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Background: The canine plays a vital role in dentofacial aesthetics and function. It supports the base of the alar and upper lip, which are crucial for smile aesthetics. When impacted, these functions are lost, leading to low self-esteem and overall poor health-related quality of life. The present study was conducted to find the prevalence of impacted and transmigrated canines in orthodontic patients and also to find the most prevalent type of canine impaction. Materials and Methods: This retrospective study was conducted in a hospital setting at Dental College. A total of 3050 OPGs (Orthopantomagram) of patients who visited dental hospitals for orthodontic treatment constituted the final sample. Demographic details regarding age, gender, and place of residence were collected from the patients. Evaluation of sample radiographs on the standard light box was performed to collect data regarding impacted and transmigrated canines. Statistical analysis was performed using descriptive statistics and Chi-square test. Results: Prevalence of impacted canine was found to be 2.46%. Impacted canine prevalence of 1.53% and 2.85% was reported in males and females, respectively. Only two female patients had transmigrated mandibular impacted canines. Comparison of arch showed a statistically significant (P value 0.02) higher prevalence in the maxillary arch, which was 1.54%, and in the mandibular arch, it was 0.92%. The present study reported significantly more unilateral impactions (P value 0.00) than bilateral impactions. Conclusion: The overall prevalence for impacted canine was 2.46%. Prevalence was higher in female patients. Early diagnosis of impacted canines is vital for planning orthodontic treatment in such patients.

BACKGROUND: Effective management of heart failure (HF) requires an integrated approach involving pharmacological and non-pharmacological interventions. Available evidence shows that patients benefit from adjunctive therapies along with guideline-directed medical therapy (GDMT). Still, there is an inadequacy in the use of the best available evidence and the self-management of symptoms by the patients. This study aimed to evaluate the effectiveness of a Heart Failure Nursing Protocol (HF-NP) on selected parameters, that is, symptoms, self-care adequacy, episodes of hospitalizations, depression, exercise capacity, medication adherence, activities of daily living (ADLs), and quality of life (QOL) of the HF patients. MATERIAL AND METHODS: A pre-experimental study was conducted in a tertiary care hospital in Northern India. A total of 101 patients were enrolled using a convenient sampling technique. Participants were trained individually through demonstrations and educational sessions about self-management of HF at home. An informational booklet was given to all the participants consisting of information about HF, dietary instructions, individual exercise schedules based on the New York Heart Association (NYHA) class, identification of worsening symptoms, daily monitoring of vital parameters, and self-management of HF at home. Telephonic encouragement was provided on day 15, 1 month, and 3 months of baseline visits. The data were checked for normality using the Kolmogorov–Smirnov test and analyzed using a paired t-test, Wilcoxon’s signed-rank test, and McNemar’s test as appropriate. RESULTS: There was significant improvement in outcomes, such as breathing difficulty (P = 0.028), activity intolerance (P = 0.013), self-care adequacy (P = 0.001), depression (P = 0.001), exercise intensity (P = 0.001), QOL (P = 0.001), and medication adherence (P = 0.001) after 3 months of intervention. CONCLUSION: HF-NP was effective in improving HF outcomes. It can be used to train patients and their family members regarding the debilitating illness, after doing a large study, and it can be incorporated into the health policy later.

Purpose: Chemotherapy-related cognitive impairments (CRCIs) are one of the adverse effects of chemotherapy, so there is a need to explore alternative measures to maintain normal cognitive functions or to prevent decline in cognitive abilities. This study was conducted to assess the effectiveness of Cognitive Training Interventions Package on cognitive functions among breast cancer survivors (BCSs). Materials and Methods: A total of 59 BCSs were randomly assigned to control and intervention groups. Participants of the intervention group were provided with a Cognitive Training Interventions Package to be practiced from 1st cycle until the completion of 4th cycle of chemotherapy. Both the groups were reassessed on the 4th cycle of chemotherapy. FACT Cog Version-3, Post Graduate Institute Memory Scale (PGIMS), and trail making test were used to assess cognitive functions. Activities of daily livings (ADLs) and depression, stress, and anxiety were measured using Barthel Index Scale and Depression, Anxiety, and Stress Scale-21, respectively. Satisfaction level among participants was measured using a self-structured questionnaire. Results: The mean age was 50.82 ± 10.12 years in the control group and 50 ± 11.24 years in the intervention group. BCSs in the intervention group demonstrated a significant improvement in attention and concentration (P = 0.02); retention for similar pairs (P = 0.001); recognition (P = 0.01); and visual attention, processing speed, and executive functions (P = 0.01). Intervention group also showed a significant improvement in ADLs (P = 0.04). Overall, the participants in the experimental group were more satisfied (mean = 2.00) as compared to those in the control group (mean = 1.896), which is supported by the observed statistical significant difference in the satisfaction levels of the participants (P = 0.04). Reduction in the levels of anxiety and depression was also noticed in both the groups but it was not significant. Conclusion: Cognitive training interventions package was beneficial for BCSs with CRCI to overcome cognitive impairments.

Objective: Breast cancer is the most common cancer among Indian females and chemotherapy is the most extensively used modality for these patients. Diagnosis of breast cancer is dreadful in itself and the initiation of chemotherapy causes stress and fear among patients. Breast cancer survivors (BCS) use different coping mechanisms to deal with these experiences and to handle these stressful events. The objective of this study was to assess the coping strategies being practiced by the BCS before receiving first cycle of chemotherapy. Method: This descriptive study was conducted on BCS attending Radiation Oncology and General Surgery OPD, PGIMER, Chandigarh from July 2018 to December 2019. Sixty two BCS were recruited using purposive sampling. Results: 51.7% participants were above 50 years of age, 56.5% had grade III breast cancer and 56.7% had left breast involvement. 62.9% were on neo-adjuvant chemotherapy and duration of confirmed diagnosis for 83.9% of them was less than a year. Most of the participants used positive coping strategies to overcome the stress related to diagnosis and chemotherapy. Out of the 46 coping activities participants retorted positive action for 31 coping activities whereas action was negative for 13 activities. Remaining two activities had equal number of positive and negative responses. Escape avoidance ‘hoped a miracle would happen’; ‘Wished that the situation would go away or somehow be over with’ were used by all the participants. Though not dominant, negative coping activities were still used by the participants to deal with stressful situations. Conclusion: BCS were predominantly using positive coping activities. In order to further increase this there is a need among medical professionals to make BCS aware and discourage the use negative coping behaviors. BCS can also be nudged to adopt positive coping styles by involving family and society in the provision of care.

BACKGROUND: Survival for breast cancer (BC) patients has improved significantly because of better treatment availability. However, patients may experience side effects after the completion of the treatment, which consequently affect their quality of life (QoL). The present study was planned to assess the QoL of BC patients after the completion of treatment. SUBJECTS AND METHODS: One hundred patients of BC after the completion of treatment from the Department of Radiation Oncology, PostGraduate Institute of Medical Education and Research, Chandigarh, India, were enrolled in the study during December 2017 to December 2018. EORTC QLQ C30/+BR23 questionnaires were used to quantify the QoL of these patients. RESULTS: The mean age of the participants was 49.35 ± 8.66 years. Mean global health status (GHS) QoL score was 64.6 ± 13.6. Functional scales, in most of the domains were high, whereas symptom scales were moderate to low for most items, showing better QoL. Pain (40.6 ± 19.1) and fatigue (54.8 ± 16.1) were the most disturbing symptoms. Patients exhibited higher scores for sexual functioning, whereas the least score was for future perspective. CONCLUSIONS: There was significant overall improvement in the QoL of patients with BC after the completion of treatment regarding functional scales and symptom scales as per EORTC QLQ-C30 questionnaire. As per EORTC QLQ-BR23 questionnaire, there was deterioration of the QoL concerning future perspectives for functional scale and hair loss for symptom scales.

Background: Heart failure is a rampant health problem affecting millions of people worldwide. Patients' knowledge about this complex disease contributes toward its self-management at home thereby, reduction in frequent hospitalizations and increased health-care cost. Aim: This study aims to assess the awareness of patients regarding self-management of heart failure. Methods and Results: A cross-sectional study was conducted on diagnosed patients having heart failure for at least 6 months with left ventricular ejection fraction

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: Family caregivers of operated neurosurgery patients function as informal extensions of the health system. But they are untrained and unprepared for their new role. It has been felt that their problems related to care provision can be resolved by appropriate training. Aim: This study aimed to compare the impact of self-instruction manual-based training of family caregivers of operated neurosurgery patients on their knowledge regarding care provision and care practices. Setting: Tertiary care hospital setting located in North India. Design: Randomized controlled trial. Materials and Methods: A randomized controlled trial was done among the operated neurosurgery patients and their caregiver dyads (n = 90). They were randomly allocated to receive either self-instruction manual and one-to-one training (TP1) or self-instruction manual only (TP2). Block randomization method was used. Sequentially numbered sealed envelope was used for allocation concealment. Monthly follow-up was done for 3 months. The primary outcome measure was knowledge gain of the caregivers. Statistical Analysis Used: Chi-square test, Student's t-test, paired t-test, repeated measures analysis of variance, and Bonferroni's correction were used. Results: The attrition rate was 15.5%. Intention-to-treat analysis was followed. Caregivers in the TP1 group had significant knowledge gain (95% confidence interval of mean difference 9.4–14.5, P < 0.05). The number of caregivers who had followed correct caregiving practices was significantly more in the TP1 group. Conclusion: Training of caregivers by providing information along with one-to-one training is an effective strategy for improving the knowledge and skills of caregivers regarding care provision of the operated neurosurgery patients.

Background Patients with head injury are discharged from hospitals in a dependent state. In the home care settings, the caregivers have to take care of the patients. In India, there is scarcity of data on interventions of family caregivers of persons with head injuries. Objective To assess the efficacy of an instructional module for caregivers of patients with head injury on recovery of the patients. Method The study was performed at the Neuro-Surgery Department of Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Total 82 patients with 41 each in experimental and control groups and their caregivers were included in the study. The caregivers of patients in experimental group were demonstrated procedures related to care of a dependent patient. An instructional module containing guidelines regarding personal hygiene, catheter care at home, prevention of bedsores, tracheostomy suctioning at home, range-of-motion exercises, care of surgical wound, and discharge instructions regarding medication and follow-up was given to the caregivers in experimental group. The efficacy of intervention was assessed on occurrence of fever, chest infection, eye infection, bedsores, wound infection, constipation, urinary tract infection, deep vein thrombosis, length of stay, and readmission in hospital in both the groups. Results Occurrence of fever, constipation, and length of stay were reduced significantly in experimental group. A reduction in the rates of chest infection, bedsore development, wound infection, and urinary tract infection were also noted in experimental group. Conclusion The study shows that training the caregivers of head injury patients enhances the recovery and prevents complications in the patients.

Background and Objective: Empathy is one of the therapeutic communication techniques for providing comfort to the client. It is an important component of meaningful interpersonal relationship. Internship is the period of tremendous changes, both personally and professionally. The current study was undertaken to assess the level of empathy among the nursing students during their internship. Methodology: The study was descriptive in nature. It was carried out at a nursing college of a North Indian city. Forty-six nursing interns participated in the study. Jefferson Scale of Empathy was administered three times to the students during the internship, i.e., at the beginning, at 6 months, and at the completion of internship. Results: Mean age ± standard deviation of the participants was 21.43 ± 0.91 with the range of 20–23 years. There was an increase in the number of participants with high level of empathy from the 23.9% at the beginning to 29.6% at the midway and 28.3% at the end of internship, but the increase was not statistically significant (P > 0.01). The mean empathy score, in the beginning, was 50.76 ± 4.2 with the range of 43–60. At the midway of the internship, the score was 52.13 ± 4.62 with the range of 40–60. However, at the end of internship the score was 52.41 ± 4.48 with the range of 40–60. There was no significant change in the empathy score throughout the internship (F = 1.816, P = 0.167). It may be because of the saturation level of empathy among the students of senior most class. Hence, future research may study empathy level among all the 4 years of training separately rather than only interns.

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.

The purpose of this review is to evaluate the previous studies that describe the effects of functional appliances and their efficiency in treating class II malocclusion. This review is limited to three appliances: activator, bionator, and twin-block appliances.

Abstract Background Sodium alterations are very common among patients with the postoperative traumatic brain injury (TBI). It can be hyponatremia or hypernatremia. Sodium disturbances can lead to serious complications and adverse outcomes including death. Aim The current study was performed to assess the effectiveness of oral rehydration solution (ORS) on natremic status of patients with postoperative TBI. Materials and Methods The study was performed in the Department of Neurosurgery of a tertiary care hospital. Total 100 patients on Ryles tube were randomly allocated. The tools used were semistructured interview schedule and biophysiologic methods. In the intervention group, administration of ORS was started on second postoperative day till fifth postoperative day. Serum sodium levels were assessed daily from zeroth postoperative day to fifth postoperative day in both groups. Statistical Analysis and Result Both the groups were homogeneous and comparable. The mean serum sodium levels before and after the intervention were not significantly different in both groups. The proportion of patients with normonatremia was significantly greater in the intervention group on third through fifth postoperative days, that is, 76, 78, and 82%, as compared with that in the control group, that is, 52, 52, and 60%. The proportion of the patients with hyponatremia was high on third through fifth postoperative days in the control group as compared with that in the intervention group. The hypernatremia developed varied from 8 to 18% in both the groups. Conclusion Thus to prevent sodium imbalance, ORS can be safely administered to the patients with postoperative TBI without increasing the risk of hypernatremia.

Abstract Background After spinal cord injury (SCI), victims may become partially or fully dependent on the caregivers. After getting discharge from the hospital, they are cared by their caregivers. Often patients return to hospital with serious complications owing to inadequate knowledge of the caregivers. So, it is essential to meet the informational needs of the caregiver regarding home care. Objective The aim of this study is to develop home care guidelines for the caregivers of the patients being discharged with SCI. Method The study was conducted in five phases. The blueprint of the home care guidelines was prepared. Face and content validity of the home care guidelines were done using the Delphi technique. An observational checklist was prepared from the final draft of the guidelines. The guidelines were found feasible after conducting a pilot study on five caregivers. To calculate the reliability of the guidelines, 30 caregivers were taught as per developed guidelines and were observed while caring for their patients by checklist. Reliability was calculated using Cronbach α coefficient. Results The checklist showed Cronbach α of 0.91. Guidelines were found to be feasible and reliable. Guidelines were developed in two languages: English and Hindi. Conclusion The home care guidelines are valid and reliable. Guidelines enable caregivers to provide the best possible care to their patient at home to prevent development of complications.

Background Majority of the stable patients after neurosurgery requiring long-term care are discharged with tracheostomy tube (TT) in situ. The caregivers need to learn the technique of change of TT at home. Aims The current study talks about the effect of an intervention on the performance regarding change of TT among the caregivers of the patients who are going to be discharged with a TT in situ. Materials and Methods The study was carried out in the Department of Neurosurgery of a tertiary care hospital. Sixty-four subjects were purposely selected. The tools used were identification data sheet and an observation checklist on the change of TT. First, the caregivers were observed during change of TT. Then, each subject was demonstrated the right technique of change of tube. Statistical Analysis and Results Majority of the subjects (89.1%) were male 70.3% were married. Age of the subject was in the range of 18-60 years, with a mean age of 30.7 ± 8.9 years. The maximum attainable performance score of the change of TT was 16. Before demonstration, only one subject had some knowledge about the change of TT. After 72 h of demonstration, the score was 12.34 ± 1.6 (77.2%). Conclusion It is recommended that the caregivers should be properly trained regarding changing the TT in order to prevent any complication while performing the procedure. The results of this study provide further strategies for other caregiver guidance programmes.

Background: Bispectral index monitoring system (BIS) is one of the several systems used to measure the effects of anaesthetic and sedative drugs on the brain and to track changes in the patient′s level of sedation and hypnosis. BIS monitoring provides information clinically relevant to the adjustment of dosages of sedating medication. It can help the nursing personnel in preventing under- and over sedation among intensive care unit (ICU) patients. Objective: The present study was conducted to assess the knowledge of nursing personnel working in the ICU regarding BIS. Methods: Fifty-four subjects participated in the study. A structured questionnaire was developed to assess the knowledge of the nursing personnel regarding BIS. Focus group discussions were held among the nursing personnel to know their views regarding BIS. Results: Mean age (years) of the subjects was 30.7΁7.19 (21-47) years, with a female preponderance. Although the use of BIS in ICU is not common, majority (94.44%) were aware of BIS and its purpose. 79.62% of the subjects knew about its implication in patient care. The mean knowledge score of the subjects was 11.87΁2.43 (maximum score being 15). Conclusion: There exists an awareness among the critical care nursing staff in our institution regarding BIS and its clinical implications. Its use in the critical care setting may benefit the patients in terms of providing optimal sedation.