Thursday, 16 March 2017

Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis


Objective Financial incentives may encourage private for-profit providers to perform more caesarean section (CS) than non-profit hospitals. We therefore sought to determine the association of for-profit status of hospital and odds of CS.
Design Systematic review and meta-analysis.
Data sources MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews from the first year of records through February 2016.
Eligibility criteria To be eligible, studies had to report data to allow the calculation of ORs of CS comparing private for-profit hospitals with public or private non-profit hospitals in a specific geographic area.
Outcomes The prespecified primary outcome was the adjusted OR of births delivered by CS in private for-profit hospitals as compared with public or private non-profit hospitals; the prespecified secondary outcome was the crude OR of CS in private for-profit hospitals as compared with public or private non-profit hospitals.
Results 15 articles describing 17 separate studies in 4.1 million women were included. In a meta-analysis of 11 studies, the adjusted odds of delivery by CS was 1.41 higher in for-profit hospitals as compared with non-profit hospitals (95% CI 1.24 to 1.60) with no relevant heterogeneity between studies (τ2≤0.037). Findings were robust across subgroups of studies in stratified analyses. The meta-analysis of crude estimates from 16 studies revealed a somewhat more pronounced association (pooled OR 1.84, 95% CI 1.49 to 2.27) with moderate-to-high heterogeneity between studies (τ2≥0.179).
Conclusions CS are more likely to be performed by for-profit hospitals as compared with non-profit hospitals. This holds true regardless of women's risk and contextual factors such as country, year or study design. Since financial incentives are likely to play an important role, we recommend examination of incentive structures of for-profit hospitals to identify strategies that encourage appropriate provision of CS.

Thursday, 9 February 2017

Daily Glass Of Beet Juice Can Beat High Blood Pressure!

Researchers at Barts and The London School of Medicine have discovered that drinking just 500 ml of beetroot juice a day can significantly reduce blood pressure. The study could have major implications for the treatment of cardiovascular disease.
Led by Professor Amrita Ahluwalia of the William Harvey Research Institute at Barts and The London School of Medicine, and Professor Ben Benjamin of Peninsula Medical School, the research reveals that it is the ingestion of dietary nitrate contained within beetroot juice -- and similarly in green, leafy vegetables -- which results ultimately in decreased blood pressure. Previously the protective effects of vegetable-rich diets had been attributed to their antioxidant vitamin content.
Professor Ahluwalia and her team found that in healthy volunteers blood pressure was reduced within just 1 hour of ingesting beetroot juice, with a peak drop occurring 3-4 hours after ingestion. Some degree of reduction continued to be observed until up to 24 hours after ingestion. Researchers showed that the decrease in blood pressure was due to the chemical formation of nitrite from the dietary nitrate in the juice.
The nitrate in the juice is converted in saliva, by bacteria on the tongue, into nitrite. This nitrite-containing saliva is swallowed, and in the acidic environment of the stomach is either converted into nitric oxide or re-enters the circulation as nitrite. The peak time of reduction in blood pressure correlated with the appearance and peak levels of nitrite in the circulation, an effect that was absent in a second group of volunteers who refrained from swallowing their saliva during, and for 3 hours following, beetroot ingestion.

Source: ScienceDaily

Friday, 9 December 2016

World Patient Safety Day

World Patient Safety day is celebrated every year on 9th of December to raise awareness about the safety of patient. Patient safety is a global public health concern and is a fundamental principle of health care. The main aim of this day is to raise awareness about patient safety issues in all parts of the world.
Hospital is a place which provides treatment to sick people round the clock. However at times, it could turn out to be life threatening as well. Every process of patient care safety involves a certain degree of uncertainty. The discipline of patient safety highlights the importance to prevent harm to patients, caused by the process of healthcare itself.  Improving patient safety means reducing harm to the patient.

Why this concern?
According to WHO, estimates show that in developed countries as many as 1 in 10 patients are harmed while receiving hospital care. The harm can be caused by a range of errors or adverse events. Recent advancement in technology has created an immensely complex healthcare system. This complexity brings many challenges for healthcare staff in order to keep the patient safe. Though, a lot of people are treated successfully but there are times when things can go wrong.

Patient Safety Issues: 

Diagnostic Errors:  such as wrong, missed or unintentional delayed diagnosis.
Health Care-Acquired Infections: These are the errors which occur during patient’s hospitalization.
Medication Errors- are when a patient gets the wrong medication, or when he or she receives the right medication but in the wrong dosage.
Readmissions: A readmission is when a patient needs to return to the hospital less than 30 days after being discharged.
Wrong-Site Surgery: Wrong-site surgery means an operation done on the wrong part of the body or on the wrong person.
Communication: Proper communication between the hospital workers as well as between the patient and doctor.

How to ensure proper patient Safety?

  • Ensure proper patient identity. Patient coding/ labelling can be helpful.
  • Do not use abbreviations while writing prescriptions. Preferably use capital letters so that it is easy for the patient to understand.
  • Training of healthcare professionals and team building activities can help in reducing such errors.
  • Proper healthcare infrastructure will help in reducing patient harm during hospitalization.
  • Effective use of signages will avoid unnecessary delays during hospitalization. 
  • Take proper charge when handing over/taking over the patients especially during shifts.
  • Engaging patient and their families in their own care. Adherence to Standard Operative Procedure (SOP) facilitates patient’s safety.
  • Doctors should be trained for rational use of medicines and especially avoid over prescription.

Monday, 5 December 2016

Short-term sleep deprivation affects heart function

People who work in fire and emergency medical services, medical residencies and other high-stress jobs are often called upon to work 24-hour shifts with little opportunity for sleep. While it is known that extreme fatigue can affect many physical, cognitive and emotional processes, this is the first study to examine how working a 24-hour shift specifically affects cardiac function.
"For the first time, we have shown that short-term sleep deprivation in the context of 24-hour shifts can lead to a significant increase in cardiac contractility, blood pressure and heart rate," said study author Daniel Kuetting, M.D., from the Department of Diagnostic and Interventional Radiology at the University of Bonn in Bonn, Germany.
For the study, Dr. Kuetting and colleagues recruited 20 healthy radiologists, including 19 men and one woman, with a mean age of 31.6 years. Each of the study participants underwent cardiovascular magnetic resonance (CMR) imaging with strain analysis before and after a 24-hour shift with an average of three hours of sleep.
"Cardiac function in the context of sleep deprivation has not previously been investigated with CMR strain analysis, the most sensitive parameter of cardiac contractility," Dr. Kuetting said.
The researchers also collected blood and urine samples from the participants and measured blood pressure and heart rate.
Following short-term sleep deprivation, the participants showed significant increases in mean peak systolic strain (pre = -21.9; post = -23.4), systolic (112.8; 118.5) and diastolic (62.9; 69.2) blood pressure and heart rate (63.0; 68.9). In addition, the participants had significant increases in levels of thyroid stimulating hormone (TSH), thyroid hormones FT3 and FT4, and cortisol, a hormone released by the body in response to stress.
Although the researchers were able to perform follow-up examinations on half of the participants after regular sleep, Dr. Kuetting notes that further study in a larger cohort is needed to determine possible long-term effects of sleep loss.
"The study was designed to investigate real-life work-related sleep deprivation," Dr. Kuetting said. "While the participants were not permitted to consume caffeine or food and beverages containing theobromine, such as chocolate, nuts or tea, we did not take into account factors like individual stress level or environmental stimuli."
As people continue to work longer hours or work at more than one job to make ends meet, it is critical to investigate the detrimental effects of too much work and not enough sleep. Dr. Kuetting believes the results of this pilot study are transferable to other professions in which long periods of uninterrupted labor are common.
"These findings may help us better understand how workload and shift duration affect public health," he said
Source: ScienceDaily

Monday, 28 November 2016

Stroke: New drug limits brain damage and promotes repair

The study, led by the University of Manchester in the United Kingdom, is published in the journal Brain, Behavior, and Immunity. The researchers believe the findings offer further support for developing the new drug as a treatment for stroke.
A stroke is an event that blocks or interrupts the blood supply to the brain, depriving cells of essential oxygen. Without oxygen, cells die within minutes. There are few effective treatments for stroke and they apply to a low proportion of patients.
A stroke can lead to lasting brain damage, long-term disability, or even death. Risk factors for stroke include high blood pressure, smoking, heart disease, having a personal or family history of stroke, obesity, and diabetes.
The new study concerns ischemic strokes, responsible for the majority of strokes. These occur when the artery that supplies oxygen-rich blood to the brain becomes blocked, most often by a blood clot.

IL-1Ra and stroke

The researchers, led by Stuart Allan, professor of neuroscience at Manchester, investigated the effect of an anti-inflammatory drug, interleukin-1 receptor antagonist (IL-1Ra), on rats after a stroke.
he researchers found that rats treated with IL-1Ra not only had reduced brain damage in the early stages following a stroke, but several days later, they showed increased numbers of new brain cells (neurogenesis). They found the results were just as promising whether the rats were young, old, lean, or obese.
The authors note that while stroke itself can also trigger a robust repair response following injury, many of the new cells generated fail to survive or integrate into the circuits that are already there.
When they analyzed the effect of IL-1Ra on neurogenesis in the rats' brains, they found the drug "not only increases stem cell proliferation, but also significantly enhances neuroblast migration and the number of newly born neurons after cerebral ischemia."
The researchers suggest previous attempts to find a drug to prevent brain damage after stroke have not successfully completed the journey from the lab to the clinic because they fail to deal with the strong inflammatory response that occurs in a stroke.

Source: MedNewstoday

Friday, 25 November 2016

Breathing-based Yoga May Help Treat Major Depression

Antidepressant medication is considered a primary treatment for major depression, but the drugs fail to fully work for more than half of Americans who use them. Now, researchers suggest a way to boost their effectiveness: breathing-based yoga
In a pilot study published in the Journal of Clinical Psychiatry, researchers reveal how 8 weeks of Sudarshan Kriya yoga improved symptoms of anxiety and depression in patients with major depressive disorder (MDD) who were not responding to antidepressants.
According to the Anxiety and Depression Association of America, depression is the most common mental illness in the United States. In 2014, around 15.7 million adults experienced at least one major depressive episode in the past 12 months.
Symptoms of depression may include persistent sadness, feelings of hopelessness, pessimism, guilt or worthlessness, fatigue, loss of interest in activities, reduced appetite, weight loss, and insomnia.
An individual is usually diagnosed with MDD if they experience at least five of these symptoms for at least 2 weeks, and such depressive episodes may commonly occur after a traumatic event, such as the death of a loved one or a medical illness.
Antidepressants - such as selective serotonin reuptake inhibitors (SSRIs) - are often the first port of call when it comes to treatment for MDD, but patients do not always respond to the drugs. While additional medication may be offered, this can lead to unpleasant side effects that cause patients to stop treatment completely, making relapses more likely.
Now, Dr. Anup Sharma, a neuropsychiatry research fellow at the Department of Psychiatry at the University of Pennsylvania's Perelman School of Medicine, and team suggest Sudarshan Kriya yoga may be an effective, low-cost, non-drug approach to help patients who do not respond to antidepressants.
Source: MedNewsToday

Thursday, 24 November 2016

India To Become The World Leader in Digital Health

In May this year, India had tabled a resolution at WHO for mHealth, which was supported by over 30 nations. This clearly signals India's intent to be a global leader in Digital Health.

Digital Health has the potential to revolutionize how populations interact with national health services and also strengthen health systems. India is now embarking on a futuristic journey to bridge the healthcare divide between have’s and have-nots using digital health tools. We have a number of projects that will extensively deploy technology.

The Ministry of Health & Family Welfare has been taking several impactful initiatives in the field of Digital Health. Our Hon’ble Prime Minister has envisioned for Digital Platform & Electronic Health to be optimally leveraged so as to meet the key challenges posed to us in health sector e.g. shortage of health human resource, accessibility of healthcare infrastructure, affordability of healthcare services etc. Electronic Health Records (EHRs) of citizens are envisaged to be created for ensuring continuity of care and other associated benefits. Delivery of services to citizens through “online mode” is at core of the overall electronic health ecosystem being talked about.

Major I.T. initiatives by Ministry include various mHealth initiatives for improving efficiency and efficacy of public healthcare across the country under the Digita India Programme. For example, the Vaccine Tracker mobile application support parents in tracking immunization status of their children and helps them in ensuring complete and timely vaccination. The India Fights Dengue mobile application provides interactive information on identification of symptoms of Dengue and links users to nearest hospitals and blood banks The Swasth Bharat (Health India) mobile application provides detailed information on healthy lifestyle, disease conditions and their symptoms, treatment options, first aid and public health alerts. Through our Kilkari mobile app initiative, we are sending audio messages about pregnancy, child birth and child care directly to families and parents. A mobile based audio training course has been developed for expanding the knowledge of our village based voluntary health workforce. Our other mHealth initiatives include National Health Portal, Online Registration System, E-Rakt Kosh, ANM Online (ANMOL), telemedicine projects (in remote & inaccessible areas), Tobacco Cessation Programme and leveraging mobile phones for reaching patients of Tuberculosis. Soon the Ministry will launch the Stress management app.

These initiatives are ensuing remarkable improvement in healthcare delivery and management. For example Online Registration System (ORS) for public hospitals, launched in July 2015, has been able to bring about a significant change in the patient registration and appointment system and as a result patients now don’t need to wait at hospitals for taking appointments. As on date all AIIMS, most of the central government hospitals and many state government hospitals are linked through ORS.