Manju Vatsa

Skeletal muscle strength in young Asian Indian females after vitamin D and calcium supplementation: a double-blind randomized controlled clinical trial.

CONTEXT Randomized control trials (RCT) of the effect of vitamin D/calcium supplementation on skeletal muscle strength have not shown promising effect in the elderly. OBJECTIVE Our objective was to assess the effect of vitamin D and/or calcium on muscle strength in young adults with vitamin D deficiency. DESIGN AND SETTING We conducted a RCT using a factorial design at a tertiary-care center from September 2010 to April 2011. SUBJECTS A total of 173 healthy females with mean age, body mass index, and 25-hydroxyvitamin D [25(OH)D] of 21.7 ± 4.4 yr, 20.8 ± 2.96 kg/m(2), and 9.3 ± 3.37 ng/ml, respectively, were block randomized to 1) double placebo, 2) calcium/placebo, 3) cholecalciferol/placebo, and 4) cholecalciferol/calcium for 6 months. Cholecalciferol was given at 60,000 IU/wk for 8 wk followed by 60,000 IU/fortnight. Elemental calcium was given in doses of 500 mg twice per day for 6 months. METHODS Assessment included hand grip (primary outcome) and pinch grip strength, distance walked in 6 min, dyspnea score, quality of life by Short Form (36) Health Survey (SP-36), serum 25(OH)D, 1,25-dihydroxyvitamin D, and intact PTH. RESULTS The serum 25(OH)D increased significantly to 29.9 ± 8.35 and 27.0 ± 9.54 ng/ml in two groups on cholecalciferol. The mean hand grip strength (19.4 ± 3.92, 21.1 ± 3.31, 20.6 ± 3.92, and 20.1 ± 4.00 kg) and its increase from baseline (0.3 ± 2.25, 0.3 ± 2.64, -0.3 ± 2.41, and 0.6 ± 2.30 kg) were comparable in four groups at 6 months. Quality of life, urinary calcium/creatinine ratio, and adverse effects were also comparable in groups. CONCLUSION Oral cholecalciferol/calcium supplementation in the dose/schedule used is effective and safe in increasing and maintaining serum 25(OH)D. However, this does not lead to improved skeletal muscle strength in young females.

Knowledge, attitude and practices among health care professionals regarding pain

ObjectiveTo assess the knowledge, attitude and practices among health care professionals regarding pain in children.MethodsThis was a prospective descriptive survey conducted at a tertiary care hospital in north India. A semi structured questionnaire regarding pain in children was administered to pediatric residents and nurses in a teaching hospital. The questionnaire consisted of 24 items, of which 18 items were rated on a 5-point scale (‘strongly agree’ to ‘strongly disagree’) and 6 items were open-ended questions.ResultsThe response rate was 89.5%. Of 77 participants, 47 (61.1%) were nurses and 30 (38.9%) were pediatric residents. The knowledge about pain scales among the studied healthcare professionals was not widespread. Majority of respondents believed that the best judge of intensity of pain is the child. Nearly two-thirds of the respondents felt that non-pharmacological measures were better to control pain and also their practices showed that most were willing to allow the parental presence during minor invasive procedures.ConclusionThere is need to improve the knowledge of health care personnel regarding pain assessment and management in children.

Quality of life and psychosocial functioning of HIV infected children.

ObjectiveTo assess the quality of life (QOL) and the psychosocial problems of HIV infected children.MethodsThe present study was a comparative, cross-sectional survey conducted in the clinic of a tertiary care hospital in north India from July–December 2007. Children suffering from cystic fibrosis (CF) were chosen as a comparison group. Children ³ 6 yr of age with HIV infection or Cystic Fibrosis, with no acute illness at the time of survey were included in the study. Quality of life of the enrolled children was assessed by using the Pediatric Quality of Life Inventory™ (PedsQL™). Pediatric Symptom Checklist (PSC) was used for assessing the psychosocial problems in the enrolled children.ResultsForty one HIV infected and 30 children with cystic fibrosis were enrolled. According to child self -report in the PedsQL™ 4.0, the difference of perceived physical health status between the two study groups was statistically significant (p=0.04), with HIV infected children demonstrating a better QOL in this domain. A significantly greater number of children with cystic fibrosis (8/30 or 26.67%) suffered from psychosocial problems as compared to HIV children (3/41 or 7.32%) [p=0.026].ConclusionsThe quality of life and psychosocial functioning is reasonably good in children with HIV infection. Thus, we should strive to maintain and optimize the overall quality of life of these children so that they can have a productive and meaningful future.

A comparison of cabbage leaves vs . hot and cold compresses in the treatment of breast engorgement

Objective: To assess and compare the efficacy of cold cabbage leaves and hot and cold compresses in the treatment of breast engorgement. Material and Methods: This was a quasi-experimental study conducted in the postnatal ward of the All India Institute of Medical Sciences (AIIMS), New Delhi. The study comprised a total of 60 mothers;30 in the experimental group and 30 in the control group. The control group received alternate hot and cold compresses and the experimental group received cold cabbage leaf treatment for relieving breast engorgement. The pre- and posttreatment scores of breast engorgement and pain were recorded. The data were analyzed using descriptive and inferential statistical methods using the statistical software STRATA. Results: Both the treatments, i.e., hot and cold compress and cabbage leaves were effective in decreasing breast engorgement and pain in postnatal mothers (P ≤ 0.001).Cold cabbage leaves and hot and cold compress were both equally effective in decreasing breast engorgement (P = 0.07), whereas hot and cold compresses were found to be more effective than cold cabbage leaves in relieving pain due to breast engorgement (P ≤ 0.001) in postnatal mothers. Conclusion: Cold cabbage leaves as well as alternate hot and cold compresses both can be used in the treatment of breast engorgement. Hot and cold compresses are more effective in decreasing pain than cold cabbage leaves in relieving pan due to breast engorgement.

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.

Comparison of two pain scales in Indian children.

Objective. To compare the Faces Pain Scale and Color Analogue Scale among children aged 6–12 years undergoing selected procedures (Venipuncture, Intravenous cannulation, Intramuscular injection, Lumbar puncture, Bone marrow aspiration) and to compare the procedural pain in a child as perceived by the child, parents and health care professionals using the above mentioned scalesMethods. This was a prospective, descriptive correlational study of children aged 6–12 years, who had undergone selected procedures. Children were assessed for their pain severity using Faces Pain Scale and Color Analogue Scale. Parents and health care professionals also independently assessed the childs pain using the same scalesResults. 181 children who fulfilled the eligibility criteria were enrolled in the study. There was a significant positive correlation (r = >0.8) between both the pain scales. There was fair to moderate positive correlation (r = 0.29 to 0.58) of pain perception of child with parents and health care professionalsConclusions. Faces Pain Scale and Color Analogue Scales seem to be appropriate instruments for measuring pain intensity among Indian children aged 6–12 years undergoing selected procedures

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.

Neonatal nursing: an unmet challenge in India.

Nurses comprise a key component to maternal and newborn health care delivery, including the care of ‘at-risk’ or sick newborns. However, the efficiency and effectiveness of services rely heavily on adequate numbers of highly skilled neonatal nurses. Currently, in India, a significant shortage of trained nurses in the field of newborn care is contributing to poor neonatal outcomes. Specifically, nurses caring for newborns lack the competency and experience needed to ensure optimal care. This deficiency has been linked to a lack of expert faculty, standardized training and minimal or no exposures to newborn clinical care areas during pre service education. Moreover, in addition to a lack of operational research in the area, nurses who provide care for newborns are often faced with numerous system related issues that impede their ability to provide optimal care. Most notably, frequent changes of work place, poor wages, and lack of continuing education, skill maintenance, recognition, and collaborative team culture further compromise the nursing care. All these lead to poor motivation and competency. To meet this challenge, it is essential that emphasis be placed on the identification and support of nursing faculty with expertise in newborn and neonatal care who are able to ensure that nurses receive standardized education for pre-service, in-service and ongoing care. In addition, importance should be placed on encouraging newborn nursing research as well as on governmental increases in salary compensation. Lastly, given the shortage of physicians to take care of sick neonates in remote areas, the creation of a cadre of Neonatal nurse practitioner/ advanced practice nurses would be an invaluable solution in developing countries. Furthermore, centralized oversight of newborn education and training would be best served, if responsibility was placed with Reproductive maternal newborn child health (RMNCH) workers and district level officers.

A Randomized Controlled Trial of 2 Inhalation Methods When Using a Pressurized Metered Dose Inhaler With Valved Holding Chamber

BACKGROUND: Information on the comparative efficacy of single deep breathing versus tidal breathing for inhaled asthma medications is limited, although such information can be of much use for the treatment of patients suffering from asthma. The objective of the present study was to compare the relative difference in improvement in peak expiratory flow (PEF) with single maximal inhalation with breath-holding versus 5 tidal breaths during inhalation of salbutamol from a pressurized metered dose inhaler (pMDI) with valved holding chamber (VHC) in children 5–15 y of age with asthma. METHODS: The randomized controlled trial was carried out on children with asthma between 5 and 15 y of age using a pMDI with a VHC either by a single deep breath with breath-hold or 5 tidal breaths. The experimental group received 200 μg of salbutamol from the pMDI with VHC with a single maximal inhalation and breath-hold technique, whereas the control group received 200 μg of salbutamol from pMDI with VHC using the 5 tidal breaths technique. The outcome variable, PEF, was reassessed 30 min after salbutamol use. RESULTS: Eighty-two subjects (mean age 8.79 ± 2.5 y, 65 boys and 17 girls) were analyzed. There was significant improvement in the PEF, from baseline (pre-intervention) to post-intervention within the single maximal inhalation with breath-hold group and tidal breathing group independently (P < .001). The mean difference in improvement in PEF between the single maximal inhalation with a breath-hold and 5 tidal breaths group was 30.0 ± 18.16 and 28.29 ± 13.94 L/min, respectively, and was not statistically significant (P = .88). CONCLUSIONS: Single maximal inhalation with a breath-hold technique is not superior to tidal breathing for improvement in PEF following salbutamol inhalation. Either method may be used in children between 5 and 15 y of age. (Indias Clinical Trials Registry CTRI/2013/04/003559.)

Comparing the Effectiveness of Webinars and Participatory Learning on Essential Newborn Care (ENBC) in the Class Room in Terms of Acquisition of Knowledge and Skills of Student Nurses: A Randomized Controlled Trial

A randomized controlled trial was conducted in tertiary level center to compare the effectiveness of Webinars (WL) vs. Participatory learning (PL) on Essential Newborn Care (ENBC) in terms of acquisition of knowledge and skills of pre-service 6th semester student nurses. They were randomized to receive teaching on four topics of ENBC by two facilitators. Gain in knowledge and skill scores in ENBC were measured using validated assessment methods. Baseline characteristics including age, education, marks and hours of internet surfing were comparable between two groups (WL: n = 28, PL: n = 30). Pre-training mean knowledge scores in WL and PL group (mean ± SD) (30.96 ± 5.62 vs. 31.43 ± 4.74 p = 0.42), and skill scores (19.14 ± 3.37 vs. 19.20 ± 3.71 respectively, p = 0.77) were comparable. Training methods resulted in equal gain in knowledge in both groups. Satisfaction scores among the participants were also comparable. Thus, using webinars on ENBC as new technology in class room teaching may be an effective, alternative method to using participatory learning.