Showing papers in "The Journal of medical research in 2013"

Health Care Provider Adoption of eHealth: Systematic Literature Review

Abstract: Background: eHealth is an application of information and communication technologies across the whole range of functions that affect health. The benefits of eHealth (eg, improvement of health care operational efficiency and quality of patient care) have previously been documented in the literature. Health care providers (eg, medical doctors) are the key driving force in pushing eHealth initiatives. Without their acceptance and actual use, those eHealth benefits would be unlikely to be reaped. Objective: To identify and synthesize influential factors to health care providers’ acceptance of various eHealth systems. Methods: This systematic literature review was conducted in four steps. The first two steps facilitated the location and identification of relevant articles. The third step extracted key information from those articles including the studies’ characteristics and results. In the last step, identified factors were analyzed and grouped in accordance with the Unified Theory of Acceptance and Use of Technology (UTAUT).

Identifying Measures Used for Assessing Quality of YouTube Videos with Patient Health Information: A Review of Current Literature.

Abstract: Background: Recent publications on YouTube have advocated its potential for patient education. However, a reliable description of what could be considered quality information for patient education on YouTube is missing. Objective: To identify topics associated with the concept of quality information for patient education on YouTube in the scientific literature. Methods: A literature review was performed in MEDLINE, ISI Web of Knowledge, Scopus, and PsychINFO. Abstract selection was first conducted by two independent reviewers; discrepancies were discussed in a second abstract review with two additional independent reviewers. Full text of selected papers were analyzed looking for concepts, definitions, and topics used by its authors that focused on the quality of information on YouTube for patient education. Results: In total, 456 abstracts were extracted and 13 papers meeting eligibility criteria were analyzed. Concepts identified related to quality of information for patient education are categorized as expert-driven, popularity-driven, or heuristic-driven measures. These include (in descending order): (1) quality of content in 10/13 (77%), (2) view count in 9/13 (69%), (3) health professional opinion in 8/13 (62%), (4) adequate length or duration in 6/13 (46%), (5) public ratings in 5/13 (39%), (6) adequate title, tags, and description in 5/13 (39%), (7) good description or a comprehensive narrative in 4/13 (31%), (8) evidence-based practices included in video in 4/13 (31%), (9) suitability as a teaching tool in 4/13 (31%), (10) technical quality in 4/13 (31%), (11) credentials provided in video in 4/13 (31%), (12) enough amount of content to identify its objective in 3/13 (23%), and (13) viewership share in 2/13 (15%). Conclusions: Our review confirms that the current topics linked to quality of information for patient education on YouTube are unclear and not standardized. Although expert-driven, popularity-driven, or heuristic-driven measures are used as proxies to estimate the quality of video information, caution should be applied when using YouTube for health promotion and patient educational material. [Interact J Med Res 2013;2(1):e6]

Severe loss of appetite in amyotrophic lateral sclerosis patients: online self-assessment study.

Abstract: Background: Undesirable loss of weight is a major challenge in amyotrophic lateral sclerosis (ALS). However, little is known about loss of appetite in ALS patients. Objective: We investigated loss of appetite in ALS patients by means of an online self-assessment and whether ALS-related symptoms were associated with it. Methods: Loss of appetite in 51 ALS patients was assessed using the Council on Nutrition Appetite Questionnaire (CNAQ). Loss of appetite is defined as a CNAQ-score of 28 or less with a predicted weight loss of at least 5% within 6 months. We developed an Internet portal to facilitate self-assessment. Results: Approximately half of the ALS patients (47%, 24/51) suffered from severe loss of appetite; after 6 months this increased to nearly two-thirds (65%, 22/34). An average weight loss of 5% was found in the group with severe loss of appetite as compared to only 2% of patients with normal appetite. Interestingly, loss of appetite was associated with respiratory dysfunction (P=.001, R 2 =.223). Conclusions: Loss of appetite was more common and more severe than expected. It was found to be an independent risk factor for unintended weight loss and may be related to dyspnea. The impact of severe loss of appetite on survival and quality of life should be established in further studies.

Evaluation of user interface and workflow design of a bedside nursing clinical decision support system.

Abstract: Background: Clinical decision support systems (CDSS) are important tools to improve health care outcomes and reduce preventable medical adverse events. However, the effectiveness and success of CDSS depend on their implementation context and usability in complex health care settings. As a result, usability design and validation, especially in real world clinical settings, are crucial aspects of successful CDSS implementations. Objective: Our objective was to develop a novel CDSS to help frontline nurses better manage critical symptom changes in hospitalized patients, hence reducing preventable failure to rescue cases. A robust user interface and implementation strategy that fit into existing workflows was key for the success of the CDSS. Methods: Guided by a formal usability evaluation framework, UFuRT (user, function, representation, and task analysis), we developed a high-level specification of the product that captures key usability requirements and is flexible to implement. We interviewed users of the proposed CDSS to identify requirements, listed functions, and operations the system must perform. We then designed visual and workflow representations of the product to perform the operations. The user interface and workflow design were evaluated via heuristic and end user performance evaluation. The heuristic evaluation was done after the first prototype, and its results were incorporated into the product before the end user evaluation was conducted. First, we recruited 4 evaluators with strong domain expertise to study the initial prototype. Heuristic violations were coded and rated for severity. Second, after development of the system, we assembled a panel of nurses, consisting of 3 licensed vocational nurses and 7 registered nurses, to evaluate the user interface and workflow via simulated use cases. We recorded whether each session was successfully completed and its completion time. Each nurse was asked to use the National Aeronautics and Space Administration (NASA) Task Load Index to self-evaluate the amount of cognitive and physical burden associated with using the device. Results: A total of 83 heuristic violations were identified in the studies. The distribution of the heuristic violations and their average severity are reported. The nurse evaluators successfully completed all 30 sessions of the performance evaluations. All nurses were able to use the device after a single training session. On average, the nurses took 111 seconds (SD 30 seconds) to complete the simulated task. The NASA Task Load Index results indicated that the work overhead on the nurses was low. In fact, most of the burden measures were consistent with zero. The only potentially significant burden was temporal demand, which was consistent with the primary use case of the tool. Conclusions: The evaluation has shown that our design was functional and met the requirements demanded by the nurses’ tight schedules and heavy workloads. The user interface embedded in the tool provided compelling utility to the nurse with minimal distraction. [Interact J Med Res 2013;2(1):e4]

Assessment of Substance Abuse and Associated Factors Among Students of Debre Markos Poly Technique College In Debre Markos Town, East Gojjam Zone, Amhara Regional State, Ethiopia ,2013

Abstract: Background: Students of higher educational institution are at higher risk of substance abuse. Currently, substance abuse is one of the most burning public health problems in Ethiopia. Although it has been known that this public health problem is a pressing issue, the real extent and magnitude of drug abuse is not yet properly explored. Methods: A cross sectional study was conducted to determine the overall prevalence of substance abuse among students and factors associated with it. Simple random sampling technique was conducted to select 423 students from the list of students name in their respective batch after stratifying them based on year of study. A pretested semi structured anonymous questionnaire was used to collect data, which was entered and cleaned using Epi Data version 3.1 and analyzed using SPSS version 16.0 statistical package. Descriptive statistics and logistic regression were performed to examine the prevalence and predictors of substance abuse. CAGE-AID was used to measure substance abuse. Results: The overall prevalence of substance abuse was 14.1 %. The commonly abused substances were alcohol 13.4 %, khat 7.8 %, and cigarette 5.4 %. Sex [AOR, 95% CI; 3.550 (1.451, 8.685)], peer pressure [AOR, 95% CI 3.405 (1.047, 11.076)], availability of the drugs [AOR, 95% CI 3.394 (1.677, 6.868)],family drug use[AOR, 95% CI; 2.698 (1.337, 5.443)], personal pleasure [AOR, 95% CI 3.346 (1.315, 8.512] and academic dissatisfaction [AOR, 95% CI 2.739(1.253, 5.985)] were found to be significantly associated with students to abuse substances

Clinical profiles of dengue fever in a teaching hospital of eastern india

Abstract: Introduction: Dengue fever is one of the most common arbo virus mediated outbreaks, being reported from different parts of the world. Dengue fever(DF),Dengue hemorrhagic fever(DHF) and Dengue shock syndrome(DSS) are different modes of presentation of the disease. Now as the outbreaks are hitting different geographic locations, different clinical manifestations are more and more being reported recently. Our aim of this study is to document varied clinical manifestations of dengue patients in a tertiary care centre of eastern India. Materials and Methods: Total 74 MAC ELISA positive dengue patients are included in this observational study and analysed. Results: Most common clinical feature was fever (100%) followed by headache(62.16%). Atypical features like transaminitis and different neurological manifestations were present in 83.83% and 11.11% cases respectively. Conclusion: One should aware of different atypical presentations of dengue fever to diagnose and intervene timely.

Effectiveness of YouTube as a Source of Medical Information on Heart Transplantation

Abstract: Background: In this digital era, there is a growing tendency to use the popular Internet site YouTube as a new electronic-learning (e-learning) means for continuing medical education. Heart transplantation (HTx) remains the most viable option for patients with end-stage heart failure or severe coronary artery disease. There are plenty of freely accessible YouTube videos providing medical information about HTx. Objective: The aim of the present study is to determine the effectiveness of YouTube as an e-learning source on HTx. Methods: In order to carry out this study, YouTube was searched for videos uploaded containing surgical-related information using the four keywords: (1) “heart transplantation”, (2) “cardiac transplantation”, (3) “heart transplantation operation”, and (4) “cardiac transplantation operation”. Only videos in English (with comments or subtitles in English language) were included. Two experienced cardiac surgeons watched each video (N=1800) and classified them as useful, misleading, or recipients videos based on the HTx-relevant information. The kappa statistic was used to measure interobserver variability. Data was analyzed according to six types of YouTube characteristics including “total viewership”, “duration”, “source”, “days since upload”, “scores” given by the viewers, and specialized information contents of the videos. Results: A total of 342/1800 (19.00%) videos had relevant information about HTx. Of these 342 videos, 215 (62.8%) videos had useful information about specialized knowledge, 7/342 (2.0%) were found to be misleading, and 120/342 (35.1%) only concerned recipients’ individual issues. Useful videos had 56.09% of total viewership share (2,175,845/3,878,890), whereas misleading had 35.47% (1,375,673/3,878,890). Independent user channel videos accounted for a smaller proportion (19% in total numbers) but might have a wider impact on Web viewers, with the highest mean views/day (mean 39, SD 107) among four kinds of channels to distribute HTx-related information. Conclusions: YouTube videos on HTx benefit medical professionals by providing a substantial amount of information. However, it is a time-consuming course to find high-quality videos. More authoritative videos by trusted sources should be posted for dissemination of reliable information. With an improvement of ranking system and content providers in future, YouTube, as a freely accessible outlet, will help to meet the huge informational needs of medical staffs and promote medical education on HTx. [Interact J Med Res 2013;2(2):e28]

Distribution of abo blood group and rh(d) factor in western rajasthan

Abstract: India is a vast country with lot of diversity in race, religion & creed. The same diversity has been observed in geographical distribution of blood groups in population within country. The ABO & Rhesus (Rh) blood group system are the most prevalent & important for transfusion of blood & its component, organ transplant, genetic studies & in legal medicine study. This study presents data about the prevalence of ABO & Rhesus (Rh) blood groups amongst blood donors during a period of ten & half year (retrospective study from January 2002 to July 2012) conducted at Blood Bank of Mahatma Gandhi Hospital, Jodhpur associated with Dr. S. N. Medical College, Jodhpur (India). During the study period blood groups of 83631 donors were screened by antigen antibody agglutination method using commercially available antiseras which were validated at our Blood Bank. The study revealed that the commonest ABO blood group was B, followed by O, A and AB respectively. Rh negative were 8.25%.

Understanding Electronic Medical Record Adoption in the United States: Communication and Sociocultural Perspectives

Abstract: Publication funded in part by the George Mason University Libraries Open Access Publishing Fund.

Thyroid dysfunction in patients with type 2 diabetes mellitus at tertiary care centre

Abstract: Background: The aim of the present study was to find the prevalence of thyroid dysfunction in patients with type 2 diabetes mellitus (type 2 DM) attending an outpatients department and medical wards in Dr D Y Patil Medical College and Hospital. Materials and Methods: Data of 50 diabetic and 50 non diabetic patients who attended OPD and admitted in medical wards of Dr D Y Patil Medical College and Hospital, pimpri, pune from September 2012 to September 2013. These subjects were investigated for total triidothyronine (T3), total thyroxin (T4), thyroid stimulating hormone (TSH), Fasting Blood Sugar(FBS), glycosylated hemoglobin (HbA1c), serum cholesterol, serum triglycerides, high density lipoprotein(HDL), low densit lipoprotein(LDL), very low density lipoprotein(VLDL), blood urea, serum creatinine. Results: The level of T3and T4were significantly lower while the level of TSH was significantly higher in type 2 diabetics as compared to non-diabetics. From the 50diabetic subjects studied, 30% showed abnormal thyroid hormone levels (22 % had hypothyroidism and 8 % had hyperthyroidism). Significantly higher levels of FPG, HbA1c, serum cholesterol, serum triglyceride, LDL, VLDL, blood urea, creatinine, and significantly lower level of HDL was observed in diabetics as compared to non-diabetics subjects. Conclusion: The prevalence of thyroid dysfunction among type 2 DM patients is very high (30 %) with subclinical hypothyroidism is being most common. All patients with type 2 DM should be screened for thyroid dysfunction to reduce the mortality rate.

Integrating telehealth care-generated data with the family practice electronic medical record: qualitative exploration of the views of primary care staff.

Abstract: Background: Telehealth care is increasingly being employed in the management of long-term illness. Current systems are largely managed via “stand-alone” websites, which require additional log-ons for clinicians to view their patients’ symptom records and physiological measurements leading to frustrating delays and sometimes failure to engage with the record. However, there are challenges to the full integration of patient-acquired data into family physicians’ electronic medical records (EMR) in terms of reliability, how such data can best be summarized and presented to avoid overload to the clinicians, and how clarity of responsibility is managed when multiple agencies are involved. Objective: We aimed to explore the views of primary care clinicians on the acceptability, clinical utility, and, in particular, the benefits and risks of integrating patient-generated telehealth care data into the family practice EMR and to explore how these data should be summarized and presented in order to facilitate use in routine care. Methods: In our qualitative study, we carried out semi-structured interviews with clinicians with experience of and naive to telehealth care following demonstration of pilot software, which illustrated various methods by which data could be incorporated into the EMR. Results: We interviewed 20 clinicians and found 2 overarching themes of “workload” and “safety”. Although clinicians were largely positive about integrating telehealth care data into the EMR, they were concerned about the potential increased workload and safety issues, particularly in respect to error due to data overload. They suggested these issues could be mitigated by good system design that summarized and presented data such that they facilitated seamless integration with clinicians’ current routine processes for managing data flows, and ensured clear lines of communication and responsibility between multiple professionals involved in patients’ care. Conclusions: Family physicians and their teams are likely to be receptive to and see the benefits of integrating telehealth-generated data into the EMR. Our study identified some of the key challenges that must be overcome to facilitate integration of telehealth care data. This work particularly underlines the importance of actively engaging with clinicians to ensure that systems are designed that align well with existing practice data-flow management systems and facilitate safe multiprofessional patient care.

Practice of ergonomic principles and computer vision syndrome (cvs) among undergraduates students in chennai

Abstract: Background: With increasing use of computers by young adults in educational institutions as well as at home there is a need to investigate whether students are adopting ergonomic principles when using computers. Objective: To assess the practice of students on ergonomic principles while working on computers and their association with the symptoms of Computer Vision Syndrome (CVS). Methodology: A cross-sectional study was conducted among the undergraduate students using pre-tested structured questionnaire on the demographic profile, practice of ergonomic principles and symptoms of CVS experienced while on continuous computer work within the past one month duration. Results: Out of 416 students studied, 58% of them viewed computer at a distance of 20 to 40 inches, 61 % viewed the computer screen at the same level, 42.8% placed the reference material between monitor and key board, 24.5% tilted screen backward and 75.7% took frequent breaks to prevent CVS. Students who viewed the computer at a distance of less than 20 inches, viewed upwards or downwards to see the computer, who did not avoid glare and did not took frequent breaks were at higher risk of developing CVS. Students who did not used adjustable chair, height adjustable keyboard were at higher risk of developing neck and shoulder pain. Conclusion: The students who were not practicing ergonomics principle and did not check posture and make ergonomic alteration were at higher risk of developing CVS.

Does Socioeconomic Status Affect Patients’ Ease of Use of a Touch-Screen (iPad) Patient Survey?

Abstract: Socioeconomic disparities influence the usage rate of advanced communication technologies in Canada. It is important to assess all patient interactions with computers and electronic devices based on these socioeconomic differences. This project studied the ease of use of a touch-screen interface program for collecting patient feedback. The interface collected feedback on physicians’ communication skills, an important health concern that has been garnering more and more attention. A concurrent paper survey was used to gather information on the socioeconomic status and the usability of the touchscreen device. As expected, patients who were older, had lower annual household income, and had lower educational attainment were associated with more difficulty using the devices. Surprisingly, 94% of all users (representing a wide range of socioeconomic status backgrounds) rated the device as easy to use. [Interact J Med Res 2013;2(1):e1]

Prevalence and Associated Factors of Unmet Need for Family Planning among Married Women in Enemay District, Northwest Ethiopia: A Comparative Cross-Sectional Study

Abstract: Introduction : Millions of women want to delay or avoid pregnancy but are not using contraception. Ethiopia has the highest levels of unmet need for family planning among African countries. The 2011 Ethiopia Demographic and Health survey found that 25.3 percent of women had unmet need for family planning, 16.3 % for spacing and 9 % for limiting. Thus, this study was designed to assess the prevalence and associated factors of unmet need for family planning in Enemay district, Nortwest Ethiopia. Methods : Community based comparative crosssectional study design was employed using multi-stage sampling technique. Data were collected through interviewing married reproductive age women using semi-structured questionnaire. Data were entered and analyzed using Epi data version 3.1 and SPSS version 16 statistical software respectively. Results : The overall unmet need for family planning was 193 (25.6%) of which 119 (15.8%) was for spacing and 74 (9.8%) for limiting. It was 69 (18.4%) and 124 (32.7%) in urban and rural areas of the district respectively. Age at first marriage, educational status of the women and their partners, partner attitude towards family planning services utilization, current menstrual status, healthcare providers visit and discussion about family planning issues were the main predicting factors of unmet need for family planning. Conclusion : The overall prevalence of unmet need in the district was high. Empowering women through education and healthcare providers visit should be strengthened.

Knowledge, Attitude and Practices of Mothers Regarding Infant Feeding Practices -

Abstract: Background: Present study was conducted to assess the knowledge, attitude and practices of mothers towards infant feeding practices. Materials and methods: The mothers of infants, coming to a tertiary care centre, Ahmedabad, on outpatient basis were interviewed using a pre-designed questionnaire. Total 150 mothers were interviewed. Results: Out of the total, 18% mothers were illiterate.58.67% mothers have been counselled by doctor about feeding. Regarding breast feeding, 96% knew about exclusive breast feeding up to 6months. 90.67% think that colostrum is good for baby.34.67% mothers have given pre-lacteal feeds, tea and jaggery was most common.84.67% mothers knew that they should take extra food during lactation. Father (36%) most commonly help in feeding while 31.33% don’t get any domestic help.78.67% women consult doctor for feeding problems. Most common reason of stopping breast feeding was inadequate milk secretion(54.67%).18% think that feeding should be stopped during illness. 75.33% women were completely satisfied with their feeding practices. Conclusion-Mothers had good knowledge about infant feeding practices. Inspite of good knowledge there are lacunae in the practices of mothers due to social and economic reasons. Level of education has positive impact on infant feeding practices. Counselling by doctors had a better impact on the attitude and practices of mothers.

Anti Biofilm Effect of Biogenic Silver Nanoparticles Coated Medical Devices Against Biofilm of Clinical Isolate of Staphylococcus Aureus

Abstract: A bstract - B iofilm represents the most prevalent type of virulent factor of most of the pathogenic microorganism and involved in crucial development of clinical infection and exhibit resistance to antimicrobial agents. Now the biofilm is considered as major target for the pharmacological development of drugs. A biofilm serves to promote bacteria persistence by resisting antibiotic treatment and host immune responses. Antibiotics are rendered ineffective when biofilms form due to their relative impermeability, the variable physiological status of microorganisms, subpopulations of persistent strains, and variations of phenotypes present. Metal nanotechnology chemistry has the potential to prevent the formation of these life-threatening biofilms on life supporting devices. In the present study, anti biofilm effect of silver nanoparticles coated catheter against clinical isolate of Staphylococcus Aureus was studied. Silver nanoparticles synthesized by leaf extract broth of Azadirhacta indica were coated on the catheter chara-cterized by scanning electron microscopy which reveals complete dispersion of the nanoparticles on the fibre surface of the catheter and the size, shape of the particles shows uniform spherical particles with the size of 50-60 nm. Distinct effect of biofilm inhibition was recorded in the nanoparticles coated catheter and maximum inhibition was observed during 72 hour of incubation. Biochemical composition of biofilm matrix mainly total carbohydrates and total protein was highly reduced. The present study would suggests the development of anti microbial coated medical devices against pathogenic microorganism. K eywords : bi ogenic silver nanoparticles, biofilm, catheter.

A Cross Sectional Study of Nutritional Anemia among Medical Students in a Medical College, at Bilaspur, Chhattisgarh -

Abstract: Background: The medical students may also suffer anaemia because of long schedule in college, clinical postings, and extra-curriculum activities. They come from different socio economic, cultural backgrounds and various geographical regions of the country. Methodology: A cross sectional study was conducted during from 1st January, 2009 to 28th February, 2009 among 3rd year MBBS Students between the ages of 20 to 25 years studying at Chhattisgarh Institute of Medical Science (CIMS), Bilaspur. A total of 96 students age ranging 20 to 25 years out of 100 students enrolled in the batch were studied. A structured questionnaire, which include general information, sign and symptoms regarding anaemia, dietary habit, BMI, general physical examination, systemic examination and a TALLQVIST strip for Hemoglobin estimation were carried out. Results: Anaemia prevalence was 30.20% among medical students. Out of total 96 students 29 students were found anaemic out of which 11 (19%) male students were anaemic. And 18 (47.4%) female students were found anaemic. The cutoff hemoglobin level below 12.0 gm% was considered anaemia. The mean hemoglobin among student was 12.4 gm % with standard deviation of 1.59, variance of 2.54, and median of 12.5. Conclusion: The studies like present one in the country can highlight the size of the problem i.e. iron deficiency without anaemia which is also called latent iron deficiency among unexpected population i.e. medical students. Iron supplementation is thus required for the target group. Therefore preventive programs and policies of the country can target this age group particularly in educational institutes.

An Evaluation Framework for Defining the Contributions of Telestration in Surgical Telementoring

Abstract: Background: An increasing quantity of research in the domain of telemedicine show a growing popularity and acceptance of care over distance systems among both clinicians and patients. We focus on telementoring solutions, developed for providing remote guidance to less experienced surgeons. Telestration is often regarded as an extra functionality of some telementoring systems. However, we advocate that telestration must be viewed as a core feature of telementoring due to its advantages. Objective: To analyze and define concepts, parameters, and measurement procedures to evaluate the impact of using telestration while telementoring. Methods: A systematic review of research dealing with telestration during remote guidance sessions was performed by querying three major online research databases (MEDLINE, Association of Computing Machinery, and Institute of Electrical and Electronics Engineers) using a predefined set of keywords (“laparoscopy”, “annotate”, “telestrate”, “telestration”, “annotation”, “minimally invasive”, and “MIS”). Results: The keyword-based search identified 117 papers. Following the guidelines for performing a systematic review, only 8 publications were considered relevant for the final study. Moreover, a gap in research defining the impacts of telestration during telementoring was identified. To fill this niche, a framework for analyzing, reporting, and measuring the impacts of telestration was proposed. Conclusions: The presented framework lays the basics for the structured analysis and reporting of telestration applied to telementoring systems. It is the first step toward building an evidence knowledge base documenting the advantages of live video content annotation and supporting the presented connections between the concepts.

Health Care Transformation Through Collaboration on Open-Source Informatics Projects: Integrating a Medical Applications Platform, Research Data Repository, and Patient Summarization

Abstract: Background: The Strategic Health IT Advanced Research Projects (SHARP) program seeks to conquer well-understood challenges in medical informatics through breakthrough research. Two SHARP centers have found alignment in their methodological needs: (1) members of the National Center for Cognitive Informatics and Decision-making (NCCD) have developed knowledge bases to support problem-oriented summarizations of patient data, and (2) Substitutable Medical Apps, Reusable Technologies (SMART), which is a platform for reusable medical apps that can run on participating platforms connected to various electronic health records (EHR). Combining the work of these two centers will ensure wide dissemination of new methods for synthesized views of patient data. Informatics for Integrating Biology and the Bedside (i2b2) is an NIH-funded clinical research data repository platform in use at over 100 sites worldwide. By also working with a co-occurring initiative to SMART-enabling i2b2, we can confidently write one app that can be used extremely broadly.

The Computerized Medical Record as a Tool for Clinical Governance in Australian Primary Care

Abstract: Background: Computerized medical records (CMR) are used in most Australian general practices. Although CMRs have the capacity to amalgamate and provide data to the clinician about their standard of care, there is little research on the way in which they may be used to support clinical governance: the process of ensuring quality and accountability that incorporates the obligation that patients are treated according to best evidence. Objective: The objective of this study was to explore the capability, capacity, and acceptability of CMRs to support clinical governance. Methods: We conducted a realist review of the role of seven CMR systems in implementing clinical governance, developing a four-level maturity model for the CMR. We took Australian primary care as the context, CMR to be the mechanism, and looked at outcomes for individual patients, localities, and for the population in terms of known evidence-based surrogates or true outcome measures. Results: The lack of standardization of CMRs makes national and international benchmarking challenging. The use of the CMR was largely at level two of our maturity model, indicating a relatively simple system in which most of the process takes place outside of the CMR, and which has little capacity to support benchmarking, practice comparisons, and population-level activities. Although national standards for coding and projects for record access are proposed, they are not operationalized. Conclusions: The current CMR systems can support clinical governance activities; however, unless the standardization and data quality issues are addressed, it will not be possible for current systems to work at higher levels.

A study on lipid profiles in chronic liver diseases

Abstract: Background: Liver diseases can affect plasma lipid levels in a variety of ways. Chronic liver diseases due to various causes are often associated with dramatic reductions in plasma triglyceride and cholesterol level due to reduced lipoprotein biosynthetic capacity. The study was conducted to determine the lipid profiles in patients with chronic liver disease and to determine if it correlates with the severity of the chronic liver disease. Materials and Methods: In an analytical cross-sectional study, 120 patients with chronic liver disease (case) and 50 age- and sex-matched healthy patients (controls) were studied. Serum triglyceride levels, total cholesterol, HDL, LDL and VLDL were then measured. Child-Turcotte-Pugh Score were calculated for each patient as an index for the extent of liver damage. Results: In patients with chronic liver diseases, with the exception of triglyceride level, there was a significant decrease in total cholesterol, LDL,VLDL and HDL cholesterol levels compared to the control group( p<0.05). However, no significant correlation was found between severity of cirrhosis and change in serum lipid levels. Conclusion: Dyslipidemia exists in patients with liver cirrhosis and screening for the same is important for intervention with appropriate therapy to prevent cardiovascular events.

Mean Platelet Volume and Red Cell distribution width in Hepatosteatosis

Abstract: Non-alcoholic fatty liver disease (NAFLD) effects about 30% of the population in developed regions of the and is considered hepatic manifestation of metabolic syndrome. Studies in literature found association between hepatosteatosis and mean platelet volume (MPV), an indicator of platelet function. Furthermore, authors suggest thatred cell distribution width (RDW) should be an inflammatory marker in certain conditions. We aimed in this study to compare RDW and MPV values of the patients with hepatosteatosis to normal population. Fifty-three patients with NAFLD admitted to our clinic and 52 healthy controls enrolled to this retrospective study. White blood cell count (WBC), hemoglobin (Hb), mean corpuscular volume (MCV), red cell distribution width (RDW), platelet count (PLT) and mean platelet volume (MPV) values of the obtained and assessed. We found that, RDW and MPV values were significantly elevated in patients with hepatosteatosis compared to control subjects. In conclusion, we think that beside MPV, RDW should also be an indicator of hepatosteatosis. More prospective studies with larger cohort are needed to confirm our results.

Serum Lipid Profile in Early Pregnancy as a Predictor of Preeclampsia

Abstract: Background: The study aimed to investigate the relationship be tween early pregnancy serum lipid concentrations an d risk of preeclampsia. Material and Methods: Serum lipid profile was measured enzymatically by standar dized assay in 270 pregnant women between 13-20 weeks of gestation. Out of these total number 58 subjects developed preec lampsia (study group) while 212 subjects remained normotensive (control group). Results: The mean serum level of total cholesterol (TC), triglycerides (TG), low density lipoprotein cholest erol (LDL-C) and very low density lipoprotein chole sterol (VLDL-C) was significantly higher in preeclamptic women as compared to normotensive pregnant women. While preeclamptic women showed significant fall in high density lipoprotein cholesterol HDL-C) level as compared to normal pregnant women. Conclusion: The measurement of serum lipid profile in early pr egnancy may serve as early predictor of preeclampsi a.

Prevalence of Insomnia Among Residents of Tokyo and Osaka After the Great East Japan Earthquake: A Prospective Study

Abstract: Background: The Great East Japan Earthquake occurred on March 11, 2011. Tokyo and Osaka, which are located 375 km and 750 km, respectively, from the epicenter, experienced tremors of 5.0 lower and 3.0 seismic intensity on the Japan Meteorological Agency scale. The Great East Japan Earthquake was the fourth largest earthquake in the world and was accompanied by a radioactive leak at a nuclear power plant and a tsunami. In the aftermath of a disaster, some affected individuals presented to mental health facilities with acute stress disorder (ASD) and/or post-traumatic stress disorder (PTSD). However, few studies have addressed mental stress problems other than ASD or PTSD among the general public immediately after a disaster. Further, the effects of such a disaster on residents living at considerable distances from the most severely affected area have not been examined. Objective: This study aimed to prospectively analyze the effect of a major earthquake on the prevalence of insomnia among residents of Tokyo and Osaka. Methods: A prospective online questionnaire study was conducted in Tokyo and Osaka from January 20 to April 30, 2011. An Internet-based questionnaire, intended to be completed daily for a period of 101 days, was used to collect the data. All of the study participants lived in Tokyo or Osaka and were Consumers’ Co-operative Union (CO-OP) members who used an Internet-based food-ordering system. The presence or absence of insomnia was determined before and after the earthquake. These data were compared after stratification for the region and participants’ age. Multivariate analyses were conducted using logistic regression and a generalized estimating equation. This study was conducted with the assistance of the Japanese CO-OP. Results: The prevalence of insomnia among adults and minors in Tokyo and adults in Osaka increased significantly after the earthquake. No such increase was observed among minors in Osaka. The overall adjusted odds ratios for the risk of insomnia post-earthquake versus pre-earthquake were 1.998 (95% CI 1.571–2.542) for Tokyo, 1.558 (95% CI 1.106–2.196) for Osaka, and 1.842 (95% CI,1.514–2.242) for both areas combined. Conclusions: The prevalence of insomnia increased even in regions that were at a considerable distance from the epicenter. Both adults and minors in Tokyo, where the seismic intensity was greater, experienced stress after the earthquake. In Osaka, where the earthquake impact was milder, disturbing video images may have exacerbated insomnia among adults. [Interact J Med Res 2013;2(1):e2]

A study of pancytopenia in adult patients more than 12 years of age in north west region of saurashtra

Abstract: Introduction: Pancytopenia is a manifestation of many serious & life threatening diseases with an extensive differential diagnosis. Major causes of pancytopenia in developing countries are megaloblastic anemia, parasitic infection, hypersplenism and aplastic anemia. Methodology: In this study total 100 cases were studied by examining Peripheral smears of blood samples obtained by routine phlebotomy procedure and stained by Romanowsky stains. Bone marrow sampleswere obtained by routine bone marrow aspiration and biopsy procedures if indicated. Biochemical and other special investigations were done to confirm the diagnosis. Results: Among the 100 cases studied, age of the patients ranged from 13 to 86 years with a mean age of 42.9 years and slight male predominance. Most of the patients presented with generalized weakness and fever. The commonest physical finding was pallor, followed by splenomegaly and hepatomegaly. The commonest marrow finding was hypercellularity with megaloblastic erythropoiesis. The commonest cause for pancytopenia was megaloblastic anemia followed by malaria. Conclusion: The present study concludes that detailed primary hematological investigations along with other supportive tests are helpful to diagnose or to rule out the causes of pancytopenia. Megloblatic anemia is commnest cause of pancytopenia in most Indian and subcontinent studies. Present study also shows that invasive procedures like bone marrow aspiration and biopsy is avoided in most cases of pancytopenia.

Effect of back Massage on Lactation among Postnatal Mothers

Abstract: Introduction: Lactation is affected by a large number of factors. Equally important as spreading the message of exclusive breast feeding is enabling mothers to sustain it adequately. Considering the ease of implementation and obvious lack of adverse effects, non pharmacologic measures are an attractive option over pharmacologic measures for improving lactation. Methods: A quasi experimental study was conducted for a period of 16 months, to assess the effectiveness of back massage on lactation among immediate postnatal mothers. A total of 220 mothers were enrolled in two groups (Group A, Experimental group-100 cases, Group B, Control group-120 cases). The effect on lactation was assessed based on various parameters, related to the baby. Results: There was significantly higher post feed weight gain, higher mean number of urinations and stools passed per day, longer duration of post feed sleep and better satisfaction in the study group compared to the control group. Conclusion: Back massage was effective in improving lactation in all parameters assessed. This can be recommended for all breastfeeding mothers, especially those facing problems with initiation and sustenance of breast feeding. Importantly, this is a simple method which can be implemented using the existing healthcare system, without straining resources.

Prevalence and antimicrobial susceptibility of enterococcus species isolated from different clinical samples in a tertiary care hospital of north india

Abstract: Introduction: The present study was carried out to determine the species of Enterococci isolated from various clinical samples and to determine its antimicrobial susceptibility pattern. Enterococci have emerged as an important cause of nosocomial infections and antibiotic resistance among Enterococcus is a major obstacle for treatment. Material and methods: Enterococcus spp. were isolated and identified from different clinical samples between Sept. 2012 to Aug. 2013 by standard biochemical test. Antimicrobial susceptibility testing was performed by modified Kirby bauers disc diffusion method as per CLSI guidelines. Result: Among the 100 isolates of Enterococcus from various clinical samples maximum isolates were from urine sample 70% and E. faecalis 92% constituted the predominant isolate. They were found to be susceptible to linezolid and vancomycin with least sensitive to ciprofloxacin and tetracycline. Conclusion: Routine speciation and in vitro antimicrobial susceptibility testing of Enterococcus in various clinical samples is emphasized due to the prevalence of wide variety of Enterococcus species and also appearance of high resistant strains.

A Study on Birth Asphyxia at Tertiary Health Centre

Abstract: Background: Birth asphyxia is an important cause of morbidity and mortality in neonatal period. Methodology: This was the cross sectional study conducted in the tertiary care centre of Ahmedabad on the full term babies with birth asphyxia. The maternal, fetal and newborn correlates were recorded according to predesigned proforma. Results: There were total 401 (6.6%) babies born with apgar score of less than 7 at one minute and among them, 320 (79.8%) were full term babies and 81 (20.2%) were preterm babies. Among the babies 52.5% were male, 56.9% were primigravida, and only 41.9% had antenatal care present, 42.2% had MSL and 47.2% were small for date babies. Conclusion: Birth asphyxia is common the babies of the mother who had not received proper antenatal care. Maternal anaemia, primipara, meconium stained liquor babies have more chances of getting birth asphyxia.

Word Frequency and Content Analysis Approach to Identify Demand Patterns in a Virtual Community of Carriers of Hepatitis C

Abstract: Background: Orkut, a Brazilian virtual social network, is responsible for popularization of the Internet among people of low income and educational level. It’s observed that rapid growth of virtual communities can be reached by low cost Internet access in community local area network houses. Orkut poses an important social resource for Brazilian patients with chronic conditions like hepatitis C virus (HCV) carriers, who face several obstacles in adapting to everyday difficulties. Objective: Identify Patterns of Recurring Demands (PRD) expressed in messages posted by members of virtual communities dedicated to HCV carriers. Methods: Pre-selection: we identified terms commonly associated to HCV on generic Internet searches (primary Keywords - Kps); Kps were used to identify the most representative HCV communities in a virtual community site (Orkut); all messages published along 8 years on all topics of the community were collected and tabulated; the word frequency was used to construct a “word cloud” (graphic representation of the word frequency) on which was applied a content analysis technique. Results: The most cited terms expressed: search for information about medications (prescribed and “forbidden”); emphasis on counting time, which were interpreted as surviving expectations; frequent mention of God, doctors, and “husbands” (female carriers were 68%). These elements provided material for further research – they will be useful in the construction of categories in discourse analysis. Conclusions: The present work is a disclosure of preliminary findings considered original and promising. The word frequency/content analysis approach expressed needs of social support and material assistance that may provide subsidies for further qualitative approach and public health policies aimed to HCV carriers. The study of PRD by word frequency may be useful in identifying demands underestimated by other means. [Interact J Med Res 2013;2(2):e12]

Occupational Exposures to Blood and Body Fluids (BBFS) among Health Care Workers and Medical Students in University of Gondar Hospital, Northwest of Ethiopia

Abstract: Introduction: Occupational exposure to blood and body fluid is a serious concern for health care workers The problem is more devastating in developing countries like Ethiopia with poor infrastructure and health setup This study tried to assess the magnitudes of occupational exposure and its associated factors among HCWs and medical students to BBFs in University of Gondar Hospital Methods: A cross sectional survey was conducted from September 6 to October 2, 2012, in University of Gondar hospital Two hundred eighty five participants (including health professionals, janitors and medical students) were participated in the study Stratified simple random sampling technique was used to select the participants Data was collected through Self-administered questionnaire and interview using structured questionnaire Result: The overall lifetime and one year prevalence’s of occupational exposure to BBF during the study period were 177(702%) and158 (629%), respectively The exposure rate of BBFs in the last-one year was highest among interns 29(906%), followed by health professionals 100(633%) and least among housekeeping staffs 28(452%)