HIV Stigma Reduction for Health Facility Staff: Development of a Blended- Learning Intervention

Introduction: The effect of stigma on health and health inequity is increasingly recognized. While many medical conditions trigger stigmatization, the negative effects of HIV stigma are particularly well documented. HIV stigma undermines access, uptake, and adherence to both HIV prevention and treatment. People living with HIV face stigma in all aspects of their daily lives; however, stigma in the health system is particularly detrimental. A key component for health facility stigma-reduction interventions is participatory training of staff, often through several days of in-person training. Though this approach shows promise, it is time intensive and poses challenges for busy health facilities. In response, the DriSti study has developed a brief blended-learning approach to stigma reduction in Karnataka State, India. This paper describes the process and final content of the intervention development. The intervention is currently being tested. Final evaluation results will be published upon study completion.

Methods: Grounded in behavior change strategies based on social cognitive theory principles that stress the importance of combining interpersonal interactions with specific strategies that promote behavior change, we used a three-phase approach to intervention development: (1) content planning—review of existing participatory stigma-reduction training activities; (2) story boarding—script development and tablet content production; and (3) pilot testing of tablet and in-person session materials.

Results: The final intervention curriculum consists of three sessions. Two initial self-administered tablet sessions focus on stigma awareness, attitudes, fears of HIV transmission, and use of standard precautions. The third small group session covers the same material but includes skill building through role-play and testimony by a person living with HIV. A study team member administers the tablet sessions, explains the process, and is present throughout to answer questions.

Conclusion: This paper describes the theoretical underpinning and process of developing the blended-learning curriculum content, and practical lessons learned.The approach covers three key drivers of HIV stigma—stigma awareness, fear of HIV transmission, and attitudes. Developing video content for the self-directed learning is complex, requires a diverse set of people and skills, and presents unexpected opportunities for stigma reduction. Co-facilitation of the in-person session by someone living with HIV is a critical component.

Development of a Novel Tablet-based Approach to Reduce HIV Stigma among Healthcare Staff in India

Although stigma is considered to be one of the major barriers to reducing the AIDS epidemic in India, efforts to reduce stigma have not been sufficiently examined. In response, a partially computer-administered three-session stigma reduction intervention was developed and is currently being tested. This paper describes the technological design, development, implementation, and management of these in-person tablet-administered assessment and intervention sessions that are being used to evaluate the efficacy of this innovative stigma reduction intervention among nursing students and ward attendants in India.

Dense Annotation of Free-Text Critical Care Discharge Summaries from an Indian Hospital and Associated Performance of a Clinical NLP Annotator

Electronic Health Record (EHR) use in India is generally poor, and structured clinical information is mostly lacking. This work is the first attempt aimed at evaluating unstructured text mining for extracting relevant clinical information from Indian clinical records. We annotated a corpus of 250 discharge summaries from an Intensive Care Unit (ICU) in India, with markups for diseases, procedures, and lab parameters, their attributes, as well as key demographic information and administrative variables such as patient outcomes. In this process, we have constructed guidelines for an annotation scheme useful to clinicians in the Indian context. We evaluated the performance of an NLP engine, Cocoa, on a cohort of these Indian clinical records. We have produced an annotated corpus of roughly 90 thousand words, which to our knowledge is the first tagged clinical corpus from India. Cocoa was evaluated on a test corpus of 50 documents. The overlap F-scores across the major categories, namely disease/symptoms, procedures, laboratory parameters and outcomes, are 0.856, 0.834, 0.961 and 0.872 respectively. These results are competitive with results from recent shared tasks based on US records. The annotated corpus and associated results from the Cocoa engine indicate that unstructured text mining is a viable method for cohort analysis in the Indian clinical context, where structured EHR records are largely absent.

Real-time feedback for improving compliance to hand sanitization among healthcare workers in an open layout ICU using radiofrequency identification

The aim of this study is to increase hand sanitizer usage among healthcare workers by developing and implementing a low-cost intervention using RFID and wireless mesh networks to provide real-time alarms for increasing hand hygiene compliance during opportune moments in an open layout Intensive Care Unit (ICU). A wireless, RFID based system was developed and implemented in the ICU. The ICU beds were divded into an intervention arm (n = 10) and a control arm (n = 14). Passive RFID tags were issued to the doctors, nurses and support staff of the ICU. Long range RFID readers were positioned strategically. Sensors were placed beneath the hand sanitizers to record sanitizer usage. The system would alert the HCWs by flashing a light if an opportune moment for hand sanitization was detected. A significant increase in hand sanitizer use was noted in the intervention arm. Usage was highest during the early part of the workday and decreased as the day progressed. Hand wash events per person hour was highest among the ancilliary staff followed by the doctors and nurses. Real-time feedback has potential to increase hand hygiene compliance among HCWs. The system demonstrates the possibility of automating compliance monitoring in an ICU with an open layout.

Electronic health records and information portability: a pilot study in a rural primary healthcare center in India

Clinical documentation and health information portability pose unique challenges in urban and rural areas of India. This article presents findings of a pilot study conducted in a primary health center in rural India. In this article, we focus on primary care in rural India and how a portable health record system could facilitate the availability of medical information at the point of care. We followed a geriatric cohort and a maternal cohort of 308 participants over a nine-month period. Physician encounters were entered into a web-based electronic health record. This information was made available to all study participants through a short messaging service (SMS). Additionally, 135 randomly selected participants from the cohort were issued a USB-based memory card that contained their detailed health records and could be viewed on most computers. The dual portability model implemented in the pilot study demonstrates the utility of the concept.

Contributors to frequent telehealth alerts including false alerts for patients with heart failure: a mixed methods exploration

BACKGROUND

Telehealth data overload through high alert generation is a significant barrier to sustained adoption of telehealth for managing HF patients.

OBJECTIVE

To explore the factors contributing to frequent telehealth alerts including false alerts for Medicare heart failure (HF) patients admitted to a home health agency.

MATERIALS AND METHODS

A mixed methods design that combined quantitative correlation analysis of patient characteristic data with number of telehealth alerts and qualitative analysis of telehealth and visiting nurses' notes on follow-up actions to patients' telehealth alerts was employed. All the quantitative and qualitative data was collected through retrospective review of electronic records of the home heath agency.

RESULTS

Subjects in the study had a mean age of 83 (SD = 7.6); 56% were female. Patient co-morbidities (p<0.05) of renal disorders, anxiety, and cardiac arrhythmias emerged as predictors of telehealth alerts through quantitative analysis (n = 168) using multiple regression. Inappropriate telehealth measurement technique by patients (54%) and home healthcare system inefficiencies (37%) contributed to most telehealth false alerts in the purposive qualitative sub-sample (n = 35) of patients with high telehealth alerts.

CONCLUSION

Encouraging patient engagement with the telehealth process, fostering a collaborative approach among all the clinicians involved with the telehealth intervention, tailoring telehealth alert thresholds to patient characteristics along with establishing patient-centered telehealth outcome goals may allow meaningful generation of telehealth alerts. Reducing avoidable telehealth alerts could vastly improve the efficiency and sustainability of telehealth programs for HF management.

Implementing an online reporting system in the anatomical pathology department of a tertiary care teaching hospital in India: a case study

This article presents a case study in designing, developing, and implementing a web-enabled reporting application for the anatomical pathology (histopathology) department of a tertiary care teaching hospital in India. The article describes workflows, requirements assessment, and implementation methods that the investigators adopted for deploying the solution. The primary focus of the study was to demonstrate the requirements assessment performed, the strategies adopted, and the challenges encountered during the development and implementation. The study demonstrates a successful deployment as well as successful adoption of healthcare information technology by the end users. Factors that played a crucial role in adoption included the combination of people, processes, and technology. The lessons learned from this study would help application developers design efficient systems that suit the requirements of the end users while keeping in mind the ever-changing need for workflows and scalability in a developing country.

Effect of ethanolic extract of clove on the keeping quality of fresh mutton during storage at ambient temperature (25 ± 2 °C)

Antimicrobial potential of ethanolic extract of clove (Eugenia caryophyllata) on fresh mutton during storage at 25 ± 2 °C was evaluated. The extract inhibited spoilage and pathogenic microflora of mutton previously treated with acidulants to reduce surface microbial load and the surface pH, up to 4 days without any deleterious change in sensory and physical qualities. Biomarker cadaverine, an indicator of spoiling/spoiled mutton, was present in 1 day stored control samples and absent up to 4 days in treated mutton. The levels of other biomarkers like biogenic amine index (0.31 mg/100 g) and free fatty acids (1.52%) were lower in 4 days stored treated samples than 1 day stored control samples (3.6 mg/100 g and 2.4%, respectively). Thus, ethanolic extract of clove can be effectively used to improve the keeping quality of fresh mutton up to 4 days at 25 ± 2 °C.

Utilization of byproducts and waste materials from meat, poultry and fish processing industries: a review

India is bestowed with vast livestock wealth and it is growing at the rate of 6% per annum. The contribution of livestock industry including poultry and fish is increasing substantially in GDP of country which accounts for >40% of total agricultural sector and >12% of GDP. This contribution would have been much greater had the animal by-products been also efficiently utilized. Efficient utilization of by-products has direct impact on the economy and environmental pollution of the country. Non-utilization or under utilization of by-products not only lead to loss of potential revenues but also lead to the added and increasing cost of disposal of these products. Non-utilization of animal by-products in a proper way may create major aesthetic and catastrophic health problems. Besides pollution and hazard aspects, in many cases meat, poultry and fish processing wastes have a potential for recycling raw materials or for conversion into useful products of higher value. Traditions, culture and religion are often important when a meat by-product is being utilized for food. Regulatory requirements are also important because many countries restrict the use of meat by-products for reasons of food safety and quality. By-products such as blood, liver, lung, kidney, brains, spleen and tripe has good nutritive value. Medicinal and pharmaceutical uses of by-product are also highlighted in this review. Waste products from the poultry processing and egg production industries must be efficiently dealt with as the growth of these industries depends largely on waste management. Treated fish waste has found many applications among with which the most important are animal feed, biodiesel/biogas, dietectic products (chitosan), natural pigments (after extraction) and cosmetics (collagen). Available information pertaining to the utilization of by-products and waste materials from meat, poultry and fish and their processing industries has been reviewed here.

Rectal stricture: a complication of tuberculosis

Tuberculosis of the rectum is rarely reported, even from areas where tuberculosis, and gastrointestinal tuberculosis in particular, is prevalent. The authors report a case of long tubercular stricture of the rectum and distal part of the sigmoid colon in a 12-year-old girl. Because of nonspecific symptoms and noncharacteristic radiological and endoscopic features, the diagnosis of this rare entity rests mainly on histological evidence of the classical tubercle in a surgical biopsy specimen.

Cystic teratoma of the pancreas

Cystic teratoma of the pancreas is an extremely rare entity: only 11 cases have been described so far in the world literature. We report the 12th case, in a 4-month-old girl.

Retrograde intussusception: a lead-point for prograde intussusception

Retrograde intussusception is an extremely rare entity. The authors report a case of retrograde jejuno-jejunal intussusception in a 12 year old. The features of interest are (1) the retrograde intussusception mass acting as a lead-point for a second prograde jejuno-jejunal intussusception, (2) the anastomotic suture line of a previous resection-anastomosis acting as the lead-point for the retrograde intussusception, and (3) the presence of a "reverse claw sign" (on a barium meal study) caused by the intussusceptum of the retrograde intussusception.

Spontaneous umbilical fistula: a rare complication of ventriculoperitoneal shunt

Although complications following ventriculoperitoneal shunt for hydrocephalus are not uncommon, leak of cerebrospinal fluid from the normal umbilicus following ventriculoperitoneal shunt is very rare. One such case is reported.

Meckel's diverticulum in children

Twenty one surgically documented cases of Meckel's diverticulum in children treated at Kasturba Hospital, Manipal since 1981 are reviewed. Of them, 14 presented with intestinal obstruction, 2 with pain abdomen, 2 with Littre's hernia and 2 were found incidentally. Only one patient presented with gastrointestinal bleeding. The clinical profile of these patients is analyzed.

Lingual dermoid

Dermoid cysts are congenital lesions derived from ectodermal differentiation of multipotential cells. Only 7% of all dermoid cysts occur in the head and neck region and about a quarter of them are seen in the floor of mouth. Dermoids confined to the tongue are rare entities. Only 13 such cases, mostly in infants, have been reported in literature. One such case of an infant with intralingual dermoid and feeding difficulty, relieved following cyst excision, is reported.

Cysticercosis of the tongue

Cysticercosis is a condition where man forms the intermediate host for the proglottids of Taenia solium. The common sites of cysticercosis are brain, skeletal muscle and subcutaneous tissues, but they can be found at any site. An unusual case of lingual cysticercosis is being reported.

Intra-abdominal lymphatic cysts in children

Ten children with intra abdominal lymphatic cysts operated in the last 8 years are reported. They formed 0.50% of all pediatric surgical admissions and 33.3% of all intra-abdominal cystic lesions. The mean age was 5 1/2 years and the male-female ratio was 1:1. Half the cysts were in the mesentery and 30% in the omentum. The other 2 cysts were located at unusual sites. Two children having mesenteric cysts presented as abdominal emergencies. Three of them were wrongly diagnosed and treated for tuberculous ascites before laparotomy. Four mesenteric cysts were excised along with the adjoining intestinal segment, and one was drained by tube marsupialisation. All 3 omental cysts and the two cysts at unusual sites were excised in toto. There was no mortality or morbidity.

Hepatoblastoma in siblings

Two infants, a brother and sister, with hepatoblastoma of the right lobe of the liver were treated and are alive and lead normal lives. Only three other familial occurrences of this tumor have so far been documented.

Problematic ulcerative lesions in sexually transmitted diseases: surgical management

Chronic intractable ulcerative lesions, with or without lymphedema, are occasional sequelae of various sexually transmitted diseases that lead to gross morbidity. This study of 15 such cases, including seven of granuloma inguinale, four of lymphogranuloma venereum, three of confined lesions (granuloma inguinale and lymphogranuloma venereum), and one of sexually transmitted amebic ulcer of the penis, employed surgical procedures aimed at sound healing after a single-stage procedure. The surgical techniques included full skin cover by direct flaps, myocutaneous flaps, sliding flaps (floating island), and excision of the involved rectum (two cases). Nine lesions healed by primary intention, one by spontaneous contraction of the wound, and two needed limited secondary procedures. In view of the paucity of literature on the subject, an argument is made for identifying such cases and saving them from prolonged morbidity by a suitable single-stage surgical procedure.