Needy Patients Research Articles

Distribution of HLA genes and disease predisposition in Bengali speaking people from India

BackgroundKnowledge of allele and haplotype frequencies of the HLA system is not only important in the search for unrelated bone marrow donors but it also provides useful insights to the probable susceptibility and resistance to disease as well as drug tolerance and toxicity in the Bengali population. MethodsIn this study, 322 Bengali speaking donors registered with MDRI were analyzed for the HLA ABDRB1 alleles using Luminex and SSP techniques. The haplotype analysis and HW test was performed using arlequin 3.5 software. ResultsThe most prevalent HLA A alleles are A*33(20%), A*24(19%), A*11(16%), A*02(14%), A*01(11%), which are known to be associated with increased risk of pulmonary tuberculosis, leprosy, cytomegalovirus and enterovirus 71 infections. The common B alleles B*15 (15%), B*35, B*40, B*44 (11%), B*52 (9%) and B*57 (6%) are associated with increased risk to cervical cancer and vasculitis. The most prevalent DRB1*15 (29%), DRB1*07 (21%), DRB1*04 (11%) and DRB1*12 (9%) are associated with Rheumatoid arthritis, bronchial asthma and inflammatory bowel disease. The most common haplotype A*33-B*44-DRB1*07 with the haplotype frequency of 6.4% was prevalent Bengali population from India. Many other common haplotypes seen in Bengali are present in other parts of the world like Asian population in USA, China, Brazil and neighboring Bangladesh and Pakistan. ConclusionThis study shows presence of common Bengali haplotypes across many countries. This will enable sharing of donors stem cells to the needy patients worldwide.

The Critical Role of Social Workers in Home-Based Primary Care

The growing homebound population has many complex biomedical and psychosocial needs and requires a team-based approach to care (Smith, Ornstein, Soriano, Muller, & Boal, 2006). The Mount Sinai Visiting Doctors Program (MSVD), a large interdisciplinary home-based primary care program in New York City, has a vibrant social work program that is integrated into the routine care of homebound patients. We describe the assessment process used by MSVD social workers, highlight examples of successful social work care, and discuss why social workers’ individualized care plans are essential for keeping patients with chronic illness living safely in the community. Despite barriers to widespread implementation, such social work involvement within similar home-based clinical programs is essential in the interdisciplinary care of our most needy patients.

Convulsive Therapy and The Journal of ECT

Convulsive Therapy and The Journal of ECT

PT326 The Evaluation of a Public Service Advertisement "Being healthy, Being away from chronic diseases" in Chongqing, China

Introduction: In developing countries poverty poses challenges in healthcare delivery. In the context of treatment involving pacemakers, most of the hospitals turn away poor patients who could not afford the expensive device. A large hospital in Eastern India took up the challenge. Objectives: To share the experience of developing a system for providing free pacemakers to poor patients Methods: Cardiologist of the hospital searched several options and zeroed on Heart Beat International (HBI) in the USA. HBI coordinates with pacemaker manufacturers who donate new devices for needy patients anywhere in the world. It distributes pacemakers through banks governed by Rotary Clubs. In the year 2005, in association with a local Rotary Club, a Pacemaker Bank was established. The steel industry to which the hospital is attached waived off the procedure charge in poor patients. The fee of US $ 5000 to HBI was donated every year by a partnering Rotary club from another city. Batches of new pacemakers were sent from USA and Germany as per requirement. Results: From March 2005 till Sep 11 2013, 147 devices were implanted in 142 poor patients. One of the beneficiaries was a poor man from distant Kabul in Afghanistan, who got information about our work. There were 105 males and 37 females in the age range of 20 to 86 years. Medtronic, Biotronic, St Jude, Vitatron and Guidant pacemakers were received. We implanted 90 dual chamber pacemakers, 50 single chamber pacemakers, 6 AICDs and one CRT device. While on regular follow up, ‘end of life’ warning was noted in five dual chamber devices and one AICD. They were replaced with new devices. The pacemaker bank experiences were shared in the HBI workshops held along with the Annual Conferences of the American College of Cardiology at Chicago, New Orleans and Atlanta. Interactions with experts led to RVOT pacing and a paper on the work was published in a Canadian journal. Sakuji Tanaka, the President of Rotary International awarded the cardiologist for humanitarian service. Conclusion: After establishing the Pacemaker Bank no patient who could live normally with a pacemaker is turned away from the hospital. Disclosure of Interest: None Declared

PT328 Variation in population health related quality of life (HRQoL) as measured by EQ5D and impact of chronic conditions on QoL: Results from CARRS Study in India and Pakistan

Introduction: In developing countries poverty poses challenges in healthcare delivery. In the context of treatment involving pacemakers, most of the hospitals turn away poor patients who could not afford the expensive device. A large hospital in Eastern India took up the challenge. Objectives: To share the experience of developing a system for providing free pacemakers to poor patients Methods: Cardiologist of the hospital searched several options and zeroed on Heart Beat International (HBI) in the USA. HBI coordinates with pacemaker manufacturers who donate new devices for needy patients anywhere in the world. It distributes pacemakers through banks governed by Rotary Clubs. In the year 2005, in association with a local Rotary Club, a Pacemaker Bank was established. The steel industry to which the hospital is attached waived off the procedure charge in poor patients. The fee of US $ 5000 to HBI was donated every year by a partnering Rotary club from another city. Batches of new pacemakers were sent from USA and Germany as per requirement. Results: From March 2005 till Sep 11 2013, 147 devices were implanted in 142 poor patients. One of the beneficiaries was a poor man from distant Kabul in Afghanistan, who got information about our work. There were 105 males and 37 females in the age range of 20 to 86 years. Medtronic, Biotronic, St Jude, Vitatron and Guidant pacemakers were received. We implanted 90 dual chamber pacemakers, 50 single chamber pacemakers, 6 AICDs and one CRT device. While on regular follow up, ‘end of life’ warning was noted in five dual chamber devices and one AICD. They were replaced with new devices. The pacemaker bank experiences were shared in the HBI workshops held along with the Annual Conferences of the American College of Cardiology at Chicago, New Orleans and Atlanta. Interactions with experts led to RVOT pacing and a paper on the work was published in a Canadian journal. Sakuji Tanaka, the President of Rotary International awarded the cardiologist for humanitarian service. Conclusion: After establishing the Pacemaker Bank no patient who could live normally with a pacemaker is turned away from the hospital. Disclosure of Interest: None Declared

Fast Track Approval of Therapeutic Blood Substitutes

Fast Track Approval of Therapeutic Blood Substitutes

English

BACKGROUND: Cataract is the leading cause of avoidable blindness in India. Around 4 million people become blind each year because of cataract. AIM: To assess the visual outcome and complications associated with cataract surgery in camp patients operated at a Medical College tertiary hospital. MATERIALS AND METHODS: It was a retrospective study where 412 camp patients underwent posterior chamber intraocular lens implantation surgery over a period of one year. Data was compiled based on demographic characteristics, and post-operative complications. It was graded as per Oxford Cataract Treatment and Evaluation Team (OCTET) definitions on first post-operative day. After one month post-operative complications, best corrected visual acuity and refractive errors were also analyzed. RESULTS: 412 eyes underwent cataract surgery with posterior chamber intraocular lens implantation .The maximum patients were in the age group of 60-69 years, 180 (43.6%) patients., Among these patients 240 were males (58.2 %) and 172 were females (41.7 %). Small incision cataract surgery (SICS) with intraocular lens implant was the commonest surgical method (80%) used. 792 eyes of 412 patients had cataract, of which 596 had the cortical type (75.3 %) and 196 had the nuclear type (24.7 %). Of the cortical type, 428 were immature and 168 were mature cataracts Based on OCTET grading, the most common first post-operative day complication was mild iridocyclitis (26.2%) followed by transient corneal edema in 86 patients. The major post- operative complications after 4 weeks of cataract surgery were pigments on PCIOL in 18 (4.36%) cases and capsular flap in 12 cases. After 4 weeks post-operative best corrected visual acuity of eye 6/18 in 89.8% cases. The commonest refractive error was Myopia with against the rule astigmatism seen in 172 out of 300 patients. CONCLUSION: Acceptable results can be obtained from eye camp surgery patients with experienced ophthalmologists in the base hospitals and these camps help in reducing huge burden of cataract patients. Our aim remains to reach more blind and needy patient

Hyaluronan-Induced Cosmetic Reconstruction of the Nostril

Tissue loss of the nostrils presents a considerable surgical challenge due to the greatly reduced availability of local tissue within such a peculiar anatomical region. The traditional reconstructive methods, such as direct suture, secondary healing, skin grafts, and local skin flaps, have shown poor provision of desirable cosmetic outcomes in this area. The authors propose an innovative and alternative method of cosmetic reconstruction of small skin defects of the nostril based on a hyaluronan-induced skin regeneration. Such a procedure allowed the healing of relatively large areas of skin loss with the formation of a truly regenerated tissue whose clinical features closely resemble those of the local normal skin. Nevertheless, the proposed procedure is lengthy and time-consuming and requires high levels of cooperation from patients. In our practice, the hyaluronan-induced skin regeneration is now considered the first choice for cosmetic reconstruction of small defects of the nostril in needy patients.

Palliative care: Bridging the unmet spiritual, physiotherapy, and emotional aspects in cancer patients

Background: Palliative care is a technique to enhance the quality of life of patient suffering from devitalizing illness. This literature review is the work accomplished to pave the strong foundation of palliative care to the needy patients and their families. At the level of hospice care, besides doctors' and nurses' skills, tender care and affectionate support is much more needed then medicines. Materials and Methods: Literature search was performed using the terms palliative care, spiritual, physiotherapy, cancer patients and emotional aspects. The full articles available in English were reviewed. Results: Palliative care is a sophisticated requirement in cancer patients. Most of the available literature has stressed that there is a large gap between the actual demands and provision of palliative care including spiritual, physiotherapy, and emotional aspects in cancer patients. Conclusions: This article discusses various aspects of palliative care and how they influence attitude of the patient and his or her family toward the curing therapy. This provides guidance how nurses and doctor can create non-medication environment for ending suffering and pain for better quality of life by tending them spiritually, physically, and emotionally.

Price Control Mechanism of Patented Pharmaceuticals in India

Patent grants monopoly to the Patentee. There is a tendency in pharma Patents amongst Patentee to overprice the drug rendering them out of reach of needy patients. Thus it is not affordable to the ordinary citizen at large and the poor are the worst sufferers. Due to the prohibitive cost of doing research, pharmaceutical companies overprice their medicines to recover the cost of doing research or to be able to conduct further research. Due to this overpricing the human rights of the sick and vulnerable are in a precarious. Lack of access to medicines is a threat to life to sick people, this violates right to life guaranteed in the Constitution besides other international declarations and covenants. Hence, the problem of un-affordability of medicine is a threat to life.

Dubai - Dubai Health Authority and Index Medical Centre sign MoU to provide medical assistance to needy patients

Dubai - Dubai Health Authority and Index Medical Centre sign MoU to provide medical assistance to needy patients

PTH-127 Appropriateness of use of MRCP (Magnetic Resonance Cholangio-Pancreaticgraphy) in Patients with Suspected CBD Stones – a District General Hospital Experience

IntroductionPatients with CBD (Common Bile Duct) stones require high risk interventions. Around 10–20% patients with symptomatic gallstones have CBD stones. Where the initial clinical, biochemical and ultrasound examinations failed to...

Pioneering New Ways To Engage The Disabled

Minnesota's Courage Center provides assistance that helps the neediest patients take more control of their health.

Long-term oxygen therapy

Long-term oxygen therapy (LTOT) has been shown to reduce pulmonary hypertension and improve survival in patients with chronic obstructive pulmonary disease and resting hypoxemia (reduced arterial partial pressure of oxygen ≤55 mmHg). However, the benefit of its use for chronic pulmonary diseases other than chronic obstructive pulmonary disease as well as for nonpulmonary conditions is debatable. Its role in patients with mild hypoxemia (reduced arterial partial pressure of oxygen >55 mmHg at rest) is presently being investigated in the LOTT. A meta-analysis of four controlled trials reporting the role of LTOT in patients with either nocturnal desaturation or daytime moderate hypoxemia found no difference in survival between patients on LTOT than those without. Advances in oxygen delivery and conservation devices have made domiciliary oxygen therapy more practical and popular for patients. There still remain concerns with the actual compliance of therapy among the needy patients.

Assessing Knowledge and Attitude of General Physician Toward Organ Dontation & Transplantation

Introduction: Organ and tissue transplantation is the best procedure for progressing organ failure. This can increase the importance of organ preparation. Someone related to its, like physicians should be familiar to transplantation law & standards so it seems that increase knowledge and attitudes of this group, can be so effective in transplantation center policities. The measurement of Knowledge and Attitude of general physician to understand their perception of the organ donation is our purpose. Method: In this cross-sectional study, A previously validated questionnaire with 36-question for evaluating Knowledge and Attitude toward organ donation and transplantation, was directly administered to 618 general physician of Tehran city in Iran for October 2009 to journey 2011. The statistics software package SPSS v 18 was used for all analyses Result: Of the 618 general physician including 304 women and 300 men, their mean age was 39/3±9.3, ranging from 25 to 80 years.80(13.1%) physicians had a donation card. in 460 (74.5%) had positive attitude toward organ donation after death but only 228(36.9%) had positive attitude in living time. The most reason between agreeable was all three reasons “helping people and for GOD and benefits of society” while the most cause of opponents was “abusage of tissue and organ donation”. Complete knowledge to transplantation rule was just in 104(16.8%). Knowledge of transplantation theoretical and financial basics was in 230(37.2%) & 156(22.6%), respectively. 296(47.6%) of Physicians identified difference between organ and tissue transplantation. There is good attitude towards organ transplantation between physicians while their knowledge of transplantation rules, theoretical and financial basics is less than half, so it needs additional awareness and education of physicians in all areas of the organ donation process in Iran. Conclusion: There is good attitude towards organ transplantation between physicians while their knowledge of transplantation rules, theoretical and financial basics is less than half, so it needs additional awareness and education of physicians in all areas of the organ donation process in Iran. In this condition, we will have an increased life expectancy in needy patients & increase social health.

Health worker perspectives on user fee removal in Zambia.

BackgroundUser fees for primary care services were removed in rural districts in Zambia in 2006. Experience from other countries has suggested that health workers play a key role in determining the success of a fee removal policy, but also find the implementation of such a policy challenging. The policy was introduced against a backdrop of a major shortage in qualified health staff.MethodsAs part of a larger study on the experience and effect of user fee removal in Zambia, a number of case studies at the facility level were conducted. As part of these, quantitative and qualitative data were collected to evaluate health workers’ satisfaction and experiences in charging and non-charging facilities.ResultsOur findings show that health-care workers have mixed feelings about the policy change and its consequences. We found some evidence that personnel motivation was higher in non-charging facilities compared to facilities still charging. Yet it is unclear whether this effect was due to differences in the user fee policy or to the fact that a lot of staff interviewed in non-charging facilities were working in mission facilities, where we found a significantly higher motivation. Health workers expressed satisfaction with an apparent increase in the number of patients visiting the facilities and the removal of a deterring factor for many needy patients, but also complained about an increased workload. Furthermore, working conditions were said to have worsened, which staff felt was linked to the absence of additional resources to deal with the increased demand or replace the loss of revenue generated by fees.ConclusionThese findings highlight the need to pay attention to supply-side measures when removing demand-side barriers such as user fees and in particular to be concerned about the burden that increased demand can place on already over-stretched health workers.

Following his passion is ‘life-changing’ – rural award winner

Most doctors can recall a career-defining moment of choice when events combined to offer divergent paths. For Kelly Gate, this year’s Rural Doctor of the Year, it was he declares dryly, ‘either fame and fortune, or peace and tranquillity’. Today’s medical manager of the rustic Bethesda Hospital in far northern KwaZulu-Natal (no guessing his choice) is describing a moment two years ago when, fed-up with ‘catching fainting patients’ in Britain to pay off his student loan and on the verge of a registrarship at McCords Hospital in Durban, that telephone call came. It was Mrs PS Khumalo, the CEO at the 222-bed Bethesda Hospital, begging her stalwart former community service officer (comserve) to ‘come help-out’ after her solo medical officer fell ill, leaving three wide-eyed comserves stranded in a sea of needy patients.

Personalized approach of medication by indirect anticoagulants tailored to the patient—Russian context: what are the prospects?

Indirect anticoagulants such as warfarin are the ‘gold standard’ for prevention and treatment of thromboembolic complications in patients at risk (in atrial fibrillation of valvular and nonvalvular etiology, the presence of artificial heart valves, orthopedic and trauma interventions, and other pathological conditions). A wide range of doses required to achieve a therapeutic effect indicates the need for a personalized approach to the appointment of warfarin. In addition to the dependence on the patient's clinical characteristics (sex, age, smoking status, diagnosis), there is a clear association between the warfarin dose and the carriage of certain allelic variants of key genes that makes it possible to apply molecular genetic testing for individual dose adjustment. This provides a more rapid target anticoagulant effect and also reduces the risk of bleeding associated with a possible overdose of warfarin. Implementation of this approach will allow more wide and safe application of indirect anticoagulants in Russia for needy patients.

Geographic disparities in care: The Maryland gynecologic oncology experience.

e16546 Background: Women with gynecologic malignancies require highly specialized care that is often unavailable at local centers. Prior reports have suggested that distance from residence to treatment facility is a barrier to care. We hypothesize that insurance status influences the distance women travel to receive gynecologic cancer care. Methods: Patients with incident gynecologic cancer diagnoses at a single urban, academic Institution were identified. Distance from the patients’ homes to the hospital was calculated in miles as well as time. Insurance status at diagnosis was captured as private (P), Medicaid (MA), Medicare (MC) or uninsured (UI). Results: 153 patients were identified. The median distance travelled to the hospital was 18.1 miles with a median time travel of 28 minutes. 48 (31%) of patients were insured by P, 42 (27%) by MA, 35 (23%) by MC and 28 (18%) were UI. Patients with MC were older than those with MA, P or UI (p<0.01). Patients with P were more likely to present with cancer of the uterine corpus (p<0.01). African American women were more likely to be covered by MA than other racial groups (p<0.01). Rates of medical comorbidities (obesity, diabetes and hypertension) were similar between insurance groups, although there was a trend towards higher body mass index in UI (p=0.08). Mean distance and time to the hospital by insurance category is shown in Table 1. The distances and times were different between groups (p=0.04, p=0.03 respectively). These differences remained significant when adjusted for site of primary disease and race (p<0.01). Adherence with treatment recommendations was similar regardless of insurance status or distance travelled. Conclusions: Insurance status plays a role in the distance women travel to receive gynecologic cancer care. The neediest patients may be shouldering an unfair burden in terms of access to specialty oncology treatments. [Table: see text]

Disability in a Group of Long-stay Patients with Schizophrenia: Experience from a Mental Hospital

Background:Recovery from schizophrenia is a complex concept. Remission of symptoms of psychotic illnesses is not necessarily linked to better functioning. Among various causes of disability, mental illnesses account for 12.3% of the global burden of diseases. Long-term hospitalization has been recognized as counterproductive and a contributory factor of disability associated with schizophrenia. Under various circumstances, many persons with mental illness are brought to mental hospitals but the measures taken for their rehabilitation and follow-up care is insufficient.Aim:In the present study we tried to find out the level of psychopathology and the associated disability in a group of patients with schizophrenia who have been staying in a mental health institution for more than 5 years due to lack of proper caregivers in the society or in their home.Materials and Methods:The study is conducted in a mental hospital of northeast India. Of the 40 patients staying for more than 5 years in the hospital, 28 fulfilled the criteria for inclusion. The Brief Psychiatric Rating Scale and World Health Organization Disability Assessment Schedule II (WHO DASII) were used for those patients. Analytical statistical methods were used subsequently.Results:Male patients were significantly older and had prolonged duration of stay. But the level of psychopathology did not differ significantly between male and female patients. Under WHODASII, understanding and communication problems are more prominent in both the groups. Of late, there are very few cases that required prolonged stay in the hospital. Many patients are fairly functional and are considered suitable for care outside hospital premises.Conclusion:Prolonged hospital stay is associated with more disability. Shorter hospital stays with proper family support is an ideal way to counteract this issue. However, due to the inadequate mandate in the Mental Health Act (MHA) 1987 and lack of other supportive facilities, patientsoften tend to languish in the hospital for longer duration, causing harm to the patients and draining scarce state resources. It is therefore necessary to revisit the MHA 1987 and provide adequate rehabilitative measures for the needy patients.