Jyoti Sarin

Diagnostic Dilemma: Solitary Fibrous Tumor or Hemangiopericytoma of the Submandibular Region in a Patient With Multiple Odontogenic Keratocysts

Solitary fibrous tumors (SFTs) are rare spindle cell neoplasms that originate from mesothelial-lined surfaces, mainly the pleura and peritoneum. SFT is a distinctive mesenchymal neoplasm of the pleura but can be found in extrapleural sites. The treatment of SFT is simple excision or wide local resection. This is the case study of a 14-year-old girl who presented with a large diffuse swelling in the left submandibular region, ultimately diagnosed with SFT and surgically excised.

Effect of Swaddling on Pain and Physiological Parameters in Neonates during Heel Lance

Neonates in the NICU experience multiple, painful, tissue-damaging procedures daily. Pain among neonates is often underestimated and untreated, producing untoward consequences. Keeping all this in view a study to determine the effect of pain and physiological parameters among neonates during heel lance with and without swaddling was carried out in Chandigarh child care center, Kotkapura, Punjab. Objectives of the study were to assess and compare pain and physiological parameters among neonates during heel lance with and without swaddling. The study was also intended to determine the relationship between pain and physiological parameters and to find the association of levels of pain with sample characteristics of the neonates with swaddling. The study was conducted in the month of December 2012 to January 2013 on 30 neonates selected through purposive sampling technique. The data was collected using Modified neonatal facial coding scale and physiological parameters record sheet. There was significant difference found in pain and heart rate of the neonates with and without swaddling. Moderate positive correlation was found between pain and heart rate during heel lance where as no significant relationship with oxygen saturation. No association of pain was found with the sample characteristics of the neonates at the time of heel lance.

Improving quality of care during childbirth in primary health centres: a stepped-wedge cluster-randomised trial in India

Background Low/middle-income countries need a large-scale improvement in the quality of care (QoC) around the time of childbirth in order to reduce high maternal, fetal and neonatal mortality. However, there is a paucity of scalable models. Methods We conducted a stepped-wedge cluster-randomised trial in 15 primary health centres (PHC) of the state of Haryana in India to test the effectiveness of a multipronged quality management strategy comprising capacity building of providers, periodic assessments of the PHCs to identify quality gaps and undertaking improvement activities for closure of the gaps. The 21-month duration of the study was divided into seven periods (steps) of 3  months each. Starting from the second period, a set of randomly selected three PHCs (cluster) crossed over to the intervention arm for rest of the period of the study. The primary outcomes included the number of women approaching the PHCs for childbirth and 12 directly observed essential practices related to the childbirth. Outcomes were adjusted with random effect for cluster (PHC) and fixed effect for ‘months of intervention’. Results The intervention strategy led to increase in the number of women approaching PHCs for childbirth (26 vs 21 women per PHC-month, adjusted incidence rate ratio: 1.22; 95% CI 1.17 to 1.28). Of the 12 practices, 6 improved modestly, 2 remained near universal during both intervention and control periods, 3 did not change and 1 worsened. There was no evidence of change in mortality with a majority of deaths occurring either during referral transport or at the referral facilities. Conclusion A multipronged quality management strategy enhanced utilisation of services and modestly improved key practices around the time of childbirth in PHCs in India. Trial registration number CTRI/2016/05/006963.

Quench for motherhood and adoption: Dilemmas of infertility

C evidence supports the use of upright positions during labour and childbirth, which has physical benefits for both mothers and babies. Despite strong evidence in support of upright birthing positions, semi-recumbent or lithotomy positions for birth continue to be practised in Nigeria. Furthermore, the use of episiotomy is commonly practised in some regions of Nigeria. Lack of evidence based guidelines and acknowledgement of the recommendation for restrictive use of episiotomy has contributed to the continuation of this surgical intervention being performed without justification. The challenges of implementing evidence-based maternity care are on-going. The complexity of closing the gap between best practice as determined by research evidence and clinical practice is well documented. This presentation will report the findings gathered from a mixed methods study that explored the views and experiences of mothers, midwives and obstetricians in Nigeria. At the outset of this study, midwives and doctors were all trapped in a vicious cycle of entrenched clinical practices. However, during the undertaking of this study, awareness and practices not based on evidence were reflected upon and challenged. A change process that involved critical thinking and some adaptation of practices occurred, such as enabling some women to adapt different positions during labour and birth and then had the effect of fewer episiotomies being performed. There was a clear willingness on the part of the midwives and doctors to change and adapt clinical practices that benefited women based on contemporary evidence. This shift resonates with an Appreciative Inquiry 4-D cycle of behavioural change. A transition from a vicious cycle of ‘practitioner’s centred’ led care to a virtuous cycle of ‘woman centred’ led care was evident.

Infertility under social, religion and cultural influence: Phenomenological exploration in Northern India

T of Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) among health care workers (HCWs) and patients has been documented with mortality rate approximating 36%. We propose ‘Advanced-Infection Control Measures’ (A-IC) used in conjunction with ‘Basic-Infection Control Measures’ (B-IC) which help to reduce pathogen transmission. B-IC include standard and transmission based precautions. A-IC are initiatives implemented within our center to enhance effectiveness of B-IC. Our objective is to study effectiveness of combining B-IC and A-IC to prevent transmission of MERS-CoV to HCWs. A retrospective observational study was undertaken. A-IC measures include; administrative support with daily rounds, infection control risk assessment, timely screening, isolation, and specimen analysis, collaboration, epidemic-plan, stock-piling, implementation of contingency plan, full PPE use for advanced airway management, real-time electronic isolation flagging system, IC team on-call, pre-transfer MERS-CoV testing and education. Total of 874 real-time PCR MERS-CoV tests were performed from July 1st, 2013 to January 31st, 2015. 694 non-HCWs were tested; of these 16 were MERS-CoV positive and community-acquired. 69% of the confirmed MERS-CoV positive cases were male, with an average age of 56 years (range: 19-84 years). Of the total tested for MERS-CoV, 180 were HCWs with zero positivity. In conclusion, adhering to a combination of B-IC and A-IC reduces the risk of MERS-CoV transmission to HCWs.P nurses require comprehensive skills related to growth and development to support communication with pediatric clients of all stages of development. Pediatrics is a specialized area of nursing. Nurses and student nurses are required to recognize, understand, and apply knowledge of growth and developmental stages to have successful communication with children in healthcare settings. Nurses encounter pediatric clients in various settings in healthcare. These range from educational settings to acute and chronic care settings. Communication with children is dependent on the child’s level of growth and development. A skilled healthcare provider who communicates effectively with children does so by recognizing stages of growth and development. Humor development, which mirrors cognitive development, is not readily used in the education of student nurses or pediatric nurses. Educating nurses and student nurses on humor development could enhance the understanding and comprehension of cognitive growth and development.Background: Current asthma care can be inconsistent due to providers’ variable approaches to asthma diagnosis and management guidelines. This variability is often a result of time and cost constraints. An approach to overcome these constraints and to increase adherence to guidelines is the SMA. The SMA is a medical appointment carried out with a group of consenting patients and their caregivers by a provider and other health professionals. SMAs are typically designed as 90-minute medical appointments in which 4 to 9 patients and their parents are seen in a group setting. This type of appointment allows both the provider and the patient to bridge a gap between individual appointments, which frequently lack the time needed for detailed education.I which is defined by QSEN as: Using information and technology to communicate, manage knowledge, mitigate error, and support decision making; is one of the core competencies for nursing set forth by the Institute of Medicine (IOM) and The Quality and Safety Education for Nurses (QSEN) faculty. One of the QSEN core skills linked to informatics is documenting and planning patient care in the electronic medical record (EMR), a skill that can be confusing to a beginning nursing student. Nursing students can also become easily confused when learning assessment skills in the classroom, but accurate assessment skills must be achieved in order to complete accurate documentation. When assessing a patient, distinquishing what the assessment findings are and what should be documented in the electronic EMR to clearly communicate the findings are special skills that are vital to the nursing role, communication among care team members and patient safety. Linking these two skills in a real-life, fun and innovative way in the classroom can make for better overall understanding of each skill and its importance to safe patient care.C is a leading cause of death worldwide and accounts for 7.6 million deaths annually. In the Middle East, an increase in cancer mortality of approximately 181% is expected during the next 15 years. We explored the barriers to colorectal cancer (CRC) screening in primary care settings in Oman. The participants were nurses (57.7%) and physicians (42.3%) with an average age of 32.5 years and clinical experience of 9.5 years. The majority (64.8%) of the participants reported that they rarely ordered, referred to, educated about, or recommended CRC screening for eligible patients. The factors perceived by nurses and physicians to have the most influence on their CRC screening practices were regular availability of patients who need CRC screening, continuing professional education about cancer prevention, availability of cancer specialists, and health facility policy about cancer screening. The only patient-related barrier to CRC screening rated as “major” by the majority of participants (63.7%) was patients’ lack of awareness about CRC tests. Significant differences existed between nurses’ and physicians’ rating of patient-related barriers, such as fear of finding out about a cancer diagnosis (P≥0.05), belief that screening is not effective (P≥0.05), embarrassment or anxiety about screening tests (P≥0.03), and culture (P≥0.0). The reported major system barriers to CRC screening were lack of hospital policy or protocols, shortage of trained healthcare providers, availability of screening services, and waiting time for screening appointments. These findings indicate a need to increase patient awareness and interventions to enhance healthcare providers’ practices. Nurse educators, researchers, and nurse administrators have major roles to play in cancer prevention.

Exploratory Study to assess the Knowledge, Expressed Practices and Attitude of Adolescents Regarding Healthy Eating Habits

Healthy eating habits are essential for maintaining good health and supporting normal growth and development irrespective of the age of an individual. However, adolescents are a nutritionally vulnerable group because of; their high requirements for growth; eating patterns and lifestyles; and susceptibility to environmental influences. India has been experiencing a nutritional transition in food choices from the typical diet to the fast food pattern thus affecting the dietary habits of young adults. The present study is aimed at assessing the knowledge, expressed practices and attitude of adolescents towards healthy eating. The study was conducted at two Secondary Schools of Gurdaspur district, Punjab, India with randomly selected sample of 100 adolescents enrolled in the ninth grade. Data was collected through structured knowledge questionnaire; structured expressed practice questionnaire, and five point Likert scale. Analysis of the data revealed that only eight percent of adolescents had average knowledge regarding healthy eating habits. A significant association was found between knowledge of adolescents and fathers education level; attitude of adolescents with their age and gender, type of family; no association was found between expressed eating practices of adolescents and demographic variables.

Effectiveness of SIM Versus PIM on Neonatal Developmental Supportive Care in Terms of Knowledge among Nursing Students

Developmental care is a broad category of Interventions designed to minimize the stress of the newborns. Current study aimed to assess and compare the knowledge of nursing students regarding Neonatal Developmental Supportive Care before and after the administration of SIM and PIM and to determine the acceptability of SIM and PIM on Neonatal Developmental Supportive Care among nursing students. An experimental approach was used with pretest-posttest comparison group design on a sample of 60 B.Sc. Nursing IVth Year students i.e. 30 in SIM group and 30 in PIM group from M.M. College of Nursing, Mullana, Ambala, selected by Simple Random and Total Enumeration sampling technique respectively. The data was collected using Structured Knowledge Questionnaire and Structured Opinionnaire. In SIM group, the mean post-test knowledge score (36 ± 3.39) were significantly higher than the mean pre-test knowledge score (18.67 ± 3.81). In PIM group, the mean post-test knowledge score (43.63 ± 2.79) was higher than the mean pre-test knowledge score (19.27 ± 3.89). The mean post-test knowledge score (43.63 ± 2.79) and the mean acceptability score (27.07±2.08) of PIM group was higher than the mean post-test knowledge score (36 ± 3.39) and the mean acceptability score (24.87±1.66) of SIM group. Therefore both, SIM & PIM were effective methods for enhancing the knowledge of nursing students regarding Neonatal Developmental Supportive Care & PIM was more effective and highly acceptable method in terms of its approval and usefulness than SIM.