Showing posts with label Preventive and social medicine. Show all posts
Showing posts with label Preventive and social medicine. Show all posts

Sunday, August 2, 2020

Technique of Breastfeeding

Hello friends!
On International Breastfeeding Week, I am sharing the proper technique for Breastfeeding. 
Must know methods for everyone.

Techniques of Breastfeeding 
Breastfeeding is nature's precious gift for infants. Breastfeeding is advised because human milk is species-specific nourishment for the baby, produces optimum growth and development, and provides substantial protection from illness. Lactation is beneficial to the mother's health and biologically supports a special MOTHER-BABY relationship.

But most breastfeeding problems are caused by the poor attachment of the baby to the breast. Thus, it is very important to learn how to feed the baby with the correct position and attachment.

Support the mother's body as support back well and use pillow, cushion, or footstool to provide comfort. Before breastfeeding, every mother should wash their hands. 
The correct way to support baby -
1. In sitting position 
a) Cradle hold-
Hold the baby horizontally facing the mother. When nursing from the right breast, use the right arm to rest on the forearm, baby's back supports on the same forearm and holds baby's bottom with hand. Support the breast with the left hand. 
b) Transition hold (cross over hold)
When nursing from the right breast, use the left arm to hold the baby. Support baby back with the left forearm, while placing the thumb and fingers at the base of the baby's head below the ears of the baby. Support the breast with the right hand. 
c) Football hold
Hold the baby under the mother's arm and let the baby face towards the breast. Support the baby with a pillow underneath. Hold the baby close the mother with the nose pointing to the nipple, use the forearm to support baby back and neck, and the hand to hold the baby head. This position is suitable for mothers who have had a Caesarean section. Since mother does not put pressure on the abdomen. 

2.Inside lying hold 
Baby and mother lying on their sides facing each other. The mother should be relaxed. The baby needs to well supported and secure as tuck a rolled-up towel or small pillow firmly behind baby' back to keep in position. Adjust the baby's distance from the lower breast by placing a folded blanket under the baby's head. To assist with the latch on using the opposite hand to support the breast(right hand for left breast vice-versa) 
Getting baby latch on to the breast -support the base of the baby's head. Baby's head slightly extended, so that the nipple is aimed at the roof of the baby's mouth. Lightly touch the baby's lip with the nipple and wait till baby opens his/her mouth wide. Bring baby to mother's breast. Not mother breast to the baby. 

Signs of good attachment-baby open his/her mouth wide with lips flanged out, more areola is seen above the baby's lip then below baby's chin is pressed onto the breast. 
Breastfeeding should not hurt if the mother keeps a finger into the corner of baby's mouth to break the suction and gently take baby off mother's breast.

By- 
Shashikala Kumari
2nd year MBBS
GMC Bettiah

Friday, April 24, 2020

Funnel Plot

-also called as Begg’s plot
-type of scatter plot
-used to examine biases in meta-analyses

An ideal funnel plot is symmetric.
If no biases, 95% of studies lie within the triangle.


Thursday, April 9, 2020

COVID-19: Use of masks

Hi everyone!

We used the WHO guidelines to write the pdf and uploaded it over here

COVID 19: How to limit the spread?

COVID19 spreads primarily through droplets of saliva or discharge from the nose when an infected patient coughs or sneezes (we should so cough or sneeze into a tissue or flexed elbow). The SARS-CoV-2 can also be carried, that's why the handwashing is so important.

We use other means of prevention to limit the spreading, for example, masks and negative pressure rooms. Let us see how it is done.

Wednesday, April 8, 2020

COVID-19: Containment strategy by South Korea

Hello everyone!

In this post, we will discuss the manner with which South Korea managed to contain the virus rather successfully.

So let me help you catch up:-

Saturday, April 4, 2020

COVID-19: SARI treatment facility design

Hi everyone,

One of our guest authors, Tanay Saxena, recently completed a course on Severe Acute Respiratory Infections Treatment Centre. He compiled a very thorough set of notes during the course based on the WHO Severe Acute Respiratory Infections Treatment Centre practical manual that has been developed for the COVID-19 pandemic.

Friday, April 3, 2020

COVID-19: Trained immunity from BCG vaccine

Would BCG vaccination really help in immunizing up against SARS-CoV-2?


Let's dig in. 

BCG is a live-attenuated strain derived from an isolate of Mycobacterium bovis used widely across the world as a vaccine for tuberculosis (TB). But that's not all, BCG vaccination is a potential goldmine against so many diseases.

COVID-19 and Pregnancy: Should Mothers Be Concerned?

Pregnancy is a special phase in a woman’s life, more so because of the various changes which her body undergoes during these 9 months. Perhaps that is why, the concern about the threat of the novel coronavirus is valid- after all pregnancy is a state of slight immunocompromise, and also because there are two lives at stake. WHO declared the COVID-19 outbreak a pandemic on March 11, 2020. Most countries have taken stringent measures to control the spread of this disease, but do pregnant women need to take more measures? So, avid obstetricians out there, let’s find out deeply about the connection between these two:

WHO’s official stand is that there is no higher risk in pregnancy of severe illness BUT because there are trials underway and due to the bodily changes in pregnancy, one can not know the extent of COVID-19 in these patients. [1] Due to the evolving crisis, we are seeing newer studies every day with new results. A study conducted in early February on 38 pregnant women showed that it did not lead to maternal deaths, and neither were there any confirmed cases of intrauterine transmissions, with rt-PCR being negative in all the neonatal specimens tested, hence leading to the belief that there is no intrauterine or transplacental transmission. [2] Even the CT scans done on pregnant women with COVID-19 positive samples, did not show major changes and recovered from pneumonia adequately. [3]

Wednesday, April 1, 2020

COVID-19: Vaccines under development

COVID-19 pandemic has led researchers around the world to work on developing a safe and effective vaccine. At present, there are 5 agents which are being extensively tested as potential vaccines. Here is some information about them.
1. mRNA- 1273 

Trial: Safety and Immunogenicity Study of 2019-nCoV Vaccine (mRNA-1273) for Prophylaxis SARS CoV-2 Infection
   
- novel lipid nanoparticle encapsulated mRNA based vaccine that encodes for spike protein of SARS-CoV-2
- an open-label phase I dose-ranging clinical trial in the United States
- Study Population: 45 healthy people, males and non-pregnant women aged 18-55
    - enrolled in one of three cohorts - 25mcg, 100mcg, 250mcg
    - IM injection of the vaccine on Day 1 and 29 in deltoid
    - Follow up: 1,2,4 weeks post each vaccination, 3,6,12 months post second vaccine

- Objective
    - To evaluate the safety and reactogenicity of a 2-dose vaccination schedule of mRNA-1273, given 28 days apart, across 3 dosages in healthy adults 
    - To evaluate the immunogenicity as measured by Immunoglobulin G (IgG) enzyme-linked immunosorbent assay ELISA to the SARS-CoV-2 S (spike) protein following a 2-dose vaccination schedule of mRNA-1273 at Day 57

2. BCG Vaccine

BCG vaccine — developed for Tuberculosis. It has favorable in vitro or in vivo effect against RSV, Yellow fever, HSV, HPV. The hypothesis is that it may induce partial protection against the susceptibility to and/or severity of SARS-CoV-2 infection

Trial 1: BCG-CORONA reducing health care workers absenteeism in SARS-CoV-2 pandemic through Bacillus Calmette-Guérin vaccination, a randomized controlled trial (BCG-CORONA)

- RCT in the Netherlands 

- Study population: 1000 Health care workers with direct COVID-infected patient      
  contact
- Study duration: 6 months
- Objective: 
    - To reduce absenteeism among HCW with direct patient contacts during the epidemic phase of COVID19
    - To reduce hospital admission, ICU admission or death in HCW with direct patient contacts during the epidemic phase of COVID19

Trial 2: BRACE - BCG Vaccination to Reduce the Impact of COVID-19 in Australian Healthcare Workers Following Coronavirus Exposure (BRACE) Trial

- Open-label two group phase III RCT in Australia

- Study population: 4170 Healthcare workers
- Study duration: 12 months
- Objective:
    - COVID 19 disease incidence over 6 months, by 12 months
    - severe COVID 19 disease incidence over 6 months, by 12 months


3. Synthetic Minigene Vaccine

Artificial antigen-presenting cell Vaccine - a synthetic minigene that has been engineered based on conserved domains of the viral structural proteins and a polyprotein protease. The vaccine will be produced using a vector system to express viral proteins and immune modulators genes to modify artificial antigen-presenting cells (APC) and to activate T cells


Trial 1: Safety and Immunity of COVID-19 aAPC Vaccine

- Open-label phase I study in China

- Study population: 100 participants aged 6months to 80 years
- Objective: 
    - Injection of COVID-19/aAPC vaccine to volunteers to evaluate the safety
- To evaluate the anti- COVID-19 reactivity of the COVID-19/aAPC vaccine

Trial 2: Phase I/II Multicenter Trial of Lentiviral Minigene Vaccine (LV-SMENP) of COVID-19 Coronavirus

- Open-label Phase I/II study in China

-Study population: 100 participants aged 6months to 80 years
- Objective:
    - Injection and infusion of LV-SMENP DC and antigen-specific cytotoxic T cell vaccines to  
healthy volunteers and COVID-19 infected patients to evaluate the safety
- To evaluate the anti- COVID-19 efficacy of the LV-SMENP DC and antigen-specific  
cytotoxic T cell vaccines

4. ChAdOx1 nCoV-19 Vaccine

Trial: A Phase I/II Study to Determine Efficacy, Safety, and Immunogenicity of the Candidate Coronavirus Disease (COVID-19) Vaccine ChAdOx1 nCoV-19 in UK Healthy Adult Volunteers

- Single-blinded, Randomized Phase I/II study in UK
-Study population: 510 participants aged 18 to 55 years
- Objective: 
    - To assess efficacy of the candidate ChAdOx1 nCoV-19 against COVID-19
    - To assess safety of the candidate ChAdOx1 nCoV


5. Recombinant Novel Coronavirus Vaccine (Adenovirus Type 5 Vector)

Trial: A Single-center,Open-label,Dose-escalating Phase I Clinical Trial to Evaluate Recombinant Novel Coronavirus Vaccine (Adenovirus Type 5 Vector) in Healthy Adults Aged 18-60 Years Old

- Open label, dose-escalating Phase I study in China
-Study population: 108 participants aged 18 to 60 years
- Objective:
    - To evaluate the safety, reactogenicity and immunogenicity of Recombinant Novel Coronavirus Vaccine (Adenovirus Type 5 Vector)

Written by Devi Bavishi
Reference: clincialtrials.gov

COVID-19: Lessons from coronavirus outbreak in China and formulating a strategy

Hello awesomites!

The following information is regarding the situation of COVID19 in China and how did China manage to reduce the incidence of new cases.


Image by  Nakeya. Medicowesome 2020

Saturday, March 28, 2020

COVID-19: The journey of a viral pandemic

Modes of transmission of SARS-CoV-2

A novel human coronavirus that emerged in Wuhan, China in the later months of 2019 has now dissipated all around the world, causing a pandemic. Let's analyze how this virus manages to spread so virulently breaching our usual barriers.

Modes of transmission of SARS-CoV-2

Thursday, August 22, 2019

Human milk bank

Hello Awesomites!

Update for community medicine:-

Because some infants could not be fed by their mothers (early demise of mothers or chronic illness), humans have adopted substitute feedings.

1.Human breast milk bank (recent advance)

2.Infant formula feed

3.Fortified human milk for premature infants

The MoHFW launched the National Human Milk Bank at Lady Hardinge Medical College-the first government-run human milk bank, and at present, the country’s largest.

The human milk bank and lactation counselling centre, 'Vatsalya - Maatri Amrit Kosh', will collect, pasteurise, test and store milk donated by lactating mothers and make it available for infants in need.

Aanchal, the mother’s milk bank established in 18 district government hospitals of Rajasthan.

Beneficiaries will mainly be premature babies (born below 32 weeks of gestation) and IUGR (intrauterine growth restriction) infants.

Following is the link for further read and research :-

Key guidelines for human milk bank

Recent news article on human milk bank

Happy Studying!

Upasana Y.


Saturday, August 17, 2019

Breast feeding in special cases

Hello Awesomites!

-HIV positive mother
-Active Pulmonary TB
-Working mothers



CONTRAINDICATION OF BREASTFEEDING :

  • HIV, HTLV-1 and 2
  • Inborn error of metabolism LIKE GALACTOSEMIA AND PHENYLKETONURIA
  • Untreated case of tuberculosis
  • Herpes lesion on mothers’ breast
  • Mother on certain medication like anti-cancer drug or radioactive isotope etc.
WITH INCREASED BURDEN OF HIV AND TB,INDIA CAN’T AFFORD TO  CONTRAINDICATE THE BREASTFEEDING.


  1. IS THERE ANY RELATION BETWEEN BREASTFEEDING AND RISK OF TRANSMISSION?
  2. DO ART HAS ANY ROLE TO DECREASE THE TRANSMISSION?


ARV INTERVENTION
RISK OF HIV TRANSMISSION FROM MOTHER TO CHILD
NO ARV                 BREASTFEEDING +
30-45%
NO ARV                 BREASTFEEDING -
20-25%
3ARVS(ART)         BREASTFEEDING +
2%
3ARVS(ART)         BREASTFEEDING -
1%

HOW TO KNOW THE HIV STATUS OF CHILDREN LESS THAN 18 MONTHS?

 
METHOD USED - DNA PCR on a DRIED BLOOD SAMPLES OF INFANT
TEST PERFORMED -

  • 6 WEEKS
  • 6 MONTHS
  • 6 WEEKS AFTER CESSATION OF BREAST FEEDING (if being EBF)
  • 18 MONTHS

PEDIATRIC COMPONENT IN PPTCT


  • DURATION OF NEVIRAPINE PROPHYLAXIS TO HIV EXPOSED INFANT SHOULD BE MINIMUM OF 6 WEEKS.


  • INITIATION OF BREAST FEEDING WITHIN AN HOUR OF DELIVERY AS THE PREFERED OPTION


  • CONTINUE BF ATLEAST FOR 1 YEAR FOR THOSE WITH HIV -VE STATUS  AND 2 YEARS FOR HIV +STATUS OF CHILDREN


  • ENSURE INITIATION OF CO TRIMOXAZOLE PROPHYLACTIC THERAPY AT 6 WEEK OF AGE



MATERNAL COMPONENT IN PPTCT
“ART TO ALL PREGNANT AND BREASTFEEDING WOMEN LIVING WITH HIV “

TARGET POPULATION
ART REGIMEN
PREGNANT AND BREAST FEEDING WOMEN WITH HIV 
BUT NOT ON ART
TDF+3TC+EFV
PREGNANT WOMEN AND BREAST FEEDING WOMEN WITH HIV AND RECIEVING ART
THE SAME ART REGIMEN MUST BE CONTINUED 
  
AFASS
 

AFASS CRIETRIA is used to decide whether a HIV positive mother can breast feed or not provided that she has not started top feed yet.
(Why? Once the mother started to top feed the child, this criteria is not used. HIV positive mother in such case should continue top feed. Because mixed kind of feed is more dangerous than top feed alone)

  • Acceptable: The mother perceives no problem in replacement feeding.
  • Feasible: The mother (or family) has adequate time, knowledge, skills, resources and support to correctly mix formula or milk and feed the infant up to 12 times in 24 hours.
  • Affordable: The mother and family, with community or health system support if necessary, can pay the cost of replacement feeding without harming the health or nutrition status of the family.
  • Sustainable: Availability of a continuous supply of all ingredients needed for safe replacement feeding for up to one year of age or longer.
  • Safe: Replacement foods are correctly and hygienically prepared and stored, and fed preferably by cup.


QUESTIONS

  1. Where do you get your drinking water?
  2.  What kind of latrine/toilet do you have?
  3.  How much money could you afford for formula each month?
    Ps: calculate the amount based on the local costs
     
  4. Do you have a refrigerator with reliable power?
     
  5. Can you prepare each feed with boiled water and clean utensils?
     
  6. How would you arrange night feeds?
     
  7. Does your family know that you are HIV positive?
     
  8. Is your family supportive of milk feeding and are they willing to help

MANAGEMENT OF BABY BORN TO MOTHER WITH TUBERCULOSIS:-


  • Continue exclusive breastfeeding till 6 months of age & thereafter as in normal population.
  • Start ATT for mother immediately. Mother will be non infective within 2 months of regular ATT


  • Preventive Chemotherapy for baby (INH 5 mg/kg/day for 6 months)


  • Use face mask while around the baby, till 2 months after starting ATT.


  • BCG Vaccine at birth.Something is better than Nothing!


  • Re- immunized with BCG after stopping Preventive Chemotherapy. 
  • (Remember, it's not only mother, Anybody (with TB) around can infect the baby with Tuberculosis!)

Is ATT drug concentration in breast milk sufficient for the baby? NO

NAME OF THE GROUP
BREAST FEEDING
BARRIER METHOD
ISOLATION
BCG VACCINATION
IAP
TO CONTINUE
COUGH HYGIENE
1.IF MOTHER ON TREATMENT -NOT REQUIRED


2.IF MOTHER HOSPITALIZED, NON-ADHERENT TO THERAPY,MDR-TB - ISOLATION REQUIRED
AT BIRTH 
OR 


EVEN WITH INH PROPHYLAXIS
DOTS
ONLY IF MOTHER IS SPUTUM NEGATIVE
FACE MASK
IF MOTHER HAS ACTIVE DISEASE,NON-COMPLIANT AND HAS RECIEVED ATT PRIOR TO DDELIVERY 
POSTPONED
OR DONE
WITH INH RESISTANT OF BCG VACCINE 
AAP
ONLY IF MOTHER IS ON ATT
FACE MASK
MDR -TB AND NON COMPLIANT
GIVE BCG IN THESE MDR TB MOTHER
WHO
TO CONTINUE
FACE MASK
MDR -TB
INH THERAPY COMPLETED THEN AFTER 2 WEEK  OF COMPLETION BCG VACCINE GIVEN 
 THE DOUBT OF WORKING MOTHERS :-

For How long can expressed breast milk is stored? 


AT ROOM TEMPERATURE 
8-10 HOURS
IN A REFRIGERATOR
24 HOURS
IN A DEEP FREEZER (-20 degree)
3 MONTHS

HAPPY STUDYING ! 
-UPASANA Y.

Thursday, January 3, 2019

Lifestyle modifications for managing hypertension

Hey guys,

Happy New Year!

Let's get started on lifestyle modifications for treating or managing hypertension.

We Decide to Eat less Salt & drink less Alcohol!

Weight loss: Reduce BMI to <25 
DASH: Diet high in fruits and vegetables and low in saturated fat and total fat
Exercise: 30minutes/day for 5-6 days/week
Dietary Sodium: <3 g/day
Alcohol: 2 drinks/day in men and 1 drink/day in women

The effect of these interventions is in descending order, with weight loss having an impact of about 5-20 mmHg lowering per 10 kg weight loss and reducing alcohol intake can lower BP by 2-4 mmHg!

Remember: If a patient's BMI is already lower than 25, you don't have to ask them to reduce weight any further for this therapeutic effect. Instead, you ask them to switch over to DASH diet!

Hope this is helpful!

Stay awesome!
-Rippie

Sunday, November 25, 2018

A few USPSTF guidelines

Hello,

USPSTF guidelines are important to remember for step 2 CK, step 3 and residency!

Here are a few high yield ones!

Saturday, November 10, 2018

Facebook: ANM registration

#Medicowesome
#PSM

In a subcenter population, Crude birth rate is 20. What is minimum expected number of pregnencies registered with ANM?

1) 110
2) 120
3)  55
4) 100

Answer within 24 hours.

Answer is Option 3)

Let's get to this tricky question.

Total subcentre population is 5000.
Total CBR =20 per 1000 mid year  population.
Hence, 20/1000* 5000
=100 births.

Now here comes the tricky part.

Abortion and still birth accounts for 10% wasted pregnencies.
So 100+10 (10% of total births)
=110.
As per rule, ANM should have 50% registration, therefore 110/2=55
Approximately C) 60

That's all.

-Demotional bloke.

Thursday, September 13, 2018

Question: Chicken pox

#Medicowesome
#Microbiology
#PSM

Q) True about chicken pox are all except:
1) Caused by HSV-3
2) SAR is 90%
3) Superficial rash
4) Single stage of rash

Answer in 12 hours 
 Answer is 4) Single stage of rash

So, this post will help you remember manifestation of Chickenpox rash. You can also differentiate between Chickenpox and Smallpox rash using same

So for Chicken pox remember this mnemonic:-

DCP SPAReS Iron man ( Always Marvel fan!)

D= Dew drops appearance
CP= Centripetal appearance
S= Superficial and Uniocular 
P=Pleomorphic
A= Axilla and flexor surface affected
R=Rapid evolution
S=Spares palms and soles 
I=Inflammation around vesicles present

Since we have rapid evolution in chicken pox, scabs are formed after 4-7 days itself.

Smallpox rash appears exactly in an opposite manner of chickenpox rash.

Smallpox rash manifests as follow:-

Centrifugal appearence
Deep and Multilocular appearence
Non-pleomorphic
Axilla is spared and extensor compartment affected 
Slow evolution
Palms and soles are affected
No inflammation around vesicles
Since we have slow evolution in chicken pox, scabs are formed after 10-14 days itself.



-Demotional bloke


Tuesday, May 15, 2018

AFASS criteria

Hello Awesomites ! :D

AFASS CRIETRIA is used to decide whether a HIV positive mother can breast feed or not provided that she has not started top feed yet.
(Why? Once the mother started to top feed the child, this criteria is not used. HIV positive mother in such case should continue top feed. Because mixed kind of feed is more dangerous than top feed alone)

Acceptable: The mother perceives no problem in replacement feeding. Potential problems may be cultural, social, or due to fear of stigma and discrimination.

Feasible: The mother (or family) has adequate time, knowledge, skills, resources and support to correctly mix formula or milk and feed the infant up to 12 times in 24 hours.

Affordable: The mother and family, with community or health system support if necessary, can pay the cost of replacement feeding without harming the health or nutrition status of the family.

Sustainable: Availability of a continuous supply of all ingredients needed for safe replacement feeding for up to one year of age or longer.

Safe: Replacement foods are correctly and hygienically prepared and stored, and fed preferably by cup.

Source: http://motherchildnutrition.org/info/afass-principles.html (Click to know what all questions are asked)

-Upasana Y.:)

Friday, March 9, 2018

Understanding randomization in clinical trials


Hi, 
I am writing this to clear basics about randomization. It is a very important concept for understanding the clinical trial design and can come handy while critically analyzing any trial or designing your own study. 
This is not very important for any med school exam. I believe this is really important because of more extensive use of evidence-based medicine (EBM) in clinical practice and many clinicians lack the ability to skillfully evaluate a scientific manuscript.

I am planning to write more blogs related to evidence-based medicine, which might help our readers across the world to become expert in EBM.

  • RANDOMIZATION - randomly allocating participants into different treatment arms, purely on the basis of chance.  

  • Randomization is the cornerstone of clinical trial design. It's a very tricky concept and gets trickier when you start evaluating scientific literature critically or start designing a robust clinical trial.

  • It is pivotal in distributing confounders (eg. sex, age, history) equally in every treatment arm. Except for chance variation among the randomized group at baseline


Two most important  features of successful randomization:

1. Procedure truly allocates treatments randomly (based on chance)
2. Assignments are tamper proof

Randomization techniques:

1. Simple randomization:
By coin flipping (one side for treatment 1 and another side for treatment 2), shuffled deck of cards (even numbers for treatment 1 and odd numbers for treatment 2), throwing dice (numbers <3 for treatment 1 and numbers >3 for treatment 2). More better methods are random table method in stats books and computer software like excel.

Uses: in large sample size (>100 it should be preferred over block randomization)
Drawback: problematic in small sample size because it can create  unequal numbers in groups.

2. Block randomization: Ensure that participants are equally distributed among each group. Randomization is done in blocks, eg block size of six.
For example, a scientist enrolls only 6 patients per visit for a trial of total 60 patients. On each visit, he divides 3 patients each to treatment group A and B. At the end he will have 30 patient in both groups. See the figure 1 below.

 
 Figure 1. Block randomization of 60 patients in 6 patient blocks.

Drawbacks: Not suitable for randomization in non blinded trials, because randomization in small blocks makes a prediction of sequence easy.


3. Stratified Block randomization: It ensure that important predictor of outcome is more evenly distributed among study groups.
For example, if the age is a major determining factor in effectiveness or toxicity of the treatment then its imperative to have a similar distribution of ages in both treatment groups. Hence patients will be the first stratified into age groups and then they will be equally randomized in each arm. Like we did for Block randomization.

Drawback: only small number of baseline variables (2-3) can be managed by this technique.

4. Adaptive randomization: used for balancing more than 2-3 baseline variables.
5. Minimization: more complex adaptive randomization


I will continue more in next blog on randomization or other important concepts. Kindly post comments or question, which might help me, you, or other readers.

Thanks,
Dr. Gee


References:

Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB. Designing clinical research. Lippincott Williams & Wilkins; 2013 May 8.

Suresh, K. (2011). An overview of randomization techniques: An unbiased assessment of outcome in clinical research. Journal of Human Reproductive Sciences, 4(1), 8–11. http://doi.org/10.4103/0974-1208.82352