ObjectiveHuman activities associated with aerosol-generating hot water sources are increasingly popular. Recently, a hypersensitivity pneumonitis (HP)-like granulomatous lung disease, with non-tuberculous mycobacteria from exposure to hot water aerosols from hot tubs/spas, showers, and indoor swimming pools, has been described in immunocompetent individuals (also called “hot tub lung”). Our objective in this study was to examine four additional cases of hot tub lung and compare these cases with others reported in the English print literature on this disease.Data sources and extractionWe retrospectively reviewed all cases (n = 4) of presumptively diagnosed hot tub lung in immunocompetent individuals at the various physician practices in Springfield, Illinois, during 2001–2005. In addition, we searched MEDLINE for cases of hot tub lung described in the literature.Data synthesisWe summarized the clinical presentation and investigations of four presumptive cases and reviewed previously reported cases of hot tub lung.ConclusionsThere is a debate in the literature whether hot tub lung is an HP or a direct infection of the lung by nontuberculous mycobacteria. Primary prevention of this disease relies on ventilation and good use practices. Secondary prevention of this disease requires education of both the general public and clinicians to allow for the early diagnosis of this disease.

Aim:Provision of end-of-life care requires that we have adequate information about the preferred place of death in the population. Since no such study is reported in India, this study was taken up in and around Pune, a large cosmopolitan city.Setting and Design:A questionnaire was designed in three parts and distributed among the people above the age of 18 in and around Pune.Materials and Methods:The questionnaire had three parts the first being a consent form, followed by one for collection of personal information and lastly questions specific to the subject matter. Filled forms were screened for inconsistencies, gaps of information and errors.Results:The population survey was mixed, both urban and rural, men and women, educated and uneducated, young and old. Despite this heterogeneity, the results were consistent to the point that most of the people surveyed preferred home as the place of death. This preference cuts across all barriers, the only difference being that women had a stronger preference for home death compared to men.Conclusions:Helping people to die at their preferred place is a part of end-of-life care. Majority of people surveyed by us, prefer to die at home, where they are relatively more comfortable. Public and governmental policies should be directed toward facilitating home deaths.

Aims:The aim of the present study is to assess the level and areas of stress among care givers nursing their loved ones suffering from cancer.Setting and Design:An assessment of care givers’ stress providing care to cancer patients at Cipla Palliative Care Center was conducted. The study involves data collection using a questionnaire and subsequent analysis.Materials and Methods:A close-ended questionnaire that had seven sections on different aspects of caregivers’ stress was developed and administered to 137 participants and purpose of conducting the survey was explained to their understanding. Caregivers who were willing to participate were asked to read and/or explained the questions and requested to reply as per the scales given. Data was collected in the questionnaires and was quantitatively analyzed.Results:The study results showed that overall stress level among caregivers is 5.18 ± 0.26 (on a scale of 0-10); of the total, nearly 62% of caregivers were ready to ask for professional help from nurses, medical social workers and counselors to cope up with their stress.Conclusion:Stress among caregivers ultimately affects quality of care that is being provided to the patient. This is also because they are unprepared to provide care, have inadequate knowledge about care giving along with financial burden, physical and emotional stress. Thus interventions are needed to help caregivers to strengthen their confidence in giving care and come out with better quality of care.

Purpose Simulated clinical events provide a means to evaluate a practitioner's performance in a standardized manner for all candidates that are tested. We sought to provide evidence for the validity of simulation-based assessment tools in simulated pediatric anesthesia emergencies. Methods Nine centres in two countries recruited subjects to participate in simulated operating room events. Participants ranged in anesthesia experience from junior residents to staff anesthesiologists. Performances were video recorded for review and scored by specially trained, blinded, expert raters. The rating tools consisted of scenario-specific checklists and a global rating scale that allowed the rater to make a judgement about the subject's performance, and by extension, preparedness for independent practice. The reliability of the tools was classified as ''substantial'' (intraclass correlation coefficients ranged from 0.84 to 0.96 for the checklists and from 0.85 to 0.94 for the global rating scale). Results Three-hundred and ninety-one simulation encounters were analysed. Senior trainees and staff significantly out-performed junior trainees (P = 0.04 and P \ 0.001 respectively). The effect size of grade (junior vs senior trainee vs staff) on performance was classified as ''medium'' (partial g 2 = 0.06). Performance deficits were observed across all grades of anesthesiologist, particularly in two of the scenarios. Conclusions This study supports the validity of our simulation-based anesthesiologist assessment tools in several domains of validity. We also describe some residual challenges regarding the validity of our tools, The MEPA Collaborators are listed in ''Acknowledgements''.