DREEM Study: Students Perceptions of Learning Environment in a Medical College in Mumbai, India.

PURPOSE: This study was carried out to assess medical education environment (MEE) at our institution and to determine if there is an association between the assessment scores and factors such as gender, residence, family educational background and medium of instruction during school years. METHODS: Students appearing for the final qualifying examination were enrolled in the cross-sectional survey after obtaining written informed consent. Demographic data and personal information such as place of residence, parental education and medium of instruction was collected. The Dundee Ready Education Environment Measure (DREEM) Questionnaire was used for assessment of MEE. The numerical variables were described in terms of mean and standard deviation, median and inter-quartile range and percentages. Independent t-test, one-way Anova, Mann-Whitney test and Kruskall- Wallis test were the analytical tests used depending upon the number of groups and characteristics of the data. RESULTS: Fifty-five students were enrolled in the study. The overall DREEM score was 119+/-22 (Median 116), 46(83.64%) reported overall positive perception). Students' perception of atmosphere (SPA) scored highest as compared to other domains. Teacher-centered teaching with emphasis on factual learning, authoritarian teachers, boredom in the course and lacking support systems were some of the problem areas identified on the basis of students' perceptions. There was a significant difference in Students' academic self-perception (SASP) and students' social self-perception scores between students coming from urban and rural backgrounds. CONCLUSIONS: Students reported an overall positive perception of MEE. Problem areas and research priorities were identified leading to a preparation of an action plan.

Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

BACKGROUND: Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. METHODS AND FINDINGS: We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6-9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2-<6 year olds ranged from 2.9% (95% CI 1.6-5.5) to 18.7% (95% CI 14.7-23.6), and for any of nine NDDs in the 6-9-year-old children, from 6.5% (95% CI 4.6-9.1) to 18.5% (95% CI 15.3-22.3). Two or more NDDs were present in 0.4% (95% CI 0.1-1.7) to 4.3% (95% CI 2.2-8.2) in the younger age category and 0.7% (95% CI 0.2-2.0) to 5.3% (95% CI 3.3-8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5-11.2) and 13.6% (95% CI 11.3-16.2) in children of 2-<6 and 6-9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6-9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population. CONCLUSIONS: The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions.

Validity of Broselow tape for estimating weight of Indian children.

BACKGROUND & OBJECTIVES: The Broselow tape has been validated in both ambulatory and simulated emergency situations in the United States and is believed to reduce complications arising from inaccurate drug dosing and equipment sizing in paediatric population. This study was conducted to determine the relationship between the actual weight and weight determined by Broselow tape in the Indian children and to derive an equation for determination of weight based on height in the Indian children. METHODS: This cross-sectional study was conducted at a tertiary care hospital in Mumbai, India. The participants' weights were divided into three groups <10 kg, 10-18 kg and >18 kg with a total sample size estimated to be 210 (70 in each group). Using the tape, the measured weight was compared to Broselow-predicted weight and percentage weight was calculated. Accuracy was defined as agreement on Broselow colour-coded zones, as well as agreement within 10 per cent between the measured and Broselow-predicted weights. The resulting data were compared with weights estimated by advanced paediatric life support (APLS) and updated APLS formulae using Pearson's correlation coefficient. RESULTS: The mean percentage differences were -11.78, -17.09 and -14.27 per cent for <10, 10-18 and >18 kg weight-based groups, respectively. The Broselow colour-coded zone agreement was 33.3 per cent in children weighing <10 kg, but only 7.4 per cent in the 10-18 kg group and 33.9 per cent in the >18 kg group. Agreement within 10 per cent was 53.13 per cent for the <10 kg group, but only 21.08 per cent for the 10-18 kg group and 33.9 per cent for the >18 kg group. Application of 10 per cent weight correction factor improved the percentages to 79.2 per cent for the <10 kg category, to 55.70 per cent for the 10-18 kg group and to 61.0 per cent for the >18 kg group. The correlation coefficient between actual weight and weights estimated by Broselow tape (r=0.89) was higher than that between actual weight and weight estimated by APLS method or updated APLS formulae (r=0.68) in 12-60 months age group as well as in >60 months age group (r=0.76). INTERPRETATION & CONCLUSIONS: Broselow weight overestimated weight by >10 per cent in majority of Indian children. The weight overestimation was greater in children belonging to over 18 and 10-18 kg weight groups. Applying 10 per cent weight correction factor to the Broselow-predicted weight may provide a more accurate estimation of actual weight in children attending public hospital. Weights estimated using Broselow tape correlated better with actual weights than those calculated using APLS and updated APLS formulae.

Presenting Research Paper: Learning the steps.

For a beginner, presenting a research paper at a conference as a podium presentation can be a daunting task. She is required to choose an appropriate conference for presentation, prepare an abstract, prepare slides and the speech that goes parallel with the slides and train oneself to answer questions posed by the audience. She has also got to overcome the fear of speaking in public and conquer the phobia of encountering a hostile audience ready to shred her paper to pieces. This communication intends to provide useful tips on how to go about preparing and presenting a research paper. Almost every conference has at least one slot reserved for oral or podium presentation of research papers. These podium presentation sessions are important for the presenters, organizers as well as for the attending delegates (Table 1). For the beginners and the recently-initiated, the challenge of organizing all the data and ideas for presentation in less than 10 minutes, might seem overwhelming. Added to that would be the anxiety of speaking in front of a crowd consisting of experts and above all, to be prepared to answer searching questions posed by the delegates. Through this communication, we intend to provide a supporting framework for the beginners about how to go about such scientific presentations, which are so vital for one's career and above all, for advancement of science. Once your research project is over, findings analyzed and report written; you should be on the lookout for conferences where presenting your research would be of relevance and interest to the delegates. But even before the conference is chosen, you could start thinking about the process of presentation.

Creating Posters for Effective Scientific Communication.

A scientific poster is a summary of one's research that is presented in a visually engaging manner. Posters are presented as a means of short and quick scientific communications at conferences and scientific meetings. Presenting posters has advantages for the presenters and for conference attendees and organizers. It also plays a part in dissemination of research findings and furthering science. An effective poster is the one that focuses on a single message and conveys it through a concise and artistically attractive manner. This communication intends to provide tips on creating an effective poster to young scientists.

Formulating the Right Title for a Research Article.

Title is an important part of the article. It condenses article content in a few words and captures readers' attention. A good title for a research article is the one which, on its own, is able to introduce the research work to the fullest extent, but in a concise manner. Writing scientific titles that are informative and attractive is a challenging task. This communication describes the importance of titles and the methods of creating appropriate titles for research papers.

Enhance the Value of a Research Paper: Choosing the Right References and Writing them Accurately.

References help readers identify and locate sources used for justifying the need for conducting the research study, verify methods employed in the study and for discussing the interpretation of results and implications of the study. It is extremely essential that references are accurate and complete. This article provides suggestions regarding choosing references and writing reference list. References are a list of sources that are selected by authors to represent the best documents concerning the research study.1 They constitute the foundation of any research paper. Although generally written towards the end of the article-writing process, they are nevertheless extremely important. They provide the context for the hypothesis and help justify the need for conducting the research study. Authors use references to inform readers about the techniques used for conducting the study and convince them about the appropriateness of methodology used. References help provide appropriate perspective in which the research findings should be seen and interpreted. This communication will discuss the purpose of citations, how to select quality sources for citing and the importance of accuracy while writing the reference list.

Satisfying Doubters and Critics: Dealing with the Peer Review.

Although peer review process intends to improve the quality of published scientific literature, many authors find the process intimidating and overbearing. Responding to reviewers' comments in a hasty and inappropriate manner is self-defeating. Authors need to answer the reviewers in an objective manner providing additional description, rational arguments and relevant evidence. Peer review is an important element of the research process. It aims to maintain the quality of scientific publications by rejecting manuscripts that are trivial, weak, irrelevant or misleading and by improving the transparency, accuracy and utility of manuscripts accepted for publication.1,2 But, the process can be intimidating for some new authors. They cannot understand, let alone digest the criticism of their submitted manuscript and hence respond in a hurry and in an inappropriate manner, further jeopardizing the chances of acceptability. This article informs new authors about the way a submitted manuscript is handled in the journal office and provides suggestions on how to respond to the reviewers' and editors' comments. More importantly, it intends to provide clues on how to minimize the chances of receiving harsh criticism.

Writing Introduction: Laying the Foundations of a Research Paper.

The Introduction section explains the rationale for undertaking the study and clearly describes the main purpose of conducting it. It should be focused, succinct and crisp. Providing an extensive and detailed literature review, not stating the hypothesis of the objectives with clarity and not providing focused information are some of the common mistakes that the authors should steer clear of.

Writing the Discussion Section: Describing the Significance of the Study Findings.

The Discussion section is an important part of the research manuscript that allows the authors to showcase the study. It is used to interpret the results for readers, describe the virtues and limitations of the study, discuss the theoretical and practical implications of the research work done and provide important "take home" message.

Describing the Methodology: Getting down to the Brass Tracks.

The Methods section of a research paper intends to inform the readers about how the research study was carried out. It allows them to judge if the methodology followed and material used were appropriate for testing the hypothesis, whether the study findings would be applicable to the patients that they treat and if the conclusions drawn and recommendations made are valid, fair and reasonable.

Using Tables and Graphs for Reporting Data.

For presenting the study results, authors need to choose from one of the three formats: text, tables and graphs. The underlying consideration of any author while making the choice is to ensure that readers find it easy to understand, to assist the author present data in a way that would catch the reader's eye, hold his interest and enhance his understanding. The choice should, therefore, be based on the advantages and limitations of each of these formats. Most of the observations are reported in textual format. Tables are useful when comparisons are to be shown. Graphs attract readers' attention better and the data they depict remains in the reader's memory. The type of graph used is dependent upon the nature of data that is to be shown. Every research paper has a lot to say through the data that has been collected and analyzed. However, this data needs to be presented in a logical, coherent and easy-to-understand manner. The way data is presented can influence the reviewers' and editors' decision. It can also make the difference between a paper being appreciated by the readers or being neglected or even trashed by them. Tables and Graphs are the two important tools that authors use to make the data more presentable and easy to read and understand.

Letter to Editor: Keeping the Dialogue Going.

Journals publish a variety of manuscripts under the section titled "Letters to the Editor". This communication discusses the important role played by letters written as a comment on an article previously published in the journal and provides suggestions regarding the way to write such letters.

Writing Case Reports: Contributing to Practice and Research.

Case reports describe a patient with unusual or unexpected features. They represent the oldest type of medical publication. They are about generating a new hypothesis and not about proving a hypothesis. Hence, despite being considered as the lowest level of evidence; they continue to be relevant for clinical practice, research and medical education. This article intends to provide guidance regarding writing a case report to those wishing to make a foray in scientific writing through reporting an interesting case.

Choosing the Right Journal for a Scientific Paper.

Authors need to take the crucial decision of choosing the journal for their prospective manuscript before even starting to write it. Although, this choice is influenced by many factors, matching the intended recipients of the main message of the manuscript with a journal's readership should override all other consideration in journal selection. That done, availability of time-bound review process,journal's visibility, indexation in databases, regularity of publication, acceptance rate and expenses involved are some other factors that will help decide the choice.

Results: Unraveling the Findings.

Results section is used to inform readers about the actual observations made in the research study. The authors should ensure that the content is appropriate, complete and objective. Using tables and graphs appropriately enhances the readers' interest and understanding.

Writing an Abstract for a Research Manuscript: Providing an Honest, Succinct and Complete Summary.

is a vital part of a research paper. Besides the title, it is the most widely read section of an article. The first impressions created by the abstract on editors and reviewers can have a great influence on the fate of the article. After its publication, a reader might decide to give the article a miss, if he finds the information provided in the abstract uninteresting, irrelevant or uninspiring. An abstract should, therefore, be packed with all important relevant information about the study, so that reviewers and readers understand the rationale of the study, are assured of adequacy of the methodology employed, are informed about the important findings and appreciate the reasonable conclusions stated in the abstract. Brevity, self-sufficiency, providing complete and accurate information in an unbiased manner are some of the important characteristics of a good abstract.

An audit of institutional ethics committee queries raised after initial project submission by a single research department at a tertiary referral center in India.

Introduction: The institutional ethics committees (IECs) raise queries following protocol reviews. The quality of these queries would be a useful metric to assess how well the IEC executes its fundamental role of protecting participants. Methods: Queries received after the initial review and replies sent by a single research department were evaluated. A content analysis was done to identify the domains and categories of queries. We categorized these queries as administrative, ethics related, and scientific. The impact of each query in improving the science or safeguarding the rights and safety of research participants (ethics) was evaluated by two authors of this manuscript: one affiliated and the other nonaffiliated to the institute. Kappa statistics were used to evaluate for agreement between the two. Results: A total of 13 studies (investigator-initiated studies [IISs]: 7 and pharmaceutical industry-sponsored studies [PSSs]: 6) formed the final sample size for analysis. The total number of queries was 364 (IIS: 106 and PSS: 258; P < 0.001). With regard to the categories, we found n = 42 (11.54%) to be irrelevant at that stage of the review process; n = 51 (14.01%) were about information already available which the IEC had missed; n = 67 (18.41%) queries where the IEC needed paraphrasing; n = 50 (13.74%) were entirely relevant with the need for further clarification; and n = 154 (42.31%) had been missed by the investigator during the initial submission. The overall agreement between the affiliated and unaffiliated investigators was just 12.9% (P < 0.001). Conclusions: We found that approximately 25% of the queries raised by the IEC were redundant. It is our opinion that this redundancy could have been channeled into greater focus on scientific and ethical aspects of the protocol. Ongoing dialog between investigators and ethics committees may help address this. Perspectives between the affiliated and the unaffiliated investigators with regard to the relevance of queries were grossly different.

Irrational ophthalmic fixed-dose combinations for dry eye syndrome.

Dry eye syndrome (DES) is a common disorder with rising incidence due to increased use of digital devices. While multiple treatment options are available, some are not efficacious or sometimes even safe for use in DES. This is particularly true for Fixed Dose Combinations (FDCs) that may contain ingredients having no rational for their use or may actually be harmful. Various committees appointed by the Government have reviewed several FDCs marketed in India and found some of them to be irrational and recommended for their removal. This paper discusses the contents of some of these FDCs marketed for DES with an aim to ensure that prescribers are mindful of their ingredients and whether there is adequate data about their efficacy and safety and prescribe them only if they consider them necessary for managing the patient.