Response of L V Prasad Eye Institute to COVID-19 outbreak in India:experience at its tertiary eye care centre and adoption to its Eye Health Pyramid

AIM:To summarize the experience of response to COVID-19 outbreak at a tertiary eye care institute and its network of health facilities in India.METHODS:Our responses are based on the principles of social distancing,hand hygiene,respiratory etiquettes,surface disinfection protocol,and rational use of appropriate personal protective equipment(PPE).We describe our response in terms of administrative controls,clinical protocols,staff protection,environmental controls,and social distancing measures.We also discuss our communication strategies and monitoring systems,to ensure compliance to protocols.RESULTS:Administrative control is mainly related to formation of task force and its functions.Clinical protocols are related to patient triaging methods and clinical examination guidelines in Outpatient,Inpatient and Operating Room.Staff protection is focused on training staff on the protocols to be followed in hospital as well as at home,and use of PPE.Environmental protocol is focused on cleaning and disinfectant methods to be used in the hospital.In addition,there are systems for communication as well as monitoring compliance to protocols.CONCLUSION:We hope that these protocols and our experience would help the ophthalmic community globally and serve as a guide to protect ophthalmologists and ophthalmic care personnel,and their patients across the world.

Neonatal Umbilical Cord Infections: Incidence, Associated Factors and Cord Care Practices by Nursing Mothers at a Tertiary Hospital in Western Uganda

Background: Umbilical cord infections complicate to neonatal sepsis that significantly contributes to neonatal mortality worldwide. There is paucity of data on the incidence, factors associated with neonatal umbilical cord infections in western Uganda, yet nursing mothers continue to practice potentially dangerous cord care practices. We described the incidence, factors associated with umbilical cord infections and cord care practices by nursing mothers at a tertiary hospital in western Uganda. Methods: This was a hospital based cross sectional study at a tertiary hospital in western Uganda between the months of March and June 2019. Two hundred and forty (240) neonates aged between 2 to 14 days attending the neonatal unit were recruited in the study. Umbilical cord infection was assessed based on the World Health Organisation (WHO) clinical definition: finding of any of discharge, redness and swelling on the umbilical stump. Data on sociodemographic characteristics, maternal and neonatal perinatal factors and cord care practices of the nursing mothers were analysed by bivariate and multivariate logistic regression using STATA 13.0 to determine factors associated with umbilical cord infection. Results: Sixty-five, 65 (27.1%) neonates had at least one sign of cord infection. Majority of the nursing mothers, 168 (70%) do not use the recommended umbilical cord care practices. Among these, 73 (30.4%) do not cleanse the cord while 95 (39.6%) cleanse with application of a dangerous substance. Application of dangerous substance to the cord (aOR: 3.0, 95% CI: 1.37 - 6.37, p = 0.006) and maternal secondary education level (aOR = 2.1, CI = 1.01 - 4.18, p = 0.046) were significantly associated with umbilical cord infection. Conclusions: The incidence of neonatal umbilical cord infection is high in this setting. Application of a dangerous substance to the umbilical stump and maternal secondary education level were significantly associated with umbilical cord infection. Clinicians should routinely examine the umbilical stump of every neonate for the signs of infection and encourage mothers to avoid application of dangerous substances to the cord. Maternal education on the recommended cord care practices during antenatal and postnatal period could reduce the incidence of umbilical cord infection among neonates in low resource setting.

The Practice of Palliative Care amongst Nurses in Selected Hospitals in Eastern Nigeria

In recent times, palliative care nursing has caught the attention of nurse researchers in Africa as more individuals are being diagnosed with chronic diseases of the aged like cancer, cardiac and cerebrovascular conditions. This study examined the influence of knowledge and attitude on the practice of palliative care among practicing nurses in eastern part of Nigeria. A descriptive cross-sectional research design was used for the study. The population of the study is all registered, licensed and practicing nurses working in the named public and private hospitals where palliative care is supposedly well established. Proportionate sampling technique was used to select 289 respondents. Three commercial instruments that were modified were used for data collection. Level of significance was set at 5%. The study was conducted from October 2018 to June 2019. Results revealed that 52.7% of the respondents had satisfactory practice of palliative care, 73.7% of the respondents had adequate knowledge of palliative care (mean 2.64 (1.06) and 77.5% of the respondents had positive attitude towards palliative care (Mean 2.81 (1.14)). There was also a significant weak positive association between nurses’ educational level and their knowledge of palliative care with an effect size of 21.9% (P = 0.003). There was also a significant association between nurses’ years of experience and their attitude to palliative care with an effect size of 35.6% (P < 0.001). There was no significant association between type of hospital facility nurses work in and their practice of palliative care (P = 0.343). Recommendations were made on how to improve the practice of palliative care among professional nurses.

Newborn Umbilical Cord Care in Parakou in 2013: Practices and Risks

Objective: The objective was to study umbilical care practices and risks in Parakou (North Benin). Patients and method: It was a cross-sectional and descriptive study carried out within a community from June 1 to August 31, 2013. It focused on all the infants born at the maternity of Parakou Health Center and their mothers. Results: Two hundred and ten newborns were included i.e. 101 boys and 109 girls. In 80.9% of cases, inappropriate substances had been applied to umbilical cord. Umbilical cord care quality was adjudged as poor, acceptable and good in 58.6%, 31.9% and 9.5% of cases respectively. A bacterial umbilical infection had been noted in 59.5% of newborns. Only 4.8% had sterile umbilical wound. The commonest bacteria were: Staphylococcus aureus (58.1%), Staphylococcus saprophiticus (53.3%), Escherichia coli (44.8%) and Pseudomonas aeruginosa (14.3%). The factors associated with umbilical infection were: low educational status of mother (p = 0.026), low-income occupation of mother (p = 0.021), customary practices to accelerate umbilical cord fall off (p = 0.007), short time to cord falling off lower than 6 days (p = 0.015). Conclusion: Umbilical cord care involves high risk for bacterial infection in our context. Strong actions must be taken within the community in order to reduce that risk.

Pharmaceutical Care:An Additional and Personalized Service in Health Care

The Pharmaceutical Care(PC)service is a growing sector.The continuous development of the role of the professional pharmacist in the sector of health services within the pharmacy leads to having an active role in the primary care.The PC service has been in operation for years in other western countries such as Spain,the United Kingdom and the United States.Several studies have been carried out,which confirm the benefits of the service in reducing morbidity,hospital admissions and the cost of the health care system.This article sets out the concept of PC and the financial benefit to health expenditure.It also analyzes the Drug Therapy Problem(DTP)and the Patient Care Process.To conclude,a patient case is presented to understand the practical implementation of the theory of the PC and to show how the professional pharmacist reports the pharmacotherapeutic case.

Patient Feedback for Acupuncture Practice Improvement:A Survey from Mayo Clinic

Objective： To understand patient satisfaction with acupuncture appointment duration for the first and subsequent appointments in the plan of care, time spent with the acupuncture provider, willingness to pay for longer duration appointments, and lack of insurance coverage. Methods： Patients who were referred for an acupuncture consult to the Center for Integrative Medicine at Mayo Clinic were asked to participate in the survey in August 2014. Patients were given paper survey at time of appointment check-in and entered into Research Electronic Data Capture Survey database tool to reveal patient-reported outcomes. Results： In total, 104 of 329 patients receiving acupuncture treatment responded to the survey with a 32% response rate. Insight and recommended changes to the duration of the initial and subsequent appointments were obtained. Most patients reported that time spent with the provider（76 cases, 74%） and appointment length（74 cases, 68%） were ＂just right＂. Seventy cases（70%） of respondents indicated that they wanted longer treatment. Patients reported return appointments with duration of 30 min was not enough. Fifty-three patients（62%） were willing to pay for additional costs not covered by insurance. Conclusions： We used patient feedback to assess the acupuncture practice in a complementary and integrative medicine program. Most patients referred for the acupuncture consult appeared to be satisfied with the current level of practice. These findings were used to establish a quality improvement plan that may be implemented to improve patient satisfaction with the acupuncture practice.