Care Practice In India Research Articles

Sustaining private eye care practices during initial days of the coronavirus pandemic

Background: The coronavirus disease 2019 (COVID-19) pandemic created new challenges for private eye care practices. Safety issues were encountered by both the healthcare workers and patients. This short communication addresses the changes made in our private eye care practice during the pandemic and the valuable lessons learned for the future. Methods: We describe the challenges faced in our tertiary private eye care practice in India with respect to treating patients and preventing the transmission of COVID-19, considering the economic hardship within this area. We discuss the emerging economic, medical, legal, educational, and psychological issues and their solutions, which eye care hospitals could follow in the future to ensure safety without compromising quality of care. Results: Hospitals required efficient operation with reduced fixed expenses. Clinical practices were followed in the hospital as per the recommendations of the country’s apex ophthalmic body. Proper triage and prescreening of patients at the entrance, digitalization, teleophthalmology, staggered appointments, and role-appropriate personal protective equipment were important preventive measures. The operating room protocols were modified to ensure the safety of the operating staff. Special consent was obtained from patients to safeguard against legal repercussions arising from the pandemic. The training of residents and fellows led to new avenues, including the use of digital tools. Hospitals attempted to provide counseling and psychological support to their doctors and staff during these trying times. Conclusions: The COVID-19 pandemic will not be the last pandemic to occur in an ever-changing world. This event provided us with many new insights into the economic, clinical, legal, and psychological challenges of the COVID-19 pandemic and with ways to overcome these challenges and emerge intact. Clinical and surgical training suffered during the pandemic; however, the impact was only temporary. Clinical research gained respect because of the efforts undertaken during the pandemic. The pandemic was exceptionally harsh on many private eye care practices, and we hope to provide useful and comprehensive solutions on how to successfully navigate a similar situation if encountered in the future.

Patient’s Consent and Autonomy in Jerry Pinto’s Em and the Big Hoom

This paper addresses the idea of patient consent in the Indian mental health care system. Mental hospitals tend to treat patients as machines. The personhood of the sufferer is treated as invalid. The paper argues that the conventional clinical practice dehumanizes patients, neglecting their autonomy and perpetuating the stigma associated with a psychiatric diagnosis. In contrast, through the narrative voice of Imelda’s son, Jerry Pinto’s novel Em and the Big Hoom (2012) intimately intertwines the experiences of mental illness within the broader context of familial struggles. Em refuses to become a mere statistic or a diagnostic label, embodying the agency to shape her narrative beyond the constraints of clinical definitions. The novel challenges the flawed clinical gaze and provides an alternative narrative that portrays an ambitious woman who does not succumb to the definitions of her illness. These alternative narratives resist reductionist perspectives, offering a more comprehensive understanding of mental illness that transcends clinical definitions. This paper critically examines the novel’s portrayal of patient autonomy and consent, shedding light on the implications for mental health care practices in India. It explores how the text serves as a catalyst for reevaluating conventional clinical perspectives and fosters a more compassionate and patient-centric mental health care system.

Innovations in Internet of Medical Things, Artificial Intelligence, and Readiness of the Healthcare Sector Towards Health 4.0 Adoption

Recent years witnessed lots of advancements in Internet of Medical Things, Innovations in Artificial Intelligence and Big Data Analytics based health care practices. Further, recent pandemic has compelled health care institutions to adopt remote patient care practices throughout the world and India is not an exception. Growth in mobile infrastructure and cheap mobile data packages also encouraged adoption of telemedicine and m-health care practices in India which eventually supports attempts of health care policy makers for transition of traditional health care systems to Health 4.0 in the lines of industry4.0. However, success of Health 4.0 depends upon the coordinated efforts from all the stakeholders. In this regard this research has been conducted to investigate the current status of Health 4.0 implementation in India and readiness of Indian health care sector towards its adoption. This paper further employs the SWOT-AHP analysis to identify the current areas that need immediate improvement to facilitate Health 4.0 adoption.

Mitigating and managing COVID-19: promises and propositions from traditional health care practices in India and China

Mitigating and managing COVID-19: promises and propositions from traditional health care practices in India and China

Sarcoma Care Practice in India During COVID Pandemic: A Nationwide Survey.

BackgroundAmidst the COVID-19 pandemic, management of cancer has been one of the most intensely debated topics across the globe. We conducted an online survey to determine the consistency/or the lack of it, in the management of sarcoma patients between centres and the changes in policies.MethodsA twenty-five question online survey was conducted among practicing physicians over a period of 10 days using online portal (surveymonkey.com). It was followed by a critical analysis based on responses to each question.ResultsOf 194 medical professionals who participated, 80% were surgeons and 53% were working in government institutes. Most respondents (81%) continued their practice with some modifications. In OP majority (67%) relied only on symptom, contact enquiry and temperature recording for screening. COVID-19 testing was done more (43%) in IP patients. Most of institutes (83%) followed rotational policy to reduce the number of staff at risk while 57% offered an alternate accommodation. 52.3% continued chemotherapy for all patients while radiotherapy for all was offered by 45%. In metastatic cases, majority preferred either no treatment or non-surgical intervention (71%).84.5% believed in adapting changes (42%—avoid supra major surgeries, 27%—Operating only emergency cases and 15.5%—High grade sarcomas with curative intent) in surgical management of sarcomas. For benign bone tumors, majority (71%) agreed on adapting changes while 25% agreed on deferring all cases. 69% preferred teleconsultations for follow-up. Complete PPE were being used for all aerosol generating procedures by 44%. Only two thirds agreed with their institutes policy of PPE usage and COVID-19 testing.ConclusionThis survey has highlighted disparity on COVID-19 screening and management in various institutes across the country. This will act as a reference point for tracking future trends in bone and soft tissue tumor management guidelines, as the COVID-19 scenario unfolds globally and particularly in India.

Critical care practice in India: Results of the intensive care unit need assessment survey (ININ2018).

BACKGROUNDA diverse country like India may have variable intensive care units (ICUs) practices at state and city levels.AIMTo gain insight into clinical services and processes of care in ICUs in India, this would help plan for potential educational and quality improvement interventions.METHODSThe Indian ICU needs assessment research group of diverse-skilled individuals was formed. A pan- India survey "Indian National ICU Needs" assessment (ININ 2018-I) was designed on google forms and deployed from July 23rd-August 25th, 2018. The survey was sent to select distribution lists of ICU providers from all 29 states and 7 union territories (UTs). In addition to emails and phone calls, social medial applications-WhatsApp™, Facebook™ and LinkedIn™ were used to remind and motivate providers. By completing and submitting the survey, providers gave their consent for research purposes. This study was deemed eligible for category-2 Institutional Review Board exempt status.RESULTSThere were total 134 adult/adult-pediatrics ICU responses from 24 (83% out of 29) states, and two (28% out of 7) UTs in 61 cities. They had median (IQR) 16 (10-25) beds and most, were mixed medical-surgical, 111(83%), with 108(81%) being adult-only ICUs. Representative responders were young, median (IQR), 38 (32-44) years age and majority, n = 108 (81%) were males. The consultants were, n = 101 (75%). A total of 77 (57%) reported to have 24 h in-house intensivist. A total of 68 (51%) ICUs reported to have either 2:1 or 2≥:1 patient:nurse ratio. More than 80% of the ICUs were open, and mixed type. Protocols followed regularly by the ICUs included sepsis care, ventilator- associated pneumonia (83% each); nutrition (82%), deep vein thrombosis prophylaxis (87%), stress ulcer prophylaxis (88%) and glycemic control (92%). Digital infrastructure was found to be poor, with only 46 % of the ICUs reporting high-speed internet availability.CONCLUSIONIn this large, national, semi-structured, need-assessment survey, the need for improved manpower including; in-house intensivists, and decreasing patient-to-nurse ratios was evident. Sepsis was the most common diagnosis and quality and research initiatives to decrease sepsis mortality and ICU length of stay could be prioritized. Additionally, subsequent surveys can focus on digital infrastructure for standardized care and efficient resource utilization and enhancing compliance with existing protocols.

Public, patient and carers' views on palliative and end-of-life care in India.

To systematically review the existing evidence on the Indian public, patient and carers' perspectives on palliative and end-of-life care. With a growing population of terminally ill people across the world, there is also an increasing awareness among international health policy makers of the need to improve the quality of life for terminally ill patients. Understanding service users' (patients, family and public) perspectives is crucial in developing and sustaining successful community-centred palliative nursing policies and service models especially in countries like India with diverse population. An integrative review was performed on five databases, using hand searches of key journals and reference citation tracking for empirical studies published in English from 1990 to 2015. A thematic analysis framework was used to analyse and identify key themes. Analysis of the six eligible studies revealed five themes. Themes describe how social, economic, cultural, religious, spiritual and traditional factors influenced the palliative and end-of-life care perspectives and experiences among Indians. They also illustrated preferences relating to place of care, as well as benefits and challenges of family caregiving during the last days of life. Although we found minimal evidence on user perspectives, nurses need to aware of those unique components of context-specific palliative and end-of-life care practices in India - socioeconomic, cultural and religious factors - on their nursing encounters. Nurses need to advocate same in policy development to enable accessibility and utility of palliative and end-of-life care services, which are scant in India. Nurses can be central in gathering the contextual evidence that advocate users' perspectives to inform further studies and national palliative care policies in India. Emerging policies in nursing education need to focus on integrating family-centred palliative and end-of-life care within curricula, whereas nursing practice may promote nurse-led community models to address the patchy palliative and end-of-life service provision in India.

Stratified Familialism: The Care Regime in India through the Lens of Childcare

This article explores the political and social economy of care in India through a focus on childcare practices, from the viewpoint of the care giver — a perspective frequently ignored or touched on only generally in earlier discussions on development or social policy. It is argued that the care regime is an ad hoc summation of informal, stratified practices. It is shaped by the institutional context, in particular the economic and social inequalities of work and livelihoods, as well as trends and absences in state economic and social policy. Central to the dynamics of care practices in India is the ideology of gendered familialism in public discourse and policy, which reiterates care as a familial and female responsibility and works to devalue and diminish the dimensions of care. By delineating the range of institutions through which everyday childcare practices are organized, this contribution draws out the differentiations and actualities of stratified familialism and care. At one end of the spectrum are those who have the possibility to retain familial carers at home and supplement them with paid and other institutional carers; at the other are those who are neither able to retain family members at home nor fill the care gap through formal institutions.

Letters

Letters

Limiting life-prolonging interventions and providing palliative care towards the end-of-life in Indian intensive care units

Purpose: This position statement aims to minimize inappropriate treatment and optimize palliative care for terminally ill patients in Indian intensive care units by standardizing the process of forgoing life support. It also defines the ethical standards for the physician–patient relationship in the context of critical care practice in India. Evidence: Evidence was gathered through a review of recently published medical literature on the subject, as well as by evaluating the relevant statutes of Indian Law. Available empirical data from critical care practice in India were sparse. Newspaper articles reflecting lay opinion on related issues were also reviewed. The terms for search were: end-of-life care; withdrawal and withholding; intensive care; terminal care; medical futility; ethical issues; palliative care. Method: Proposals from the Chair were debated and recommendations were formulated through a consensus process. The process took into account the guiding ethical principles and clinical practices elsewhere in the world, and incorporated the socio-cultural and legal perspectives unique to this country.

The association of smoking and acne in men in Hong Kong and in India: a retrospective case--control study in primary care settings

Previous studies on the association of smoking with acne vulgaris have reported conflicting results. The objective of this study was to investigate such an association. Our setting was three primary care practices in Hong Kong and one primary care practice in India. Patient characteristics in all four practices are similar. All medical records in these practices incorporate a section in which the smoking habits of each patient is routinely documented. We searched our database and retrieved 632 records of patients with acne seen in the previous 5 years. We also retrieved 632 records of age- and sex-matched controls. Fifty-three out of 379 male patients with acne and 25 out of 379 male controls were smokers (P = 0.001; OR, 2.3; 95% CI, 1.4-3.8). Six out of 253 female patients with acne and three out of 253 female controls were smokers (OR, 2.0; 95% CI, 0.5-9.4). We conclude that smoking is likely to bear a positive correlation with acne for men. Our numbers are too small for a definite conclusion to be drawn for females.

ICUs worldwide: critical care in India.

Critical care practices in India have evolved significantly over the past decade. Critical care initially began as a service in major hospitals, but with the formation of the Indian Society of Critical Care Medicine the development of this speciality has been very rapid. Regular conferences, updates, continuing medical education programmes and workshops have emerged, and postdoctoral training programmes have been developed. Scientific publications have begun to appear and in spite of the diverse problems and standards, meaningful speciality-related activities have begun. Future challenges include the development of guidelines, the consolidation of training activities and research on the outcome of critical tropical problems.