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Background: Quality and safety of prescribing drugs in older people remain a global healthcare concern. Inappropriate prescribing pattern in the elderly population is now considered as a major public health issue and polypharmacy is one of the common problems among the elderly patients. Aims and Objectives: The aims of this study were (1) to analyze the prevalence, pattern of polypharmacy with respect to age, and gender among the elderly patients and (2) to evaluate the most frequently prescribed drugs in the geriatric population. Materials and Methods: This prospective, cross-sectional, and observational study was conducted among the elderly patients admitted in the Department of General Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu. The duration of research project was 12 months from May 2018 to April 2019; approval for the study was taken from the Institutional Ethical Committee. Data on total number of prescribed drugs and main and adjuvant drugs prescribed to patients during treatment were collected and analyzed. Results: A total of 289 patients, that is, 167 male and 122 female were included in the study. The prevalence of minor polypharmacy (2-4 drugs) accounted for 15.22%, major polypharmacy (=5 drugs) for 81.35%, and hyper polypharmacy (=10 drugs) for 3.46%. Most commonly prescribed drugs were vitamins, proton-pump inhibitors, antipyretic agents, and H2 receptor blockers. They accounted for 21.70%, 5.78%, 5.42%, and 4.94%, respectively. Conclusion: Polypharmacy is a preventable and can be rectified by prescribing appropriate medications. In future, a multidisciplinary approach which will be involving doctors, nurses, and pharmacists, shall be implemented for rational use of drugs in elderly patients. [ABSTRACT FROM AUTHOR]

The editors and authors convincingly argue that ethnographic and peripheral perspectives are important in order to more fully understand the processes by which Tibetan medicine became professionalized in India; additionally, many of the leading figures in the professionalization process were from these peripheral areas, particularly Ladakh. Other significant changes examined include those related to migration of medical practitioners, and how professionalization affected healing practices and social relations between practitioners and patients. [Extracted from the article]

Background: Diabetes mellitus (DM) describes a group of metabolic disorders characterized by high blood glucose levels. People with diabetes have an increased risk of developing a number of serious life-threatening health problems resulting in higher medical care costs, reduced quality of life and increased mortality. Knowledge of the prevalence about coexisting medical conditions in specific population groups helps healthcare providers and policymakers to allocate health resources efficiently and tailor diabetic care management to effectively utilize healthcare programs while decreasing healthcare expenditure. Aims and Objectives: To find out the pattern of comorbidity burden among Type-II diabetes mellitus patients attending outpatient department of a rural tertiary care institute of North India. Materials and Methods: Study setting: Outpatient department (OPD) of General Medicine of Rural Tertiary Care Institute in North India. Study design: Descriptive, cross-sectional. Study population: Patients who had already been diagnosed by a physician of having Type 2 diabetes mellitus (T2DM) and attended OPD for follow-up during study period i.e. 1st November 2019 to 31st January 2020. Results: Among 82 study participants, 36 were males and 46 females. A total of sixty-six study participants had co-morbidities along with diabetes mellitus. Most common co-morbidity recorded was related to cardiovascular system and neuropathies. Adherence to treatment was followed by 46 (56%) and dietary advice by 42 (51%) study participants. Conclusion: In light of the chronicity of the disease and increasing prevalence of diabetes with associated comorbid conditions, there is a need for clearcut guidelines to address health risks of diabetes with other comorbid conditions. There should be provision for regular formal health education sessions to address co-morbidities, complications due to diabetes. [ABSTRACT FROM AUTHOR]

India has been engaged in tuberculosis (TB) control activities for over 50 years and yet TB continues to remain India's important public health problem. The present study was conducted to compare the performance of GeneXpert MTB/RIF (GXpert) assay with composite reference standard in diagnosing cases of tubercular pleural effusion (TPE) and to evaluate the reliability of rifampicin resistance. A cross-sectional study was performed in a Department of Medicine of a rural teaching tertiary care hospital in central India. In all consecutive patients with pleural effusion on chest radiograph presenting to Department of Medicine, GXpert assay and composite reference standard was performed to evaluate the diagnostic accuracy of GXpert assay for detecting TPE in comparison to composite reference standard. Standard formulae were used to calculate the sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), positive likelihood ratios (LR+) and negative likelihood ratios (LR-). Mc-Nemar's test was applied to compare variables. All comparisons were two-tailed. We considered the difference to be statistically significant if the P value was less than 0.05. The sensitivity of the GXpert assay in diagnosing TPE was 16.6% among 158 study participants, the specificity was 100% and diagnostic accuracy was 52.5% which was statistically significant (p value < 0.05). It had a PPV of 100% (95%CI: 88.3% - 100%) and a NPV of 47.5% (95%CI: 39.3% - 55.7%). The LR+ and LR-were 23.5 (95%CI: 1.43–38.6) and 0.83 (95%CI: 0.76–0.91) respectively. GXpert assay has a very high specificity in diagnosing TPE but has a low sensitivity. In comparison to composite reference standard Thus its clinical utility is limited when used as a standalone test. A physician's clinical acumen in combination with routine pleural fluid analysis should be the key factor in the diagnosis of TPE in clinically and radiologically suspected patients, especially in high TB burden countries. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases are the leading cause of mortality in India and acute coronary syndrome (ACS) is one of its anomalies, affecting mainly the coronary arterial blood supply and further the functioning of heart muscle. Its subtypes are Non-ST elevation myocardial infarction (NSTEMI), unstable angina, and ST-elevation myocardial infarction (STEMI). There are various diagnostic tools available to detect ACS like; electrocardiography (ECG), Cardiac stress test, Coronary CT angiography, Coronary angiogram and cardiac biomarkers. Yet, tools for assessment of prognosis are scanty and new prognostic tools are always welcomed, one such is anion gap, which can be detected by assessment of certain ions present in the serum, urine or plasma, etc. In this study we will assess the role of anion gap, in the assessment of prognosis in ACS. Objective: 1. To estimate anion gap (AG) in cases of acute coronary syndrome (ACS) at the time of diagnosis; 2. To evaluate association of anion gap (AG) with the prognosis of acute coronary syndrome (ACS) Methodology: The study will be conducted in the Department of Medicine of a Rural Tertiary Care Hospital. Estimation of anion gap (AG) in cases of acute coronary syndrome (ACS) will be evaluated at the time of admission and after five days of treatment. Anion gap will be calculated or measured as difference between measured cations (Na+ + K+) and the measured anions (Cl- + HCO3-) in serum. Any complications during the management will be noted (Heart failure arrhythmias, Hypotension, Reinfarction, Death) will be correlated with anion gap (AG). Chi square test will be applied to evaluate statistical difference between among anion group quartile groups. Results: The study will play a key role in identifying and assessing various other prognostic tools like anion gap, in assessing the severity of disease to some extent in patients with acute coronary syndrome. Conclusion: High value of serum anion gap levels is associated with poorer prognosis of the disease outcome in patients with acute coronary syndrome. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to analyze the yield of retinal images obtained in a rural diabetes eye care model.Methods: An analysis of a sample of nonmydriatic fundus photography (NMFP) of posterior segment ophthalmic images, obtained by an indigenous equipment (3 nethra-Forus Royal), was done in a district-wide rural diabetic retinopathy (DR) screening program; a trained optometrist did the initial image grading. DR and diabetic macular edema (DME) were classified based on international DR and DME severity scale. The agreement between the optometrist and retina specialist was very good (κ = 0.932; standard error = 0.030; 95% confidence interval = 0.874-0.991).Results: Posterior segment images of 2000 eyes of 1000 people with diabetes mellitus (DM) were graded. The mean age of the participants was 55.7 ± 11.5 standard deviation years. Nearly 42% of the screened participants (n = 420/1000) needed referral. The most common referable posterior segment abnormality was DR (8.2%). The proportion of people with any form of DR was seen in 110/1225 eyes, and sight-threatening DR was seen in 35/1225 eyes. About 62% of posterior segment images were gradable. The reasons for ungradable posterior segment images (34%) were small pupil, unfocused/partially available field of images, and cataract.Conclusion: A NMFP model was able to detect referable posterior segment abnormalities in a rural diabetes eye care program. Reasons found for ungradability of images in the present study can be addressed while designing future DR screening programs in the rural areas. [ABSTRACT FROM AUTHOR]

This paper focuses on telemedicine implementation, which can be used to extend modern medical knowledge to remote areas in developing countries. By examining doctor- patient interactions in the context of a telemedicine program in India, we posit how the behaviour of the actors interacting over virtual media is determined by interplay between two dominant institutional logics, namely logic of care and logic of choice. The paper draws on the tenets of institutional logics to extend the theoretical understanding about processes of engagement of actors with a new technology and explicates how the engagement evolves with the use of technology. The research emphasizes the essential role of considering the dynamics of logic of care and logic of choice in the design and implementation process. [ABSTRACT FROM AUTHOR]

This is a story about finding joy and love in unexpected times and places. I am a family medicine resident in rural India nearing the end of my training. Family physicians rise to the occasion no matter what. Here, I describe how two of us met and managed a wedding in the midst of a lockdown. [ABSTRACT FROM AUTHOR]

The Indian Systems of Medicine and Homoeopathy (ISM&H) were given an independent identity in the Ministry of Health and Family Welfare in 1995 by creating a separate Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) in November 2003. Mainstreaming of AYUSH implies integration of infrastructure, manpower and medicines of Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH) to strengthen the public health care delivery and strengthen the AYUSH systems at grass root level by establishing a linkage between modern medicine and AYUSH systems in a collaborative way. Mainstreaming of AYUSH is a policy commitment of government of India and it received momentum by the launch of National Rural Health Mission (NRHM) in April, 2005. The present study was done in two villages of district Yamunanagar, Haryana on the sample of 25 which consisted professional allopathic doctors, traditional healers and village respondents to know their awareness and attitudes regarding AYUSH. In the present study it was found that the potential barriers that emerge are the lack of awareness about the government's AYUSH scheme and for successful implication it is required that awareness at grass root level should be promoted. [ABSTRACT FROM AUTHOR]

Problem The lack of skilled service providers in rural areas of India has emerged as the most important constraint in achieving universal health care. India has about 1.4 million medical practitioners, 74% of whom live in urban areas where they serve only 28% of the population, while the rural population remains largely underserved. Approach The National Rural Health Mission, launched by the Government of India in 2005, promoted various state and national initiatives to address this issue. Under India's federal constitution, the states are responsible for implementing the health system with financial support from the national government. Local setting The availability of doctors and nurses is limited by a lack of training colleges in states with the greatest need as well as the reluctance of professionals from urban areas to work in rural areas. Before 2005, the most common strategy was compulsory rural service bonds and mandatory rural service for preferential admission into post-graduate programmes. Relevant changes Initiatives under the National Rural Health Mission include an increase in sanctioned posts for public health facilities, incentives, workforce management policies, locality-specific recruitment and the creation of a new service cadre specifically for public sector employment. As a result, the National Rural Health Mission has added more than 82 343 skilled health workers to the public health workforce. Lessons learnt The problem of uneven distribution of skilled health workers can be solved. Educational strategies and community health worker programmes have shown promising results. Most of these strategies are too recent for outcome evaluation, although this would help optimize and develop an ideal mix of strategies for different contexts. [ABSTRACT FROM AUTHOR]

This article presents the results of a study that sought to see if poor populations could be informed of their entitled health services and if they were, if that would increase the delivery of heath services. Developing countries have a real problem with health care delivery even if the services are available. Inadequate service delivery often results from a lack of accountability by the health care workers and since the population generally doesn't know what they are entitled to, they rarely urge for service. The study found that informing the public did positively effect the delivery of health and social services and the authors conclude that patient education programs may improve the delivery of services elsewhere.

Store and forward and real time or videoconferences are the two types of teledermatology services practiced. Dermatology and radio-diagnosis are visual specialties suited for store-and-forward teledermatology (SAFT). Advances in information technology, electronic instruments and biotechnology have revolutionized and brought changes in SAFT. Cellular phone, digital camera, personal digital assistants, Wi-Fi, Wi-Max and computer- aided-design software are incorporated to deliver the quality health care to remote geographic regions. Complete SAFT care equivalent to face-to-face consultation (Gold standard) is essential. Health care providers in rural areas are the 'eyes' for the consultants. Consultants to guide them should have a rapid periodic audit of visual parameters and dimensions of lesions. Given this background, this article reviews advances in 1) capture, store and transfer of images. 2) Computer Aided measurements of generalized and localized lesions and 3) the integration model to meet all the above two requirements in a centralized location. This process enables diagnosis, management, periodic assessment and complete follow-up care to achieve patient and physician satisfaction. Preservation of privacy and confidentiality of digital images is important. Uniform rules and regulations are required. Indian space research organization (ISRO), Government of India has demonstrated telemedicine pilot projects utilizing the satellite communication and mobile telemedicine units to be useful in meeting the health care needs of remote and rural India. we have to join hands with them to meet dermatology problems in rural areas. [ABSTRACT FROM AUTHOR]

The article discusses the study which determines the usability of sub-centers in rural areas in India. It has been found out that users of sub-centers mostly comprise of cultivators and wage labor. In addition, about 35% illiterates and 25% with below primary level of education use sub-center very often. With the very often users, only 16% were educated up to middle and above. Moreover, these findings implied that the rural health sub-centers are unable to attract economically better off as well as the educated people.

This paper attempts to review the components of National Rural Health Mission and their viability. India has already built up vast rural health infrastructure and made substantial improvements in manpower and services at different levels of health care but poor governance and poor or non-utilization of the available resources remains a cause of worry. Before accomplishing the implementation of the mission in India, we must recall that all schemes conceived earlier were also excellent in idea but failed miserably during their actual implementation. A well beginning is half-done. It is always better to get organised before accomplishing such a huge mission. [ABSTRACT FROM AUTHOR]

The article presents a study which explores the pattern of disease and the availability of health facilities in Ludhiana, Amritsar and Bathinda, three rural areas in Punjab, India. The study aims to find out the major diseases and their status of prevalence in these areas and the kind of health facilities available for the masses. Results of the study show that anemia was the most prevalent disease, followed by reproductive health problems, joint pain and gastric and stomach problems. It was also revealed that majority of the respondents had a near government health institution within the range of two kilometers but most of them did not get proper treatment in government health center at village level. Several suggestions to strengthen the public health care system were given.

Since October, 1965, births and deaths in rural Gujarat State, India, have been recorded under two independent systems in a random sample of units. First, a part-time local "registrar" is appointed in each sample unit (village or segment thereof) who: prepares a house list; conducts a baseline survey showing the individuals in each household; and maintains a list of the vital events reported by informants whom he contacts fortnightly. Second, a staff member at the rural health centre is assigned part-time supervisory and survey duties: to check the initial listings of the registrar; thereafter, to inspect the registrar's records at least quarterly; and to conduct a household survey each six months, updating the household register and recording births and deaths independently. The registrar's list is sent to the district office immediately before the survey, where it is matched with the survey list forwarded by the local supervisor. A list of unmatched events is returned to the supervisor who with the registrar revisits households to resolve the discrepancies. Under-registration is estimated to be 13 to 20 percent by the registrar method, 8 to 17 percent by the survey method. The birth rate is estimated to be about 44 and the death rate about 19. [ABSTRACT FROM AUTHOR]

Multidrug resistance (MDR) is already occurring among some equids in India. Donkeys and mules are a mobile species moving between regions and international borders, often populating areas of India where private community pharmacies, or medical stores, are the primary healthcare provider for both humans and animals. This article highlights how the capacities of drug retail outlet workers might affect their antibiotic dispensing practices, particularly in relation to donkeys and mules, in order to consider how this might impact the development of antimicrobial resistance (AMR) on a wider scale. A mixed-methods approach was implemented using patient simulation method (n = 28), semi-structured interviews (SSIs) (n = 23), focus group discussions (FGDs) with veterinary practitioners and non-governmental organisation animal health workers (n = 2 FGDs), and participant observation. Fewer than 48 per cent of drug retail outlet workers admitted to having had any formal training in pharmaceuticals at all, while 78 per cent reported having no formal training in animal-related pharmaceuticals. Moreover, 35 per cent of all participants sold antibiotics without a prescription, unprompted and without specifically being asked for antibiotics. Of the antibiotics dispensed, only 21 per cent were correctly dispensed for the symptoms presented, and all dosages dispensed were incorrect (underdosed). Furthermore, 43 per cent of drug retail outlet workers interviewed believe that some antibiotics can be legally dispensed without a prescription. Equine owners in northern India are frequently being sold antibiotics without a prescription and, in most cases, with incorrect diagnoses, treatment choice, and dosage. A substantial gap in capacities exists amongst Drug Retail Outlet (DRO) workers, with few being sufficiently qualified or trained to dispense antibiotics to animal owners. The study highlights the need for further training of private DRO workers as well as knowledge extension and awareness training for both DRO workers and animal owners regarding antimicrobial resistance and its potential impact upon livelihoods. It also illustrates the need to identify a balance whereby greater enforcement of regulation at all levels is implemented, while at the same time maintaining sufficient access to medicine for rural populations. [ABSTRACT FROM AUTHOR]

The Cross Sectional study was conducted to evaluate the quantitative indicators of MCH services in the Rural population of Ludhiana District in four villages of the field practice area of the Rural Health Training Center. The methodology adopted was a supervision and observation of the routine services provided by the team of the field workers. . The data collected was, analyzed in the Epi -info soft ware and presented in the form of tables and charts. The family planning coverage was found to be 57.7%, family size 5.4, 100% coverage of tetanus immunization of pregnant mothers, in 0-1 year age group BCG coverage was 94.0%, DPT-3/OPV-3was 56.7%, and of Measles was 29.3%.in 0-5 year age group BCG coverage was 96.4%, DPT-3/OPV-3 was 88.1%, and of Measles was 82.6%. From the study it was concluded that there is a need of mobilization of both health personnel and community towards utilization of MCH services. [ABSTRACT FROM AUTHOR]

The authors analyze the Bachelor of Medicine and of Surgery (MMBS) rural degree in India. They state that the degree will be of shorter duration than the standard MMBS in the country and the graduates of the degree will be allowed to practise only in rural areas. They note the debate that emerge with regard to the short duration of the degree. They also cite the specialist topics that will be excluded in the degree, such as kidney transplantation and angiography.

The article reports that the four-year-course Bachelor in Rural Medicine and Surgery has been proposed by the Medical Council of India (MCI) and the Union Health Ministry.

This article looks at efforts in India to lower the rate of maternal deaths from pregnancy. In the poorest, most rural parts of India, prenatal and postnatal health care is not available which results in a high death rate. In wealthier areas the birth rate declines as maternity services are readily available. India has instituted a process called Maternal and Perinatal Death Inquiry and Response (MAPEDIR) which is a collaborative effort with several agencies from around the world to capture the causes of death. MAPEDIR has been implemented in 16 districts of five states with high maternal mortality and has catalysed local action in some of them.

The article presents an overview of a study on the profile of pregnant women and the quality of antenatal care in rural north India. The study found that about 88.3% of the subjects received no home visits from health workers during pregnancy. It showed that 12% of the women got sex determination tests (SDT) while 19.5% had taken some oral medicine. Half of the respondents preferred home deliveries with the help of traditional birth attendants.

Relates the author's experience as a house officer in a rural village in India. Background on the "regular jaw dropper" whose jaw would not shut after a yawn; How the doctor learned the treatment for temporomandibular dislocation; Other cases treated; The respect patients gave the physician.

Presents the records of a surgeon who spent time treating people in rural India. Examples of cases seen including a woman with breast cancer; State of medical facilities in the region; Diseases seen including tuberculosis and cholera; How India's health care system was designed primarily for infectious disease; Number of patients awaiting surgery at one institute of medicine.

Highlights the health scheme launched in Madhya Pradesh, India, to ensure community health services reach the state's villages. Details of the scheme; Reasons for the high mortality rate in Madhya Pradesh; Implications of decentralizing India's primary health care system.

Presents the experiences of the author concerning a patient who developed appendicitis. Experience of the author as a rural physician in India; Case of a boy with appendicitis but does not have the money for transportation; Loan provided by the physician; Loan that was paid back with interest for the delay.