Home care for stroke patients ineffective, reveals new study

Dinesh C Sharma

New Delhi: For years, doctors in Indian hospitals have been recommending home-based care for rehabilitation of stroke patients. But a new study – largest of its kind – has revealed that this does not work.

Stroke patients require continuous care including physiotherapy to recover and minimize life-long disability. In the absence of adequate professional and affordable rehabilitation facilities, doctors often recommend care at home by family members supplemented physiotherapist visits. Hospital-based care is also offered in various centres but is costly.

In order to study if home-based care results in desired outcomes, a study was done at 14 public, private and district hospitals across the country. A total of 1250 stroke patients were followed up over six months. The study participants were divided in two groups – one received standard package of care given by respective hospital while the other group was given home-based care which included training to family members and weekly visits by physiotherapists for two months. The results revealed that there was no reduction in disability for patients who got care at home, compared to those who received the standard package.

The findings, published in medical journal The Lancet on Tuesday, have surprised medical community because earlier studies carried out in developed countries had indicated that community-based rehabilitation played significant role in recovery of stroke patients. The World Health Organisation (WHO) too recommends such an approach.
“We found that despite extensive training in hospital and during follow up visits in the home, there was no difference in the degree of recovery or quality of life of people who received this extra treatment,” explained Professor Richard Lindley of the George Institute for Global Health and the University of Sydney, who led the study.

The study, supported by the National Health and Medical Research Council (NMHRC) of Australia, was coordinated by Christian Medical College, Ludhiana. Patients in the intervention group had access to physiotherapists who taught the family techniques such as mobility training and communication practice.

“Professional help like training and visits by physiotherapists was provided for first two months only because the intervention needed to be cost effective and sustainable. If family members required more training, then the aspiration of routinely providing rehabilitation through family caregivers might not be feasible,” pointed out Jeyaraj Pandian, neurologist from Christian Medical College, Ludhiana who led the trial. “Our training programme might not have been sufficient (in time and content) to deliver effective family rehabilitation, as we observed only about 30 minutes of daily activities in the intervention group. Conventional western rehabilitation is usually associated with greater daily therapy time.” Accredited Social Health Activist (ASHA) might have been a more effective strategy, but probably more expensive.

Dr Vijaya Nath Mishra, a neurologist at the Sir Sunderlal Hospital at BHU, Varanasi, said the results of the study are surprising. “We will have to carefully examine the evidence because we have so far believed and also observed that caregivers and family members have a major role in outcome of stroke.” Dr Mishra was not associated with the study.

It is estimated that around 1.6 million people have a stroke in India each year, yet the vast majority receive no formal rehabilitation. The whole country has just 35 stroke units, and most are in the cities, despite stroke being the third commonest cause of death in the adult population.

Professor G V S Murthy of the Indian Institute of Public Health, the Co-Chair of the study, commented, “task shifting is increasingly seen as a solution to targeting chronic diseases in many countries in the world. But our results show it may be ineffective for some conditions and waste already limited resources. We need more rigorous examinations of such family and community led programs before they become commonplace.”

The participating hospitals included Christian Medical College, Ludhiana; Apollo Gleneagles Hospitals, Kolkata; All India Institute of Medical Sciences, New Delhi; Baptist Christian Hospital, Tezpur; Christian Medical College and Hospital, Vellore; GNRC Hospitals, Dispur; Lalitha Super Specialty Hospital, Guntur; Nizam Institute for Medical Sciences, Hyderabad; Postgraduate Institute for Medical Sciences and Research, Chandigarh; Sree Chitra Tirunal Institute for Medical Sciences and Technology; Global Hospitals, Chennai; BGS Global Hospitals, Bangalore; Amrita Institute of Medical Sciences, Kochi and St Stephen’s Hospital, New Delhi. (India Science Wire)


Twitter handle: @dineshcsharma

 

The US and India will work together for Prosperity through Partnership

Newsroom24x7 Network

Washington DC: Indian Prime Minister Narendra Modi’s just concluded visit to the US and his meeting with the American President Donald Trump at the White House on 26 June 2017 reinforced the close ties between the United States and India.

The two leaders have reiterated their commitment to further strengthen ties to achieve “prosperity through partnership.

Highlights of this cooperation, according to a White House press release,  include:

Global Partners on Defense and Security

Major Defense Partner The United States will continue to remain a “reliable provider” of advanced defense articles in support of India’s military modernization efforts. United States-sourced defense articles, including the Sea Guardian Unmanned Aerial System, Apache attack helicopters, and C-17 aircraft will further enhance the capabilities of the Indian Armed Forces and provide additional opportunities for interoperability. Completion of these sales would increase bilateral defense trade to nearly $19 billion, supporting thousands of United States jobs. If selected, United State offers to sell F-16 and F/A-18 fighter aircraft to India would represent the most significant defense cooperation between the United States and India to date.

DTTI The United States-India Defense Technology and Trade Initiative (DTTI) remains the premier forum for deepening collaboration on defense co-development and co-production. The seven DTTI Joint Working Groups continue to discuss a range of technologies and platforms for potential co-development, including India’s participation in the Future Vertical Lift program. DTTI representatives met most recently in April 2017.

Military-Military Engagements Key military and civilian defense leaders continue to meet via reciprocal counterpart visits and strategic and policy dialogues, promoting closer service ties and improving interoperability among our forces. The annual MALABAR naval exercise, occurring in July 2017 in the Indian Ocean, will be the most complex to date, including participants from the U.S. Navy, Indian Navy, and the Japan Maritime Self-Defense Force. The United States and India also participate in the VAJRA PRAHAR Special Forces exercise, the RED FLAG air force exercise, and YUDH ABHYAS army exercise.

Counter-Terrorism Partnership The United States and India are committed to combatting terrorism in all its forms and to strengthening cooperation on terrorist screening, intelligence, and information sharing, terrorist use of the internet, and multilateral terrorist designations. Reflecting this partnership, the U.S. Terrorist Screening Center and Indian counterparts are cross-screening known and suspected terrorists for investigative and intelligence purposes.
Law Enforcement Cooperation. The United States has provided anti-terrorism assistance training for more than 1,200 Indian security personnel since 2008.

Facilitating Strategic Trade The High Technology Cooperation Group (HTCG) facilitates greater civil high technology and defense trade between American and Indian businesses, leveraging India’s status as a Major Defense Partner. In 1999, 24 percent of all exports from the United States to India required an export license. Currently, licensed exports still make up only a small percentage of trade with India; in 2016, only 0.4 percent required a license, commensurate with the United States’ closest allies and partners.

Committed to Increasing Free and Fair Trade

Trade Two-way trade in goods and services reached $114 billion in 2016. With the Indian economy growing at 7 percent annually, both countries are committed to further expanding and balancing the trade relationship.

Aviation In 2017, Indian airline SpiceJet announced the order of 100 new Boeing 737MAX-8s, bringing its order to 205 planes valued at more than $20 billion and, according to industry, creating and sustaining 130,000 American jobs in the state of Washington and elsewhere. At the Paris Air Show in June, SpiceJet announced a preliminary commitment for an additional 20 Boeing aircraft.
India is projected to become the world’s third-largest commercial aviation market by 2020. Through the U.S-India Aviation Cooperation Program, the United States has increased the safety and security of India’s rapidly growing aviation sector, and generated over $600 million in exports of U.S. manufactured goods and services.

Trade Facilitation The United States and India, both signatories to the World Trade Organization’s Trade Facilitation Agreement (TFA), are working together to implement the TFA’s provisions and help lower the cost of trade for both our countries.

Investment According to the Government of India, the United States is one of the top five destinations for investment from India. The U.S. Bureau of Economic Analysis reports that Indian companies have invested over $11 billion in the United States economy, creating and sustaining more than 52,000 jobs. Industry sources indicate these investments are spread across 35 states.
Capital Markets. The Department of Treasury and Indian Ministry of Finance continue to collaborate on resolving outstanding tax disputes, building Indian capital markets, and promoting greater bilateral investment. Enhanced technical cooperation includes areas such as the development of India’s municipal bond market. The just-completed issuance of a municipal bond for the city of Pune was India’s first municipal issuance since 2011.

Powering the New India

Liquefied Natural Gas Exports and Investment Indian energy companies have signed more than $30 billion in long-term contracts for U.S.-produced liquefied natural gas (LNG), including from Louisiana and Maryland. Industry estimates that Indian companies have invested more than $10 billion in the United States LNG and shale sectors.

Nuclear Power The United States and India are committed to realizing commercial civil nuclear cooperation, in particular through a contract for six Westinghouse Electric AP-1000 nuclear reactors to be built in Andhra Pradesh, India. Once completed, the project will provide reliable electricity for millions of Indian citizens.

Fossil Energy The U.S. Trade and Development Agency will host a Refineries Performance Optimization Reverse Trade Mission in fall 2017, familiarizing senior executives from Indian refining companies with U.S. technologies that can optimize the performance of India’s oil refineries.
Grid Expansion and Modernization. The Department of Commerce will lead a Smart Grid and Energy Storage Business Development Mission to New Delhi, Hyderabad, and Mumbai in March 2018 to showcase U.S. technologies and services that can help India address its grid modernization needs. The two countries also announced the Smart Grid and Energy Storage consortia under the U.S.-India Joint Clean Energy and Research Development Center.

Energy Finance The U.S.-India Clean Energy Finance Task Force is delivering recommendations to mobilize U.S. technology exports and American and Indian private investment in India’s $1.2 trillion power market. Additionally, the Department of State is facilitating connections between American and Indian industry, state governments, and universities to advance energy solutions.
Expanding Ties Between Our Citizens

Today, nearly 4 million Indian-Americans reside in the United States and over 700,000 U.S. citizens live in India. Last year, the United States Government issued nearly one million visas to Indian citizens, and facilitated 1.7 million visits by Indian citizens to the United States.
Global Entry Trusted Traveler Program. The United States began accepting applications from India for the expedited entry program, facilitating travel in both directions that will lead to more business, investment, and tourism. In 2016, Indian visitors in the United States spent nearly $13 billion, making India the sixth largest market for U.S. travel and tourism exports.

Skills Development More than 166,000 Indian students studied in the United States in 2016, contributing $5 billion in economic activity and supporting some 64,000 American jobs. Over the last decade, Indian students contributed $31 billion to the U.S. economy.
Entrepreneurship. The United States and India will co-host a Global Entrepreneurship Summit this year in India, focused on supporting women entrepreneurs, and geared toward solving 21st century challenges and improving lives. President Trump has asked Ivanka Trump to lead the United States delegation to the Global Entrepreneurship Summit.

Indian Americans have embraced innovation and entrepreneurship, sitting at the forefront of Silicon Valley’s technology revolution, and founding an estimated 15 percent of Silicon Valley startups. They have helped to develop the Pentium chip, fiber optics, and noise canceling headphones, among numerous other innovations.

Tackling Global Challenges

Exploring Space The United States and India are working together in the exploration of space, from discovering water on the surface of the Moon to sharing data on Mars from our respective orbiters. The joint NASA-ISRO Synthetic Aperture Radar (NISAR) satellite, scheduled for launch in 2021, will help scientists to better understand some of Earth’s most complex systems and hazards.
Afghanistan Development. The United States and India support increased stability and prosperity in Afghanistan and their expanded development coordination and cooperation benefits all three countries. India has spent $2 billion on development assistance to Afghanistan since 2001, and pledged an additional $1 billion in 2016. In September 2017, the United States will co-sponsor the India-Afghanistan Export, Trade and Investment Fair in New Delhi, to promote expanded Afghan commercial ties with India.

Global Agriculture Cooperation Fifty years after the Green Revolution helped India to free millions from hunger, the United States and India have trained more than 1,500 agricultural practitioners from 17 countries across Africa and Asia on specialized farming practices to improve productivity and income.

U.N. Peacekeeping Burden Sharing India and the United States remain committed to U.N. peacekeeping and building the capacity of African partners, training participants from 13 countries and the African Union. The two sides will conduct additional joint training in July 2017 and lead a mobile training team in Africa this fall.

Disease Research and Treatment For more than 40 years, the United States has collaborated with India on disease research, including tuberculosis (TB), HIV, and rotavirus, and non-communicable diseases – cancer, diabetes, and cardiovascular diseases. The United States supports India’s ambitious goal to end TB by 2025, through the scale-up of detection, diagnosis, and new treatments for drug-resistant TB.

Global Health Security Agenda (GHSA) As GHSA Steering Group members, the United States and India recognize the importance of strengthening global capacity to counter infectious disease threats. India is working across sectors to address antimicrobial resistance (AMR) stewardship, a key threat to global health security and modern medicine. The United States remains committed to supporting India as it develops and implements multi-sectoral national action plans to combat AMR and two national AMR networks for the use of antimicrobial surveillance.

People’s power and participation has set the foundation for India’s transformation: Narendra Modi

Newsroom24x7 Network

P​rime Minister Narendra Modi met Mark Rutte, Prime Minister of Netherlands during his visit to Netherlands​. Photo Courtesy: Lalit Kumar

The Hague:  Prime Minister Narendra Modi, during his visit to Netherlands on Tuesday, talked about how the spirit of Jan Shakti (people’s power) and Jan Bhagidari (people’s participation) has set the foundation for India’s transformation and helped in fulfilling people’s aspirations.

The PM was speaking at a reception hosted by the Indian diaspora.

Modi also interacted with Dutch CEOs and invited them to invest in India. He especially spoke about reform initiatives of Government of India over the last 3 years and shared remarks on the importance of India-Netherlands ties.

Modi also held extensive talks with Prime Minister of Netherlands Mark Rutte on India-Netherlands relations. Both leaders shared the view that strong ties between the two nations are beneficial for the world.

The Prime Minister in his tweet on the reception by the Indian diaspora at The Hague said it was an “unforgettable community reception. It was a delight to be among the diaspora. Sharing my speech.”