Brayal D. Souza

Background and Objectives: The assessment of second-victim phenomena within health care organizations and the evaluation of existing support systems are crucial for health care leaders. However, there is a paucity of evidence highlighting nurses’ perceptions associated with the physical and psychological distress they experience following an adverse event in lower and middle-income countries (LMIC). Hence, this study aims to explore the magnitude of second-victim experiences among nurses and their perceptions of support resources available. Support systems focusing on training and resilience in coping, peer support programs, and mental health resources have been deployed by some hospitals to combat second victim syndrome. The objective of this research is to investigate the extent of second-victim experiences among nurses in a tertiary teaching hospital in south India and their perceptions regarding the availability of different support resources. Methods: A total of 1074 respondents participated in the study, which was conducted at a teaching tertiary care hospital in Coastal Karnataka in April 2023. The respondents consisted of nurses aged 20 years and older who were directly involved in patient care. Standardized and validated instruments were employed to collect the data. All survey responses were coded and summarized in a master Excel sheet, and subsequently, the data were exported to IBM SPSS Statistics 25 for analysis. Descriptive statistics were utilized to summarize the obtained data. Results: One of the primary findings of the study is the inadequacy of organizational support services addressing the second victim experience. A majority of the nursing professionals highlighted the role of non-work-related support, such as love from friends and families, to cope with the experiences related to being a second victim. While timely responses from nursing supervisors are acknowledged and appreciated in the present study, nurses also reported a tendency for attribution of blame by their supervisor. In addition, our study reveals the role of second victim syndrome in absenteeism and turnover. This can be attributed to the significant psychological and mental distress experienced by nurses in such situations. Conclusion: The present study attempted to examine the second victim experiences of nursing professionals. The originality and value of this research lie in addressing the lack of evidence regarding nurses’ perceptions and the physical and psychological distress they encounter following adverse events. This study sheds light on an understudied area, highlighting the need for further attention and support for nurses in the aftermath of adverse events.

Background: The COVID-19 pandemic prompted significant transitions in many lives, with UNICEF reporting that 73% sought help for physical and mental well-being. This study is grounded in life course theory, examining youths’ emotional and behavioral adaptations during this period. The study was carried out to explore the lived experiences of youth during and after the COVID-19 pandemic through photovoice methodology. Methods: Employing a qualitative, community-based participatory approach, the study was conducted among students aged 18 to 25 years. Data collection in this study is conducted using photovoice methodology, a participant-led research approach in which the researcher and the participant collaborate through photographs and narratives. Data were gathered from participants in Udupi, Karnataka, through 72 photographs and 24 journals, complemented by one-on-one interviews using the SHOWeD prompt technique. Results: Twenty-four youths (8 males, 16 females) from India, Malaysia, and Sri Lanka participated. Four primary themes emerged: fears leading to resilience, societal pressures, coping strategies during adversity, and new beginnings post-pandemic. Youth utilized various mechanisms, including social support and spirituality. Conclusion: The study highlights youth’s adaptive strategies and resilience amid significant challenges, utilizing the photovoice approach.

Objective: By considering risk factors of patients with acute ischemic stroke in the neurology department and intensive care unit (ICU), the study explored which indicators affected the patient’s condition, and by comparing the biochemical indicators of survival and death patients with ischemic stroke in ICU, the study explored which biomarkers can be associated with the patient’s prognosis. Methods: The study retrospectively analyzed 27 patients with acute ischemic stroke from ICU and 43 patients from the neurology department. The analysis indicators include medical history, lifestyle habits, electrocardiogram, biochemical indicators, and inflammatory cytokines. The study compared the differences in the above factors between patients admitted to the ICU and those not admitted to the ICU. Multivariable logistic regression analyses were performed to identify predictors affecting the death of patients transferred to ICU. Results: Neutrophilic granulocyte and D‐dimer in patients with ischemic stroke from ICU were significantly increased ( p < 0.05). In ICU, compared with patients alive, we found that cardiac troponin I in patients who finally died was significantly increased ( p < 0.05, OR is 29.250, and 95% CI is 2.789, 306.811). Conclusions: Acute ischemic stroke patients with higher neutrophils and D‐dimer were more likely to enter into the ICU. Cardiac troponin I elevation seems to be associated with the poor prognosis of patients in ICU.

This study measured the quality of discharge teaching and discharge readiness levels in ischemic stroke patients to understand the factors affecting the discharge. A total of 120 patients with mild-to-moderate ischemic stroke were recruited using simple random sampling. Three instruments, namely, a demographic data questionnaire, the readiness for hospital discharge scale, and the quality of discharge teaching scale, were used for data collection. Descriptive statistical analysis and parametric tests with a correlation matrix, one-way analysis of variance, and independent t-tests were used for data analysis, providing robust evidence that the quality of discharge teaching was strongly correlated with patient readiness (r = 0.625, p<0.001) and underscoring that effective education was a key, modifiable factor for improving outcomes. The results advocated for preemptive screening and individualized discharge plans to enhance care quality and reduce readmission risks.

Background and Aim: Antimicrobial resistance (AMR) is a critical global health threat, projected to cause up to 10 million deaths annually by 2050. Livestock production, where antimicrobials are widely used, plays a significant role in the emer­gence and spread of resistant pathogens. In India, small-scale dairy farming forms a key part of rural livelihoods, yet lim­ited evidence exists on antimicrobial usage and animal health practices in this sector. This study assessed antimicrobial usage patterns, awareness, and associated animal health management practices among smallholder dairy farmers in West Medinipur district, West Bengal. Materials and Methods: A community-based cross-sectional study was conducted between January and June 2024. Using expert-validated questionnaires and observational checklists, data were collected from 302 household dairy farmers and eight veterinarians across four blocks. Descriptive statistics, Chi-square tests, and logistic regression analyses were per­formed to identify factors associated with antimicrobial misuse and non-adherence to withdrawal periods. Results: All farmers reported antimicrobial use for their cattle, yet only 18.2% had heard of AMR and 8.9% adhered to drug withdrawal periods. About 13.2% used antimicrobials without prescriptions and 15.2% relied on previous prescriptions. Storage of antimicrobials at home (odds ratio [OR] = 3.998; 95% confidence interval [CI] = 1.598–10.002), sharing drugs with peers (OR = 5.289; 95% CI = 2.148–13.020), and lack of veterinary consultation (OR = 0.148; 95% CI = 0.0365–0.597) were significant predictors of misuse. Farm-level practices such as absence of isolation units, herd overcrowding, and poor cleaning frequency were significantly associated with higher cattle morbidity (p < 0.001). While all farmers vaccinated and dewormed cattle, 78.1% did not quarantine new animals, and only 19.5% maintained treatment records. Veterinarians generally adhered to guidelines but reported inadequate facilities for safe drug disposal. Conclusion: This study reveals widespread antimicrobial misuse and low AMR awareness among small-scale dairy farm­ers, compounded by inadequate biosecurity and waste disposal practices. Strengthening AMR mitigation requires targeted farmer education, regulation of over-the-counter antimicrobial sales, better veterinary infrastructure, and integration of One Health-based waste management systems. Interventions should prioritize prescription-based antimicrobial access, continuous farmer training, and community-level monitoring to safeguard both animal and human health. Keywords: Antimicrobial resistance, antimicrobial use, drug withdrawal period, India, One Health, smallholder dairy farming.

This study aims to identify the nature and prevalence of patient safety incidents and the design, development, and implementation of a patient-reported incident management system. The system's effectiveness in capturing patient-reported incidents and promoting patient empowerment was also evaluated. Findings reveal that nearly 33.8% of patients reported experiencing a patient safety incident, with 81.6% of these incidents identified by the patients themselves. After the implementation of the system, 47% of reported incidents were addressed by staff, indicating a significant improvement in patient empowerment. Furthermore, there was a 71% increase in overall incident reporting. Following the introduction of the patient-reported incident management system, 67% of patients reported feeling more empowered, and 53% provided positive feedback regarding the system's user-friendliness.

Background: Financial burdens faced by patients in India suffering from chronic kidney disease (CKD) are linked to healthcare access and inadequate insurance coverage. This study analyses out-of-pocket expenses and explores their healthcare utilisation patterns. Materials and Method: This time-bound hospital-based cross-sectional study was conducted in a tertiary care hospital in Udupi district, Karnataka, among patients who have undergone haemodialysis (HD) treatment for at least a year. Following ethics approval and CTRI registration, informed consent was obtained from all the patients prior to data collection. Result: The study involved 109 HD patients. The direct medical and non-medical costs incurred by HD patients were Rs 9,400 (IQR = 13,700) and Rs 3,200 (IQR = 2,000), respectively. The monthly health-related OOPE was Rs 16672.0 (IQR = 14,630.0). Overall, 103 (94.5%) individuals had been hospitalised since they began HD, and 50.5% of patients were hospitalised within the past year. On linear regression analysis, it was observed that the joint monthly income (β 0.134, 95% CI 0.007 - 0.182, P value = 0.048), number of dialyses per week (β 1.14, 95% CI 7541.5 - 16551.07, P value < 0.001), and social security (β −1.02, 95% CI −13463.0 - 7982.56, P value < 0.001) exhibited significant correlations and served as predictors for household out-of-pocket expenditure (HROOPE) experienced by the patients. Conclusion: The study concludes that people receiving HD incur a considerable financial cost. Additionally, the CKD population uses healthcare services at a notable rate, including frequent hospital stays, visits to outpatient departments (OPDs), and emergency treatment, underscoring the pressing need for an increase in insurance coverage.

Introduction: Mental illnesses are one of the major contributors to the overall burden of disease among the young. We investigated the predictors of emotional and behavioral problems among in-school adolescents in the Indian context. Methods: Using stratified sampling, 1441 adolescents were recruited to participate in the study in Udupi taluk. The study instruments included a socio-demographic pro forma and the adolescent self-reporting version of the Strengths and Difficulties Questionnaire (SDQ) to assess the emotional and behavioral problems among them. We explored the predictors of total difficulties, as well as externalizing and internalizing problems and gender differences. SPSS version 25 was used to analyze the data. Descriptive statistics, a Chi-square test for associations, an independent t-test to explore the gender differences, correlation analysis, and backward stepwise logistic regression for the predictors were used. Results: The mean age of the participants was 15.31 ± 0.76. An almost equal percentage of male (49.6%) and female (50.4%) participants provided data. Abnormal scores were highest under conduct problems (8.5%), and the total difficulties reached 5.1%. The male participants had higher levels of conduct, hyperactivity, peer relationship, and externalizing problems the while the female participants experienced higher levels of emotional and internalizing problems. It was observed that there was a significant positive relationship between age and emotional problems, conduct problems, hyperactivity, peer problems, and total SDQ score. An older age predicted an abnormal total difficulties score and externalizing and internalizing behaviors, while the type of school predicted the total difficulties and internalizing behaviors. Conclusion: The age of the adolescent, their gender, and the type of school they attended emerged as predictors of the emotional and behavioral problems among them.

Introduction The primary goal of quality improvement is to enhance patient outcomes, particularly in the emergency department (ED). Timely and effective care is crucial in these situations. By comprehending the challenges, evaluating current performance and implementing quality improvement projects, areas in need of enhancement can be pinpointed and addressed, resulting in better outcomes. Methodology This interventional study explores the implementation of quality improvement in the ED of a quaternary care teaching hospital in South India. It follows the Plan-Do-Check-Act (PDCA) cycle guided by the Donabedian model. Descriptive statistics were employed to measure changes in outcomes before and after implementation. To improve processes, Donabedian principles were applied, and a performance audit was conducted based on patient feedback and stakeholder input. Various ED indicators were measured. To address identified issues, formal root cause analysis was performed, leading to the generation of PDCA rapid change cycles. These cycles were implemented over 6 months, with two cycles executed, followed by postimplementation evaluation. Results Post implementation, improvements were observed in several aspects of ED operations. These included reduced ED average length of stay, decreased time to analgesia, shorter cross-consultation time, faster transfer time from ED and improved investigation turnaround time (TAT). Additionally, there was a reduction in revisits to ED within 72 hours and a decrease in patients who left without being seen. These positive changes demonstrate the effectiveness of the quality improvement intervention using the PDCA cycle. Conclusion A comprehensive understanding of patient profile in the ED and factors influencing care is essential for the hospital to ensure sufficient resources and skilled emergency medicine physicians are available 24/7. By enhancing services in the ED, reducing patient waiting times and improving TAT, the overall efficiency of services can be improved. This leads to provision of timely quality care to patients and ultimately improves their outcomes.

Background: Patient identification is an important patient safety goal, healthcare providers have primary responsibility for verifying a patient's identity appropriately before intended interventions in the hospital. It is important for the hospital management team to develop and ensure the practice of patient identification policy. Objective: To assess knowledge, attitude, and compliance to patient safety goal of patient identification Methods: An observational cross-sectional study was conducted among 231 staff nurses of inpatient departments using random sampling at a tertiary hospital. The staff nurses were assessed for knowledge, attitude, and practices on patient safety of right patient identification using a knowledge-based questionnaire, structured validated questionnaire to measure attitude towards patient safety, and observational checklist for compliance to patient identification in practice Results: More than 50 percent of the nurses had a positive attitude towards reporting, acknowledging and dealing with mistakes, and concentrating on causes that could result in improving patient safety. Majority believed, management provided fair treatment for reporting but were more inclined and invested towards meeting targets of the organization. The compliance with all the identification practices was more than 80% with few areas of improvement identified for a compliance rate of less than 90%. Conclusion: Patient identification practices require special attention in health care delivery to avoid misleading errors and harm. It is thereby important to measure compliance and attitude of HCP at regular intervals to improve reporting and devising strategies. The compliance rate can be further improved by using strategies like standardizing approaches, provision of clear protocol, training, and patient education, and most importantly creating a culture of reporting and demonstrating management's inclination towards quality assurance