Browsing by Author "Saramma, PP"

Now showing 1 - 9 of 9
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    Alcohol-based hand rub and surgical site infection after elective neurosurgery: An intervention
    (NEUROLOGY INDIA, 2011)
    Background: Controlled studies on the effect of alcohol-based hand rub before and after each patient contact on surgical site infection (SSI) among neurosurgical patients are scarce. Aim: To evaluate the effect of alcohol-based hand rub before and after each patient contact on SSI after elective neurosurgical procedures. Setting and Design: Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala. An intervention study using a 'before-after' design. Material and Methods: Two 9-month study periods were compared; between these periods, an infection-control protocol incorporating an alcohol-based hand rub was implemented for a period of 3 months and continued thereafter. Consecutive patients who underwent neurosurgery between January and September 2006 (control group, before protocol) and between January and September 2007 (intervention group, after protocol) were included. Outcome measures included SSI rates, profile of microorganisms and patient survival. Statistical Analysis: SPSS statistics version 17.0. Results: A total of 1,899 operated cases were reviewed. The patients in the control and intervention groups were similar with regard to sex, age and type of neurosurgery. The surgical site infection rates were 22 (2.3%) out of 974 in the control group and 14 (1.5%) out of 925 in the intervention group (P = 0.2). Patient survival rates were 97.6% (control) and 98.3% (intervention). Post hoc power calculation for an alpha value equal to 0.05, the power obtained was 24.9%, showing inadequacy of sample size to get significant results. To achieve 80% power, the sample size required is about 4,800 each for the control and intervention groups. Conclusion: Use of alcohol-based hand rub before and after each patient contact in the neurosurgical intensive care unit did not show a significant reduction in SSI in the present study. This lack of difference between the two groups may be related to the inadequate sample size. The other possibility is that both the strategies are of equal efficacy for prevention of SSIs.
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    Alcohol-based hand rub and ventilator-associated pneumonia after elective neurosurgery: An interventional study.
    (Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 2011)
    BACKGROUND: Interventional studies on the effect of alcohol-based hand rub on ventilator-associated pneumonia (VAP) among neurosurgical patients are scarce.AIM: To observe the effect of alcohol-based hand rub on tracheobronchial colonization and VAP after elective neurosurgical procedures.MATERIALS AND METHODS: An interventional study using a "before-after" design in a tertiary care center in Kerala. Two 9-month study periods were compared; between these periods, an infection control protocol incorporating an alcohol-based hand rub was implemented for a period of 3 months and continued thereafter. Consecutive patients who required mechanical ventilation after neurosurgery between January and September 2006 and 2007, respectively, were included. Outcome measures included VAP rate, tracheobronchial colonization rate, profile of microorganisms and patient survival.RESULTS: A total of 352 patients were on mechanical ventilator for a varying period of 1-125 days. The patients in the control and intervention groups were similar with regard to sex, age and type of neurosurgery. Tracheobronchial colonization was seen in 86 (48.6%) of 177 in the control group and 73 (41.7%) of 175 among the intervention group (P = 0.195). The VAP rates in the control and intervention groups were 14.03 and 6.48 per 1000 ventilator days (P = 0.08). The predominant organisms causing VAP and tracheobronchial colonization were Klebsiella and Pseudomonas aeruginosa, respectively, in both groups. Patient survival rates were 87.6% (control) and 92% (intervention).CONCLUSION: Clinical results indicated a better outcome, showing a reduction in tracheobronchial colonization rate and VAP rate, although this was not statistically significant.
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    Child rearing issues for mothers with epilepsy: A case control study
    (Annals of Indian Academy of Neurology, 2014) Saramma, PP; Thomas, SV; Sarma, PS
    Background: Epilepsy can cause additional problems in child rearing to mothers with epilepsy (MWE). We aimed to ascertain the knowledge and practice of child rearing in MWE with a pretested questionnaire and compare it with that of mothers without epilepsy (MWoE).Materials and Methods: A standard questionnaire on knowledge (20 questions) and practice (10 questions) of child rearing was prepared through literature review, consultation with subject experts and interview with patients. The questionnaire was administered to 20 MWE with infants less than one-year age and 20 MWoE (matched for age, parity and education). Results: The knowledge on safety needs of infants was significantly ( P <0.01) lower for MWE than for MWoE but the over all knowledge on child rearing was comparable for both groups (12.45 ± 2.95 for MWE and 13.1 ± 3.13 for MWoE). The mean score on child rearing practice (CRP) was significantly lower ( P <0.05) for MWE (27 ± 2.51) than for MWoE (28 ± 1.6). There were three instances of accidentally dropping the baby for the epilepsy group. There was a trend towards better CRP as the knowledge on CR increased.
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    Effect of a self-instructional module on the child rearing knowledge and practice of women with epilepsy
    (SEIZURE-EUROPEAN JOURNAL OF EPILEPSY, 2014) Saramma, PP; Sarma, PS; Thomas, SV
    Women with epilepsy (WWE) have poorer knowledge and skill in child rearing than women without epilepsy. Purpose: To evaluate the effect of a self-instructional module (SIM) on the child rearing knowledge (CRK) and practice (CRP) of WWE and developmental outcome of their babies. Methods: One hundred women in first trimester of pregnancy that were enrolled in to the Kerala Registry of Epilepsy and Pregnancy and consenting to participate were given a self instructional module (SIM) or a comparator booklet by random concealed allocation. Their child rearing knowledge (CRK) was assessed by a standardized protocol at entry (first trimester) and at 3-4 months postpartum. Their child rearing practice (CRP) was evaluated in third postpartum month. The developmental outcome of babies was assessed at 1 year of age as per registry protocol. Results: Eighty eight women completed this 1 year study. The CRK score was significantly higher (p = .034) for the intervention group (32.91 +/- 5) when compared to the comparator group (30.61 +/- 5) However, a corresponding improvement in CRP score was not observed for the former. Developmental outcome of 68 babies showed a positive weak correlation between CRP and developmental quotient both mental and motor. The intervention group demonstrated significant increase in their CRK. Nevertheless the results did not indicate a significant improvement in the CRP. Conclusion: The SIM improved the CRK of WWE. Nevertheless, the child rearing practices did not show corresponding improvement. (C) 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
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    Effect of a selfinstructional module on the child rearing knowledge and practice of women with epilepsy
    (Seizure - European Journal of Epilepsy., 2014-06) Saramma, PP; Sarma, PS; Thomas, SV
    Women with epilepsy (WWE) have poorer knowledge and skill in child rearing than women without epilepsy. PURPOSE: To evaluate the effect of a self-instructional module (SIM) on the child rearing knowledge (CRK) and practice (CRP) of WWE and developmental outcome of their babies. METHODS: One hundred women in first trimester of pregnancy that were enrolled in to the Kerala Registry of Epilepsy and Pregnancy and consenting to participate were given a self instructional module (SIM) or a comparator booklet by random concealed allocation. Their child rearing knowledge (CRK) was assessed by a standardized protocol at entry (first trimester) and at 3-4 months postpartum. Their child rearing practice (CRP) was evaluated in third postpartum month. The developmental outcome of babies was assessed at 1 year of age as per registry protocol. RESULTS: Eighty eight women completed this 1 year study. The CRK score was significantly higher (p=.034) for the intervention group (32.91±5) when compared to the comparator group (30.61±5) However, a corresponding improvement in CRP score was not observed for the former. Developmental outcome of 68 babies showed a positive weak correlation between CRP and developmental quotient both mental and motor. The intervention group demonstrated significant increase in their CRK. Nevertheless the results did not indicate a significant improvement in the CRP. CONCLUSION: The SIM improved the CRK of WWE. Nevertheless, the child rearing practices did not show corresponding improvement.
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    Hyponatremia after aneurysmal subarachnoid hemorrhage: Implications and outcomes
    (Neurosci Rural Pract., 2013-01) Saramma, PP; Menon, RG; Srivastava, A; Sarma, PS
    Background : Hyponatremia is the most common electrolyte abnormality seen in patients with aneurysmal SAH. Clinically significant hyponatremia (Serum Sodium <131 mEq/L) which needs treatment, has been redefined recently and there is a paucity of outcome studies based on this. This study aims to identify the mean Serum Sodium (S.Na+) level and its duration among inpatients with SAH and to identify the relationship between hyponatremia and the outcome status of patients undergoing surgery for SAH. Materials and Methods : This outcome study is undertaken in the department of neurosurgery, The Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala. Medical records of all patients with SAH from 1 st January to 31 st July 2010 were reviewed. Preoperative status was assessed using World Federation of Neurosurgical Societies (WFNS) grading system. Discharge status was calculated using the Glasgow outcome score scale. Results : Fifty nine patients were included in the study and 53 (89.8%) of them have undergone surgical treatment. Hyponatremia was observed in 22 of 59 patients (37%). The mean Sodium level of hyponatremic patients was 126.97 mEq/L for a median duration of two days. Glasgow outcome score was good in 89.8% of patients. We lost two patients, one of whom had hyponatremia and vasospasm. Conclusion : Hyponatremia is significantly associated with poor outcome in patients with SAH. Anticipate hyponatremia in patients with aneurysmal subarachnoid hemorrhage, timely detect and appropriately treat it to improve outcome. It is more common in patients who are more than 50 years old and whose aneurysm is in the anterior communicating artery. Our comprehensive monitoring ensured early detection and efficient surgical and nursing management reduced morbidity and mortality.
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    Hyponatremia after aneurysmal subarachnoid hemorrhage: Implications and outcomes
    (J Neurosci Rural Pract., 2013-01) Saramma, PP; Menon, RG; Srivastava, A; Sarma, PS
    Background : Hyponatremia is the most common electrolyte abnormality seen in patients with aneurysmal SAH. Clinically significant hyponatremia (Serum Sodium <131 mEq/L) which needs treatment, has been redefined recently and there is a paucity of outcome studies based on this. This study aims to identify the mean Serum Sodium (S.Na+) level and its duration among inpatients with SAH and to identify the relationship between hyponatremia and the outcome status of patients undergoing surgery for SAH. Materials and Methods : This outcome study is undertaken in the department of neurosurgery, The Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala. Medical records of all patients with SAH from 1 st January to 31 st July 2010 were reviewed. Preoperative status was assessed using World Federation of Neurosurgical Societies (WFNS) grading system. Discharge status was calculated using the Glasgow outcome score scale. Results : Fifty nine patients were included in the study and 53 (89.8%) of them have undergone surgical treatment. Hyponatremia was observed in 22 of 59 patients (37%). The mean Sodium level of hyponatremic patients was 126.97 mEq/L for a median duration of two days. Glasgow outcome score was good in 89.8% of patients. We lost two patients, one of whom had hyponatremia and vasospasm. Conclusion : Hyponatremia is significantly associated with poor outcome in patients with SAH. Anticipate hyponatremia in patients with aneurysmal subarachnoid hemorrhage, timely detect and appropriately treat it to improve outcome. It is more common in patients who are more than 50 years old and whose aneurysm is in the anterior communicating artery. Our comprehensive monitoring ensured early detection and efficient surgical and nursing management reduced morbidity and mortality.
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    Women with epilepsy have poorer knowledge and skills in child rearing than women without epilepsy
    (SEIZURE-EUROPEAN JOURNAL OF EPILEPSY, 2011)
    Epilepsy can negatively impact the child rearing ability of women because of the risk related to seizures, adverse effects of antiepileptic drugs and psychosocial factors.Objective: To compare the child rearing knowledge (CRK) and practices (CRP) of women with epilepsy (WWE) with a matched group of women without epilepsy (WWoE).Methodology: This study was carried out in the Kerala registry of epilepsy and pregnancy (KREP) at Sree Chitra Tirunal Institute for Medical Sciences and Technology in India. We prospectively recruited 100 WWE in first trimester of pregnancy from the KREP and 93 age, education and parity matched pregnant WWoE from the antenatal clinics of the Government medical college Thiruvananthapuram. Their child rearing knowledge (CRK) and practices (CRP) were evaluated with previously validated protocols. The CRK was assessed at the time of enrolment (first trimester of pregnancy) and the CRP was assessed when the baby was three to four months old.Results: Eighty-eight women each from WWE and WWoE had completed the study, over a period of three years. WWE and WWoE were comparable for age (25.56 +/- 4.66 and 25.69 +/- 4.49 years), pregnancy outcome and type of delivery. WWE had excess fetal loss and postnatal seizures. The CRK was significantly lower for WWE (23.53 +/- 6.3) than for WWoE (26.08 +/- 5.3). The CRP was significantly lower for WWE (25.01 +/- 9.6) than for WWoE (28.14 +/- 7.1). WWE performed poorer in all domains of child rearing practices namely feeding, growth and development, cleaning and protection and infant stimulation. Poorer CRK was strongly associated with lower CRP while several demographic and economic characteristics were not relevant. WWE fared poorer in feeding and nursing their babies in spite of having the right knowledge in that domain. This may be due to several undisclosed concerns and social dynamics that need to be addressed while preparing any interventions. (C) 2011 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.