Search

Aim and objective To reduce the incidence of infiltration and phlebitis by 50% over 2 months among children admitted to the emergency room (ER) of a tertiary care hospital. Materials and methods The study was conducted in the pediatric ER of a tertiary care hospital in North India. All children aged >28 days, receiving intravenous (IV) medication and/or fluids, were enrolled between June (2017) and September (2017). Existing practices of IV line insertion and maintenance were observed and recorded. The visual infusion phlebitis score and infiltration assessment scale were to grade the extent of two. The intervention classified as “IV line insertion and maintenance bundle” included the introduction of low-cost mobile sterile compartment trays, audit and feedback, organizational change, introduction of infection control nurse and quality improvement (QI) team formations were implement in different Plan-Do-Study-Act (PDSA) cycles. Reduction in the “incidence of phlebitis and infiltration” was outcome measures while “scores on checklist of IV line insertion and IV line maintenance and administration of drugs” were process measures. Result The process measures, for IV line insertion, maintenance and administration of drugs through IV line, revealed an increase in scores on the checklist. There was a significant decrease in the incidence of infiltration and phlebitis from 82.9 and 96.1% to 45 and 55%, respectively, postimplementation of all PDSA cycles. Conclusion Multifaceted QI IV line insertion and maintenance bundle reduced the incidence of infiltration and phlebitis. These interventions when integrated into daily work bundles along with continuous education and motivation help in sustaining the goal and attaining long-term success. How to cite this article Singh N, Kalyan G, Kaur S, Jayashree M, Ghai S. Quality Improvement Initiative to Reduce Intravenous Line-related Infiltration and Phlebitis Incidence in Pediatric Emergency Room. Indian J Crit Care Med 2021;25(5):557–565.

Introduction: Low- and middle-income countries (LMICs) face numerous challenges in the implementation of noncommunicable disease (NCD) prevention programs due to a shortage of health manpower. Task shifting to nurses is a viable and effective solution to address the health-care human resource crisis. The major advantage of involving nurses is that they are the largest, skilled, and already established workforce in any health-care institution. Despite the effectiveness of NCD interventions by nurse practitioners (NPs), there is a relative lack of evidence from LMICs which prevents the scale-up of the NPs model for better health outcomes. We, therefore, intend to assess the existing evidence on the effectiveness of interventions by NPs for the management of chronic NCDs in LMICs. Methods and Analysis: Electronic databases, i.e., PubMed, Excerpta Medica Database (EMBASE), CINAHL, Cochrane Central Register of Controlled Trials, and clinical registries of different LMICs in the English language shall be searched between 2004 and 2019 (last 15 years). Research designs to be included are randomized controlled trials, before–after studies, and Quasi-experimental studies. The primary outcome includes the change in behavioral risk factors, physiological risk factors, and clinical parameters. Subgroup and sensitivity analysis will be performed. Ethics and Dissemination: Ethical approval has been obtained from the institute ethics committee. Results will be disseminated through peer-reviewed scientific journals and presentation at national and international conferences. Study Design: Systematic review. PROSPERO registration number CRD42019118430

Context: Chronic kidney disease (CKD) patients have suboptimal quality of life (QOL). Various studies/researches have revealed that breathing exercises have a positive and favorable impact on different systems of the body. Aims: This study aims to assess the effect of a breathing training program on QOL in patients with predialysis CKD. Settings: The study was a single-center study conducted at PGIMER, Chandigarh. Design: Randomized controlled trial. Methods: Sixty individuals were enrolled and randomized using lottery method. QOL was assessed or evaluated by Kidney Disease and QOL questionnaire (KDQOL™-36). Breathing exercises were taught to the intervention group. Patients included in control group continued with the routine care. Assessment of QOL was done after 4 weeks in both the groups. Results: Change in KDQOL™-36 scores showed significant difference between control and the intervention group. The mean scores of control group in the subscale effects of kidney disease, SF-12 Physical functioning (Physical Health Composite) and SF-12 Mental functioning (Mental Health Composite) were 84.79, 39.16 and 37.40, respectively, whereas in intervention group, the respective mean scores were 91.88, 43.92, and 44.16. The difference was statistically significant (P = 0.04, P = 0.01, and P = 0.003, respectively). Conclusions: Breathing training program improves QOL in patients with predialysis CKD.

Background: Marriage has a complex relationship with mental illness. The marriage of a person with mental illness (PMI) is a controversial issue with varied opinions. There is a dearth of studies exploring perception about marriage among caregivers of patients with severe mental disorders. Materials and Methods: Thirty caregivers were interviewed in depth using a semi-structured interview schedule. Quantitative data were analyzed using MS Excel, while qualitative data were interpreted based on Colaizzi's framework. Results: About half (53%) of the caregivers believed that PMI should marry, and 46% of caregivers believed that marriage could worsen the mental illness of their patient. The qualitative analysis showed that factors that affect the decision among caregivers to get their mentally ill wards married include shovelling off the stigma of keeping the unmarried ward at home and to have somebody to take care of the unmarried ward after their death. Many caregivers believe that marriage and/or sexual intercourse can be a cure/treatment for various mental disorders. Conclusion: Caregivers of patients with severe mental illness have many misconceptions about the association of marriage and outcome of mental illnesses.

Introduction: Stroke rehabilitation and caregivers training is central to improve post stroke care and reduce caregivers’ burden. Mobile applications(app) may provide a patient and caregiver centric modality to improve stroke care Aim: To develop and evaluate feasibility of a medical application for delivering post stroke care. Methods: A mobile app was developed on an android operating system following a preliminary assessment of post stroke complications to train caregivers. App consists of videos of home based care strategies for bedsore prevention, feeding, mouth care, ROM exercises, catheter care, psychological support to patients etc. App includes awareness videos on stroke, problems faced after stroke, follow up schedule, feedback option. App feasibility was assessed among 25 bedridden stroke survivors and their caregivers selected purposely. App validation was done by 16 stroke experts including neurologists, nurses, psychologists, physiotherapists using semi-structured-questionnaire for data collection. Following this, final "Stroke Home Care" app was developed. Results Feasibility: Mean age of patients and caregivers was 52.6±14.8 and 32.4±8.9years, respectively. 64% patients females, 75% caregivers males. 56% lived in rural. Median NIHSS 14 (IQR: 12-17). Complications were 56% Ryle’s tube, 72% Foley’s catheter, 12% bedsore. 64% caregivers were graduates. 52% sons. All caregivers responded that app contents, videos and language was understandable and appropriate. 92% preferred ‘Hindi’ language. All agreed to App enhancing their stroke knowledge. All were satisfied. Validation: Mean age of experts was 33.2±4years. 75% females. 56% nursing experts and postgraduates,19% MDs. 50% Nursing teachers, 19% Neurology fellows. None faced any app installation problem. 81.3% experts highly satisfied with app functions, its contents, voice clarity, video clarity and duration, contents’ sequence, understandability. Discussion/Conclusion: “Stroke Home Care” App is feasible, pragmatic and user-friendly for use by caregivers of stroke survivors in a resource limited setting/developing country. It should be tested by an RCT to evaluate its efficacy in reducing post stroke complications and reducing caregivers’ burden.

Background Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality in India. CVDs are to a large extent preventable with the availability of wide range of interventions focusing on primary and secondary prevention. However human resource deficit is the biggest challenge for implementing these prevention programs. Task shifting of the cardiovascular risk assessment and communication to nurses can be one of the most viable and sustainable option to run prevention programs. Methods The study was quasi experimental in nature with 1 year follow up to determine the effect of CVD risk assessment and communication by nurses with the help of risk communication package on primary and secondary prevention of CVDs. The study was done in the outpatient departments of a tertiary health care center of Northern India. All the nurses (n = 16) working in selected OPDs were trained in CVD risk assessment and communication of risk to the patients. A total of 402 patients aged 40 years and above with hypertension (HTN) were recruited for primary prevention of CVDs from medicine and allied OPDs, whereas 500 patients who had undergone CABG/PTCA were recruited from cardiology OPDs for secondary prevention of CVDs and were randomized to intervention (n = 250) and comparison group (n = 250) by using block randomization. CVD risk modification and medication adherence were the outcomes of interest for primary and secondary prevention of CVDs respectively. Results The results revealed high level of agreement (k = 0.84) between the risk scores generated by nurses with that of investigator. In the primary prevention group, there were significantly higher proportion of participants in the low risk category (70%) as compared to baseline assessment (60.6%) at 1 year follow up. Whereas in secondary prevention group the mean medication adherence score among intervention group participants (7.60) was significantly higher than that of the comparison group (5.96) with a large effect size of 1.1.(p Conclusion Nurse led intervention was effective in risk modification and improving medication adherence among subjects for primary and secondary prevention of CVDs respectively. Trial registration Trial registration no CTRI/2018/01/011372 [Registered on: 16/01/2018] Trial Registered Retrospectively.

Background: Hospitalisation is a stressful situation especially for children. Health care providers (HCPs) play an important role in caring for the sick children. Objective: To assess the health care providers’ collaboration and satisfaction about care decisions and parents’ satisfaction about care provided to the patients admitted in Pediatric Intensive Care Unit. Materials and Methods: This was a descriptive study conducted among 32 HCPs working in PICU and 50 parents of children admitted to the PICU of a tertiary care teaching and referral hospital in India. The subjects were selected by total enumeration sampling method. Information profile details and data related to parental satisfaction were gathered using a structured interview schedule. Data related to HCPs’ collaboration and satisfaction about care decisions were gathered using a structured questionnaire. The data were analyzed using SPSS (Version 20.0). Results: Majority of the parents were highly satisfied (92%) with the care provided by the HCPs. More than two-third (87.5%) of the HCPs were highly satisfied with the collaboration among them related to care decisions. Conclusion: Majority of the parents of children admitted to PICU, were highly satisfied with the care provided to their children. Furthermore, most HCPs showed a high level of collaboration among themselves and were satisfied with the care decisions related to the PICU children.

Objective: To evaluate the effectiveness of interventional package on the level of anxiety, depression, and fatigue. Methods: The study was conducted in room no. 5, first floor, B Block, Department of Radiotherapy, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh Quasi experimental pretest-posttest design was used in the study. A total of 60 patients receiving radiotherapy/chemotherapy were assigned in two groups of 30 each, through total enumeration sampling technique. The tools used for the study were Zung Anxiety Scale, Beck Depression inventory, and Fatigue Scale. The protocol used for the study includes the Jacobson's Progressive muscle relaxtion technique, counsling and home care techniques. Results: Sociodemographic variables and clinical profile of participants in both groups were comparable. Interventional package significantly reduces the anxiety, depression, and fatigue (P < 0.001 in 3 variables) in experimental group. Conclusions: Interventional package for patients with cervical cancer proved to be an effective modality in reducing the anxiety, depression, and fatigue.

Objective: The study was conducted to assess the effectiveness of “percutaneous coronary intervention (PCI) care program” among patients undergoing PCI. Subjects and Methods: A quasi-experimental design was adopted, and purposive sampling technique was used to enroll the patients in the experimental and control groups. Different tools were used to collect the data, which include numerical pain and comfort rating scale, Barthel Index for activities of daily living, assessment for the presence of vascular complications, modified CADEQ-SV questionnaire, State-Trait Anxiety Inventory scale, self-structured satisfaction scale, and PCI manual. Results: There was a significant decrease observed in state anxiety (P < 0.001), pain level at 12 h (P = 0.03), discomfort within 12 h (P < 0.001) and 24 h (P = 0.002), improving knowledge regarding coronary artery disease (CAD) (P < 0.001), and activities of daily living as well as significant increase in satisfaction level (P < 0.001) among patients undergoing PCI in the experimental group than the control group. Conclusion: The study concluded that this program was effective in reducing anxiety, pain, and discomfort and increased satisfaction level, knowledge regarding CAD, and independence in self-care activities for PCI patients.

Background To evaluate the effectiveness of short-timed post-meal and one-time daily exercise on glycemic control in patients with T2DM. Methods Sixty-four T2DM patients were randomised into crossover design. Group A (n = 32) underwent post-meal exercise (moderate-intensity brisk walking covering 1500–1600 steps for 15 min, starting 15 min after each meal) from d1 to d60 followed by one-time daily exercise (45 min pre-breakfast brisk walking at stretch covering 4500–4800 steps) from d61 to d120, while it was vice versa for the group B (n = 32). The five-point blood glucose profile was performed on d1, d30, d60, d90 and d120, and HbA1c on d1, d60 and d120. Fitness wrist band was used for step-counting to ensure the intensity of exercise and compliance to exercise protocol. Results Group A patients showed a significant improvement in five point blood glucose profile and HbA1c after performing post-meal exercise (p

To investigate the efficacy of distraction by flippits/distraction cards in relieving pain associated with pediatric venipuncture process in young children.This study was a prospective, non-blinded, randomized controlled trial. The sample consisted of 210 children aged 4 to 6 y undergoing phlebotomy in the sampling room of the Advanced Pediatric Center outpatient department and were randomly assigned to control and intervention groups. Latter were exposed to distraction using flippits/distraction cards during the procedure. Pain was assessed for both groups by using FLACC (Face Legs Activity Cry Consolability) behavior pain assessment scale. In addition, procedural pain was also assessed by Wong Bakers Faces Pain Scale (WBFPS) using children and parents' report.Flippits (distraction cards) had a significant effect on behavioral response to pain in children during blood sampling as evidenced by lower mean pain scores in the intervention group (2.75 ± 0.97) as compared to the control group (3.24 ± 0.85) as per FLACC behavioral pain assessment scale (p 0.001). Parents and self reported pain as per Wong Baker Faces Pain Scale was also lower in the intervention group as compared to the control group (p 0.001). Odds of severe pain/discomfort (total pain score 7-10) were 2.5 times higher in controls as compared to the intervention group (OR 2.5; 95% CI: 1.40-4.45) (P 0.002).The use of simple distraction technique using flippits can significantly relieve the pain associated with blood sampling in children.

Objective: Cervical cancer is one of the most common malignancies among women. The present study aims to assess the risk factors for cervical cancer in women aged 25-80 years. Methods: The current study was a case-control study. In total, 75 age matched cases and 75 controls were enrolled. In case group sampling technique was total enumeration. Sampling for control group is done by purposive sampling. Women who satisfied the inclusion criteria were included in the study. A questionnaire was developed to assess the risk factors of cervical cancer among the participants. Face to Face interview were conducted with the participants. Results: There was a significant association (P < 0.05) of cervical cancer with education, place of residence, using an old cloth sanitary napkins, young age at marriage, number of husband's partners, washing the genitalia after sexual intercourse, and availability of health services. Bathing daily and during menstruations was found to be preventive factors for cervical cancer. In logistic regression, the utilization of health services and the presence of sexually transmitted infections showed a significant association with the development of cervical cancer. Conclusions: The present study aimed to assess the risk factors of cervical cancer. With prior knowledge of risk factors, cervical cancer can be identified. Identification of high-risk populations and starting early screening is found to be effective in early recognition of cervical cancer.

Background Behavioral symptoms among postoperative patients with intracranial tumors and distress among caregivers are common. Objectives This article aimed to assess the effectiveness of a brief nurse-led intervention on behavioral symptoms of postoperative patients with intracranial tumors and distress of their caregivers. Methods A randomized controlled trial was conducted on 80 patients with intracranial tumors and their family caregivers in a tertiary care institute in India. A brief nurse-led intervention was provided in the form of individual counseling, and a pamphlet was given to patients and caregivers in the experimental group at the time of discharge. Behavioral symptoms of patients and distress of caregivers were assessed. Findings Patients in the experimental group had significantly fewer behavioral symptoms and less severity of behavioral symptoms as compared to the control group. Caregivers in the experimental group had significantly less severity of distress as compared to the control group.

Background: Alcoholism is considered as a major health as well as a social problem. Often the family members of alcoholics suffer intense psychological, physical and social trauma due to the core drinking problem of the family member. Most deeply affected are the wives of alcoholics. Aim: The present descriptive study aimed to investigate the problems faced and coping strategies used by the wives of alcoholics. Methodology: A total of 30 wives of alcoholic clients seeking treatment in De-addiction Centre were interviewed for the same. The problems were identified using a non standardized 17 item structured questionnaire while coping in wives of alcoholics was assessed using standardized tool. Results: The findings revealed the problems faced by alcoholics wives were in multiple domains viz. physical, psychological and social. While most highly reported were the emotional problems and least reported were the problems of physical violence. Coping strategies used by wives of alcoholics were reported in three major styles: engaged, tolerant and withdrawal. Conclusion and Recommendations: The problems faced by alcoholics have often wedged the attention in society yet finding and applying effective interventions to reduce the pain and suffering of being a partner of alcoholic is still a challenge.

The effectiveness of music therapy for relieving pain and anxiety during burn dressing changes has not been reported from India. PURPOSE This study was conducted to assess the effect of music therapy on pain, anxiety, opioid use, and hemodynamic variables during burn dressing change. METHODS Patients in a tertiary care burn unit who were >10 years old, conscious, able to respond, and oriented to time, place, and person participated in a 2-month, quasi-experimental, cross-over pilot study. Each served as his/her own control. Dressings were changed every other day alternating between the control (standard pain management) and experimental (control plus patient-selected music) intervention. Pain was assessed using a numerical rating scale, anxiety was scored using the State Trait Anxiety Test (higher scores indicated more pain and anxiety), and hemodynamic parameters and analgesics were recorded. Wilcoxon Test and chi-squared tests were utilized for statistical analysis. RESULTS Median pain scores (5, interquartile range [IQR] IQR: 3-7; and 6, IQR: 5-8) and median anxiety scores (12, IQR: 8-17; and 14, IQR: 10-19) were significantly lower during the experimental than during the standard dressing change, respectively (P

Background: Yoga is proven beneficial in improving quality of life among breast cancer survivors receiving chemotherapy, but its effectiveness in lymphoma patients needs to be explored. As chemotherapy-induced neutropenia is very common among lymphoma patients, they are much prone to infections from the environment. Furthermore, trained yoga instructors are not available in every setting, so there is a need to develop home-based yoga program modules for lymphoma patients receiving chemotherapy. Aim: The aim of the study was to explore the feasibility and safety of yogic exercises among lymphoma patients during chemotherapy. Subjects and Methods: An interventional, single-arm prepost design study was conducted at a tertiary health-care center. Patients suffering from malignant lymphoma (18–65 years) with Eastern Cooperative Oncology Group performance status from 0 to 2, planned to receive chemotherapy were administered a home-based yoga program over a period of 2 months from the start of chemotherapy. The primary outcome variables were retention rate, acceptance rate, safety, and adherence. Health-related quality of life (HRQOL), fatigue level, overall sleep quality, depression, anxiety level, and pain were also assessed. Statistical Analysis: Descriptive statistics was used to see the feasibility and adherence. The paired t-test was used to compare various pre and postintervention outcome measures. Results: Fourteen patients (median age: 36 years, range13–65 years) of malignant lymphoma were enrolled in the study. Male-to-female ratio was 9:5. Non-Hodgkin's lymphoma patients constituted 64%. The recruitment rate was 93%. Favorable retention (100%), acceptability (97%), adherence (78.6%), and no serious adverse events following yoga practice were reported. Improvement was also found in HRQOL, fatigue, sleep, depression, and anxiety. However, it needs further validation in a randomized study. Conclusion: Home-based yoga program is safe and feasible among the patients suffering from malignant lymphoma receiving chemotherapy.

Background: Ventriculoperitoneal (VP) shunting is the most common neurosurgical treatment for hydrocephalus. In spite of significant developments in the technology and design of shunt systems, shunt surgery is still associated with morbidity. Aim: To identify the problems faced by children on VP shunt and assess their quality of life (QOL). Setting and Design: A cross-sectional exploratory study. Materials and Methods: A total of 31 children on VP shunt were selected through consecutive sampling technique, and hydrocephalus outcome questionnaire was used to collect the data, with the converted metric score ranging from 0 to 1. Hydrocephalus due to stroke, hemorrhage, and malignant tumors was excluded. Results: The mean age of patients was 11.51 ± 4.26 years. Headache and generalized pain were the common problems experienced (42%). The mean score of QOL was 0.67 ± 0.21. Among the three domains, cognitive domain was the most affected. Among the clinicoradiological factors, multiple surgeries (P = 0.02) had the most significant impact on QOL. Conclusion: Children who underwent VP shunt face various health-related problems in different domains and low QOL. Although cognitive domain was the most affected, multiple surgeries had the most significant impact on QOL. Appropriately focused interventions and holistic management are essential to improve the QOL of children undergoing VP shunt.

School children can act as change agent not only for families but for community. The study aimed to assess effectiveness of information package on knowledge and practices of parents/family members of school children studying in Govt. Sr. Sec. School on food hygiene in Dhanas and Daddu Majra Colony, UT, Chandigarh. A non-randomised controlled trial was conducted on 201 school children studying in VIIth standard and their parents/family members. Purposive sampling technique was utilised to enrol 101 in case and 100 participants in control group. Interview schedule for knowledge assessment and observation checklist for assessing the practices of parents/ family members was used. Pre assessment of both the groups was done by a home visit. Experimental group school children were educated on food hygiene as per the protocol. Pre and post-test knowledge of school children on food hygiene was assessed and were asked to disseminate the information to their parents/family members. After 15 days, second time home visit was done to the parents/family members of both the groups for the post assessment of knowledge and practices. Significant improvement in knowledge and practices of parents/family members related to food hygiene was observed. Hence, school children can be an effective tool in health related knowledge dissemination which can further promote healthy practices.

Infection of the internal jugular vein (IJV) catheter continues to be a common cause of death in patients with end-stage renal disease undergoing hemodialysis (HD). The present study aimed to evaluate the effectiveness of personal hygiene on the incidence of IJV catheter-related bloodstream infection (CRBSI). A randomized, controlled, parallel, and non-inferiority trial was conducted on patients initiated on maintenance HD via right IJV catheter. Patients were randomly allocated to control and intervention group via computer-generated random table. Intervention package for the intervention group included hand washing (2–4 hourly and whenever visibly dirty), feet washing (12 hourly), and axillary shave (at any point during the study, no hair growth in axilla). Patients were provided with a pamphlet and reinforced to continue package till IJV catheter was in situ. Patients were followed up twice a week for one month from the date of catheter insertion for the incidence of CRBSI. The primary outcome of the study was percentage of patients free from CRBSI. On intention-to-treat analysis, the percentage of patients without CRBSI was 53.7% and 29.3% in the intervention and control arm, respectively [P = 0.04; 25.12% (1.43–45.28%)]. Positive blood cultures were higher in control (73.3%) as compared to the intervention group (28.6%) (P = 0.19). Personal hygiene interventions are an effective method to reduce the incidence of CRBSIs among population undergoing maintenance HD via non-cuffed IJV catheter.

Background: Substance users approach a treatment facility for a variety of reasons as well as avoid or delay in help seeking due to perceived fears with treatment facilities. Sometimes these factors might be associated with treatment outcomes. Objectives: We studied the relationship of reasons and fears of treatment seeking with treatment outcome in substance users. Materials and Methods: One hundred subjects, attending the Drug Deaddiction and Treatment Centre, PGIMER, were prospectively recruited by purposive sampling. A semistructured proforma was used to gather sociodemographic and clinical data. Reasons of help-seeking and fear questionnaire, social support scale, and PGI locus of control scale were then applied. Followup data were available for 69 patients, which were classified into good or poor outcome based on relapse status. Results: At 6 months followup, 22 patients had relapsed, while 47 patients did not relapse. A higher degree of dysfunction due to substance at baseline was associated with relapsed status at followup. Parents or guardians coming to know about resuming substance and being unemployed for a long time were the reasons associated with relapsed status, while needing to consult a doctor immediately was significantly related to abstinent status at followup. Fear of not being able to meet substance using friends was associated with a poorer outcome in the form of relapse. Conclusions: Reasons for treatment seeking as well as fears related to treatment have significant implications on the clinical outcome of substance abusing patients. Addressing these could help in better patient outcomes.

Background: Patients seek treatment for substance use disorders because of certain reasons that they consider significant and important, but on the other hand, they do have various fears or apprehensions about the treatment, which act as barriers for treatment-seeking. In this study, we aim to assess their reasons for seeking treatment, the associated fears about treatment, their social support and locus of control, and also to find the relationship among these variables. Materials and Methods: One hundred subjects attending the Drug Deaddiction and Treatment Center, Postgraduate Institute of Medical Education and Research (PGIMER) were prospectively recruited, with purposive sampling from 15 June to 14 July, 2011. The sociodemographic and clinical variables were ascertained through a semi-structured performa. The PGI Locus of Control Scale, Social Support Scale, and Reasons of Help-seeking and Fear Questionnaire were applied. Results: The common reasons for seeking treatment were - having become a habitual user, taking substance for a long time, and a need to take it every day. The common fears about treatment were the fear of disappointing others, loss of secrecy of substance use, and being considered a failure in life. The locus of control was primarily internal. Certain reasons like taking substance for a long time, feeling ill, and feeling sad were associated with a lower social support. Social support was not associated with the locus of control. The most affected areas of impairment were finance and health. Conclusions: Certain reasons and fears regarding treatment are more common than others. It is important to look into reasons and fears that are related to better treatment outcomes.

Introduction: The umbilical cord is one of the routes of entry of microorganisms that can cause infection. Hence, affordable, effective, and safe cord care regimens are needed to prevent from such infections. Methods: The study was conducted in Nehru Hospital, PGIMER, Chandigarh, with the objective to assess the effect of two cord care regimens – human breast milk and 4% chlorhexidine on bacterial colonization and other clinical outcomes. A total of 105 newborns were enrolled and randomized into three groups (35 participants in each group) – human breast milk, 4% chlorhexidine, and dry cord care group (control group). The umbilical cord swab baseline sample was taken and cultured from each of the participants. The first application (either breast milk or 4% chlorhexidine) was done immediately after the baseline cord swab sample was taken. In the dry cord care group (control group), nothing was applied on the cord. Cord swab was again taken at 72 ± 12 h and at 120 ± 12 h after birth. Umbilical cord separation time was noted. Results: There was no statistically significant difference in cord colonization at baseline (P = 0.13). At 72 ± 12 h, 34.3%, 5.7%, and 51.4% had colonization in the breast milk, chlorhexidine, and dry cord care, respectively (P

As a part of nursing curriculum students have both academic and clinical working hours. Nursing students works in various conditions and come across various stressors during their professional training. There is evidence of increased level of stress in nursing students and the positive impact of Emotional intelligence on performance of nursing students both academically and in patient care The study was conducted on students of B. Sc. Nursing students. A protocol of Emotional intelligence skill training was made based on Goleman's model of Emotional Intelligence and seven sessions were planned. Total 325 subjects were enrolled for study but data analysis was done only for 224 subjects who attended all the seven sessions of Emotional Intelligence skill training. Pre test score at baseline before the intervention was assessed and post test score was assessed one month after the intervention. The outcomes were assessed on pre and post test score using statistical methods. In distribution of subjects according to Emotional Intelligence test score in high, average and below average level in pretest and post test, significant improvement after intervention was found in Emotional Intelligence(p value