Maintenance of Consent Paper in Daily Dental Practices

Background: To assess maintenance of consent paper in daily dental practices. Methods: It was a cross-sectional study. To assess maintenance of consent paper in daily dental practice at the chambers of the dentist. Data were collected through face to face interview. Dental chambers were selected by simple random sampling technique and respondents were selected purposively in Mymensingh sadar. 50 chambers and 70 dental surgeons were interviewed. Study period was January to March, 2019. Results: In respect of distribution of the chamber owners by sex, female owners comprised 16% and 84% was male owners. By educational background of chamber owners, 40% owners had no B.D.S degree. It was found that 16% dental chambers had two dental surgeons and 84% dental chambers had one dental surgeon. Of all, 92.90% dental surgeons had knowledge about consent paper. The study showed that 80% dental surgeon sometimes, 7.1% dental surgeon always maintained consent paper in daily practice. Among the dental surgeons, 44.3% sometimes faced problem for taking consent paper in daily practice. Among all, 71.4% maintained verbal consent, 7.1% written and 21.4% maintained implied consent. Of all, 94. 3% dental surgeons maintained written consent paper only for costly treatment and specialized cases while 18.6% thought that it was not important and 40% thought that time consuming and 34.3% thought that patients were not interested. It was also found that 42% ancillary of the dental chambers had diploma degree and 58% had no degree. Conclusion: It is a general legal and ethical principle that one must get valid consent because it is the patients' rights before starting treatment or physical investigation. JOPSOM 2021; 40(1): 22-25

Influenza in patients with respiratory failure admitted to intensive care units in Poland and the use of extracorporeal respiratory support: a survey-based multicenter study

Background In Poland, little is known about the most serious cases of influenza that need admittance to the intensive care unit (ICU), as well as the use of extracorporeal respiratory support. Methods This was an electronic survey comprising ICUs in two administrative regions of Poland. The aim of the study was to determine the number of influenza patients with respiratory failure admitted to the ICU in the autumn–winter season of 2018/2019. Furthermore, respiratory support, outcome and other pathogens detected in the airways were investigated. Results Influenza infection was confirmed in 76 patients. The A(H1N1)pdm09 strain was the most common. 34 patients died (44.7%). The median age was 62 years, the median sequential organ failure assessment (SOFA) score was 11 and was higher in patients who died (12 vs. 10, p = 0.017). Mechanical ventilation was used in 75 patients and high flow nasal oxygen therapy in 1 patient. Extracorporeal membrane oxygenation (ECMO) was used in 7 patients (6 survived), and extracorporeal carbon dioxide removal (ECCO2R) in 2 (1 survived). The prone position was used in 16 patients. In addition, other pathogens were detected in the airways on admittance to the ICU. Conclusion A substantial number of influenza infections occurred in the autumn–winter season of 2018/2019 that required costly treatment in the intensive care units. Upon admission to the ICU, influenza patients had a high degree of organ failure as assessed by the SOFA score, and the mortality rate was 44.7%. Advanced extracorporeal respiratory techniques offer real survival opportunities to patients with severe influenza-related ARDS. The presence of coinfection should be considered in patients with influenza and respiratory failure.

Balanced Convolutional Neural Networks for Pneumoconiosis Detection

Pneumoconiosis remains one of the most common and harmful occupational diseases in China, leading to huge economic losses to society with its high prevalence and costly treatment. Diagnosis of pneumoconiosis still strongly depends on the experience of radiologists, which affects rapid detection on large populations. Recent research focuses on computer-aided detection based on machine learning. These have achieved high accuracy, among which artificial neural network (ANN) shows excellent performance. However, due to imbalanced samples and lack of interpretability, wide utilization in clinical practice meets difficulty. To address these problems, we first establish a pneumoconiosis radiograph dataset, including both positive and negative samples. Second, deep convolutional diagnosis approaches are compared in pneumoconiosis detection, and a balanced training is adopted to promote recall. Comprehensive experiments conducted on this dataset demonstrate high accuracy (88.6%). Third, we explain diagnosis results by visualizing suspected opacities on pneumoconiosis radiographs, which could provide solid diagnostic reference for surgeons.

Membrane Filtration Opportunities for the Treatment of Black Liquor in the Paper and Pulp Industry

Black liquor is a highly alkaline liquid by-product of the kraft pulping process, rich in organic molecules (hemicelluloses, lignin, and organic acids) and inorganic pulping chemicals such as sodium salts and sulphur-containing compounds. The release of this wastewater without further treatment could have serious environmental and financial implications. Therefore, a costly treatment process is used nowadays. Nanofiltration has been studied in the last few years as a promising alternative to recycle the cooking chemicals required for the separation of lignin and cellulose, but the development of pH-stable membranes with the potential to operate at industrial scales is fundamental in order to make this possible. In this study, the filtration performance of two in-house made membranes is evaluated and compared with a commercial NF membrane to determine the viability of their use for the treatment of black liquor. For this purpose, filtration experiments with simulated black liquor were performed. We identified that Membrane A has the higher potential for this application due to its competitive permeate flux (ca. 24 L m−2 h−1 at a trans-membrane pressure of 21.5 bar), and high rejection of organic components and salts from the cooking liquor (on average, 92.50% for the TOC, 84.10% for the CO32−, 88.70% for the sulphates, 73.21% for the Na+, and 99.99% for the Mg2+).

A call for revamping the policy on import process of anticancer drugs in Pakistan

Madam, cancer therapy in Pakistan is a costly treatment financially exhausting patients and their caregivers. Due to the sky high costs of treatment, there is a lack of cancer care facilities in the country. The sale and regulation of anticancer drugs and biologics is controlled by the Drug Regulatory Authority Pakistan (DRAP). DRAP is responsible for granting No Objection Certificate (NOC) to import unregistered drugs either for the patient or the institutional use of a hospital, both subject to renewal. This process can take up from a minimum of 10 days to a maximum of 30 days, for an individual patient it may take up to 1 to 3 days. This was a task almost unachievable before the formation of DRAP. (1,2) In Pakistan, there have been challenges such as price hike in local medicines (3), anticancer drug shortages due to unavailability of active pharmaceutical ingredients (4) as well as COVID19 related raw material and drug availability (5). The average time for importing an unregistered drug from outside the country is about 4-6 weeks, which may be further delayed for months. Our discourse aims to bring attention to this issue, as delay in initiation or continuation of treatment significantly reduces the chances of the patient’s survival with time, which is something they do not have much of We propose the following steps as part of making this process easier for the stakeholders and patients alike: Reduce the time of import of unregistered drugs to 1 week (revamp import process/fast-track) Decentralize authority to provincial DRAP to reduce the burden Once an unregistered drug is imported, it should be registered in the list of special status drugs to fasten future process Facilitate the cancer centers on procurement of import medicines. Hospitals who face inventory challenges- should be able to easily borrow an imported medicine item from a nearby hospital where it is available. Exempt custom duties and taxes on import of such medicines Encourage local manufacturing of generic drugs Abolish regularity duties on import of raw material of said medicines for the manufacturer of such generic drugs Allow multiple sources of drug import Trainee program for DRAP officials dealing with biologics Derive an online process/portal to communicate and update patients and hospitals for delays and implement procedures to deal with such issues (6). Continuous...

Additional cost of end-stage kidney disease in diabetic patients according to renal replacement therapy modality: a systematic review

The prevalence of end-stage kidney disease (ESKD) is growing worldwide; the survival of these patients requires renal replacement therapy (RRT, a complex and costly treatment). Over 20% of the patients that start RTT had diabetes. Limited evidence on the effect of comorbidities on the cost of RRT exists. This review summarizes the available evidence on the effect of diabetes mellitus (DM) on the cost of RRT. Electronic databases were searched using key words that combined RRT with DM and cost. References were identified with title, abstract, and full-text screening. The studies included were published in English and presented data on the cost of RRT in ESKD patients with comparison between DM status. Seventeen studies were included in this review. The crude and adjusted cost of care estimates for patients on dialysis was generally higher for DM patients. The cost of care of ESKD patients differed according to various treatment modalities and these differences, mainly driven by inpatient costs. Overall, we found an increased cost of RRT care in patients with DM regardless of the type of treatment. Future analysis of the effects of multiple comorbidities should be considered to better understand the effect of DM on the cost of RRT.

Correction to: Cystic Fibrosis Revisited - A Review Study

In the following article, the author reported an error in the abstract’s result section [1]. The results section of the abstract has been changed as follows: Results: The main benefits (e.g., specialized centres for the treatment of CF exist or a new breakthrough in the gene therapy of CF has been made) and limitations (e.g., comorbidity of CF, lifelong and costly treatment, or adverse impact on patient’s and caregiver’s quality of life) in the treatment of CF are highlighted. The original results section of the abstract was published as: Results: The main benefits (e.g., specialized centres for the treatment of CF exist or a new breakthrough in the gene therapy of CF has been made) and limitations (e.g., comorbidity of CF, lifelong and costly treatment, or adverse impact on patient’s and caregiver’s quality of life) in the treatment of narcolepsy are highlighted. The original article can be found online at 10.2174/1573406412666160608113235

EPIDEMIOLOGICAL CHARACTERISTICS OF BREAST CANCER IN THE REPUBLIC OF MORDOVIA

The article analyzes the main epidemiological characteristics of breast cancer in the Republic of Mordovia in comparison with the Russian Federation. Based on the official accounting and reporting documentation for 2011-2019. the territorial and age-specific features of the incidence were determined, the structure of pathomorphological forms of breast cancer was assessed, the weighted average cost of providing specialized medical care for breast neoplasms in a hospital in the Republic of Mordovia was calculated. It has been shown that the incidence of breast cancer in the Republic of Mordovia for 2011-2019 increased, which corresponds to the all-Russian laws: 6.11 per 100 thousand women in the age group of women 25-29 years old to 213.14 in the age group 60-64 years. Infiltrating ductal carcinoma prevailed in the structure of the pathomorphological form of breast cancer among the inhabitants of the Republic - 58.8%. It has been shown that the cost of providing specialized hospital care for stage III breast cancer is 8 times higher than for stages I-II of breast cancer. Thus, the analysis showed that breast cancer is a serious medical and social problem, and effective treatment of the disease requires costly treatment in a specialized hospital, and the cost of drug therapy for the disease increases significantly at advanced stages.

A STUDY ON AWARENESS ON AB-PMJAY FOR TREATMENT OF DISEASES WITH SPECIAL REFERENCE TO CANCER CARE IN THANJAVUR DISTRICT OF TAMIL NADU

Ayushman Bharat or Modicare, the Central Government aims to provide a health insurance cover of Rs 5 lakh to 500 million Indians free of cost. This includes families from lower income groups that fall under the socio-economic caste census (SECC) data of 2011. PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year. In Tamil nadu a scheme called ‘Chief Minister Kalaignar’s Insurance Scheme for Life Saving Treatments’ (KHIS) was launched in the year 2009 to ensure that poor and low income groups who cannot afford costly treatment, are able to get free treatment in Government as well as private hospitals for serious ailments. Later this scheme was modified with extended coverage in the year 2011 and re-launched in the name of ‘Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS)’. Under this scheme, the sum assured for each is revised as Rs.1 lakh every year for a total period of four years and for a total value of Rs. 4 lakh. Now, a value addition is made to the exicting CMCHIS, after the launch of PM-JAY, providing an insurance cover upto Rs 5 lakh per family, per year for secondary and tertiary hospitalization

Necessity to empower clinical teachers, especially surgeons and emergency medicine specialists in Breaking Bad News

In the medical field, “breaking bad news” usually includes conditions in which a person has developed symptoms of a deadly disease, such as AIDS and cancer. However, in some other definitions, breaking bad news involved other situations, such as the symptoms of chronic diseases and painful situations, such as diabetes, failure of treatment plans, difficult and costly treatment plans, disability, amputation, and paralysis (1). Breaking bad news is the most critical type of relationship between a doctor or medical staff and patients. During this process, the doctor or another medical staff is required to convey bad news and other unpleasant information to patients. This news and information can include diagnosis with a dangerous illness, recurrence of a bad condition, or treatment failure, or even death. The issue of breaking bad news was first raised by Buck man in clinical research. According to Buck man, the bad news is defined as any news that leads to negative changes in a person’s attitude toward his future and can have significant psychological consequences for the person (2). The way bad news is conveyed is very important. In ancient times, people who transmitted bad news were called bad people and it was believed that bad fate awaited these people. Therefore, it is natural for patients or their companions who receive bad news on patient’shealth status or his death from an inexperienced doctor to blame the doctor for the mentioned conditions and to behave aggressively toward the doctor(3). Most patients expect to be approached with empathy and compassion when presented with bad news. They also expect to receive information clearly and are concerned about ambiguities during a dangerous illness (4).