Kamlesh Kumari Sharma

Anti‐emetic effect of ginger powder versus placebo as an add‐on therapy in children and young adults receiving high emetogenic chemotherapy

Chemotherapy‐induced nausea and vomiting (CINV) are major adverse effects of chemotherapy. Ginger has been used in postoperative and pregnancy‐induced nausea and vomiting. Data on its utility in reducing CINV in children and young adults are lacking.

Comparison of health-related quality of life of children during maintenance therapy with acute lymphoblastic leukemia versus siblings and healthy children in India

Abstract Data on quality of life (QOL) specifically in maintenance therapy of acute lymphoblastic leukemia (ALL) are minimal. This study was done to assess various items listed in domains of QOL (physical, emotional, social and school health domains) of children with ALL during maintenance therapy, and compare the same with those of their siblings and other healthy children. Forty children on maintenance therapy of ALL, 40 siblings and 40 healthy children were assessed for QOL by child self-report using PedsQL 4.0 Generic Core in the local language. Means were computed and compared for each domain with one-way analysis of variance (ANOVA), wherein higher values reflected better QOL. Overall QOL of children with ALL in maintenance therapy (77.16 ± 10.98) was significantly poorer than that of siblings (93.56 ± 4.41) and healthy children (93.02 ± 3.76) (p < 0.001), but their abilities of self-care, household work, exercise, attentiveness, memory and homework were unaffected. There was significantly higher absenteeism due to sickness and hospital visits, and increased emotional problems (fear, anger, sleeping problems) among children with ALL. In the social health domain, children with ALL reported difficulty in maintaining friendships and competing. QOL of siblings was as good as that of healthy children in physical, social and school health domains, but they had increased emotional problems such as anger and sadness. Healthy children reported significantly higher future worries and bullying than children with ALL and siblings. This study validated that the QOL of children with ALL during maintenance therapy was significantly poorer than that of siblings and healthy children. The study identified various items in each domain of QOL that were affected in these children, and thus would assist in guiding healthcare professionals to focus on these specific items so as to improve their overall QOL.

Knowledge Regarding Oral Anticoagulation Therapy among Patients with Stroke and Those at High Risk of Thromboembolic Events

BACKGROUND Apart from atrial fibrillation, indications for oral anticoagulation common in our clinical practice include rheumatic heart disease and mechanical heart valve replacement. Evaluation of current patient knowledge regarding oral anticoagulation therapy (OAT) is the first step in improving the quality of anticoagulation therapy and patient care. The aim of the present study was to assess the knowledge regarding OAT among patients with stroke and those at high risk of thromboembolic events in a tertiary care hospital in India. METHODS A descriptive cross-sectional design was used; 240 patients on OAT because of various indications (mechanical heart valve replacement, rheumatic heart disease, atrial fibrillation, and stroke) attending the neurology and cardiology outpatient clinics and inpatient services were recruited. A structured self-developed questionnaire was used to assess the knowledge in these patients. RESULTS Most patients (62.9%) were ignorant about the target prothrombin time/international normalized ratio (PT/INR) levels with only 30% having their recent INR within the target range; 50% of the patients had a poor knowledge score, and the knowledge gap was most prominent in the domains of dietary interactions followed by drug interactions, adverse effects, and PT/INR monitoring. Knowledge score also had a significant association with gender, education, monthly income, and place of residence (P < .05). CONCLUSION Patients knowledge about OAT was suboptimal. The findings support the need for educational interventions to improve the knowledge regarding OAT and, thereby, achieve an appropriate and safe secondary prevention of stroke.

Predictors of breastfeeding problems in the first postnatal week and its effect on exclusive breastfeeding rate at six months: experience in a tertiary care centre in Northern India.

In spite of the countless benefits of breastfeeding, prevalence of exclusive breastfeeding (EBF) has been far from optimal in the developing world. Breastfeeding problems at or after 4 weeks has been reported as one among the constraints to EBF. The study aimed to determine the breastfeeding problems in the 1 st postnatal week, their predictors and impact on EBF rate at 6 months. Under a prospective cohort design, 400 mother-newborn dyads were assessed for breastfeeding problems before discharge and at 60 ± 12 h of discharge. Nearly 89% of the mother-newborn dyads had one or more BF problems before discharge. Major concern was difficulty in positioning and attaching the infant to the breast (88.5%), followed by breast and nipple problems (30.3%). BF problems continued to persist even after discharge in a significant proportion of the mothers (72.5%). The only independent predictor of BF problems in the 1 st week was the caesarean section (odds ratio: 1.9, 95% confidence interval: 1.3-3.2, P < 0.05). There was a marked improvement in the EBF status (69.5%) at 6 months, and BF problems did not predict EBF failure at 6 months.

Perception of Indian parents on health-related quality of life of children during maintenance therapy of acute lymphoblastic leukemia: a comparison with siblings and healthy children.

Background: Advancements in treatment have improved the prognosis of children with acute lymphoblastic leukemia (ALL). Therefore, there is a need to explore health-related quality of life (HRQOL) in depth, specifically in maintenance therapy, where the available data are minimal. This study was conducted to assess the varied items listed in the domains of HRQOL of Children with ALL during maintenance therapy from a parent’s perspective. Methods: Forty children on the maintenance therapy of ALL, 40 siblings, and 40 healthy children were enrolled, and the HRQOL was assessed by parent proxy reports and child self-reports using PedsQL generic core 4.0 in local language. Results: Parents significantly overrated the HRQOL of ALL patients, their siblings, and healthy children in comparison with child self-report in all domains of health. The HRQOL of children with ALL on maintenance therapy was significantly poorer than siblings and healthy children, but their ability to self-care, household work, attentiveness, and ability to do homework were not affected as per parents’ reports. Parents reported that absenteeism because of sickness and hospital visits was more among children with ALL than siblings and healthy children. Children with ALL had emotional problems such as fear, anger, sleeping problems, and worries. In a social health domain, parents reported difficulty in competing among children with ALL. The HRQOL of siblings was as good as healthy children in physical, social, and school health domains as per parents’ reports. Conclusions: In our cohort, parents overrated HRQOL in all groups of children. The study identified the various items in each domain of HRQOL that were affected in children with ALL from parents’ perspective; this would guide health care professionals to focus on these specific items so as to improve the overall HRQOL of children with ALL.

Domestic Violence against Nurses by their Marital Partners: A Facility-based Study at a Tertiary Care Hospital

Background: In recent times, domestic violence against women by marital partners has emerged as an important public health problem. Objectives: 1. To determine the prevalence, characteristics and impact of domestic violence against nurses by their marital partners, in Delhi, India. 2. To identify nurses’ perceptions regarding acceptable behavior for men and women. Materials and Methods: A facility-based pilot study was conducted at All India Institute of Medical Sciences (AIIMS), New Delhi. Data were collected using self-administered standardized questionnaire, among 60 ever married female nurses working at AIIMS hospital, selected by convenience sampling. The principal outcome variables were controlling behavior, emotional, physical and sexual violence by marital partners. Data were analyzed using SPSS 12 software. The test applied was Fishers exact test and 1-sided Fishers exact test. Results: Sixty percent of nurses reported marital partner perpetrated controlling behavior, 65% reported emotional violence, 43.3% reported physical violence and 30% reported sexual violence. About 3/5th of nurses (58%) opined that no reason justified violence, except wife infidelity (31.67%). Of the physically or sexually abused respondents, 40% were ever injured, and 56.7% reported that violence affected their physical and mental health. Conclusion: There is a high magnitude of domestic violence against nurses and this is reported to have affected their physical and mental health.

A study to evaluate the effectiveness of an indigenous exercise protocol in patients with heart failure to improve their quality of life: (Exercise in congestive heart failure study [E - CHF study])

Background: Congestive heart failure (CHF) is characterized by an intolerance to activities of daily living, office environment and shortness of breath in any level of extraneous activity depending on their level of heart failure (HF). This significantly contributes to reduced participation and poor quality of life (QoL) among these patients. Methods: The study was conducted from June 2014 to December 2014 in Cardio-Neuro-Centre, OPD, AIIMS, New Delhi on 40 medically stable CHF outpatients (mean age 46.3±11.4 years) in NYHA class -I & II with 3 month follow-up. IEP (Indigenous Exercise Protocol) training, consisting of one supervised session at baseline visit followed by home-based practice and telephonic encouragement and monitoring of the group was given. Outcome measures were QoL, physiological parameters (6 minute walk test - distance, VO2 max and double product) and frequency of hospitalization. Results: The results showed significant difference between QoL (P < 0.02) as measured by KCCQ, mean walking distance on the 6 minute walk test (P < 0.01) and VO2 max (P < 0.01) at entry and after 12 weeks within the experimental group, but compared to the control group, no significant difference was found between the two groups. Two hospitalizations and one death were reported in the control group, whereas none was reported in the experimental group. Conclusion: IEP was effective in achieving adequate exercise tolerance in experimental group. It showed no deleterious effect and is safe to practice at home, but more evidence is needed to consider using IEP when caring for stable heart failure patient.

Biplot evaluation of test environments and identification of lentil genotypes with durable resistance to fusarium wilt in India

Abstract. Fusarium wilt (caused by Fusarium oxysporum f. sp. lentis) is the most crucial limiting variable for decreasing yield levels of lentils (Lens culinaris Medik.) around the world. A set of 20 diverse lentil genotypes comprising breeding lines and released varieties was evaluated, along with susceptible controls, for resistance to fusarium wilt through natural incidence for two continuous years (2010–11 and 2011–12) in six diverse lentil-growing environments in India. Analysis of variance showed that the effect of genotype (G) and environment (E) for disease incidence was highly significant. Among the three sources of variation, the biggest contribution in disease occurrence was accounted for by environment (54.68%), followed by G × E interaction (17.32%). The high G × E variation necessitated assessment of the genotypes at different locations (environments). GGE biplot analysis of the studied genotypes revealed that genotype PL 101 and released cultivar L 4076 had low levels of disease incidence. The sources of resistance to fusarium wilt have great potential for use in lentil-breeding programs. Another biplot of relationships among environments demonstrated that, among the test locations, Sehore and Faizabad, were the most effective for differentiation of genotypes. On the basis of discriminating ability and representativeness, the Sehore location appeared an ideal testing site for natural incidence of F. oxysporum f. sp. lentis.

Video teaching program on management of colostomy: Evaluation of its impact on caregivers

Context: Care of a child having colostomy has not been institutionalized for a long time for economic and administrative reasons. After stoma formation, stoma care has to be provided to the child by caregivers at home. Hence, caregivers need to be provided with ongoing education and support, commencing from preoperative teaching to discharge from the hospital and home care. Aims: The aims of this study were to develop video-based learning resource material and to evaluate its effectiveness in terms of knowledge and skill attainment by caregivers. Settings and Design: The study design was time series, one group pretest and post test. This was conducted among 30 caregivers attending pediatric surgery outpatients and indoor departments of a tertiary level care center. Materials and Methods: A video teaching program (VTP) related to pediatric colostomy was developed and used to teach the caregivers about colostomy care. Pretested and validated knowledge questionnaire, observational checklist, and stoma assessment scale (SAS) were used to assess the knowledge and skills of caregivers before and after the administration of VTP immediately (post test 1) after and 2 weeks (post test 2) after the intervention. Statistical Analysis Used: Repeated measures analysis of variance (ANOVA), Bonferroni correction, Mann-Whitney U test, and Kruskal-Wallis test were used. Results: There were significant increases in knowledge (from 10.9 ± 2.5 to 16.4 ± 1.67 and 15.9 ± 4.02, P = 0.001, maximum score 20) and skill scores as assessed by the observation checklist (from 5.6 ± 2.0 to 9.8 ± 1.6 and 8.6 ± 2.1, P = 0.001, maximum score 12) immediately after and 2 weeks after the VTP. However, a decline in skills was observed at 2 weeks when compared with immediate scores, as measured by the observation checklist. There was no significant increase in the skill scores of caregivers as measured by SAS at 2 weeks compared to the immediate scores. Conclusion: The VTP was effective in bringing about an increase in the knowledge and skill of caregivers of children having colostomy. Therefore, video can be utilized for the counselling of caregivers of children with colostomy.