Opportunities and Challenges of Nurses after Upgradation of Class 2 Status

Nurse’s job facilities and challenges have emerged as a burning issue in health care delivery system in Bangladesh. This descriptive cross sectional study with a mixed quantitative and qualitative design aimed to explore the opportunities and challenges of nurses after upgradation of class 2 status. The study was carried out in two specialized public hospitals for one year duration among purposively selected 144 nurses with a semi structured interview administered questionnaire In depth interview and focus group discussion (FGD) were conducted among selected personnel. The study revealed that the mean age of nurses was 42.3 (±6.3) years, majority (86.1%) were female, most of them (79.1%) were senior staff nurse with 16.8 years mean working experience. The study explored the opportunities of nurses after upgradation of class 2 status like increased responsibilities and honor in working place, promotional opportunities mentioned by majority of respondents. On the other hand, the challenges were noted as not changing the physicians attitude, not changing the working environment, limited scope for utilization of professional skill, not having job security mentioned by majority of respondents. The study also found that most of the nurses (90.3%) were satisfied after upgradation, but a large portion were not satisfied regarding fringe benefits and current salary structure. From FGD and in depth interview some suggestions come forward for nursing profession empowerment like good salary package, medical incentive, residence and training facilities etc. Few opportunities increased in upgradation of nurses in class 2 status, however nurses were depriving from many of their facilities, which indicated that 2nd class status was partially implemented in professionally, socially and culturally. Bangladesh Journal of Medical Education Vol.13(1) January 2022: 20-26

QT Interval Dynamics and Cardiovascular Outcomes: A Cohort Study in an Integrated Health Care Delivery System

Background Long QT has been associated with ventricular dysrhythmias, cardiovascular disease (CVD) mortality, and sudden cardiac death. However, no studies to date have investigated the dynamics of within‐person QT change over time in relation to risk of incident CVD and all‐cause mortality in a real‐world setting. Methods and Results A cohort study among members of an integrated health care delivery system in Northern California including 61 455 people (mean age, 62 years; 60% women, 42% non‐White) with 3 or more ECGs (baseline in 2005–2009; mean±SD follow‐up time, 7.6±2.6 years). In fully adjusted models, tertile 3 versus tertile 1 of average QT corrected (using the Fridericia correction) was associated with cardiac arrest (hazard ratio [HR], 1.66), heart failure (HR, 1.62), ventricular dysrhythmias (HR, 1.56), all CVD (HR, 1.31), ischemic heart disease (HR, 1.28), total stroke (HR, 1.18), and all‐cause mortality (HR, 1.24). Tertile 3 versus tertile 2 of the QT corrected linear slope was associated with cardiac arrest (HR, 1.22), ventricular dysrhythmias (HR, 1.12), and all‐cause mortality (HR, 1.09). Tertile 3 versus tertile 1 of the QT corrected root mean squared error was associated with ventricular dysrhythmias (HR, 1.34), heart failure (HR, 1.28), all‐cause mortality (HR, 1.20), all CVD (HR, 1.14), total stroke (HR, 1.08), and ischemic heart disease (HR, 1.07). Conclusions Our results demonstrate improved predictive ability for CVD outcomes using longitudinal information from serial ECGs. Long‐term average QT corrected was more strongly associated with CVD outcomes than the linear slope or the root mean squared error. This new evidence is clinically relevant because ECGs are frequently used, noninvasive, and inexpensive.

An overview of microneedle applications, materials, and fabrication methods

Microneedle-based microdevices promise to expand the scope for delivery of vaccines and therapeutic agents through the skin and withdrawing biofluids for point-of-care diagnostics – so-called theranostics. Unskilled and painless applications of microneedle patches for blood collection or drug delivery are two of the advantages of microneedle arrays over hypodermic needles. Developing the necessary microneedle fabrication processes has the potential to dramatically impact the health care delivery system by changing the landscape of fluid sampling and subcutaneous drug delivery. Microneedle designs which range from sub-micron to millimetre feature sizes are fabricated using the tools of the microelectronics industry from metals, silicon, and polymers. Various types of subtractive and additive manufacturing processes have been used to manufacture microneedles, but the development of microneedle-based systems using conventional subtractive methods has been constrained by the limitations and high cost of microfabrication technology. Additive manufacturing processes such as 3D printing and two-photon polymerization fabrication are promising transformative technologies developed in recent years. The present article provides an overview of microneedle systems applications, designs, material selection, and manufacturing methods.

Mobility Patterns in Different Age Groups in Japan during the COVID-19 Pandemic: a Small Area Time Series Analysis through March 2021

In the COVID-19 era, movement restrictions are crucial to slow virus transmission and have been implemented in most parts of the world, including Japan. To find new insights on human mobility and movement restrictions encouraged (but not forced) by the emergency declaration in Japan, we analyzed mobility data at 35 major stations and downtown areas in Japan—each defined as an area overlaid by several 125-meter grids—from September 1, 2019 to March 19, 2021. Data on the total number of unique individuals per hour passing through each area were obtained from Yahoo Japan Corporation (i.e., more than 13,500 data points for each area). We examined the temporal trend in the ratio of the rolling seven-day daily average of the total population to a baseline on January 16, 2020, by ten-year age groups in five time frames. We demonstrated that the degree and trend of mobility decline after the declaration of a state of emergency varies across age groups and even at the subregional level. We demonstrated that monitoring dynamic geographic and temporal mobility information stratified by detailed population characteristics can help guide not only exit strategies from an ongoing emergency declaration, but also initial response strategies before the next possible resurgence. Combining such detailed data with data on vaccination coverage and COVID-19 incidence (including the status of the health care delivery system) can help governments and local authorities develop community-specific mobility restriction policies. This could include strengthening incentives to stay home and raising awareness of cognitive errors that weaken people's resolve to refrain from nonessential movement.

Integration of Complementary and Alternative Medicines in Health care system to combat COVID 19- A Validation

Human mankind has always been under the wrath of various epidemics viz. Spanish Flu, Asian Flu, Hong Kong Flu, influenza A-H1N1 virus, SARS in 2003, etc. The on-going COVID 19 pandemic has posed as a serious concern to humans with no proper treatment and no specific drugs against this virus. There have been various challenges to the current health care delivery system. There is dearth of reported RCTs evaluating effects of antivirals. Corticosteroid treatment has reported to have delayed coronavirus RNA clearance with its widespread use leading to development/exacerbation of fungal diseases like Mucormycosis. Various vaccines designed have many questions about their efficacy that may rise with time, as SARS-CoV-2 has numerous variants, and it can mutate over time. With limited success in developing antivirals, Complementary and Alternative medicines like Traditional Chinese medicines, Ayurvedic and homoeopathic medicines have been gaining momentums in recent years displaying promising results. Methodical researches are warranted to further evaluate the efficacy of Complementary and alternative medicines. For curtailing the devastating effects of COVID 19 requires reviewing the current health policies by integrating complementary medicine with conventional system. To channelize all the available therapeutic options to win the battle against COVID-19 is the need of hour.

Teachers’ view about feminization of Medical Education in Bangladesh

This descriptive type of cross-sectional study was driven to explore the teachers’ view about feminization of medical education in Bangladesh. This study was carried out in 4 government and 4 non-government medical colleges of Bangladesh during the period of July 2019 to June 2020. From all four phases, total 104 teachers were respondents of this study to seek information regarding the factors affecting and effects of feminization of medical education in Bangladesh with a pretested self-administered questionnaire. The study revealed that high social respect, high marriage value, parental pressure, financial security are the factors for feminization of medical education in Bangladesh. Other factor that may influence female students to get admitted in the MBBS course is female students are more studious. There are limited better alternate profession for female students. This study also revealed that empathetic to patients are more satisfied with female doctors, they like some specific subspecialty as their career choice and feminization do not hamper quality of health care. 46 (44.2%) teachers were disagreed that female doctors like to work in rural area. and 49 (47.1%) teachers were disagreed that female doctors are efficient in medical emergency management during disaster. Study recommended establishment of female friendly working environment at all levels of the hospital. Study also recommended further long term and wider scale study with more participants to observe the impact of feminization of medical education on health care delivery system in Bangladesh Bangladesh Journal of Medical Education Vol.12(2) July 2021: 4-9