducted on user fee across the world, however, very limited number of studies have been conducted in India. This study was one of studies conducted at government hospitals in four states in India with the support of the World Health Organization and the Ministry of Health and Family Welfare. Methodology: The data was collected from overall eight district hospitals, eight rural hospitals and four medical college hospitals, which were selected from the four selected states in India. Separately structured interview schedules were used for the stakeholders like employees and policy makers. The data was analyzed by the SPSS programme. Results: The results were reported under four major sections like views on policy guidelines, operational systems, revenue generation and value creation to the users. It was found that the state of Rajasthan was to develop and govern relatively better policy of the user fee scheme. In maintaining appropriate operational systems Rajasthan was doing best, followed by Karnataka and Gujarat. In implementing appropriate mechanisms for collection of revenue Rajasthan and Gujarat were doing better. In creating value and support to patients, Rajasthan and Gujarat was doing better. Overall the user fee management was not adequately done in the states; however the state of Rajasthan has relatively improved because of the organized structure of the user fee management. Conclusion: In the whole process, some of the important concerns of patients like value for money, meeting the genuine needs of patients and encouraging poor patients to utilize the services were inadequately addressed. After many years of implementation of the user fee scheme, the hospitals have been unable to improve quality of services up to patients’ expectations. The lesson learnt from the Rajasthan model may be replicated in other states which will be more useful. Further, it is very important for every state-run hospital to concentrate on viable systems, reduce unnecessary usage of services by the patients within the hospital and efficient operational management. It is to be noted in all four states, the policy makers and majority of the health care providers and some percentage of patients have considered that user fee should continue and it will be useful to the states.