Hem Chandra

A study of concordance between adolescent self-report and parent-proxy report of health-related quality of life in school-going adolescents.

OBJECTIVES The purpose of the study was to determine the degree of concordance between the self-report and the parents proxy report of health-related quality of life (HRQoL) in school-going adolescents using the World Health Organization Quality of Life (WHOQOL)-BREF instrument in India. METHODS Twenty schools were purposively selected out of the 1900 schools in Lucknow, India. About 5% adolescents (between 10-19 years) per school were randomly selected by lottery system. Subjects, whose parents consented for childs participation, completed the WHOQOL-BREF self-report and their parents filled the WHOQOL-BREF proxy-report for adolescents HRQoL. Degree of concordance and association were assessed using Cohens κ and Spearmans correlation, respectively. RESULTS Five hundred fifteen adolescents (mean age=14 years with a standard deviation of ± 2 years; 48.2% females) were included. κ Statistic values ranged from fair to moderate for all facets and dimensions of HRQoL between adolescent and parent report (κ=0.31-0.58, P<.01). There were moderate to very strong correlations between adolescent self and parent proxy report (r=0.62-0.81, P<.01) which declined with age of adolescent. The mothers scores correlated best in psychological dimension (r=0.81-0.88, P<.01) while that of father correlated best in environment dimension (r=0.81-0.79, P<.01), irrespective of childs gender. CONCLUSION Our study illustrated that fair to moderate agreement existed between parent proxy and subjects self-report for adolescents HRQoL. That may be an indicator for suitability of parents proxy report in certain dimensions, if a child is unavailable or unable to respond. However, further research may provide new insights into the determinants of concordance between subject self and parent proxy report of adolescent HRQoL.

Validation of WHO QOL-BREF Instrument in Indian Adolescents

ObjectiveThis study attempts to test the psychometric properties of World Health Organization Quality of Life (WHOQOLBREF) instrument in Indian adolescents.MethodsOf 1900 schools in Lucknow city, 20 schools were invited for participation. To make WHOQOL-BREF instrument culturally appropriate for Indian adolescents, a minor modification was done by replacing one item in Social domain “Are you satisfied with your sex life?” with “Are you satisfied with the respect you receive from others?”. The revised WHOQOL-BREF was administered to subjects in school after obtaining written parental consent.ResultsFrom August 2007–January 2008, 525 adolescents were recruited (mean age 14.04±2.09 yr; 52.38 % males). Adolescents reported highest HRQoL in social relations and lowest in environment domain. The instrument showed good internal consistency (Cronbach’s a=0.87; p-value<0.01) as well as good content, construct and predictive validity (pvalues<0.05). Psychological domain had best predictive validity, whereas, social relations domain had best content validity.ConclusionThe study provides evidence that revised WHOQOL-BREF is a reliable and valid instrument and can be used in Indian adolescents.

Augmenting nursing care quality and implementing change management in India: an amalgamated approach

BACKGROUND AND AIM High dependency on nursing care in healthcare delivery systems in recent times has made the quality appraisal of nursing care even more imperative for nursing administrators. This study demonstrates the utility of a two-phase technique to identify the most significant shortcomings pertaining to nursing care delivery in general wards of a tertiary care hospital. The same could be used to set priorities. METHODS The first phase involved the use of the Delphi technique facilitating the experts to identify the major problems. The mean rank score was used for grading the problems. The second phase of the study involved getting direct feedback from the ward nurses. The sample size was 147 at a level of significance of 5%. RESULTS Consensus was reached among experts on four problems that should galvanize nursing administration vis-à-vis quality improvement. The responses of ward nurses in the second phase gave a better insight into these problems. CONCLUSION AND IMPLICATIONS FOR NURSING MANAGEMENT Identifying the existing problems and fostering a team spirit among all stakeholders hold the key in strategizing quality improvement in nursing care. Nursing administrators worldwide, after making suitable situation-specific customizations, may use this approach to realize both these objectives.

Profile of Seropositives Visiting a HIV Screening Centre of a Tertiary Care Teaching Institute in North India

HIV/AIDS continues to behave as a pandemic and is still a major issue as far as morbidity and mortality are concerned. The burden has already started to decline. According to UNAIDS/ WHO estimates, there are 35.3 million people living with HIV worldwide [1]. National AIDS Control Organization (NACO), supported by UNAIDS and WHO, indicate that the national adult HIV prevalence in India is approximately 0.27%. This corresponds to an estimated 20.9 lakhs of people living with HIV in the country [2]. Since the detection of the first case in 1986 from Chennai, HIV/ AIDS is spreading very fast in India. The spread is a consequence of a specific behavioral pattern and the distribution is quite uneven in India. Hence to strengthen interventional strategy, an assessment of socio-demographic factors, level of awareness as well as risk behavior of the population is mandatory. The Integrated Counseling and Testing Centre (ICTC) is an entry point to free HIV testing in India. It provides the general public with an opportunity to learn and accept their HIV serostatus in a confidential environment [3]. Abstract

Strategizing quality implementation in intensive care unit: a statistically-sound, novel approach using Delphi technique

Background: Ascendancy of Intensive Care Medicine in the realm of healthcare has made Continuous Quality Improvement (CQI) in Intensive Care Units (ICUs) most imperative for hospital administrators worldwide. Perspicuous identification of all clinical and non-clinical drivers warranting contemplation is the most arduous step in achieving the same. This study avers the effectiveness of a statistically-sound, novel approach using Delphi technique in identifying various drivers to be prioritized for strategizing CQI in the postoperative ICU of a premier tertiary care hospital in Asia. Methods: Three rounds of Delphi survey were initially planned. Mean Rank Scores (MRS) was used to rank the opinions in this study. Results: Statistically validated consensus was reached among expert participants on five drivers that should galvanize hospital administration vis-a-vis strategizing quality implementation in the post-operative ICU. Foremost among these was adequate staff that is tantamount to desirable staff-patient ratio (MRS: 9.4), and regular medical audit for sustainable quality in healthcare delivery (MRS: 9.1). Experts further concurred that communication skills of ICU staff (MRS: 8.9), continuous medical education and training of these staff (MRS: 7.6) along with perspicuous ‘Standard Operating Procedures’ (MRS: 7.1) were other points to be considered. Conclusions: With regard to the process of planning, identification of correct drivers holds the crux in strategizing quality implementation in any setup. Implementing change management is equally imperative. This approach can be used to realize both of these.

Does effective designing of operation theaters contribute towards staff satisfaction

Purpose – This study aims to measure the staff satisfaction achieved with regard to the recently furnished modular operation theaters (MOTs). Design/methodology/approach – A cross-sectional study through questionnaire-based interviews was done. Desired sample size for ANOVA design came out to be 25 per level at a level of significance of 5 per cent and a power of 85 per cent. Findings – Overall, mean rating of the satisfaction of the staff was 7.52 with a standard deviation (SD) of 2.35. Mean ratings (with standard deviations) of surgeons, nurses and anesthetists were 7.14 (1.26), 7.21 (0.95) and 8.21 (0.48), respectively. One sample t-test showed that all the three categories of staff were satisfied. Post-hoc test revealed that the anesthetists were significantly more satisfied than the surgeons (p = 0) and the nurses (p = 0.001). Maximum satisfier was aseptic environment provided by the MOTs. Hatch box with ultraviolet technology also attracted high ratings from all the three categories. Staff considere...

Gauging Skills of Hospital Security Personnel: a Statistically-driven, Questionnaire-based Approach

OBJECTIVES This study aims to gauge the technical and soft skills of the hospital security personnel so as to enable prioritization of their training needs. METHODOLOGY A cross sectional questionnaire based study was conducted in December 2011. Two separate predesigned and pretested questionnaires were used for gauging soft skills and technical skills of the security personnel. Extensive statistical analysis, including Multivariate Analysis (Pillai-Bartlett trace along with Multi-factorial ANOVA) and Post-hoc Tests (Bonferroni Test) was applied. RESULTS The 143 participants performed better on the soft skills front with an average score of 6.43 and standard deviation of 1.40. The average technical skills score was 5.09 with a standard deviation of 1.44. The study avowed a need for formal hands on training with greater emphasis on technical skills. Multivariate analysis of the available data further helped in identifying 20 security personnel who should be prioritized for soft skills training and a group of 36 security personnel who should receive maximum attention during technical skills training. CONCLUSION This statistically driven approach can be used as a prototype by healthcare delivery institutions worldwide, after situation specific customizations, to identify the training needs of any category of healthcare staff.