Abstract:

Background: Potentially every aspect of life in cancer patients is found to be accompanied by a mental illness of anxiety and depression that affects the Physical relationships, Psychological well-being, Social relationships and the Environmental domain thereby reducing the QOL of cancer patients significantly. The advancements in cancer treatment have led to marked improvement in the survival rates of cancer patients; however, distressing symptoms of anxiety and depression arising due to treatment modalities are yet to be endured. The proposed study is considered valuable since it emphasized on the quality of life of cancer patients during their treatment for cancer symptoms as one of the possible outcomes. Because patients are the best source of information for QOL data, therefore inpatients for chemotherapy treatment and outpatients for radiotherapy treatment were recruited in the study to obtain a unique perspective on how QOL is defined, assessed, and perceived with respect to anxiety and depression during the treatment sessions.

Objectives: The present study was conducted to assess the association and correlation of Anxiety and Depression with the domains of Quality of Life of cancer patients during inpatient Chemotherapy sessions or outpatient Radiotherapy sessions. The primary objective was to analyze the anxiety and depression levels (Recognition patterns) with their impact on QOL of cancer patients during chemotherapy or radiotherapy sessions.

Methods: It was a Psychological intervention, non-experimental, cross-sectional, descriptive, observational, hospital-based evaluation study. The Research study was conducted at Medical and Radiation Oncology department of Dr. B.L. Kapur Memorial Hospital, New Delhi, India with total duration of 5 months (December 2015- April 2016). A convenient sample of 60 patients undergoing cancer treatment was selected in which 30 cancer patients were on chemotherapy (CT Group) and the other 30 cancer patients were on radiotherapy (RT Group). Data collection was performed by using 3 validated Psychological interventional tools: WHOQOL-Bref Questionnaire, Zung Self-Rating Anxiety scale (ZSAS) and Zung Self-Rating Depression scale (ZSDS). Appropriate statistical tests by using SPSS v.17 software were utilized to determine the significant association of anxiety and depression with QOL domains.

Results: As a result, it was observed that 21(35%) males [6(20%) in Chemotherapy group and 15(50%) in Radiotherapy group] and 39(65%) females [24(80%) in Chemotherapy group and 15(50%) in Radiotherapy group] participated in the research study. Majority of the patients 32(53.34%) were found to be in the age range of 46-60 years. Out of the enrolled subjects, 33(55%) were undergoing Breast cancer treatment, 6(10%) were undergoing Head cancer treatment, and 21(35%) were undergoing Neck cancer treatment. Anxiety affected the Physical domain (p=0.007), and Environmental domain (p=0.036) in the Chemotherapy group; and Social domain (p=0.016) in the Radiotherapy group. On the other hand, Depression affected the Social domain (p=0.043) in Chemotherapy group; and Social domain (p=0.012) in the Radiotherapy group. Values of p < 0.05 were considered to be statistically significant.

Conclusion: It is evident from the research study that Cancer patients on chemotherapy were more badly affected in some domains of Quality of life due to anxiety and depression as compared to the patients on radiotherapy treatment regimen. Moreover, it was observed that with the increase in Anxiety and Depression symptomatic levels, there was a marked decline in respective domains of the Quality of life of the cancer patients during Chemotherapy and Radiotherapy sessions. Thus, it was observed that levels of Anxiety and Depression were inversely (negatively) correlated with the domains of Quality of life of cancer patients during chemotherapy or radiotherapy.

Descriptors: WHOQOL-Bref Rating scale; Zung Self-Rating Anxiety scale (ZSAS); Zung Self-Rating Depression scale (ZSDS); Quality of Life; Sample study evaluation; Cancer patients; Chemotherapy treatment; Radiotherapy Treatment.

Identifiers: Anxiety (ZSAS), Depression (ZSDS), & WHOQOL-Bref Profile of cancer patients during Chemotherapy & Radiotherapy

Population: AdultCancer Patients undergoing either Chemotherapy or Radiotherapy sessions

Independent variables: Anxiety, Depression, Socio-demographic & Clinical characteristics

Dependent variables: Physical health, Psychological well-being, Social relationships, Environment domain

Outcome measure: Quality of Life of cancer patients during Chemotherapy & Radiotherapy

Domain: QOL as a characteristic function of Anxiety and Depression

Type of Measure: Subject-reported, Care-giver-reported, Investigator reported

Keywords: Cancer, Chemotherapy, Radiotherapy, Quality of Life, WHOQOL-Bref Questionnaire, Zung Self-Rating Anxiety scale, Zung Self-Rating Depression scale, Physical domain, Psychological domain, Social domain, Environmental domain.

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Abstract:

Background: The patient of diabetes in Central hospital Nampula has the prevalence of obesity, poor knowledge regarding diabetes, completely depends on the diabetic pharmacological treatment and lack of awareness of complication of diabetes. There is a need of lifestyle modification, increase knowledge of diabetes to improve obesity, glycaemic control, reduce its complication.

Methods: This is clinical intervention study,648 of the participants of diabetes mellitus taken for study in outpatient diabetic clinic in hospital central Nampula, according to inclusion and exclusion criteria, participated in the pre-test at baseline and post-test after the second follow up session of education, during each session of education body mass index and fasting blood sugar were recorded. Education commenced with instruction in groups of each session followed by individual advice sessions for each patient with different specialists. 

Results: The present study found that educational intervention of diabetes was highly effective to increase knowledge of diabetes with compare of pre-test and Post-test score (P <. 001), fasting blood sugar and body mass index significantly decreased from baseline in the second follow up (P <. 001). Age was significantly correlated with body mass index and fasting blood sugar (P<. 001,) Posttest with body mass index and fasting blood sugar were significantly correlated (P<. 01). A post hoc Turkey test on body mass index when compared with fasting blood sugar found significantly (P=. 05) at baseline, at first follow up (P=. 005) and at second follow up (P=. 005). 

Conclusion: The present study found that educational intervention was highly effective in controlling body mass index, fasting blood sugar and improves knowledge of diabetes among participants of diabetes mellitus. 

Keywords: Diabetes Mellitus, blood sugar, body mass index, effect education, control, participants

References:

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[2]. Balagopal, P., Kamalamma, N., Patel, T.G. and Misra, R. (2008) ‘A community-based diabetes prevention and management education program in a rural village in India’, Clinical Care/Education/Nutrition/Psychosocial Research, 31 (6), pp. 1097–1104. doi: 10.2337/dc07-1680. In-text citations: (Balagopal et al., 2008)

[3]. Choi, T.S.T., Davidson, Z.E., Walker, K.Z., Lee, J.H. and Palermo, C. (2016) ‘Diabetes education for Chinese adults with type 2 diabetes: A systematic review and meta-analysis of the effect on glycemic control’, Diabetes Research and Clinical Practice, 116, pp. 218–229. doi: 10.1016/j.diabres.2016.04.001. In-text citations: (Choi et al., 2016)

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[5]. 5.5 general diabetes self-management and education (2016) Available at: https://www.icsi.org/guideline_sub-pages/diabetes/55_general_diabetes_self-management_and_education/ (Accessed: 14 August 2016). In-text citations: (5.5 general diabetes self-management and education, 2016)

[6]. Mollaoğlu, M. and Beyazıt, E. (2009) ‘Influence of diabetic education on patient metabolic control’, Applied Nursing Research, 22 (3), pp. 183–190. doi: 10.1016/j.apnr.2007.12.003. In-text citations: (Mollaoğlu and Beyazıt, 2009)

[7]. Moattari, M., Ghobadi, A., Beigi, P. and Pishdad, G. (2012) ‘Impact of self-management on metabolic control indicators of diabetes patients’, Journal of Diabetes & Metabolic Disorders, 11 (1), p. 6. doi: 10.1186/2251-6581-11-6. In-text citations: (Moattari et al., 2012)

[8]. Ricci-Cabello, I., Ruiz-Pérez, I., Rojas-García, A., Pastor, G., Rodríguez-Barranco, M. and Gonçalves, D.C. (2014) ‘Characteristics and effectiveness of diabetes self-management educational programs targeted to racial/ethnic minority groups: A systematic review, meta-analysis and meta-regression’, BMC Endocrine Disorders, 14 (1), p. 60. doi: 10.1186/1472-6823-14-60. In-text citations (Ricci et al., 2014)

[9]. Salinero-Fort, M., Santa, C., Arrieta-Blanco, F., Abanades-Herranz, J., Martín-Madrazo, C., Rodés-Soldevila, B. and Burgos-Lunar, de (2011) ‘Effectiveness of PRECEDE model for health education on changes and level of control of HbA1c, blood pressure, lipids, and body mass index in patients with type 2 diabetes mellitus’, BMC public health., 11. In-text citations: (Salinero-Fort et al., 2011)

Abstract:

Critical Appraisal of head-to-head studies is an important decision-making skill. Questions followed by evidence statements are responses that give researchers the evidence-based information they need to make decisions on the best treatment for an indication. The lung is the organ that HIV most frequently infects, and respiratory complications, such as pneumonia, are a common cause of death. The question of interest is: “Which of two treatments is the best one to mitigate lung infections in poor HIV patients?” This paper is a critical appraisal done to find an antibiotic that may be best for poverty-stricken HIV patients with pneumonia. There have been many reports of substandard drugs being donated to poorer countries. Critical appraisals need to be done on certain drugs that are donated to poverty-stricken countries to see if the drug is cost-effective, useful and affordable. It should be unethical to donate useless drugs to vulnerable poor HIV patients with lung infections.

Keywords: Critical appraisal, Decisionmaking, Randomized Controlled Trial (RCT) Human Immunodeficiency Virus (HIV) 

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Abstract:

Rhinosinusitis occurs worldwide and affects about 16% of the adult American population annually significantly impairing their quality of life. Allergic rhinitis and chronic rhinosinusitis are prevalent non communicable diseases increasing around the world, even in Africa.

This study is aimed at assessing the prevalence and management of rhinosinusitis in Mbingo Baptist Hospital, in children, teenagers and adults. In Cameroon, the investigator did not find any readily documented and published statistics indicating the case of rhinosinusitis. In the hospital where this study was carried out, observation made in the frequency of rhinosinusitis and knowing the possible complications prompted the investigator find out about the prevalence and its management.

Thus the following research question of “what is the prevalence and management of rhinosinusitis?”

Our main objective is to assess the prevalence and management of rhinosinusitis in Mbingo Baptist Hospital.

More specifically, the investigator will be able:

· To define and describe rhinosinusitis

· To assess the management of rhinosinusitis in MBH

· To come out with the prevalence of rhinosinusitis in MBH

· To ascertain the standard management of rhinosinusitis

The prevalence of AR is very high (>35%) among Nigerian Africans, and it is likely that environmental factors are responsible for major differences with other countries. Knowing the prevalence of Rhinosinusitis will serve as reference for many other investigations. This prevalence would tend to increase if the condition is not well managed at the level of the hospital.

This is a cross sectional study in which data are collected from the hospital registers for patients having rhinosinusitis since 2011 till 2015. With these data, we aim at giving the prevalence of rhinosinusitis during this period.

The study will also include 5 case studies met in the ENT department during the period of the study both on an in patient and outpatient basis.

We shall assess the demographic data, patient’s history and management. The aim of these case studies is to have an indepth idea on the management of rhinosinusitis in Mbingo Baptist Hospital compared to the already addressed international standards.

Statistics of all cases of rhinosinusitis were taken from the ENT department registers from the year 2011 to 2015 (January to September). It is obvious that the prevalence of adult patients with rhinosinusitis is more than two times the prevalence of both the children and teenagers mixed. The total number of children from 2011 to 2015 was 677, teenagers were 514 and adults 3477, for a final total of 4668 people with rhinosinusitis.

 This may be due to the fact that adult patients have reinfections or relapsed conditions and therefore need to visit the hospital more frequently. This also may show their increase fragility and incapacity to control or to resist the allergens or causative agents. This information is better symbolized on figures 16, 17 and 18. For all of them the number of patients seen with rhinosinusitis was higher in 2014.

From the table indicating the total prevalence of Rhinosinusitis from 2011 to 2015, it is showing that the prevalence of rhinosinusitis is lowest in 2015 with a percentage of 10.5% and highest in 2011 (13.9%). The total average prevalence (from 2011 to 2015) is 11.7%. Since the department began being functional by 2011, population awareness about this condition was not well spread and resulted to an increase in prevalence in relation to the total number of patients seen in that year, which obviously is the smallest number.

As far as the management of rhinosinusitis is concerned, from the 5 case studies seen, it consisted in general of the following:Normal saline drops, Nasal decongestant, Corticosteroid spray and tablets, Antibiotics, Antihistamines, Functional Endoscopic Sinus Surgery.

To conclude, Rhinosinusitis which is the inflammation of the nasal mucosa, has proved to be a problem in the sub-Saharan African regions as described in the literature review. 

It is a universal health concern in the sense that it affect anybody and anyway provided the allergens or causative agents are present. 

This condition can either be acute or chronic, allergic and non-allergic, and can be managed medically and surgical, all depending on the gravity of the condition.

Though the prevalence of rhinosinusitis depends on the realities of each country and even reach up to 35% in Nigeria, the one identified by this study and representative of the whole country is lower (11.7%). The fact that this prevalence is around this average value, and considering the type of management done by the health professional which meet standard protocols and practice, we can say that rhinosinusitis is under control. Because population is dynamic, it may difficult to bring that value lower. Proper preventive measures will help reduce the prevalence of rhinosinusitis, among which the intensified education of the population and on preventive measures.

The standard guideline of management of rhinosinusitis will consist of one or the combination of the following:

1. Antihistamine (1 week to 1 month) (may continue for a period of 6 months)

2. Corticosteroids (2 weeks to 1 month)

3. Antibiotics (penicillins or cephalosporins with sometimes with an addition of anaerobes antibiotics like metronidazole) (5 days to 2 weeks dependently)

4. Nasal decongestant (1 to 2 weeks) (if associated with severe nasal congestion)

5. Nasal spray steroids (2 weeks to 1 month) (may continue for a period 6 months)

6. Surgical intervention (Functional Endoscopic Sinus Surgery) for those patients with facial sinuses polyps.

References:

[1]. Bhattacharyya N. Contemporary assessment of the disease burden of sinusitis. Am J Rhinol Allergy. 2009;23(4):392-395

[2]. Brook I, Frazier EH, Foote PA. Microbiology of chronic maxillary sinusitis: comparison between specimens obtained by sinus endoscopy and by surgical drainage. J Med Microbiol 1997; 46:430-2.

[3]. Brook I, Yocum P, Frazier EH. Bacteriology and beta-lactamase activity in acute and chronic maxillary sinusitis. Arch Otolaryngol Head Neck Surg 1996; 122:418-23.

[4]. Brook I. Bacteriologic features of chronic sinusitis in children. JAMA 1981; 246:967-9.

[5]. Fokkens W, Lund V, Mullol J, European Position Paper on Rhinosinusitis and Nasal Polyps Group European position paper on rhinosinusitis and nasal polyps 2007. Rhinology. 2007;45 (suppl 20):1-139 http://www.ep3os.org/EPOS2007.pdf Accessed February 16, 2011

[6]. Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. EPOS 2012: European position paper of rhinosinusitis and nasal polyps 2012. Rhinol Suppl 2012:1- 298.

[7]. Gliklich RE, Metson R. The health impact of chronic sinusitis in patients seeking otolaryngologic care. Otolaryngol Head Neck Surg. 1995;113(1):104-109 [PubMed]

[8]. Global atlas of allergic rhinitis and chronic rhinosinusitis. 2015

[9]. Jarvis D, Newson R, Lotvall J, Hastan D, Tomassen P, Keil T, et al. Asthma in adults and its association with chronic rhinosinusitis: the GA2LEN survey in Europe. Allergy 2012; 67:91-98.

[10]. Klossek JM, Dubreuil L, Richet H, Richet B, Beutter P. Bacteriology of chronic purulent secretions in chronic rhinosinusitis. J LaryngolOtol 1998; 112:1162-6.

[11]. Pleis JR, Lucas JW, Ward BW. Summary health statistics for U.S. adults: National Health Interview Survey, 2008. National Center for Health Statistics. Vital Health Stat 10. 2009; (242):1-157 www.cdc.gov/nchs/data/series/sr_10/sr10_242.pdf Accessed February 16, 2011 [PubMed]

[12]. Prokopakis E, Vlastos I, Pant H, Ferguson BJ. Chronic rhinosinusitis observation or treatment. CurrOpin Allergy ClinImmunol 2013; 13:31-36.

[13]. Prokopakis EP, Hellings PW, Velegrakis GA, Kawauchi H. From ancient Greek medicine to EP3OS. Rhinology 2010; 48:265-272.

[14]. Prokopakis EP, Vlastos IM, Ferguson BJ, Scadding G, Kawauchi H, Georgalas C, et al. SCUAD and chronic rhinosinusitis. Reinforcing hypothesis driven research in difficult cases. Rhinology 2014; 52:3-8.

[15]. Ramadan HH. What is the bacteriology of chronic sinusitis in adults? Am J Otolaryngol 1995; 16:303-6.

[16.] Rontal M, Bernstein JM, Rontal E, Anon J. Bacteriologic findings from the nose, ethmoid, and bloodstream during endoscopic surgery for chronic rhinosinusitis: implications for antibiotic therapy. Am J Rhinol 1999; 13:91-6.

Abstract:

Health care associated infections affect hundreds of millions of people around the world and it is a major global issue for patient safety. Moreover, the most common way that micro-organisms (germs), particularly bacteria, are spread and cause infection is by being carried on people’s hands. Hand hygiene is the most important measure to avoid the spread of harmful germs and to prevent ill health. Regular and thorough hand hygiene is always important when working in an environment or organization where health care is provided. So, having clean hands helps to protect patients, particularly the most vulnerable, as well as health care workers.

This change project proposed to improve hand hygiene compliance among health care workers in Intensive care units (Cardiac, Medical & Neonatal ICU’s) of a tertiary hospital in UAE. This included increasing compliance to hand washing, as well as introducing another simple, quick and effective procedure of hand hygiene which is using alcohol hand rub. The hand hygiene compliance rate showed gradual improvement over time, starting from below standard hand hygiene at base line assessment (44%), to reach its maximum at 3 weeks post intervention assessment (94%). These results indicate that the systematic application of the change model and WHO multimodal strategies is associated with improvement in hand hygiene compliance of healthcare workers and thus it could result in a sustained positive impact.

Although hand washing was found to be the preferred method for hand hygiene at 3 weeks into the intervention, yet the preference was reversed in the 3 weeks post intervention assessment to alcohol hand rub. In general, the literature suggests healthcare workers are possibly more concerned about their own safety than transmitting infection to patient. Yet in this project, they are found to be in different to the two indications with similar levels of compliance at baseline and postintervention.

References:

[1] Ahmed QA et al. (2006). Muslim health-care workers and alcohol based handrubs. Lancet, 367:1025–1027.

[2] Allegranzi B et al (2008). The burden of hospital-acquired infections (HAI) in developing countries: a systematic review. Poster presented at: 48th Interscience Conference on Antimicrobial Agents and Chemotherapy/46th Annual Meeting of the Infectious Diseases Society of America, Washington, DC, abstr. K-4106

[3] Allegranzia B., Storra J., Dziekana G., Leotsakosb A., Donaldsonb L., Pitteta D (2007). The First Global Patient Safety Challenge ―Clean Care is Safer Care: from launch to current progress and achievements. Journal of Hospital Infection: 65(S2) 115–123.

[4] Barbacombe J., (2004). Back to the basics – hand washing. Geriatric Nursing 25, 90–92.

[5] Bartholomew LK, Parcel GS, Kok G, Gottlieb NH. Planning health promotion programs: an intervention mapping approach. San Francisco, CA: Jossey-Bass, 2006.

[6] Bhalla A, Aron DC, Donskey CJ (2007). Staphylococcus aureus intestinal colonization is associated with increased frequency of S. aureus on skin of hospitalized patients. BMC Infectious Diseases, 7:105.

[7] Bischoff W, Reynolds T, Scssler C, Edmond M, Wenzel R.,(2000). Hand washing compliance by health care workers: the impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med ; 160: 1017-21 washing compliance by health care workers: the impact of introducing

[8] Bjerke NB., 2004. The evolution: hand washing to hand hygiene guidance.

[9] Critical Care Nursing Quarterly, 27:295–307.

[10] Boyce JM, Pittet D. (2002). Guideline for hand hygiene in healthcare settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/ SHEA/APIC/IDSA Hand Hygiene Task Force. Morbidity and Mortality Weekly Report, 51:1–45.

[11] Brooks I, Brown RB., (2003). The role of the ritualistic ceremonial in removing barriers Between subcultures in the National Health Service. J AdvNurs; 38: 341e352.

[12] Burnes, B. (2000). Managing Change. A Strategic Approach to Organisational Dynamics, 3rd Edition. Essex, England: Prentice Hall.

[13] Centres for Disease Control and Prevention, (2002). Guideline for Hand Hygiene in Health-Care settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene task Force. MMWR ; 51 (No. RR-16):1—48.

[14] Cosgrove SE (2006). The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis ; 42(Suppl. 2):S82eS89.

[15] Duggan J., Hensley S., Khuder S., Papadimos T. And Jacobs L.(2oo8). Inverse correlation between level of professional education and rate of hand washing in a teaching hospital. Infection Control and Hospital Epidemiology vol; 29, no. 6:534-538.

[16] Dumpis U et al (2003). Prevalence of nosocomial infections in two Latvian hospitals. Eurosurveillance, 8:73–78.

[17] Encyclopaedia Britannica Online. www.britannica.com.

[18] Erasmus V., Brouwer W., Beeck, F., Oenema A., Daha J., Richardus H., Brug J., 21 ( 2009). A Qualitative Exploration of Reasons for Poor Hand Hygiene. Among hospital workers: Lack of Positive Role Models and of Convincing Evidence that Hand Hygiene Prevent Cross Infection. Infection Control and Hospital Epedimiology30:415-419

[19] Ferlie E, Shortell S., 2001. Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Q;79:281e315.

[20.] Fridkin S et al.(1996): The role of understaffing in central venous catheter- associated bloodstream infections. Infection Control and Hospital Epidemiology, 17:150–158.

Abstract:

Paracetamol was licensed for assumedly safe worldwide usage in 1955 and is debatably the most common form of pain relief, headache palliative and hyperthermia medication used in both pediatric and adult populations in the Americas. Acetaminophen as it is commonly referred to in the United States is a component of very numerous treatment protocols for a wide range of ailments worldwide. Its patency permits has given rise to newer names in various countries using such names as paracetamol and panda. Although fatal and nonfatal liver based injuries, (some microscopic and others macroscopic) have been reported since 1966 due to overdose medications (usually self inflicted) due to self medications. Despite these problems, it’s a reasonably safe drug when taken within its therapeutic dose range. Paracetamol poisoning is portrayed as a foremost causative factor in the emergence of acute liver damage in the Americas. It is note worthy that certain factors tend to favor the emergence of paracetamol induced liver damage like chronic use of alcohols, certain enzyme inducing drugs, and associated liver parenchymal diseases even under the circumstances of a normal therapeutic usage of the drug- paracetamol / acetaminophen. Certain questions beg for answers. Are there new findings from decades of pharmacovigilance? Is there a possibility of genetic mutations observed? Is paracetamol still steadfastly safe as portrayed in pregnancy as has been documented since 1966? These are some questions seeking updates.

Keywords: Hepatic failure; drug poisoning; pharmacovigilance; epidemiology; prevalence; hyper medication

References:

[1]. Efficacy and safety of acetaminophen vs. ibuprofen for treating - NCBI

[2]. www.ncbi.nlm.nih.gov/pubmed/15184213 by DA Perrott et al- ‎2004 -.

[3]. Larson AM, Polson J, Fontana RJ, Davern TJ, Lalani E, Hynan LS, Reisch JS, Schiødt FV, Ostapowicz G, Shakil AO, Lee WM; Acute Liver Failure Study Group. (December 2005). Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology (Baltimore, Md.) 42 (6): 1364–72.

[4]. Sheen C, Dillon J, Bateman D, Simpson K, Macdonald T (2002). "Paracetamol toxicity: epidemiology, prevention and costs to the health-care system". QJM: monthly journal of the Association of Physicians 95 (9): 609–19. doi:10.1093/qjmed/95.9.609. PMID 12205339. 3b. Buckley N, Eddleston M (December 2005). "Paracetamol (acetaminophen) poisoning". Clinical evidence (14): 1738–44. PMID 16620471...

[5]. Gunnell D, Murray V, Hawton K (2000). "Use of paracetamol (acetaminophen) for suicide and nonfatal poisoning: worldwide patterns of use and misuse". Suicide & life-threatening behavior 30 (4): 313–26. PMID 11210057.

[6]. Hawkins LC, Edwards JN, Dargan PI (2007). "Impact of restricting paracetamol pack sizes on paracetamol poisoning in the United Kingdom: a review of the literature". Drug safety: an international journal of medical toxicology and drug experience 30 (6): 465–79.doi:10.2165/00002018-200730060-00002. PMID 17536874.

[7]. Khashab M, Tector AJ, Kwo PY (March 2007). "Epidemiology of acute liver failure". Current gastroenterology reports 9 (1): 66–73. doi:10.1007/s11894-008-0023-x. PMID 17335680.

[8]. Lee WM (July 2004). "Acetaminophen and the U.S. Acute Liver Failure Study Group: lowering the risks of hepatic failure". Hepatology 40 (1): 6–9. doi:10.1002/hep.20293. PMID 15239078.

[9]. Davidson DG, Eastham WN. Acute liver necrosis following overdose of paracetamol. Br Med J 1966; 2:497.

[10]. Seeff LB, Cuccherini BA, Zimmerman HJ, et al. Acetaminophen hepatotoxicity in alcoholics. A therapeutic misadventure. Ann Intern Med 1986; 104:399.

[11]. Zimmerman HJ, Maddrey WC. Acetaminophen (paracetamol) hepatotoxicity with regular intake of alcohol: analysis of instances of therapeutic misadventure. Hepatology 1995; 22:767.

[12]. Maddrey WC. Hepatic effects of acetaminophen. Enhanced toxicity in alcoholics. J Clin Gastroenterol 1987; 9:180.

[13]. Whitcomb DC, Block GD. Association of acetaminophen hepatotoxicity with fasting and ethanol use. JAMA 1994; 272:1845.

[14]. Schiødt FV, Rochling FA, Casey DL, Lee WM. Acetaminophen toxicity in an urban county hospital. N Engl J Med 1997; 337:1112.

[15]. Benson GD. Hepatotoxicity following the therapeutic use of antipyretic analgesics. Am J Med 1983; 75:85.

[16]. Watson WA, Litovitz TL, Klein-Schwartz W, et al. 2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2004; 22:335.

[17]. Lee WM. Acetaminophen and the U.S. Acute Liver Failure Study Group: lowering the risks of hepatic failure. Hepatology 2004; 40:6.

[18]. Pharmacogenomic implications of population admixture: Brazil as a model case.

[19]. Suarez-Kurtz G, Paula DP, Struchiner CJ

[20]. Pharmacogenomics. 2014 Feb; 15(2):209-19.

[21]. Ward R. M., Bates B. A., Benitz W. E., Burchfield D. J., Ring J. C., Walls R. P., et al. (2001). Acetaminophen toxicity in children. Pediatrics 108 1020–1024 10.1542/peds.108.4.1020 [Cross Ref]

[22]. Long term effect of reduced pack sizes of paracetamol on poisoning deaths and liver transplant activity in England and Wales: interrupted time series analyses. BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f403 (Published 07 February 2013) Cite this as: BMJ 2013;346:f403,Keith Hawton, professor of psychiatry and director centre for suicide research1, Helen Bergen, researcher1, Sue Simkin, researcher1, Sue Dodd, scientific assessor2, Phil Pocock, principal statistician3, William Bernal, reader in hepatology4, David Gunnell, professor of epidemiology5, Navneet Kapur, professor of psychiatry and population health6

[23]. University of Oxford Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, Headington, Oxford OX3 7JX, UK

[24]. Post Authorisation Signal Unit, Vigilance and Risk Management of Medicines, Medicines and Healthcare products Regulatory Agency, London, UK

[25]. Statistics and Clinical Audit, NHS Blood and Transplant, Stoke Gifford, Bristol, UK

[26]. Liver Intensive Therapy Unit, Institute of Liver Studies, King’s College Hospital, London, UK

[27]. University of Bristol, School of Social and Community Medicine, Canynge Hall, Bristol UK

[28.] University of Manchester, Centre for Suicide Prevention, University Place, Manchester, UK

Abstract:

India is one of the major destinations for conducting clinical trials. The Drug Controller General of India (DCGI) is the governing body responsible for all pharmaceutical-research and regulatory issues in India. While conducting clinical trials in India, regulations have come to ensure safety and well-being of the study subjects in the trial.

But, it has seen due to unethical Clinical Trials, Subject's rights were compromised and unprotected. This is one of the main reasons for the clinical research amendment and make regulation subject friendly by protecting the right, safety and well-being of the subject participant in the trial. So, the results of clinical studies are more credible, and authenticate.

But, some of regulatory amendments become a challenge for Research Industries and its stakeholders.

Hence, this study identifies following things:

· Reason of Regulatory amendment in India

· Comparative study between previous and amended regulation

· Impact of this Regulatory amendment on Subject’s protection, Research Industry and Stakeholder (includes Sponsors/Investors, Industry, Investigators and Ethic Committee)

References:

[1]. http://www.cdsco.nic.in/forms/list.aspx?lid=1585&Id=1

[2]. Sama: Resource Group for Women and Health. Memorandum to the Health Minister on World Health Day opposing HPV vaccinations. April 2010.

[3]. Department of Health Research, Ministry of Health and Family Welfare. Seventy-second report on alleged irregularities in the conduct of studies using Human Papillomavirus (HPV) vaccine by PATH in India. August 2013.

[4]. Report of Professor Ranjit Roy Chaudhury expert committee to formulate policy and guidelines for approval of new drugs, clinical trials and banning of drugs. July 2013.

[5]. Pandey A, Aggarwal AR, Seth SD, Maulik M, Bano R, Juneja A. Clinical trials registry—India: redefining the conduct of clinical trials. Indian J Cancer2008;45:79-82.

[6]. Mudur G. Human papillomavirus vaccine project stirs controversy in India. BMJ2010;340:c1775.

[7]. AHRP/cms/content/view/898/84/ (Internet reference about Mr. Amar Jasani statement)

[8]. THE HEALTH SITE/news/no-more-clinical-trials-till-you-can-monitor-them-supreme-court-to-centre/

[9]. JANANEETHI/jananeethi/projectregard/papernews/supremecourt_onclinicaltrial_4-1-12.pdf

[10]. IPSNEWS/2011/10/india-unauthorised-clinical-trials-on-bhopal-victims/

[11]. Dhananjay Mahapatra.2644 died during clinical trails during 7 years, The Times of India, Oct, 2012.

[12]. Hob’ble Mr. Justic R.M. Lodha, Hon’ble Mr. Justic Anil R. Dave. SwasthayaAdhikaManch, Indore & Anr. Vs. Min. of Health & Family Welf. &Ors. WP © 33 OF 2012, ORDER DATED: 3^rdJan2013,with W.P.(C) No.79 of 2012, 

http://courtnic.nic.in/supermecourt/temp/wc%203312p.txt,8.10.2012,26.7.13

[13]. Ethical Guidelines for Biomedical Research on Human Participants Indian Council of Medical Research, New Delhi, 2006

[14]. The Drug and Cosmetic (Amendment) Bill, 2013 (Bill No. LVIII OF 2013)

[15]. The Indian Medical Council (Professional conduct, Ethic & Etiquettes) Regulation, 2002, 7.22 CHAPTER 7 : MISCONDUCT

[16]. Minutes of the meeting of the Ethics Committee held on 20th November, 2012 at 09:00 A.M. in the Council Office, Sector-8 pocket-14, Dwarka, New Delhi-77. Available at: hhtp:www.mciindia.org/meetings/Ethics/2012/Minutes_20.11.2012.pdf

[17]. Pawan Kumar Bansal. Politicians who exposed malpractices in medical sector. Available at: http:www.merines.com/article/plioticians-who-exposeed-mal[ractices-inmedical-sector/15894017.shtml#sthash.ctMh8LEV.Fhc3l1z.dpuf

[18]. ‘www.unethicalclinicaltrial.org/Case_studies.aspx’ of swasthyaadhikarmanch

Abstract:

This paper reviewed an original article written by Sabblah et al on the adverse drug reaction reporting by medical doctors in a region in Ghana in 2012 but article originally published in 2014.

All over the world, spontaneous adverse drug reaction reporting is the mostly used method of monitoring the safety of drugs. This method is challenged with underreporting by healthcare professionals. The original article seeks to assess the knowledge of doctors about the adverse drug reaction (ADR) reporting system in Ghana, the rate of reportage and the attitude of the doctors on spontaneous reporting of ADRs. The method used was a cross-sectional survey and a self-administered questionnaire was used to collect data.

This review was to summarize and critique the content of the study and state possible recommendations. In critiquing, the authority, accuracy, currency and objectivity of the study were assessed. The study’s relevance, stability and graphs/tables were also assessed. In the article there were no recommendations or limitation to the study itself, recommendations were however made for improving spontaneous reporting. The results cannot be generalized so further studies are recommended in a national scope.

Keywords: Ghana; spontaneous reporting; ADR; doctors; review; underreporting

References:

[1.] Aagaard L, Stenver DI, Hansen EH. (2008) Structures and processes in spontaneous ADR reporting systems: a comparative study of Australia and Denmark. Pharm. World Sci. 30(5):563-570. Doi: 10.1007/s11096-008-9210-y 

https://www.ncbi.nlm.nih.gov/pubmed/18350372

[2.] Ahmad SR. (2003) Adverse drug event monitoring at the Food and Drug Administration. J Gen Intern Med. 285:437–443 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494803/

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 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871451/

Abstract:

Aim: The Trial master File (TMF) is a method used worldwide to collect and file documents related to clinical trials. The aim of this study was to review the ICH GCP guidelines related to the TMF and to provide an overview of the requirements of the TMF.

Method: A review of the ICH CGP guidelines related to the TMF and additional resources.

Topics reviewed: Six main topics was identified and discussed to provide an overview: What is a Trial Master File (TMF), the importance and benefits of the TMF, TMF and essential documents as outlined in the ICH GCP E6 guidelines from section 8.1 to 8.4, electronic TMF (eTMF), additional documents filed in the TMF

Conclusion: The TMF setup and maintenance during a clinical trial is essential to ensure all the required documents are filed and to ensure all the relevant documents are available and audit ready at all times.

Keywords: Trial Master File, TMF, GCP, essential documents, investigator, sponsor 

References:

[1] ICH Guidelines. (1997). Federal Register, 62(90), 25691-25709.

[2] European Medicines Agency. Reflection paper on GCP compliance in relation to trial master files (paper and/or electronic) for management, audit and inspection of clinical trials. London: EMA; 2015. [Cited 2016 Nov 06]. Available from: 

http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2013/02/WC500138893.pdf.

[3] Mielebacher, J. (2015). Volume 7 Issue 4 22 Journals for Clinical Studies Electronic Trial Master File: Gaining Efficiency for Oversight and Control. JCS, 7(4).

[4.]  Pereira P. Quality in clinical research activities: Role of institution/clinical trial site. J Nat Accrued Board Hosp Healthcare Providers [serial online] 2015 [cited 2016 Nov 6]; 2:4-8. Available from: 

http://www.nabh.ind.in/text.asp?2015/2/1/4/160232

Abstract:

Background: The control of human immunodeficiency virus and acquired immune deficiency syndrome depends on several factors which include life-long commitment to antiretroviral therapy. Poor adherence to antiretroviral therapy leads to serious consequences such as drug resistance and eventually high morbidity and mortality. We assessed adherence to antiretroviral therapy and associated factors among people living with human Immunodeficiency virus and acquired immune deficiency syndrome.

Materials and methods:

This crosssectional study was conducted in Monze and Nyimba districts of Zambia. A simple random sample of 364 consenting participants attending antiretroviral therapy clinic was selected between February and March 2015.

 A structured interview schedule was used to collect data. Multivariate binary logistic regression analysis was carried out using IBM^®SPSS^® for windows version 20.0 to ascertain the factors associated with adherence to antiretroviral therapy among the participants.

Results: Of the 364 participants, 83.5% had high adherence to antiretroviral therapy while 16.5% had low adherence. Knowledge of antiretroviral therapy (OR 0.27, 95% CI: 0.14 - 0.54) and antiretroviral therapy clinic site (OR 2.34, CI: 1.25 - 4.40) were statistically significantly associated with adherence to antiretroviral therapy in our study.

Conclusion: Most of the participants were adherent to antiretroviral therapy. There is still need to give more information on human immunodeficiency virus and acquired immune deficiency syndrome and adherence to people living with human immunodeficiency virus and acquired immune deficiency syndrome especially before the initiation of antiretroviral therapy. Also, health care providers need to establish other possible barriers to antiretroviral therapy adherence so as to manage the patients better.

Keywords: Human Immunodeficiency Virus, Acquired Immune Deficiency Syndrome, Adherence, Antiretroviral Therapy

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Abstract:

Introduction: Acute Kidney injury (AKI), is defined as an abrupt reduction in kidney function measured by a rapid decline in glomerular filtration rate resulting in the retention of metabolic waste products and dysregulation of fluid, electrolyte, and acid-base homeostasis. AKI is also defined in terms of a rise in serum creatinine concentration or by azotemia (a rise in blood urea nitrogen [BUN] concentration). The causes of acute renal disease can be related to the factors that interfere with structure and function of renal arteries, glomerular, renal tubules and urinary tracts. The current treatment for AKI is mainly supportive in nature; no therapeutic modalities to date have shown efficacy in treating the condition. Maintenance of volume homeostasis and correction of biochemical abnormalities remain the primary goals of treatment.

Methods: I undertook a systemic review different books and journals and came up with summary statement. Accordingly supporting evidence and general recommendation was generated for the future research.

Result: using the literature review the definition, causes and treatment algorithm of acute kidney injury was jotted down.

Conclusion: Acute kidney injury (formerly known as acute renal failure) is a syndrome characterised by the rapid loss of the kidney's excretory function and is typically diagnosed by the accumulation of end products of nitrogen metabolism (urea and creatinine) or decreased urine output, or both.

Keywords: Acute renal failure, creatinine, kidney, acute kidney injury, urea, blood urea nitrogen, dialysis.

References:

[1] Andreoli SP. Acute renal failure. CurrOpinPediatr 2002; 14:183.

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[3] Chan JC, Williams DM, Roth KS. Kidney failure in infants and children. Pediatr Rev 2002; 23:47.

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[10] Hiraoka M, Hori C, Tsuchida S, et al. Ultrasonographic findings of acute tubulointerstitial nephritis. Am J Nephrol 1996; 16:154.

[11] Hoschek JC, Dreyer P, Dahal S, Walker PD. Rapidly progressive renal failure in childhood. Am J Kidney Dis 2002; 40:1342.

[12] http://emedicine.medscape.com/article/243492-overview#a1

[13] Harrison's Principles of Internal Medicine, 17th ed, Braunwald E, Fauci AS, Kasper DL, et al (Eds), McGraw Hill Book Company. New York 2008.

[14] Kist-van Holthe tot Echten JE, Goedvolk CA, Doornaar MB, et al. Acute renal insufficiency and renal replacement therapy after pediatric cardiopulmonary bypass surgery. PediatrCardiol 2001; 22:321.

[15] Kist-van Holthe tot Echten JE, Goedvolk CA, Doornaar MB, et al. Acute renal insufficiency and renal replacement therapy after pediatric cardiopulmonary bypass surgery. PediatrCardiol 2001; 22:321)

[16] Kidney Disease: Improving Global Outcomes. Clinical practice guideline on acute kidney injury. 2011. www.kdigo.org.

[17] (Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int. 2012;2:124-138

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[19] Lee WS, Ooi TL. Deaths following acute diarrhoeal diseases among hospitalised infants in Kuala Lumpur. Med J Malaysia 1999; 54:303.

[20] Lee WS, Ooi TL. Deaths following acute diarrhoeal diseases among hospitalised infants in Kuala Lumpur. Med J Malaysia 1999; 54:303.

[21] Mishra J, Dent C, Tarabishi R, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005; 365:1231.

[22] Moffett BS, Goldstein SL. Acute kidney injury and increasing nephrotoxic-medication exposure in noncritically-ill children. Clin J Am SocNephrol 2011; 6:856.

[23] Mehta RL, Kellum JA, Shah SV, et al. 2007. Acute Kidney Injury Network (AKIN): report of an initiative to improve outcomes in acute kidney injury. Critical care, 11, R 31

[24] Molitoris BA, Levin A, Warnock D, et al. Improving outcomes of acute kidney injury: report of an initiative. Nat ClinPractNephrol 2007; 3 (8): 439-44

[25] Moghal NE, Brocklebank JT, Meadow SR. A review of acute renal failure in children: incidence, etiology and outcome. ClinNephrol 1998; 49:91

[26] Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007. 11(2):R31

[27] Moghal NE, Brocklebank JT, Meadow SR. A review of acute renal failure in children: incidence, etiology and outcome. ClinNephrol 1998; 49:91.].

[28] Rossi R, Kleta R, Ehrich JH. Renal involvement in children with malignancies. PediatrNephrol 1999; 13:153.

[29] Schrier RW, Wang W, Poole B, Mitra A. Acute renal failure: definitions, diagnosis, pathogenesis, and therapy. J Clin Invest. 2004 Jul. 114(1):5-14.

[30] SVachvanichsanong P, Dissaneewate P, Lim A, McNeil E. Childhood acute renal failure: 22-year experience in a university hospital in southern Thailand. Pediatrics 2006; 118:e786

[31] Schneider J, Khemani R, Grushkin C, Bart R. Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med 2010; 38:933.

[32] The Harriet Lane Handbook, 15th, Siberry GK, Iannone R (Eds), Mosby, St. Louis 2000)

[33.] Washburn KK, Zappitelli M, Arikan AA, et al. Urinary interleukin-18 is an acute kidney injury biomarker in critically ill children. Nephrol Dial Transplant 2008; 23:566

Abstract:

Education has been the bedrock of national development since inception but in recent times Nigeria has witnessed a lot of agitations in nearly all the geo-political zone of the federation which has stagnated national unity. This increasing trend of agitations has taken another shape especially in the Niger delta region and other parts of the country which has left political unrest, social, economic and psychological losses and pains. This paper therefore explored frustration aggression theory and consent that aggression is always based on frustration which is the justification for the increasing trends of agitations in Nigeria. Also this paper, examined the different group of agitators based on their demand and then focuses on counselling and moral education which is a universal permanent and pervasive phenomenon in human society as well as the earliest factors that influence human life as a panacea in curbing the increasing trends of agitations in Nigeria. The concept of counselling and moral education was explained and recommendation was also given. 

Keywords: moral education, counselling, agitation, youth, Nigeria and violence.

References:

[1] Atwater, E. (1988). Adolescence. (2nd Ed). New Jersey: Prentice Hall, Inc.

[2] Azaiki, S. (2007). Inequities in Nigerian Politics. Ibadan: Y-Books.

[3] Biswalo, (1996). An introduction to guidance and Counselling Diverse Africa Contexts. Dare Salaam: Dare salaam University Press.

[4] Boyle, P. (2010). ‘Nigeria’s Taliban Enigma’. BBC News, 31 July 2009, http://news.bbc.co.uk/2/hi/8172270.stm (accessed 8 July 2010).

[5] Charles, E. C. (1963). Moral Education in family, school and church, (Philadelphia: The West Minster Press, p.60. 2.

[6] Corey G. (1988). Issues and Ethics in the Helping professions. Pacific Grove, CA, Brooks Cole.

[7] Corey, G. (1991). Theory and Practice of Counselling and Psychotherapy. 4th ed. Pacific Grove. California: Brooks/Cole Publishing Company.

[8] Dollard, J. Miller, N. E, Doob, L.W, Mowrer, O.H, Sears, R.(1939). Frustration and Aggression. New Haven, Yale University Press. 

[9] Egbe, M. E. (2004). The State and Civil Society in Nigeria: Study of the Movement for the Survival for the Ogoni People (MOSOP) Lagos: NIIA Occasional Papers.

[10] Egbo, A.C. (2013). Development of Guidance and counselling, Enugu; Joe best publishers.

[11] Fafunwa, B. (1976). History of Education in Nigeria. London: George Allen and Unwin Ltd. 

[12] Federal Ministry of Education (2004). National policy on Education, Lagos federal Government printers.

[13] Ile, C. & Akukwe, C. (2001). Niger delta, Nigeria, Issues, Challenges and opportunities for equitable development. Retrieved on 27/10/2011 from http://nigeriaworld.com/feature/article/niger-delta.html

[14] Kelly (2008). Bringing peace to the Niger Delta. www.usip.org/pubs/unpeacebriefings_niger_delta html.

[15] Midlarsky, M. (1975). On War: Political Violence in the International System, New York, Free Press.

[16] Mutie, E. K. & Ndambuki, P. (2004). Guidance and Counselling for Schools and Colleges. Nairobi: Oxford University Press.

[17] National Bureau of Statistics (2006). Federal Republic of Nigeria 2006 Population Census. accessed 26/10/2011 from http://www.nigerianstat.gov.ng/nbsapps/Connections/Pop2006.pdf

[18] Nigeria Dangerous Slide: The New York Times 2012 (Retrieved 0n the 20 April 2013)

[19] Ojukwu C. C. (2009). Igbo Man’s Burden Abeokuta: EMI Publications.

[20] Okoye, A.U. (2010) Counselling in the industrial setting Visa Vis industrial relation. Aroka; Erudite publishers.

[21] Omipidan, I. (2013). Total War. www.sunnewspaper online 19 May 2013 (Retrieved on 22 May 2013

[22] Omoregbe, J. (2000). Ethics: A Systematic and Historical Study. Lagos: Joja Educational Research and Publishers.

[23] Uzodima, E. (2014). Biafra Zionists Federation attempts to seize Enugu radio station, kills police officer. Daily post 5 June.

[24] Whitely, C. H. (1982). The Justification of Moral Philosophy. Vol. 57, No. 222

[25.]

Wiredu, K. (1992). The Moral Foundations of an African Culture: In Kwasi Wiredu and Kwame Gyekye (eds) Person and Community Ghanaian Philosophical Studies 1. Washington D.C: The Council for Research in Values and Philosophy.

Abstract:

While numerous studies relate to mental illness, few provide prevalence estimates of diagnosable mental illness (e.g., major depressive disorder as opposed to feeling depressed, or generalized anxiety disorder as opposed to feeling anxious), and fewer still provide national prevalence estimates of diagnosable mental illness. It been proven that most people with alcohol or substance use and anxiety disorders experience them independently, but having both can be a vicious cycle. The symptoms of one disorder can make the symptoms another worse; an anxiety disorder may lead to using alcohol or other substances to self-medicate or alleviate anxiety symptoms. The co-occurrence of substance abuse, particularly alcohol abuse, is common among people who have social anxiety disorder. People with this disorder report that alcohol helps lessen their social anxiety, although it often makes it worse. Alcohol abuse usually develops after the onset of this disorder. PTSD and substance abuse commonly occur together. People suffering from this disorder often use alcohol or drugs to try to ease their anxiety, but substance abuse can exacerbate PTSD symptoms. Mental ill-health is strongly associated with poverty and social deprivation and living in poverty, exposure to stressful life events like crime and violence; inadequate housing, unemployment and social conflict, are all linked to mental ill-health. An overwhelming majority of people with mental and psychosocial disabilities are living in poverty, poor physical health, and are subject to human rights violations.

References:

[1.] Borges G, Angst J, Nock MK, Ruscio AM, Kessler RC. Risk factors for the incidence and persistence of suicide-related outcomes: a 10-year follow-up study using the National Comorbidity Surveys. J Affect Disord 2008 ; 105 (1-3): 25-33.

[2.] Cohen S, Doyle WJ, Baum A. Socioeconomic status is associated with stress hormones. Psychosom Med 2006; 68: 414-20.

[3.] Collins JW Jr, David RJ, Symons R, et al. African-American mothers’ perception of their residential environment, stressful life events, and very low birth weight. Epidemiology 1998; 9: 286-9.

[4.] Chen E, Matthews K. Cognitive appraisal biases: an approach to understanding the relation between socioeconomic status and cardiovascular reactivity in children. Ann Behav Med 2001; 23:101-11.

[5.] Dube, S.R., Miller, J.W., Brown, D.W., Giles, W.H., Felitti, V.J., Dong, M.,& Anda, R.F. (2006). Adverse childhood experiences and the association with ever using alcohol and initiating alcohol use during adolescence. Journal of Adolescent Health, 38, 1–10.

[6.] Edwards, V. J., Holden, G. W., Felitti, V. J., & Anda, R. F. (2003). Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. American Journal of Psychiatry, 160, 1453–1460. 

[7.] 

EversonRose SA, Barnes LL, et al. Neighborhood socioeconomic conditions are associated with psychosocial functioning in older black and white adults. Health Place 2011; 17:793-800.

[8.] Gallo LC and Matthews KA. Understanding the association between socioeconomic status and physical health: do negative emotions play a role? Psychol Bull 2003; 129:10-51.

[9.] Goldberg DP, Huxley PY. Common mental disorders: a bio-social model. London: Tavistock/ Routledge; 1992.

[10.] Grzywacz JG, Almeida DM, Neupert SD, et al. Socioeconomic status and health: a micro-level analysis of exposure and vulnerability to daily stressors. J Health Soc Behav 2004; 45:1-16.

[11.] Knapp, M., McDaid, D., & Parsonage, M. (2011). Mental Health Promotion and Mental Illness Prevention: The Economic Case. 15972. Department of Health, London, UK. 

[12.] Inge, P., Arvin, B., Victoria, C., Sithembile, M., Crick, L., Sharon, K., & … the Mental Health and Poverty Research Programme, C. (2009). Planning for district mental health services in South Africa: a situational analysis of a rural district site. Health Policy & Planning, 24(2), 140. Retrieved from EBSCOhost. p. 141.

[13.] Joanna Saisan, M.S.W., Melinda Smith, M.A., and Jeanne Segal, Ph.D. Last updated: October 2016.

[14.] Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry 1999 ; 56 (7):617-26.

[15.] Lantz PM, House JS, Mero RP, et al. Stress, life events, and socioeconomic disparities in health: results from the Americans’ Changing Lives Study. J Health Soc Behav 2005; 46:274-88.

[16.] Matthews KA, Raikkonen K, Everson SA, et al. Do the daily experiences of healthy men and women vary according to occupational prestige and work strain? Psychosom Med 2000; 62:346-53.

[17.] McCreary Centre Society. (2012). Mental Health and Substance Use: A BC Adolescent Health Survey 2008 Fact Sheet. McCreary Centre Society. McCreary Centre Society: Vancouver. http://www.mcs.bc.ca/pdf/AHS4_Mental_Health_Substance_Use_Factsheet.pdf. 

[18.] McLeod JD, Kessler RC. Socioeconomic status differences in vulnerability to undesirable life events. J Health Soc Behav 1990; 31:162-72.

[19.] Miller, T. & Hendrie, D. (2008). Substance abuse prevention dollars and cents: a cost-benefit analysis. Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, DHHS Pub. No. (SMA) 07-4298. Rockville, MD. 

[20.] Ndosi NK, Mbonde MP, Lyamuya EL. Profile of Suicide in Dar es Salaam. East African Medical Journal 2004;81: 207-11.

[21.] Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, et al. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry 2008 ; 192(2):98-105.

[22.] Slap GB, Vorters DF, Chaudhuri S, Centor RM. Risk factors for attempted suicide during adolescence. Pediatrics 1989; 84: 762-72.

[23.] World Health Organization. Towards a common language for functioning disability and health-ICF. Geneva: World Health Organization; 2002.

Abstract:

For the purposes of this paper, the review of the article titled“Multiple ethical review in North–South collaborative research: the experience of the Ebola-Tx trial in Guinea” published in 2016 in the Indian journal of medical ethics, will focus on the following subtitles; the literature review, article summary and structure. In critiquing this article, the author of this paper will explore the credentials and work of the article’s author to establish its authority and accuracy. We will deal with the time surrounding the publication of the article as well as the current references cited in the article. The objectivity of the article will be considered in terms of biasness, consideration of holistic information surrounding the subject and how the author navigated through the various issues to remain objective. The article’sstability will be reviewed based on the type of publication. The author will also zero in on the tables to point out important and relevant information. We will also review the relevance of the content in relation to the title of the article. This paper will also point out some of the recent work being done related to multiple ethical reviews in research and at the end of this article review, a clear and concise conclusion will be given.

References:

[1] Beeson, D., & Lippman, A. (2006). Egg harvesting for stem cell research: medical risks and ethical problems. Reproductive BioMedicine Online, 13(4), 573-579.

[2] Crump, J., Sugarman, J. & Working Group on Ethics Training (WEIGHT.) (2010). Ethics and best practices guidelines in Global Health. The American Journal of Tropical Medicine and Hygen, 83(6), 1178-1182

[3] Hyde, A.A, Wali, S.A., Khan, A.N., Tech, N. B., Kass, N.E., & Dawson, L. (2004). Ethical review of Health research; a perspective for developing country researchers. Journal of Medical Ethics, 30(1), 68-72.

[4] htt://globalhealthtrials.tghn.org seen on 14.11.2016.

[5] Erin, C. A., & Harris, J. (2003). An ethical market in human organs. Journal of medical ethics, 29(3), 137-138.

[6] Emanuel, E.J., Wendler, D., Killen, J., & Gandy, C. (2004). What makes clinical research in developing countries ethical? The benchmark of ethical research. Journal of Infectious Diseases, 189(5), 930-937.

[7] Kayser, B., Mauron, A., & Miah, A. (2007). Current antidoping policy: a critical appraisal. BMC medical ethics, 8(1), 1.

[8] Ravinia, R., Tinto, H., Rouamba, A., Talisuna, Adoke, Y., Kadima Ebeja, A., Maketa, V., Grieftens, K.P., Buve, A. & Crawley, F. (2010). Health research: The challenges related to ethical review and informed consent in developing countries. Giornale Italiano Di Medicina Tropicale, 15.N.1-4, p15.

[9] Sumathipala, A., Siribaddana, S., & Patel, V. (2004). Under-representation of developing countries in the research literature: ethical issues arising from a survey of five leading medical journals. BMC Medical Ethics, 5(1), 1.

[10.] Schopper, D., Dawson, A., Upsani, R., Ahmad, A., Jesani, A., Ravinetto, R., Segelid, M.J., Sheel, S., & Sigh, J., (2015). Innovation in research ethics governance in humanitarian settings BMC medical ethics. DOI 1186/5 12910 - 015 – 0002 – 3

Abstract:

Background: Colostomy care is an important nursing intervention to ensure patient and family centered care. A number of patients go through colostomy procedure annually. The assessment of nurse's knowledge of colostomy care has not been conducted before in study hospital. Therefore, it is important to assess the knowledge of nurses caring for colostomy patients.

Purpose: The purpose of this study was to determine the effect of structured in-service education on knowledge level among nurses working in male and female surgical units.

Method: Participatory Action Research (PAR) approach was selected using pre and post - test method to assess the nurse's knowledge regarding colostomy care after the approval of IRB in a tertiary hospital, Islamabad, Pakistan.

Sample: The purposive sampling technique was used to select the study participants (n=39).

Finding: The study findings showed that in pre-test nearly all of the study participants (n=36, 92.3%) received the score between 0-10 (poor and average). While in post-test the majority of the study participants (n=34, 87.18%) received the score between 21-25 (excellent). Pair t-test showed the mean score in pre-test 6.08 ±3.74 and post-test mean score 22.38±5.54, P-value < 0.05, Paired‘t’ test revealed that the nurses gained significant knowledge after the structured in-service education.

Conclusion: The study concluded that there is an intense need for nurse managers to pay attention to this special area of nursing care by developing the mechanism for nurse's in-service education on regular basis for colostomy care. Moreover, future researches are warranted to validate the findings of this study.

Keywords: Colostomy care, pre-test, post-test, nurse's knowledge, assessment, in-service education.

References:

[1]. Anaraki, F., Vafaie, M., Behboo, R., Maghsoodi, N., Esmaeilpour, S., & Safaee, A. (2012). Quality of life outcomes in patients living with stoma. Indian Journal of Palliative Care, 18(3), 176-180. doi: 10.4103/0973-1075.105687

[2]. Ardigo, F. S., & Amante, L. N. (2013). Knowledge of the Professional about Nursing Care of People With ostomies and their Families. Text Context Nursing, 22(4), 1064-1071. doi: https://dx.doi.org/10.1590/S0104-07072013000400024

[3]. Baldwin, C. M., Grant, M., Wendel, C., Hornbrook, M. C., Herrinton, L. J., McMullen, C., & Krouse, R. S. (2009). Gender differences in sleep disruption and fatigue on quality of life among persons with ostomies. J Clin Sleep Med, 5(4), 335-343.

[4]. Bales, I. (2010). Testing a computer-based ostomy care training resource for staff nurses. Ostomy Wound Manage, 56(5), 60-69.

[5]. Bhzeh, N. M., Teleb, S. M., Mahmoud, M. A., & Soliman, A. M. (2013). Colostomy: Developing Nursing Care Standards for Patient with Colostomy. The Medical Journal of Cairo University, 81(2), 57-64.

[6]. Bulkley, J., McMullen, C. K., Hornbrook, M. C., Grant, M., Altschuler, A., Wendel, C. S., & Krouse, R. S. (2013). Spiritual well-being in long-term colorectal cancer survivors with ostomies. Psychooncology, 22(11), 2513-2521. doi: 10.1002/pon.3318

[7]. Burch, J. (2011). Resuming a normal life: holistic care of the person with an ostomy. British Journal of Community Nursing, 16(8), 366-373. doi: 10.12968/bjcn.2011.16.8.366

[8]. Dabirian, A., Yaghmaei, F., Rassouli, M., & Tafreshi, M. Z. (2011). Quality of life in ostomy patients: a qualitative study. Patient preference and adherence, 5, 1-5. doi: 10.2147/ppa.s14508

[9]. Gül, P., Ayhan, A., & Tevfik, P. (2013). Emotions of gynecologic cancer patients dealing with permanent colostomy: a qualitative interview study. Journal of Cancer Therapy, 4(6), 1060-1067. doi: http://dx.doi.org/10.4236/jct.2013.46120

[10]. Krans, B. (January 8, 2016). What is Colostomy Retrieved June 28, 2016, from http://www.healthline.com/health/colostomy#Overview1

[11]. Krouse, R. S., Herrinton, L. J., Grant, M., Wendel, C. S., Green, S. B., Mohler, M. J., … Hornbrook, M. C. (2009). Health-Related Quality of Life Among Long-Term Rectal Cancer Survivors With an Ostomy: Manifestations by Sex. Journal of Clinical Oncology, 27(28), 4664-4670. doi: doi:10.1200/JCO.2008.20.9502

[12]. Lebona, B., Jasmine, E., Lakshmi, K., & Indira, D. (2016). Assess the knowledge regarding colostomy care among staff nurses and nursing students in NMCH, Nellore International Journal of Applied Research, 2(5), 306-310.

[13]. Polit, D. F., & Beck, C. T. (2004). Nursing research principles and methods (Seventh ed.). Philadelphia: Lippincott Williams & Wilkins.

[14]. Recalla, S., English, K., Nazarali, R., Mayo, S., Miller, D., & Gray, M. (2013). Ostomy care and management: a systematic review. Journal Wound Ostomy Continence Nurses, 40(5), 489-500; quiz E481-482. doi: 10.1097/WON.0b013e3182a219a1

[15]. Sinha, A., Goyal, H., Singh, S., & Rana, S. P. (2009). Quality of life of ostomates with the selected factors in a selected hospital of delhi with a view to develop guidelines for the health professionals. Indian journal of palliative care, 15(2), 111-114. doi: 10.4103/0973-1075.58455

[16]. Smith, D. M., Loewenstein, G., Rozin, P., Sherriff, R. L., & Ubel, P. A. (2007). Sensitivity to disgust, stigma, and adjustment to life with a colostomy. Journal of research in personality, 41(4), 787-803. doi: 10.1016/j.jrp.2006.09.006

[17]. Sun, V., Grant, M., McMullen, C. K., Altschuler, A., Mohler, M. J., Hornbrook, M. C., … Krouse, R. S. (2014). From diagnosis through survivorship: health-care experiences of colorectal cancer survivors with ostomies. Support Care Cancer, 22(6), 1563-1570. doi: 10.1007/s00520-014-2118-2

[18]. Thamilselvam, P., Khairuzi, S., & Fadzli, I. (2013). Quality of life after colostomy. Reviews of Progress, 1(19), 1-4. doi: http://reviewsofprogress.org/UploadedArticle/37.pdf

[19]. Zakri, R. H., Shah, S. A., Khaliq, T., & Asghar, T. (2010). Impact of Ostomy Surgery on Hospitalized Patients at a Tertiary Care Hospital in Pakistan. Ann. Pak. Inst. Med. Sci, 6(1), 36-39.

Abstract:

Ever since the birth of mankind there has been a relationship between life, disease, nature and herbal medicinal plants. Primitive medicine men started studying diseases and treatments through the use of nature around him. Through their intuition and by regular practice of trial and error methods, they identified and evolved a system of medical knowledge on herbal remedies. The history of herbal medicine is as old as human history.

In recent decades, there are malpractices, by some unethical herbal practitioners and herbal drug manufactures, which are injurious and at times fatal to the people. Hence the need for standardization of herbal medicine and enforcement of regulations for the same, are indispensable. This Article strives to analyze various measures of standardization, regulations and actions against malpractices in Herbal Medical System to safeguard the welfare of the people.

Keywords: Herbal Medical Systems, Standardization, Regulations, People’s welfare.

References:

[1]. Abhishek, K; Ashutosh, M and Sinha, BN (2006), “Herbal drugs- present status and efforts to promote and regulate cultivation”, The Pharma Review, 6, 73-77.

[2]. Abhishek, K; Ashutosh, M and Sinha, BN, “Herbal drugs- present status and efforts to promote and regulate cultivation”, Pharma Review, 2006 6, 73-77.

[3]. Bodhisattwa Maiti et al., “Recent Trends in Herbal Drugs: A Review”, International Journal of Drug Research and Technology, 2011,Vol.1 (1),17-25 

[4]. British Pharmacopoeia, Vol. IV, Appendix XVI B, A356–A363 (2005).

[5]. Good Manufacturing Practices for pharmaceutical products, In: WHO Expert Committee on Specifications for Pharmaceutical Preparations. Thirty-second report. Geneva, World Health Organization, 1992:14-59 (WHO Technical Report Series, No. 823).

[6]. H. Wagner, et al, “Handbook of Medicinal Plants”, Chapter 21, Haworth Medical Press, Binghamton (2001).

[7]. Harish, P (2001), “Herbal drugs”, Current Science, 81(1), 15

[8]. M.Mosihuzzaman and M. Iqbal Choudhary, “Protocols On Safety, Efficacy, Standardization, And Documentation Of Herbal Medicine”, Pure Applied. Chemistry, Vol. 80, No. 10, Pp. 2195–2230, 2008. Doi:10. (IUPAC Technical Report)

[9]. Page LR, “Whole Herbs or Standardized Plant Constituents?”, Total Health Journal, 2001,23(4):20.

[10]. Report by David R. and Walker, B, “Regulation of Herbal Medicines and Practitioners”, March 2015.

[11]. Romanian Pharmacopoeia X, Chap. IX, Ed, Medicala, Bucuresti (1993).

[12]. Satarupa Banerjee and Analava Mitra, “Changing Landscape of Herbal Medicine: Technology Attributing Renaissance”, International Journal of Pharmacy and Pharmaceutical Sciences, Vol.4,Supl.1, 2012

[13]. Sukhdev, S; Arun, N and Kalia, AN (2008), “Patentability of herbal products: A review”, The Pharma Review, 4,118-124.

[14]. The Madras Public Health Act 1939 & The Travancore-Cochin Public Health Act 1955.

[15]. Vardana Garg et al., “Facts about Standardization of Herbal Medicine: A Review”, Journal of Chinese Integrative Medicine, October 2012, Vol.10, No.10.

[16]. WHO technical report series, “Guidelines for the Assessment of Herbal Medicines”, 1996, 863, 178-184.

[17]. WHO Global Survey, “National Policy on Traditional Medicine and Regulation of Herbal Medicines”, World Health Organization Geneva, May 2005, 168 pages.

[18]. Willard T, “Edible and Medicinal Plants of the Rocky Mountains”, Calgary, Wild Rose College of Natural Healing,1996.

[19]. WHO guidelines on safety monitoring of herbal medicines in pharmacovigilance systems, World Health Organization, Geneva, 2004

[20]. Winslow, L; Kroll, DJ (1998), “Herbs as Medicines, Archives of Internal Medicine”, 158, 2192-2199.

Abstract:

Health care workers are at an increased risk of accidental needle stick injuries because of the environment in which they work.

Objective is to study the prevalence of needle stick injury in the hospital and preventive practices taken into consideration.

Cross-sectional study design used, in a secondary care hospital in kuje, Abuja, Nigeria. Participants were 161 doctors, nurses, lab technicians and hospital cleaners. Statistical analysis: chi-square test and proportions

High percentages (79.5%) of health care workers were reported to have had one or more needle stick injuries in their career. The average number of the injuries ever found was like 3.85% per health care workers. 36 (22.4%) reported to have had needle stick injuries in the last one month. More than half claimed it was due to tiredness that caused the injury. Most of the injuries occurred during recapping, most washed the site of injury with soap and water while few did nothing. Only 10 took post exposure prophylaxis of HIV/AIDS after their injury.

In conclusion occurrence of needle stick injuries were found to be common. Recapping of needles which is an avoidable practice was found to be part of the contributing factor to the injuries.

Therefore prevention of needle stick injuries is an integral part of preventive programs and training and retraining of hospital staff for safety practices in handling needles and sharp objects needs to be continuous in the hospital.

References:

[1]. Adeboye AA, Moss GB, Soyinka F, Kreiss Jk. The epidemiology of needlestick and sharp instrument accidents in Nigerian Hospital. Infect Control Hosp Epidemiol 1994; 15:27-31

[2]. British journal of medicine(occupational and environmental medicine);Journal List > Br.J Ind Med > v.44(8).1987 Aug

[3]. CCOHS; Canadian Center for occupational health and safety. https://www.ccohs.ca/oshanswers/diseases/needlestick. Copyright 1997-2016

[4]. Elder A, Paterson c. Sharp injuries in UK health care: A review of injury rates, viral transmission and potential efficacy of safety devices. Occup Med (Lond) 2006;56:566-74

[5]. Ganczak M., Bohatyrewicz A., Korzen M., Karakiewicz B. The comparison of sharp injuries reported by doctors versus nurses from surgical wards in the context of the prevalence of HBV, HCV and HIV infections. Pol Przegl Chir. 2012;84:190-195.(PubMed)

[6]. Gestal JJ. Occupational hazards in hospital: risk of infection. Br J Ind Med 1987 jul

[7]. Henderson D.K. management of needlestick injuries. JAMA.2012;307:75-84(PubMed)

[8]. Kirchner, B(2012). Safety in ambulatory surgery centers: Occupational safety and Health Administration surveys”. AORN Journal. 96: 540-5.

[9]. OSHA USD of Labour? www.osha,gov/SCTc/etools/hazards

[10]. Occupational health, safety and hygiene- The Carter center. www.cartercenter.org>org>lecture_notes

[11]. Pruss- ustun A, Rapiti E, Hustin Y. sharps injuries; global burden of disease from sharps injuries to health – care workers. Geneva: WHO; 2003(Who Environmental Burden of Disease Series, No.3)

[12]. Pournaras S, Tsakris A, Mandreveli K, Faitatzidou A, Douboyas J, Tourkantonis A. Reported needlestick and sharp injuries among health care workers in Greek general hospital. Occup Med (Lond) 1999;49;423-6

Abstract:

Background: With the increase in the rate of cancer morbidity, there was a marked increase in the research area for the development of strategies for the management of cancer disease. However, this objective could only be achieved through various phase of clinical trials requiring humans as a subject of study. This raised an ethical issue as survey research conducted in the form of questionnaires consisted of the classic questions of anxiety, depression, psychosis, or agitation which may or may not suit the patient’s ability to consent due to certain factors. In the present study, it was observed that how the patient and the care-giver supported in the completion of this research survey during the patient’s inpatient chemotherapy or outpatient radiotherapy treatment.

Objectives: The primary objective of the present study was to determine and analyze the percentage of cancer patients enrolled in the study that required assistance either from the interviewer or from the care-givers in filling up of the QOL questionnaire form during the inpatient chemotherapy or outpatient radiotherapy sessions.

Methods: It was a cross-sectional, descriptive, hospital based evaluation study. Total duration of the study was 5 months (December 2015- April 2016), conducted in Medical and Radiation Oncology department of DR. B.L. Kapur Memorial Hospital, New Delhi, India. A convenience sample of 60 patients with cancer was selected. They were further divided into Chemotherapy group (n= 30) and Radiotherapy group (n= 30). Therefore, 30 cancer patients were on chemotherapy and the other 30 cancer patients were on radiotherapy. Data was obtained through direct interview, using validated Psychological intervention tool in the form of Questionnaire: WHOQOL-Bref Questionnaire, Zung Self-Rating Anxiety scale and Zung Self-Rating Depression scale.

Results: A total of 60 cancer patients were included in the study in which Chemotherapy group consisted of 30n cancer patients and Radiotherapy group consisted of 30n cancer patients. In the study, 6(20%) were males and 24(80%) were females in the chemotherapy group, and, 15(50%) were males and 15(50%) were females in the radiotherapy group. Majority of the patients 32(53.34%) were in the age range of 46-60 years. It was observed that maximum patients in chemotherapy, as well as, radiotherapy groups marked their ability to consent to participate in the study with less assistance from the researcher and the care-givers even during the treatment regimen.

Conclusion: It could be concluded from the results obtained from the study that the patients undergoing chemotherapy (66.6%), or radiotherapy (76.7%) sessions were able to consent freely without much assistance of the researcher or the care-giver. This further implied that in Indian scenario people are becoming more aware and thus, cooperated by participating in research studies so as to help manage the deadly disease “CANCER”.

Keywords: Cancer, Patient’s consent, Patient themselves, Assisted by researcher, Assisted by relatives.

References:

[1]. Ananthanarayanan, R. M., Janardhan, V., Kannan, G., Nigam, N., Palani, T., Rani, V., et al. (2011). Assessment of quality of life of cancer patients in a tertiary care hospital of South India. Journal of Cancer Research and Therapeutics, 275-279. Available at:http://medind.nic.in/jat/t11/i3/jatt11i3p275.htm

[2]. Nichita, E. C., & Buckley, P. F. (2007). Informed Consent and Competency: Doctor’s Dilemma on the Consultation Liaison Service. Psychiatry (Edgmont), 4(3), 53–55.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922359/

[3]. Sturman, E. D. (2005). The capacity to consent to treatment and research: A review of standardized assessment tools. Clinical Psychology Review, 954 – 974.

http://users.phhp.ufl.edu/rbauer/forensic_neuropsychology/capacity_consent_treat_research_05.pdf

[4]. Triebel, K. L., Martin, R. C., Nabors, L. B., & Marson, D. C. (2009). Medical decision-making capacity in patients with malignant glioma. Neurology, 73(24), 2086–2092.

http://doi.org/10.1212/WNL.0b013e3181c67bce

[5]. WHOQOL Group. (1998). Development of the World Health Organization WHOQOLBREF quality of life assessment. Psychol Med, 28:551–8.

[6]. Zung, W. W. K. (1971). A rating instrument for anxiety disorders. Psychosomatics, 12(6), 371–379. Available at: https://psychology-tools.com/zung-anxiety-scale/

[7]. Zung, W. W. K. (1965). A Self-Rating Depression Scale. (1965). Arch Gen Psychiatry, 12: 63-70. Available at: https://psychology-tools.com/zung-depression-scale/

Abstract:

Background: The quality of life of cancer patients during chemotherapy sessions or radiotherapy sessions encompasses several changes. However, patient had to suffer a lot during the sessions. In order to, measure their quality of life through manual way, it is advisable to implement the computerized electronic version of QLQ so that the patient could deal with the different questions independently without hesitation that might led to increase in cognitive ability during the sessions. Moreover, the healthcare professionals could direct and plan the treatment accordingly so as to improve the QOL of cancer patients.

Objectives: The overarching purpose of this study had been to evaluate the acceptability of QOL assessments among healthcare professionals and cancer patients, by addressing how QOL assessments could be utilized to predict anxiety and depression scores, and by revealing how technology could contribute to the accuracy of QOL assessments and facilitate their implementation into oncology practices. The introduction of the electronic version of the QLQ could however, benefit the overall QOL of patients by bridging the gap between research and clinical practice among Indian population.

Methods: It was a cross-sectional, descriptive, hospital based evaluation study. Total duration of the study was 5 months (December 2015- April 2016), conducted in Medical and Radiation Oncology department of Dr. B.L. Kapur Memorial Hospital, New Delhi, India. A convenience sample of 60 patients with cancer was selected. They were further divided into Chemotherapy group (n= 30) and Radiotherapy group (n= 30). Data was obtained through direct interview, using validated Psychological intervention tool in the form of Questionnaire: WHOQOL-Bref Questionnaire, Zung Self-Rating Anxiety scale and Zung Self-Rating Depression scale, which was further managed through a statistical program, using appropriate statistical tests.

Results: A total of 60 cancer patients were included in the study in which Chemotherapy group consisted of 30n cancer patients and Radiotherapy group consisted of 30n cancer patients. In the study, 6(20%) were males and 24(80%) were females in the chemotherapy group, and, 15(50%) were males and 15(50%) were females in the radiotherapy group. Majority of the patients 32(53.34%) were in the age range of 46-60 years.

Conclusion: Utilizing technology to implement QOL assessments into clinical practice has several advantages that make it more feasible for physicians to use QOL information with their patients for predicting and determining anxiety and depression scores during cancer treatment. Electronic methods of assessment are more accurate and less time-consuming than paper-and pencil questionnaires (manual method).

Keywords: Cancer, Chemotherapy, Radiotherapy, Quality of Life, WHOQOL-Bref Questionnaire, Zung Self-Rating Anxiety scale, Zung Self-Rating Depression scale, Computerized QOL, Electronic version.

References:

[1]. Perry, S., Kowalski, T. L., & Chang, C.-H. (2007). Quality of life assessment in women with breast cancer: benefits, acceptability and utilization. Health and Quality of Life Outcomes, 5, 24. http://doi.org/10.1186/1477-7525-5-24

[2]. WHOQOL Group. (1998). Development of the World Health Organization WHOQOLBREF quality of life assessment. Psychol Med, 28:551–8.

[3]. Zung, W. W. K. (1971). A rating instrument for anxiety disorders. Psychosomatics, 12(6), 371–379. Available at: https://psychology-tools.com/zung-anxiety-scale/

[4]. Zung, W. W. K. (1965). A Self-Rating Depression Scale. (1965). Arch Gen Psychiatry, 12: 63-70. Available at: https://psychology-tools.com/zung-depression-scale/

Abstract:

Background: During chemotherapy or radiotherapy sessions, cancer patients often go through a series of physical, psychological, social and environmental changes that affects the QOL of the patients. While assessing for the anxiety and depression scores affecting the QOL, maximum of the patients left the question of sexual activity, suicidal ideation and weight issues unanswered.

Objectives: The present paper focused on the issue of sexual activity, suicidal ideation, and weight changes during chemotherapy or radiotherapy sessions while determining the anxiety and depression scores for QOL of cancer patients during the treatment regimen.

Methods: It was a cross-sectional, descriptive, hospital based evaluation study. Total duration of the study was 5 months (December 2015- April 2016), conducted in Medical and Radiation Oncology department of Dr. B.L. Kapur Memorial Hospital, New Delhi, India. A convenience sample of 60 patients (Chemotherapy group (n= 30) and Radiotherapy group (n= 30)) with cancer was selected. Data was obtained through direct interview, using validated Psychological intervention tool in the form of Questionnaire: WHOQOL-Bref Questionnaire, Zung Self-Rating Anxiety scale and Zung Self-Rating Depression scale, which was further managed through a statistical program, using appropriate statistical tests.

Results: A total of 60 cancer patients were included in the study in which Chemotherapy group consisted of 30n cancer patients and Radiotherapy group consisted of 30n cancer patients. In the study, 6(20%) were males and 24(80%) were females in the chemotherapy group, and, 15(50%) were males and 15(50%) were females in the radiotherapy group. Majority of the patients 32(53.34%) were in the age range of 46-60 years.

Conclusion: It could be concluded from the present study that in Indian scenario, cancer patients felt sexual activity and suicidal ideation as a social stigma which is further accompanied by hesitation. Moreover, maximum patients observed stable weight and some patients observed increase in weight during chemotherapy sessions.

Keywords: Cancer, Chemotherapy, Radiotherapy, Quality of Life, missing values, sexuality, suicidal ideation, weight increased, weight stability.

References:

[1]. Deshpande, P. R., Sheriff, M. K., Nazir, A., Bommareddy, S., Tumkur, A., Naik, A. N. (2013). Patient-reported quality of life outcomes in Indian breast cancer patients: Importance, review of the researches, determinants and future directions. J Can Res Ther, 9 (1), 11-6. Doi: 10.4103/0973-1482.110341

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[5]. http://journals.lww.com/cancernursingonline/Abstract/2000/12000/Sexuality_and_the_Cancer_Survivor__A_SILENT.11.aspx

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[7]. http://www.ejmanager.com/mnstemps/109/109-1446880098.pdf?t=1468312514

[8]. WHOQOL Group. (1998). Development of the World Health Organization WHOQOLBREF quality of life assessment. Psychol Med, 28:551–8.

[9]. Zung, W. W. K. (1971). A rating instrument for anxiety disorders. Psychosomatics, 12(6), 371–379. Available at: https://psychology-tools.com/zung-anxiety-scale/

[10]. Zung, W. W. K. (1965). A Self-Rating Depression Scale. (1965). Arch Gen Psychiatry, 12: 63-70. Available at: https://psychology-tools.com/zung-depression-scale/

Abstract:

Background: In recent times there had been increase in incidence of cancer in India as nearly two people were diagnosed every minute with cancer. This is mainly attributed to urbanization, industrialization, life style changes, population growth and increased life span. There is no current universally accepted definition for quality of life (QOL) as it takes into account many aspects of life which is very difficult to define and measure. Therefore, there is wide range of concepts and opinions about "quality of life" and, over time, these concepts had been turning to the patient's perception about the disease and treatment and its effects, in an objective and subjective way. Evaluation of quality of life was attempted in two ways, objective assessments done by the interviewer and subjective assessments completed by the patients themselves. Nowadays, QOL could be defined by the WHO as an individual’s perception of their own position (experience) in life, in the context of the culture and value systems in their life and in relation to their goals, expectations, standards, and concerns. The proposed study was considered valuable since it emphasized on quality of life as one of the possible outcomes that stressed on the factor that patients with cancer often experienced a loss of control and feelings of helplessness, anxiety and depression during chemotherapy or radiotherapy treatment.

Objectives: This study was conducted to assess the Patient’s perspective of QOL with respect to different domains of Quality of Life in Cancer patients during inpatient Chemotherapy Treatment or outpatient Radiotherapy Treatment sessions. The primary objective was to analyze subjective impacting factors of QOL in homogenous surviving cancer patients receiving chemotherapy or radiotherapy sessions. Because patients were the best source of information for QOL data as the patients are the ones who are experiencing the effects of the illness and treatment, therefore they might provide a unique perspective on how QOL could be better assessed and defined with respect to treatment regimens.

Methods: It was a cross-sectional, descriptive, hospital based evaluation study. Total duration of the study was 5 months (December 2015- April 2016), conducted in Medical and Radiation Oncology department of DR. B.L. Kapur Memorial Hospital, New Delhi, India. A convenience sample of 60 patients with cancer was selected. They were further divided into Chemotherapy group (n= 30) and Radiotherapy group (n= 30). Therefore, 30 cancer patients were on chemotherapy and the other 30 cancer patients were on radiotherapy. Data was obtained through direct interview, using validated Psychological intervention tool in the form of Questionnaire: WHOQOL-Bref Questionnaire, Zung Self-Rating Anxiety scale and Zung Self-Rating Depression scale, which was further managed through a statistical program, using appropriate statistical tests.

Results: A total of 60 cancer patients were included in the study in which Chemotherapy group consisted of 30n cancer patients and Radiotherapy group consisted of 30n cancer patients. In the study, 6(20%) were males and 24(80%) were females in the chemotherapy group, and, 15(50%) were males and 15(50%) were females in the radiotherapy group. Majority of the patients 32(53.34%) were in the age range of 46-60 years. The study population had Breast cancer 33(55%), Head cancer 6(10%), and Neck cancer 21(35%). Anxiety affected the Physical domain

(p= 0.007), Environmental domain (p= 0.036) in the Chemotherapy group and Social domain

(p= 0.016) in the Radiotherapy group. On the other hand, Depression affected the Social domain (p= 0.043) in the Chemotherapy group, and Social domain (p = 0.012) in the Radiotherapy group. Values of p < 0.05 were considered to be statistically significant.

Conclusion: The cancer patients who completed this survey/research study were able to conceptualize their quality of life by clearly stating which areas of their life that was important to them and how satisfied they were with that area. It was observed that in the chemotherapy group, overall health was significantly correlated with the psychological domain (r= -0.395; p = 0.031), social domain (r= -0.429; p = 0.018), and environmental domain (r= -0.598; p < 0.001) of the WHOQOL-Bref questionnaire. On the other hand, the radiotherapy group showed no significant difference.

Keywords: Cancer, Chemotherapy, Radiotherapy, Quality of Life, WHOQOL-Bref Questionnaire, Zung Self-Rating Anxiety scale, Zung Self-Rating Depression scale, Physical domain, Psychological domain, Social domain, Environmental domain, Patient-reported outcomes, Open-ended questions, Overall Health satisfaction.

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Abstract:

Background: Prostate cancer has become the leading cancer and cause of death in Zimbabwean men. The number of confirmed prostate cancer cases has been on the increase since the turn of the century. Considering this trend a retrospective cross sectional study was carried out to determine the pattern of the disease and the role played by the prostate specific antigen in its detection.

Objectives: The aim of the study was to determine the emerging pattern and the role of the prostate specific antigen in the detection of prostate cancer.

Methodology: A retrospective cross sectional study using secondary data was carried out. Prostate specific antigen results of 176 outpatients who visited a small medical facility in the Midlands Province of Zimbabwe were retrieved. Of these 26 proceeded to have biopsies done and the histology reports were retrieved and analyzed. The data was analyzed using Graph Pad Prism 6 software.

Results: 14.2% of the patients were confirmed by biopsy to have prostate cancer. Prostate specific antigen levels of greater than 20 ng/ml were associated with biopsy confirmed Prostate Cancer.

Conclusion: It was found out that Prostate Cancer is a major health problem in Zimbabwean men. Despite the low specificity of the prostate specific antigen, the test still plays a major role in the detection of prostate cancer. The age of those with confirmed Prostate Cancer is going down. There is need for improved health budget and public health education in Zimbabwe.

Keywords: Emerging pattern, prostate cancer, prostate specific antigen, retrospective cross sectional, Zimbabwe

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Abstract:

Rectal cancer is a disease in which malignant (cancer) cells form in the tissues of the rectum. Age and family history can affect the risk of rectal cancer. Signs of rectal cancer include a change in bowel habits or blood in the stool. Rectal bleeding is a symptom of a problem in the GI (Gastrointestinal tract). The definition is broad as it means any blood passed rectally; consequently, the blood may come from any area or structure in the GI tract that allows blood to leak into the GI lumen (area where food and fluid is processed for absorption or removal as waste). For example, a bleeding ulcer in the stomach can have the blood excreted in the person's fecal material Rectal bleeding may be due to problems on the rectum itself or from many other problems that occur elsewhere in the GI tract. Perirectal bleeding is bleeding in an area adjacent to the rectum and may be due to abscesses or fistulas.

Rectal cancer is the growth of abnormal cancerous cells in the lower part of the colon that connects the anus to the large bowel. Rectal cancer develops usually over years; its actual cause is not known, but risk factors include increasing age (over 50), smoking, family history, high-fat diet, or a history of polyps or colorectal cancer or inflammatory bowel disease.

Radiation therapy can be used to kill or shrink rectal cancers. Follow-up is important to make sure that rectal cancer does not recur.

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