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Author(s): R Sindhuri [1]; Reenaa Mohan (corresponding author) [2]; Pravin Surendran [2]; R Saranya [3] Background Coronavirus disease (COVID-19) was first reported in Hubei province, Wuhan, China, in December 2019 [...], Background: Pregnant Health Care Professionals (HCPs), who serve as front-line warriors of COVID-19 will invariably experience a stressful pregnancy period. Ensuring their well-being during this COVID-19 pandemic period is a big challenge and guidelines or standard operating procedures (SOP) for the same are non-existent or are scarce. Objectives: To explore the challenges and experiences of pregnant HCPs during the COVID-19 pandemic. Methods: A qualitative study was conducted among 19 pregnant HCPs (14 Doctors and 5 staff nurses) working in Pondicherry, who were selected using purposive sampling for in-depth interviews. After obtaining informed written consent, face-to-face interviews were conducted until the attainment of the point of saturation. Audio recordings of the interviews were transcribed in English. Transcripts were proofread and manually analyzed for content. Codes obtained from the analysis of transcripts were merged to form broad categories. Results: The majority 15 (78.9) of HCPs belonged to the clinical department and had work experience from 2-4 years. The mean age of the respondents was 29.4 ± 3.6 years. Four broad categories (of challenges), namely, Personnel level (Fear of infection in workplace, Inadequate antenatal care), Family level (Family pressure to quit job, Guilt of spreading the infection to family members), society level (Criticism by neighbor for working, Stigma), and work level challenges (Fear of losing the job, Uncomfortable work environment) emerged from the study. Conclusion and Recommendations: Challenges faced by the pregnant HCPs due to their nature of work remain by and large not addressed. Hence, specific guidelines or SOPs addressing these issues of pregnant health care workers and their swift and strict implementation are the need of the hour. Keywords: Hospital guidelines, IDI, pregnant HCPs, work safety

Introduction: The dynamic and flexible nature of qualitative studies is expected to impose new challenges upon the researchers in obtaining informed consent. The study objectives were to explore the challenges perceived by the researchers in obtaining informed consent in qualitative research and their suggestions to improve it. Material and Methods: It was a descriptive qualitative study in which In-depth interviews were conducted among ten qualitative researchers purposively selected from one medical college in Puducherry. Transcripts prepared from the audio recordings were thematically analyzed manually. Results: The challenges identified were inadequate knowledge of the researcher in designing qualitative consent form, reluctance to sign consent document by participant, ensuring confidentiality and risk benefit communication. The main suggestions provided by the participants were to use of multimedia tools to improve their understanding and creating a rapport to enhance their trust to participate in the study. Conclusions: Since most of the challenges were related to the reluctance of participants to provide consent due to various reasons and lack of adequate knowledge of the researcher, creating a good rapport with the participants and providing simple information through multimedia approaches and ethical training of qualitative researchers will aid us to overcome majority of these challenges.

Background: Cerebrovascular diseases are the most common and devastating disorders. Early diagnosis using biochemical tests plays a significant role. Methods: This hospital-based analytical cross-sectional study conducted over 18 months using a pre-designed structured questionnaire. Patients (n = 82) presenting with aute stroke belonged to age group of 30-85 years were included in the study. Patients with an old stroke, transient ischaemic attacks and those on antiplatelet and statin therapy were excluded. We studied the correlation between serum platelet indices and plasma gelsolin (GSN) levels in patients presenting with acute stroke. Results: Among the study participants 59.8% were males; 31.7% were 56-65 years of age. Ischaemic stroke was evident in 78.5% of the study participants; the others had haemorrhagic stroke. There was a weak negative correlation between platelets and GSN levels, which was not statistically significant. There was no correlation between platelet count and platelet distribution width (DW) and severity of the stroke, and a weak correlation was observed between mean platelet volume (MPV) and severity of stroke (r = 0.142, P = 0.21). Conclusions: MPV and pGSN can be used as an indicator to determine the severity and prognosis of the patient. [ABSTRACT FROM AUTHOR]

Background: Framework Convention on Tobacco Control (FCTC) recognized pictorial health warnings on tobacco products as a powerful public health intervention tool to communicate health risks and to bring about a behavioral change like quitting and reduction in tobacco consumption Objectives: To explore the perceptions on pictorial warnings on tobacco products and to find out the prevalence of ever and current tobacco product users, influencing factors and barriers in intention to quit tobacco among male college students. Material and Methods: An Exploratory Mixed-Method study [Two Focus Group Discussions (FGDs) among students followed by survey among 450 male college students] was carried out in an engineering college in Puducherry during December 2016- February 2017. Results: As perceived by the students, the new pictorial warnings when compared to the old ones had better precision of pictures, convey the message better and elicit fear among the users. Out of 450 participating students, 57 (12.7%) students were ever users and 39 (8.7%) were current users of tobacco. Among current users, 30 (76.9%) has intention to quit the habit. Out of 450 students, 184 (41.1%) students have noticed the pictorial warnings and 111 (24.7%) of them stated that it will encourage users in quitting. Conclusion: Though the new pictorial warnings bring a sense of fear on initiators, it fails to create an impact on chronic users. Majority of the current users has intention to quit tobacco and would like to follow a healthy lifestyle.

Background: In India, routine Pap smear screening is an ongoing process for the detection of cervical cancer, but the follow-up component remains unaddressed. The objectives of the present study were to find out the proportion of abnormal Pap smear results among women aged 30 years screened through the cervical cancer screening program at RHTC, their follow-up status, and explore the reasons and solutions for loss to follow-up (LTFU). Methodology: An explanatory mixed-method study (quantitative: A record-based cohort study followed by qualitative: Five in-depth interviews with loss to follow-up patients and 14 key informant interviews with stakeholders who were purposively selected to identify barriers and possible solutions for LTFU using an interview guide) was conducted in RHTC over 3 months. Ethical principles were adhered to. Results: The results showed that 307 of the 1328 women screened had abnormal Pap smear results. Of the 31 women with precancerous lesions, 26 (83.9%) were on regular follow-ups, and 5 (16.1%) were on irregular follow-ups. Manual content analysis showed five broad categories as barriers to LTFU, namely: (1) general awareness and practical issues; (2) family-related issues; (3) economic issues; (4) cultural issues; and (5) healthcare-associated issues. Community-level awareness generation for capacity building through health education constantly; displaying creative health information models (information, education, and communication); a positive deviance approach; a family and partner-centered approach; the formation of support groups; proactive intervention; and an incentive-based follow-up approach were possible solutions to mitigate the rate of LTFU. Conclusion: Improper knowledge, socio-cultural myths, and a lack of support from partners and family members were the main barriers identified for LTFU. Hence, to strengthen the follow-up component after the initial screening test, periodical sensitization and initiating an incentive-based follow-up approach should be recommended. [ABSTRACT FROM AUTHOR]

Introduction: Anemia in elderly patients of any degree contributes significantly to morbidity and mortality and has a significant effect on the quality of life. Despite of high prevalence, very few studies have examined the effect of anemia in elderly patients in India. Hence, this study is undertaken to know the prevalence and clinicopathological pattern of anemia in elderly patients. Objectives: 1. To estimate the prevalence of anemia in the elderly aged 65 years and above. 2. To determine the severity, clinicohematological patterns, and causes of anemia in the elderly aged 65 years and above. Materials and Methods: A hospital-based descriptive cross-sectional study was done. The study was conducted for 1 year; during this period, elderly patients aged 65 years and above admitted for other medical conditions were recruited in the study using consecutive sampling technique until the desired sample size of 236 was achieved and they were evaluated for anemia. Among them with hemoglobin cutoff value <13 g% for men, <12 g% for women were further evaluated to known the cause of anemia and its clinicohematological pattern. Ethical committee approval was obtained. Data were analyzed using SPSS Software version 23.0. Results: The mean age of the participants was 73.9 ± 7.4 (standard deviation [SD]) years. Majority, 53.8%, of the participants were males. Among the 236 elderly patients, recruited in the study 65.3% were anemic and among them 44.2 had mild anemia and 37% had moderate anemia. Mean hemoglobin value of the participants was 10.7 ± 2.83 SD and it ranged from 3 to 16.3 g/dl. There was no significant difference in the hematological parameters between male and female elderly patients in the study. The main cause of anemia was found to be due to chronic diseases followed by iron-deficiency anemia. Conclusion: This study concludes that anemia was highly prevalent among elderly patients and most of them had identifiable and treatable etiology. Hence, all elderly patients with anemia should be evaluated properly for underlying etiology and treated accordingly to reduce the mortality and morbidity in elderly patients with multiple comorbidities. [ABSTRACT FROM AUTHOR]

Background: COVID-19 is a rapidly spreading infectious pandemic. Increase in the level of systemic inflammatory markers is known to play fugitive role in the prognosis of the patients. This study retrospectively correlates the various hematological parameters with computed tomography severity score in COVID-19 patients. Method: The demographic, hematological, and radiological parameters of 150 patients were collected and analyzed. The performance of complete blood count (CBC) indexes for monitoring and predicting the severity of COVID-19 in patients was evaluated by analyzing and comparing CBC results with radiological severity score. Results: Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) correlated positively while lymphocyte correlated negatively with chest computed tomography severity score. Neutrophil, lymphocyte, eosinophil, monocyte, NLR, and PLR showed a significant difference between radiologically mild and severe COVID-19 cases (P < 0.05). Conclusion: The prognostic value of NLR in predicting the severity of illness is well established in our study. Increased NLR should prompt the clinicians to predict increased lung involvement by COVID-19 and should cater the treatment accordingly. [ABSTRACT FROM AUTHOR]

Introduction: Proper positioning and attachment play a key role in exclusive breastfeeding. Whereas incorrect breastfeeding techniques lead to poor milk transfer and early discontinuation of breastfeeding. Objectives: 1. To assess the breastfeeding techniques among postnatal mothers and to identify the factors associated with improper positioning and poor attachment. 2. To prioritize the action points to improve the poor breastfeeding practices according to the viewpoint of the staff nurses. Materials and Methods: A hospital-based mixed-methods study was carried out in Puducherry for 6 months. In quantitative phase, 99 postnatal mothers were interviewed consecutively and breastfeeding techniques were observed based on Baby Friendly Hospital Initiative and Integrated Management of Neonatal and Childhood Illness guidelines. In qualitative phase, 45 staff nurses ranked the action points to improve the poor breastfeeding practices. Bivariate and multivariate analyses were employed. Mean rank and Kendalls' Concordance Coefficient were calculated for the ranked data. Results: About 28.3% and 27.3% of mothers demonstrated improper positioning and poor attachment, respectively. Young mothers, housewives, <10 days old infants, and failure to receive breastfeeding counseling were associated with poor breastfeeding techniques. Poster displays, healthcare workers' training, targeted counseling, and assistance were the priority action points suggested by the staff nurses. Conclusion: Maternal age, maternal occupation, infants' age, and breastfeeding counseling influenced breastfeeding techniques. The prioritized action points need to be implemented to achieve the level of Baby Friendly Hospital. [ABSTRACT FROM AUTHOR]

Introduction: Postmenopausal bleeding (PMB) is a common and early symptom of cervical and endometrial cancer. Its early detection can improve the cure rate and reduces mortality. Objectives: The objective of the study is to find out the prevalence and determinants of PMB in a rural community setting and the reasons for not undergoing cervical cancer screening among postmenopausal women. Materials and Methods: A sequential exploratory mixed methods study where qualitative (group interviews) phase followed quantitative (survey) phase in the community. The survey was undertaken among the representative sample of 1,530 postmenopausal women in 34 villages of Villupuram district, Tamil Nadu. Data were collected by house-to-house survey. Analysis: Bivariate and multivariate analysis was done using SPSS 24 software package. Results: The prevalence of PMB was found to be 1.8%. Only 5.6% women had undergone screening. The majority did not go for screening due to lack of awareness, or they did not have any symptoms or feared about negative results. Occupation (daily wage laborers), use of oral contraceptive pills at least for 1 year, recurrent abortions (> three abortions), reproductive tract infection (more than 10 episodes in lifetime), abdominal obesity (increased waist-hip ratio), and underweight were identified as significant risk factors for PMB. Conclusion and Recommendations: Nearly 2% of women have PMB, and most of the factors identified as determinants are preventable. Cervical cancer screening rate was poor among the respondents and lack of awareness was stated as the major reason for it. Hence, the promotion of healthy lifestyles and contraceptives in early reproductive life and awareness for the need of early screening is recommended. [ABSTRACT FROM AUTHOR]

Introduction: Adaptation to the "Competency-based Medical Education" (CBME) is a major challenge faced by medical colleges all over India. Hence, the present study aimed to evaluate the mechanisms adopted in the process of implementation of CBME in Phase I at our institution., Methods: In this qualitative study, 12 faculty members including professors, associate professors, assistant professors, and tutors from preclinical departments of the first professional year participated as the study participants. Focus Group Discussion were conducted with the participants regarding the strategies adopted and the challenges faced in implementation of CBME. Gap analysis was done based on the guidelines from CBME modules. In depth interview was conducted with the heads of the pre-clinical departments to propose appropriate action plans. The interviews were audio-recorded and thematic analysis of the transcripts was done., Results: The crucial areas identified were the implementation of early clinical exposure, AETCOM, integrated, and skill modules during the COVID pandemic. The faculty expressed lack of clarity in designing the sessions for "Self-Directed Learning". Tapering the content relevant to basic sciences was a major challenge faced in the integrated sessions. The faculty members requested sensitization to different student centric instructional methods for small group teaching and guidelines for valid assessment strategies., Conclusions: Acquisition of competencies is enhanced by appropriate instructional methods and effective assessment strategies. Frequent and constant hands-on training on the CBME modules through "Faculty Development Programs" plays a crucial role in the successful implementation of CBME., Competing Interests: None declared., (Copyright: © Journal of Advances in Medical Education & Professionalism.)

Competing Interests: There are no conflicts of interest.