Government Hospitals In India Research Articles

Oral misoprostol alone, compared with oral misoprostol followed by oxytocin, in women induced for hypertension of pregnancy: A multicentre randomised trial.

To assess whether, in those requiring continuing uterine stimulation after cervical ripening with oral misoprostol and membrane rupture, augmentation with low-dose oral misoprostol is superior to intravenous oxytocin. Open-label, superiority randomised trial. Government hospitals in India. Women who were induced for hypertensive disease in pregnancy and had undergone cervical ripening with oral misoprostol, but required continuing stimulation after artificial membrane rupture. Participants received misoprostol (25 micrograms, orally, 2-hourly) or titrated oxytocin through an infusion pump. All women had one-to-one care; fetal monitoring was conducted using a mixture of intermittent and continuous electronic fetal monitoring. Caesarean birth. A total of 520 women were randomised and the baseline characteristics were comparable between the groups. The caesarean section rate was not reduced with the use of misoprostol (misoprostol, 84/260, 32.3%, vs oxytocin, 71/260, 27.3%; aOR 1.23; 95% CI 0.81-1.85; P = 0.33). The interval from randomisation to birth was somewhat longer with misoprostol (225 min, 207-244 min, vs 194 min, 179-210 min; aOR 1.137; 95% CI 1.023-1.264; P = 0.017). There were no cases of hyperstimulation in either arm. The rates of fetal heart rate abnormalities and maternal side effects were similar. Fewer babies in the misoprostol arm were admitted to the special care unit (10 vs 21 in the oxytocin group; aOR 0.463; 95% CI 0.203-1.058; P = 0.068) and there were no neonatal deaths in the misoprostol group, compared with three neonatal deaths in the oxytocin arm. Women's acceptability ratings were high in both study groups. Following cervical preparation with oral misoprostol and membrane rupture, the use of continuing oral misoprostol for augmentation did not significantly reduce caesarean rates, compared with the use of oxytocin. There were no hyperstimulation or significant adverse events in either arm of the trial.

Palliative Care for Newborns in India: Patterns of Care in a Neonatal Palliative Care Program at a Tertiary Government Children's Hospital.

Neonatal palliative care is a specialized area within children's palliative care, which focusses on the needs of infants with life-limiting or life-threatening conditions. Nearly one quarter of global neonatal deaths occur in India, where neonatal palliative care evidence is limited. This study describes the development and implementation of a neonatal palliative care program within a neonatal intensive care unit (NICU) at a government hospital, describing the implementing an 8-month pilot palliative care program for neonates, including the patterns of care, and barriers and enablers of success. The hospital-based palliative care team included trained pediatric palliative care physicians, a nurse, and a counselor. There was a steady increase in monthly referrals. There were 110 referrals in total, including 89 (81%) deaths and 18 (16%) babies were alive at the time of final follow-up, 10 months after the pilot program was completed. The program addressed physical symptoms, including providing morphine, as well as psychosocial and spiritual concerns of families. A model of hospital-based palliative care for neonates can be implemented within NICUs in tertiary government hospitals in India. Neonatal palliative care programs should include partnerships with charitable organizations to support implementation costs and provide palliative care training, mentorship, and capacity-building support.

Impact of Quality Improvement (QI) Initiatives on Neonatal Mortality in NICU: A Retrospective Analysis in Tertiary Care Centre in Western India

Introduction: The global “under-five mortality” has dropped 60% from 93 deaths per 1,000 live births in 1990 to 37 in 2020 in the last three decades. It is vital to adopt proven quality improvement initiatives to provide quality care to improve neonatal mortality and morbidity. Aim of the study was to assess the impact of the quality improvement interventions and strategies in reducing the neonatal mortality statistics.
 Methods: The study was conducted in a 500 bedded Government Hospital in India. The management implemented various tactics, such as enhancing the existing infrastructure, upgrading equipment, augmenting the workforce, and implementing established clinical protocols, to enhance the quality of intensive care services provided in the NICU. The QI points were identified based on the shortcomings that were identified and shortlisted based on the working of NICU pre QI implementation. The outcome was measured as neonatal mortality indicators and the data was compared between pre and post implementation period.
 Results: After implementing quality improvement measures, there were notable enhancements in the total floor area, availability of skilled personnel, and equipment. The number of total admissions to the NICU increased by 79%, and mortality reduced from 20.93% to 7.82%. There was a statistically significant decrease in disease-specific neonatal mortality rates, with a p-value of less than 0.001.
 Conclusions: This study concludes that implementation of proper and comprehensive QI interventions and strategies in NICUs can help in decreasing the neonatal mortality.

Randomized Controlled Trial Comparing Ferrous Sulfate and Iron Sucrose in Iron Deficiency Anemia in Pregnancy.

Anemia among pregnant women is one of the major health concerns for healthcare workers. The management becomes a concern in the pregnancy where the question arises of which is better the intravenous iron sucrose or the oral ferrous sulfate tablets. To answer this, a randomized control trial comparing both the treatment options in a tertiary care government hospital was set up in the hilly terrains of India. This study discusses the effectiveness and practical aspect of using both, which seems to be the better out of both, and why. The study was conducted as a parallel-group, open-label randomized controlled trial (RCT) in the Department of Obstetrics and Gynecology of a tertiary care government hospital in India, with approximately 4,000 delivery loads annually. Ethical clearance was obtained from the institute's ethics committee (IEC), and the trial was registered with the Clinical Trial Registry of India (REF/2022/06/055013). Two hundredsixty-eight pregnant women between 18 and 45 years of age with moderate iron deficiency anemia (IDA) (hemoglobin (Hb) 7-9g/dl, microcytic-hypochromic, and serum ferritin <30ng/ml) were included in the study. Patients were randomly divided into two groups: group 1 with 134 patients to receive intravenous iron sucrose and group 2 with 134 patients to receive oral ferrous sulfate tablets. The intravenous iron sucrose is superior in terms of tolerability and correction of iron deficiency anemia during pregnancy. It yields a quicker rise in Hb and serum ferritin with no major side effects. In the difficult terrain of Himachal Pradesh, this makes IV iron sucrose a better option for anemic pregnant women who do not have easy access to health facilities resulting in a large number of them reaching hospitals with moderate to severe anemia at a later gestation.

Medical teacher in Tamil Nadu government sector: A role model for youngsters in India

Introduction: Government hospitals in India generally have a negative opinion among pubic due to lack of sanitation and facilities but in Institute of orthopaedics and traumatology, Coimbatore government medical college hospital headed by Prof. Dr. S. Vetrivel Cherian is having facilities and patient care in par with corporate hospitals. Aim of the article is to teach and inspire young doctors about the methods and innovations adopted by him for the welfare of patients.Materials and Methods: As a retrospective study from 2000–2022, the efforts of Dr. S. Vetrivel Chezian in the public sector and how he expanded the orthopaedic medical services at Coimbatore Medical College are covered in detail.Discussion: He revolutionized trauma care services by leg bone surgery fracture fixation within 6 hours of admission even during covid 19 pandemic. He established modern lightweight artificial limb centre during covid-19 pandemic for the welfare of differently abled people without direct expenditure to the government under AB PMJAY thus making Coimbatore the first district in India with no waiting list for artificial limbs. He improved new born and children care by prevention and surgical correction of foot deformities (Clubfoot) every Thursday even during covid-19 pandemic and established ward for no attender destitute patients for the first time in India. He upgraded department of orthopaedics to Institute of orthopaedics and traumatology and improved patient care by providing various amenities. He also had passion for teaching which enabled him to publish books and encouraging post graduates by giving medals.Conclusion: Various initiatives taken by Prof. Dr. S. Vetrivel Chezian not only improved the patient care but also changed the perception about government hospitals among public and also his actions serve as a role model for young doctors.

STUDY OF RISK FACTORS ASSOCIATED WITH MUCORMYCOSIS IN COVID-19 PANDEMIC AT TERTIARY CARE HOSPITAL IN INDIA

Background: The second wave of SARS-COV2 pandemic in India has witnessed a massive increase in the number of mucormycosis cases. The present study is aimed at evaluating the risk factors associated with the development of mucormycosis. The case-control study involved Methods: patients admitted to the general medicine and ENT wards of a tertiary care government hospital in India between 1st June and 31st July 2021. During the study period, 70 cases of mucormycosis were compared with 140 biologically-matched controls. Univariate and multivariate logistic regression analyses were carried out to evaluate the association of the following parameters with the development of mucormycosis: demographic factors, severe acute respiratory illness (SARI)/COVID-19, RT-PCR swab status, comorbidities, CT severity grading, and use of steroids, antibiotics, antivirals, anticoagulants, immunomodulators, and oxygen therapy. The st Results: udy involved a total of 210 subjects (70 cases and 140 controls). The ndings of univariate analysis demonstrated that SARI, high-dose steroid use (cumulative dose of dexamethasone ≥40 mg for 5 days), diabetes mellitus, usage of remdesivir, CT severity grade more than moderate were associated with statistically signicant odds for developing mucormycosis. Multivariate analysis showed individual association of SARI, diabetes mellitus and high-dose steroid with the development of mucormycosis. SARI, diabetes mellitus, and high-dose corticosteroids Conclusion: are found to be risk factors in developing mucormycosis, which requires immediate medical attention in this current pandemic.

Simulation-based approach for minimizing waiting time in AIIMS, Delhi using Queuing model

The government hospitals in India influenced by multiple factors causing longer waiting time of patients in comparison to private hospitals, which worsen the threat to healthcare facilities. The optimization of available resources considering the arrival rate of patients and the availability of facilities for the minimization of queuing is the utmost requirement. The current study has been carried out within the outpatient's department to minimize queue length of one of the largest and busiest hospital, AIIMS in Delhi, represent a struggling health care delivery system with high waiting times of patients. The primary queuing data was collected for total samples of 1200 patients during the four-week study period (1st July to 30th July 2020), (Monday-Friday) and working hours of general OPD (08:30 am to 01:00 pm). The detailed queuing secondary data was collected from AIIMS for three years (1st January 2015 to 31st July 2017). Data has been analyzed by queuing models, M/M/1: Poisson-exponential, single server model-infinite population and up to M/M/8: Poisson-exponential, multiple server model-infinite populations.

Implementation of 5S management method for lean healthcare in clinical biochemistry laboratory of a government hospital in India

Government healthcare organizations are facing big challenges as a result of increasing burden of diseases. Since the resources are limited, by restructuring the organizational infrastructure a better use of available resources is possible, which will improve the quality of services. The 5S approach is an effective tool of lean management principles which reduces waste through a better organized workplace, leading to improved quality service. The objectives of this study were to analyse the perceptions of healthcare workers about 5S methodology and examine the feasibility and effectiveness of implementing 5S in a clinical biochemistry laboratory. This interventional study was conducted in three phases. First phase was about advocacy and training of trainers. The second phase included a implementation of 5S and practicing it under supervision. The third phase had review meeting, and filling of the feedback questionnaire. The study revealed that the laboratory has become a more organised and safe place to work. It has helped in developing a positive attitude in the staff towards their responsibilities and inspired others to follow 5S methodology. Implementation of 5S required commitment of top management and total involvement of staff at all levels.

Call based enquiry for COVID-19 vaccine (Covishield) adverse events in a tertiary care government hospital in India

Background: Vaccination is one of the crucial intervention to fight against the ongoing COVID-19 pandemic. The ongoing vaccination drive aims for achieving national vaccination coverage. Due to the expedited roll out of COVID-19 vaccine, there has been a fear and concern regarding its safety. The present study aims to enquire actively about the adverse events after COVID-19 vaccination and disseminate this information to the public to promote vaccine acceptance.Methods: A call based active enquiry was done to know the frequency and severity of various adverse events among the recipients of COVID-19 vaccine’s Covishield (SII-ChAdOx1 nCoV-19) first dose. Call based enquiry was done for local as well as systemic adverse events on day 1, 3 and 7 of vaccination.Results: Out of the total of 1201 who responded to calls on all three days, 766 (63.7%) of them had at least one of the adverse event. There were only 4 (0.33) recipients who had severe/serious events. The most frequent systemic and local AEFI reported was body ache/ malaise and pain at injection site in 309 (25.7%) and 664 (55.3%) participants respectively. Most of the AEFI’s improved over a week with only 17 (1.4%) participants reporting persistence of any adverse event on day 7 of vaccination.Conclusion: Our study can provide scoping base for development of a proper surveillance program to monitor the AEFI by ‘active’ query and use of a call-based system especially for novel vaccines.

Exploring the experiences, psychological well-being and needs of frontline healthcare workers of government hospitals in India: a qualitative study

The present study aims to understand the experiences, challenges, psychological well-being and needs of clinical and non-clinical government healthcare workers (HCWs) during the COVID-19 pandemic in the Hyderabad-Karnataka (H-K) region. This qualitative study used purposive sampling method to recruit 221 HCWs working in the H-K region government hospitals during the COVID-19 pandemic. Semi-structured interviews were carried out with those HCWs who agreed to participate. The data analyzed using conventional content analysis revealed three main themes: (1) experiences and challenges faced by HCWs; (2) psychological well-being and coping strategies used by HCWs; and (3) experience of and need for social support. The main findings of the current study are as follows: The HCWs experienced fear and apprehension during the early stages of the pandemic, but gradually, their fears reduced, and they perceived the situation to be the “new normal”. They experienced work-related (scarcity of resources, problems with PPE, communication issues, violence, and stigma) and family-related (fear of infecting family members, choosing work over family, inability to undertake family roles) challenges while serving during the pandemic. They reported increased psychological issues (psychological distress, experience of loss, and feelings of guilt and helplessness). Conversely, they reported a need for emotional stability. The HCWs reported using adaptive (emotion-focused, problem-focused, and religious) and maladaptive (avoidance and substance abuse) coping strategies to cope with these challenges and psychological problems. They also sought social support (from family, friends, colleagues, and superiors) and raised the need for organizational, personal, and societal support to cope with the pandemic. The HCWs experienced physical and psychological burnout, especially from stretching beyond the assigned roles due to a shortage of resources and workforce. However, amidst juggling with work and family responsibilities, HCWs were found to be emotionally stable and reported to have a positive outlook in general. Besides, emphasizing the regulation of policies for meeting their primary needs, they stressed the need for professional psychological services with need-based intervention strategies.

An Analytical Study on Acute Liver Injury in Patients Caused by Classic Heat stroke

Heat Stroke is a kind of medical emergency that can cause severe dehydration and neurological changes as a result multi-organ injuries or failure could be possible. Heat strokes occur when the body temperature exceeds 40 0C due to external heat and humidity. The liver is widely affected by heatstroke that’s why taking care of patients suffering from heatstroke is very important. Various studies have been reported in the literature regarding acute liver failure but none of the studies discussed acute liver failure during the hospital stay. Patients during their hospital stay will have a higher risk of mortality due to heatstroke. In this paper, an analytical study has been done on admitted patients to a government hospital in India. These patients are suffered from heatstroke from April 2007 to September 2011 and a second time period from July 2018 to September 2019. The sample includes 60 patients with 58 (97%) males having a totaled number of 12 fatalities. The observed International Normalized ratio (INR) parameter is greater than 1.6 and no increased mortality has been noticed, aspartate aminotransferase (AST), as well as alanine aminotransferase (ALT) levels, were not associated with an increased mortality rate.

Standard health data exchange model enables the use and reuse of data to improve maternal health programs and services: a case study from India

Background The evidence on development of a health data exchange (HDX) in India is lacking, both in terms of the use of data for patient care (use) and aggregate data use (reuse) to improve maternal health services and programs. This study describes the requirements and proposes an HDX model development, focused on the adoption and use of design standardization. Methods A landscape analysis was conducted through a literature review to understand the existing HDX models. A qualitative case study focusing on a tertiary care state government hospital in India was performed. Twenty key informants were selected through purposive sampling and virtual interviews were undertaken. A mix of deductive and primarily inductive data analysis was conducted using the NVIVO 12.0 software. Findings Following an iterative design process and based on the essential requirements suggested by the key informants, an inter-organizational HDX scheme was developed. The HDX model leverages the electronic health records to enable the use of data for patient care, and use of aggregate patient data to support management and administrative decisions at the institutional, state-wide and national levels. The model describes how to balance the inter-organizational and intra-organizational data exchange needs. Integrating systems at the local level with those at the state and the national level was identified as one of the key components of this process. Conclusions The patient-level data is critical for the delivery of best attainable health care. At the same time, the aggregate data is critical, especially in the domain of decision-making and global health. The development of a versatile HDX model is a pre-requisite for a successful use and reuse of data, by ensuring that no functionality is lost and that the data is used in the best way possible.

Challenges in Care of Children with Acute Leukemia in a Government Hospital in India: A Retrospective Analysis

Abstract Introduction Acute leukemia (AL) is among the most common treatable cancers in childhood but many children are forced to abandon therapy. Objective We have explored reasons for treatment abandonment through this study. Materials and Methods Retrospective analysis from an ongoing registry data of childhood AL patients, where all newly diagnosed AL patients of ≤18 years of age (June 2014–November 2017) were included. Patients &gt;18 years of age, having any history of treatment of AL outside our institute, and/or patients with relapsed AL were excluded. The primary outcome of the study was treatment abandonment rate. Results A total of 710 AL patients were included in the study, average distance traversed to reach the hospital being 161.66 km. Most children were aged 1 to 10 years (49.4%, n = 351), followed by &gt;10 to 18 years (46.6%, n = 331), and ≤1 year age (3.9%, n = 28). The commonest symptoms were fever (67.4%), pallor (38.6%), bleeding (11.5%), bone pain (13.8%), neck swellings (14.9%), and, rarely, testicular swellings or Superior vena cava (SVC) syndrome (1.1%). A high abandonment rate was noted prior to leukemia subtyping (35.2%, n = 250) mostly among males 62% (n = 155) and the 1- to 10-year group 55.6% (n = 139). A total of 460 (64.8%) patients were subsequently subcategorized by immunophenotyping. Precursor B-cell (Pre-B) Acute Lymphoblastic Leukemia (ALL) in 307 (43.2%) patients was the commonest subtype, followed by early Pre-B ALL (Pro-B ALL) in 10 (1.4%), T-cell ALL (T-ALL) in 51 (7.1%), Acute Myeloid Leukemia (AML) in 45 (6.3%), Acute Promyelocytic Leukemia (APML) in 28 (3.9%), and Mixed Phenotypic Acute Leukemia (MPAL) in 19 (2.6%). Conclusion The most common group of patients was aged 1 to 10 years (median age: 5 years). An abandonment rate of 35.2% was seen prior to complete diagnostic workup. The reason for this high abandonment, despite good disease prognosis, is a relevant social and health issue, and needs further evaluation. The problems discussed in this study are relevant to lower-income families and areas where health care is not easily accessible. The government agencies, nongovernment organizations and society would need to work together to overcome these issues.

One Year Outcomes Following Orthotropic Heart Transplantation at a Tertiary Care Center in India

Purpose Cardiac transplantation remains the gold standard for end stage heart failure. Even after 25 years, the progress of heart transplants in India has not been as expected, especially in the public sector. Till recently, ours was the only government hospital in India with a successfully running heart transplant program. This study' s primary objective was to evaluate the 1- year survival of heart recipients in the last five years at our centre and risk factors associated with early mortality. Methods A retrospective analysis of records of 40 transplant patients, performed between 2014 2019 at our center was done to calculate one-year survival and evaluate risk factors for mortality. The following risk factors were analysed for a significant correlation with mortality- infections, primary graft dysfunction (PGD), allograft rejection, ischemia time and INTER-MACS (Interagency Registry for Mechanically Assisted Circulatory Support) score. Adults who are in current follow up (n= 21 ) were interviewed for evaluation of their per capita income and quality of life and a correlation was sought with quality of life. Results The mean age of patients was 31.2 ± 1 2.7 years. The 1- year survival of patients transplanted during 2014-15 and 2016-19 was 65% and 85%, respectively. None of the risk factors studied correlated with mortality. The most common cause of death in the first year following transplant was an infection. A total ischemia time of more than 240 minutes, higher preoperative PA pressures and INTER-MACS score Conclusion The 1- year survival of patients transplanted during 2014- 15 and 2016- 19 was 65% and 85%, respectively. There was no correlation between infections, primary graft dysfunction (PGD), allograft rejection, ischemia time, INTER-MACS score and mortality. The QOL of heart recipients, from economically weaker sections, is similar to that of India' s general population. There is no correlation between per capita income and quality of life after a heart transplant.

One year outcomes following orthotopic heart transplantation at a tertiary care center in India

Introduction: Cardiac transplantation remains the gold standard for end stage heart failure. Even after 25 years, the progress of heart transplants in India has not been as expected, especially in the public sector. Till recently, ours was the only government hospital in India with a successfully running heart transplant program. This study's primary objective was to evaluate the 1-year survival of heart recipients in the past 5 years at our center and risk factors associated with early mortality. The secondary objective was to assess the correlation between per capita income and quality of life (QOL). Methodology: A retrospective analysis of records of 40 transplant patients, performed between June 2014 and June 2019 at our center, was done to calculate 1-year survival and evaluate risk factors for mortality. The following risk factors were analyzed for a significant correlation with mortality-infections, primary graft dysfunction (PGD), allograft rejection, ischemia time, and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) score. Adults (>18 years of age) who are in the current follow-up (n = 21) were interviewed for the evaluation of their per capita income and QOL. A correlation was sought for between per capita income and QOL. Results: The mean age of patients was 31.2 ± 12.7 years. The 1-year survival of patients transplanted during 2014–2015 and 2016–2019 was 65% and 85%, respectively. None of the risk factors studied correlated with mortality. The most common cause of death in the 1st year following transplant was an infection. A total ischemia time of more than 240 min, higher preoperative PA pressures, and INTERMACS score ≤2 are significant risk factors for developing PGD. The mean monthly per capita income of the 21 patients, interviewed for QOL, is ₹7142 ± 3050. The cost of heart transplant for the first 2 years (including surgical expenses) is ₹997,760 ± 104,751 rupees at our institute, and the current mean monthly spending for medicines is ₹15,214 ± 5041. Conclusion: The 1-year survival of patients transplanted during 2014–2015 and 2016–2019 was 65% and 85%, respectively. There was no correlation between infections, PGD, allograft rejection, ischemia time, INTERMACS score, and mortality. The QOL of heart recipients, from economically weaker sections, is similar to that of India's general population. There is no correlation between per capita income and QOL after a heart transplant.

Peritoneal Dialysis Catheter Insertion by Nephrologist Using Minilaparotomy: Do Survival and Complications Vary in Obese?

Introduction:Peritoneal dialysis catheter (PDC) placement for chronic kidney disease (CKD) amongst overweight and obese patients is difficult owing to deeper operating field. Literature being discordant on survival and complications in this patient subset, we attempted to analyse this research question in Indian population.Materials and Methods:We retrospectively analysed PDC inserted by nephrologist using surgical minilaparotomy for survivals and complications amongst 'overweight and obese' cohort ('O') at two tertiary care government hospitals in India, and compared results with normo-weight cohort ('N'), with 12−36 months follow-up.Results:245 PDCs were inserted by surgical minilaparotomy and 'N' to 'O' ratio was 169:76. 'O' group were more rural residing (P = 0.003) and post-abdominal surgery (P = 0.008) patients. The 1, 2, and 3-year death censored catheter survival rate was 98.6%, 95.8%, and 88.2% respectively in 'O' group, and 97.6%, 94.5% and 91.8% in 'N' group respectively (P = 0.52). Patient survival (P = 0.63), mechanical complications (P = 0.09) and infective complications (P = 0.93) were comparable despite technically challenging surgery in 'O' group. Refractory peritonitis related PDC removal was comparable (P = 0.54). Prior haemodialysis or catheter related blood stream infections or diabetes were non-contributory to results.Conclusions:Catheter survival and patient survival amongst obese and overweight CAPD patients was non-inferior to normal weight patients. Mechanical, and infective complications were comparable despite technically challenging abdominal terrain in 'O' group. The overall CAPD performance was good amongst obese and overweight.

Tracheostomy: A shift in paradigm from a simple bedside procedure to a potential source of spread of COVID-19

Introduction: Tracheostomy is defined as the creation of stoma at the skin surface that leads into the tracheal lumen. Tracheostomy in critically ill patients is usually performed in order to assist in weaning of prolonged ventilation. Objective: This article outlines the necessary changes to be adapted during the procedure of tracheostomy in the wake of COVID-19 pandemic. Methods: The methods suggested in the present study were obtained by performing a detailed observation of the many cases which were performed in a Tertiary Government Hospital in India. Results: The methods presented in this study were followed for every tracheostomy procedure performed since the emergence of COVID-19 pandemic. This resulted in reduced exposure to a great extent, the involved healthcare workers did not contact with COVID-19 infection. Conclusion: Modifications are necessary for the protection of healthcare workers in the absence of healthcare infrastructure like negative pressure/laminar flow operation theaters.

High - Low Engaged Employee Commitment and Citizenship Behaviour Examined with Moderated Mediation

This study examines the mediating and moderating variables through which human resource management practices are linked with behavioral outcomes. We developed and tested a moderated mediation model linking perceived HR practices to organizational commitment and citizenship behavior. Drawing upon the AMO framework that assumes HR bundles to influence outcomes, we explore through social exchange theory and self-determination theory the moderating effect of level of engagement and mediating effect of organizational commitment on HR practices and organization citizenship relation. The data of 401 employees working in government hospitals in India support this model. The findings suggest that the level of engagement of employees influences the relationship of HR practices on organization commitment which has been observed with the interaction effect. The implications for practitioners are discussed.

Availability and use of continuous positive airway pressure (CPAP) for neonatal care in public health facilities in India: a cross-sectional cluster survey

ObjectivesTo determine the availability of continuous positive airway pressure (CPAP) and to provide an overview of its use in neonatal units in government hospitals across India.SettingCross-sectional cluster survey of a...

Etiological study of bone marrow aspiration cytology in children in a tertiary care government hospital in India with a special focus on adolescent females

Background: Bone marrow aspiration (BMA) cytology is a common and cheap technique which reveals the marrow cellularity, its structure, and stages of differentiation of different blood cells. Objectives: The objectives of the study were to study the etiology and the common presentation in patients undergoing BMA in pediatric age group with special focus on the adolescent females. Materials and Methods: This cross-sectional descriptive study was carried out in the Department of Pediatrics and Pathology of a Medical College Hospital of Bihar, India. The study was done from May 1, 2018, to April 31, 2019, on 259 cases. BMA was carried out and relevant clinical history, physical examination, and laboratory data were retrieved. Results: Out of 259 cases, 1 case was excluded from the final analysis due to inadequate marrow. Male-to-female ratio was 1.16:1. The most common indication was unexplained anemia (46.5%) and pancytopenia (26.7%). The most common etiological diagnosis was nutritional anemia (27.5%) followed by hypoplastic anemia (22%). Among adolescents (&gt;11–18 years), male:female ratio decreased to 1:1 where nutritional anemia was the most common cause followed by hypoplastic anemia. Conclusion: The common hematological disorders prevailing in our community in pediatric age group are nutritional anemia, hypoplastic anemia, and acute leukemia.