Tangible impact of patient communication modules on medical students and interns.

Attitude, ethics, and communication are key attributes in the doctor-patient relationship and to strengthen these qualities, the National Medical Commission, the body that regulates medical education and medical professionals in India introduced a course called Attitudes, Ethics and Communication (AETCOM) in the undergraduate medical curriculum. The objective of this study was to ascertain the perceptible qualitative influence of the modules in communication in the AETCOM course and to obtain feedback on its implementation. In this cross-sectional study, the attitude of medical students in all stages of training including internship was first explored using a Communication Skills Attitude Scale. Out of 27 modules in AETCOM course, five modules named foundations of communication deal with communication, and they are taught from the first to final professional years of training. After introducing communication modules in AETCOM for all professional years, feedback was collected from interns who had completed training in all modules. The interns provided feedback with a validated scale and two focused group discussions. Additionally, feedback from faculty involved in teaching AETCOM was analyzed. There was a significant increase in the positive attitude scores in the final year and internship compared to the first year. Eighty percent of the interns agreed that communication modules in AETCOM were useful and that they equipped them with the communication skills required for actual practice during their internship. Faculty agreed that these modules motivated the students to acquire communication skills. However, faculty also felt that these modules alone may not be sufficient to learn communication skills.NEW & NOTEWORTHY In the current study, we have assessed the attitude of medical students toward learning communication skills in all stages of their training. The novelty of our study is that communication modules were formally introduced for the first time into the medical curriculum and feedback was obtained from a cohort of interns who completed training in all modules in communication from AETCOM. The feedback from faculty and students provided us with concepts to improvise these modules.

Daily versus alternate day oral iron therapy in iron deficiency anemia: a systematic review.

Daily administration of oral iron is considered the current treatment standard for treating iron deficiency anemia due to availability and reduced cost compared to intravenous iron therapy. But adverse effects like epigastric pain, heartburn, and constipation reduce compliance to daily oral iron. There is scanty evidence regarding compliance and efficacy with alternate-day iron therapy. As per our knowledge, this is the first systematic review to compare daily with alternate-day oral iron therapy. Six electronic databases including PubMed and EMBASE were searched for randomized controlled trials, quasi-experimental studies published between January 2000 to March 2023 that compared daily with alternate day iron therapy in individuals diagnosed with iron deficiency anemia. The primary outcome analyzed was a change in hemoglobin. The other hematological parameters were assessed as secondary outcomes. Risk of bias was assessed regarding randomization process, deviation from intended intervention, missing outcome data, measurement of the outcome, and selection of the reported result. Out of the 9 full-text articles, 2 were not included as one was an ongoing trial and the second one had a different study design. The reviewed trials involved 594 participants, and the study participants ranged from 19 to 200. The mean age of the participants in the reported trials was 21 ± 2 to 49 ± 16 years. There is no significant increase in hemoglobin level and also the iron indices namely ferritin, hepcidin, total iron binding capacity, and reticulocyte count between daily and alternate-day dosing of iron. However, the frequency of adverse effects especially nausea, metallic taste, and altered bowel habits are reduced with alternate-day dosing. Oral iron given daily or on alternate days did not have a significant difference in the hemoglobin levels though iron absorption may be affected in the initial few days.Trial registration: The review protocol was registered with PROSPERO (Prospero2023CRD42023393095).

Simulated patient videos to supplement integrated teaching in competency-based undergraduate medical curriculum.

The competency-based undergraduate medical curriculum in the preclinical years requires clinical topics to be taught using a linker clinical case for students to appreciate the clinical application of basic sciences. The objective of this study was to evaluate student and faculty satisfaction regarding the construct and delivery of an aligned and integrated curriculum that involved the use of linker clinical cases. We aimed at evaluating the perceptions and performance of students when paper cases were supplemented with a simulated patient (SP) video. This interventional study was conducted by inviting 250 medical students from the first professional phase from the 2020-2021 batch. Integrated modules were prepared for two clinical conditions: myocardial infarction (MI) and nephrotic syndrome (NS). The topic NS was taught with a paper-based case while the topic MI was supplemented with an SP video. Feedback from students and faculty was collected using a newly developed and validated questionnaire and focused group discussions. The students performed significantly better in the assessment conducted after the topic MI compared to NS. The majority of the students (80%) expressed a preference for the video to understand the clinical relevance when compared to the paper case. Overall, the students (83-87%) expressed satisfaction with integrated teaching sessions using clinical cases. Using linker clinical cases in an aligned and integrated preclinical curriculum allowed students to interrelate the subjects and apply them to clinical contexts. The SP videos prepared from an authentic setting facilitated learner engagement with a better understanding of the clinical relevance of the basic sciences.NOTE & NOTEWORTHY In this study, we have introduced linker cases to teach clinical correlation of basic sciences for integrated modules in the competency-based undergraduate medical curriculum. The novelty of our study is the inclusion of simulated patient video that was internally prepared and validated to supplement linker clinical paper cases in integrated modules.

Student perceptions towards online learning in medical education during the COVID-19 pandemic: a mixed-methods study.

BACKGROUND: This mixed-methods study was undertaken to ascertain undergraduate medical students' perceptions of remote learning following the COVID-19 restrictions. 545 students participated in this study. METHODS: Data was collected using a validated questionnaire and four focus group discussions. RESULTS: Regarding recorded lectures, the quantitative findings indicated that they were important during online learning and the qualitative findings explained that the recorded lectures enabled individual students to pace and customize their learning. The majority of the students agreed that recorded lectures were relevant to their learning, though they watched less than 50% of recorded lectures. Qualitative findings described procrastination as the rationale for not watching the videos. The online live lectures had a relatively higher percentage of contribution towards learning in comparison with instructor recorded video lectures. Students were more engaged with live lectures, and 63.3% of respondents agreed. Qualitative findings confirmed the opportunities for interacting with peers and better clarification of doubts by teachers during live lectures. CONCLUSIONS: Online learning with recorded and live lectures provided continuity in medical education during the COVID-19 pandemic. When compared to recorded video lectures, synchronous live lectures were regarded as superior by students largely due to the opportunity to directly communicate with the instructor and receive quick feedback.

Implementation and assessment of a module to enhance prescribing competency in undergraduate medical students.

BACKGROUND: Enhancing the prescribing competency of medical students will help them evaluate each case based on their knowledge. It will help them prescribe independently and they will also be able to empathize and counsel patients effectively. In view of this, it was planned to implement a module on prescribing competency and assess the same for undergraduate medical students. METHODS: Faculty training to implement the module was conducted by eminent faculty in this area. After a pre-test, a workshop was conducted for students, wherein they were trained on rational prescribing based on WHO guide to good prescribing followed by small group discussions to identify P (personal) drugs for bronchial asthma and later with comorbidities. Students had to write a prescription and practice communicating the same to a standardized patient. The module was evaluated using a check list (from the WHO guide) and compared with a pre-test. A feedback was provided to the students at the end of the assessment. RESULTS: The scores (median and interquartile values) for prescribing significantly improved from 5 (2, 7) to 25 (24, 27), maximum score being 30. The scores for the communication also increased from 17.5 (14, 24.25) to 53 (52, 55), maximum score being 60, in the post-test. The differences were statistically significant p < 0.01(Wilcoxon Signed Ranks Test). The students expressed that their critical thinking and problem solving capabilities had increased and more importantly 'they felt like a doctor'. CONCLUSION: More such modules need to be prepared and prescribing competency needs reinforcement during the clinical years of the medical curriculum for its effective implementation communicating the same to a standardized patient. The module was evaluated using a check list (from the WHO guide) and compared with a pre-test. A feedback was provided to the students at the end of the assessment.

One-month long foundation course for newly joined Indian medical undergraduates: Faculty and students' perspective.

BACKGROUND: A one-month long foundation course has been introduced at the entry-level for first-year MBBS (Bachelor of Medicine and Bachelor of Surgery) students in the medical institutions across India from 2019. Therefore, the present study is aimed at describing the experience of implementing a one-month long foundation course conducted for the Competency-based Undergraduate Medical Curriculum (CBUC) of Indian Medical Graduate as per the guidelines from the National Medical Commission (NMC) (erstwhile Medical Council of India, MCI). We have evaluated the student and faculty perceptions towards the effectiveness of the program. METHODS: The foundation course had six modules Orientation, Skills, Field visit to Community Health Centre, Professional Development including Ethics, Sports and Extracurricular activities, Computer Skills, and Language enhancement program. Regular feedback wascollected from students (N = 250) and teachers (N = 26) involved in the Foundation course using a semi-structured questionnaire. The program's overall feedback was also obtained at the end of the course, using a validated questionnaire. The quantitative findings were expressed in frequency and percentage. The qualitative observations (reflections of students and faculty) were subjected to thematic. RESULTS: The students and faculty appreciated the one-month long foundation course. The course's defined objectives were met as indicated by most students (98.4%) and faculty (75%). The course seemed to be useful for students to embark on a formal MBBS curriculum. It also exposed them to new knowledge and practices, as indicated by the feedback. Thematic analysis of the students' and faculty's reflections was carried out and two themes were identified, i.e., 'strengths' and 'challenges.' The Foundation Course Committee will work out appropriate remedial measures to overcome the challenges in the future sessions for subsequent batches. CONCLUSIONS: The one-month-long foundation course was found to be beneficial for newly joined students to get introduced and adjusted to higher education systems' demands. Also, the challenges faced during the program needs to be addressed with suitable remedial measures while implementing for subsequent batches. This effort will ensure a smooth conduct of the foundation course for the future batches of medical undergraduates and make the program more effective.

Interprofessional education - a case for Gerodontology training.

Increasing life expectancy, concepts of patient well-being, and the multiplicity of needs of the geriatric population, demand contribution, and collaboration of physicians, dentists, psychologists, pharmacists, and other allied health disciplines, to provide quality care to patients. Interprofessional education (IPE) is an approach to education that improves collaboration among health professionals and it can aid in better management of geriatric patients. Communication and cooperation affect health care performance and hence, influence patient outcomes. Currently, each of the disciplines mentioned has customized undergraduate and/or postgraduate training in geriatric care. Though a uni-disciplinary educational approach increases knowledge and skills of individual professions separately, IPE offers significant advantages. IPE seeks to have students learning together, as well as from each other to develop exemplary collaborative practice. The World Health Organization (WHO) has proposed that IPE will ensure optimum health care. However, IPE is yet to find its proper place in dental education. It would help dental students to develop a positive attitude toward geriatric patients and increase their empathy and efficiency in the management of these patients. This manuscript seeks to highlight the concept of interprofessional education (IPE) in gerodontology and develop recommendations for implementation of IPE in India.

Tamoxifen-induced vasculitis.

INTRODUCTION: Tamoxifen is a selective estrogen receptor modulator used widely for the treatment of breast cancer. Apart from its common adverse reactions such as endometrial cancer, deep vein thrombosis, pulmonary emboli, there are very few reports about its ability to cause vasculitis. CASE REPORT: A 45-year-old woman who underwent modified radical mastectomy was started on tamoxifen. Six months later, she developed vasculitis which was confirmed by immunofluorescence-induced vasculitis in a pre-menopausal woman. MANAGEMENT AND OUTCOME: Dapsone was used to relieve her symptoms for two weeks, but the lesions reappeared when dapsone was stopped. She continues to suffer from vasculitis as tamoxifen could not be discontinued. DISCUSSION: This case report is important in order to draw attention towards this rare, but equally severe side effect of cutaneous vasculitis due to the most commonly used drug for breast cancer. In view of the absence of alternative medications for pre-menopausal women, it is necessary to have a strict monitoring of its adverse effects as well as more intensive research for a better agent.

Looking beyond the Obvious: Cefepime-induced Nonconvulsive Status Epilepticus.

Cephalosporins are a commonly used class of antibiotics in various types of infections. Cefepime, a fourth-generation cephalosporin, has been reported to cause neurotoxicity, which can present itself as varied manifestations. Nonconvulsive status epilepticus (NCSE) is a rare manifestation of this neurotoxicity. This condition often proves difficult to diagnose because it is chiefly an electroencephalogram-based diagnosis. The authors report a case of cefepime-induced NCSE in a 57-year-old female patient with compromised renal status.

Meropenem Induced Hypokalemia.

Meropenam, a beta-lactam antibiotic has been used for severe infections of skin, tissue, intra- abdominal and urogenital infections in hospitalized patients. The common adverse effects reported are diarrhoea, vomiting, rashes and hypersensitivity reactions. Here we report two cases of meropenam induced hypokalemia, wherein, meropenam was prescribed for cellulitis and urinary tract infection in the first and second case respectively. Hypokalemia can manifest as muscular weakness, fatigue, muscle cramps, constipation, ileus, flaccid paralysis, hyporeflexia, hypercapnia, tetany, rhabdomyolysis or respiratory failure. Hence, it is necessary to make physicians aware of such an adverse effect which can develop with meropenam.

A Rare Instance of Levofloxacin Induced Myoclonus.

Levofloxacin is a widely used fluoroquinolone, mainly as a respiratory antimicrobial agent. It is employed as a second line therapeutic modality in pulmonary tuberculosis as well. The drug has been in use for ages, and is known to be both efficacious and safe. However, it is not free of adverse effects. The most dangerous ones are those involving the Central Nervous System (CNS). Although rare, levofloxacin can cause involuntary movements like chorea and myoclonus. Here by, we present a case of an elderly male patient who developed reversible myoclonus/chorea after a course of levofloxacin (which was initiated as part of his anti-tubercular therapy) following the development of peripheral neuropathy secondary to isoniazid.

A Study to Assess the Therapeutic Effect of Enalapril on Olanzapine Induced Metabolic Syndrome in Wistar Rats.

INTRODUCTION: Metabolic Syndrome (MS) is a complex of risk factors for the development of cardiovascular complications and Type 2 Diabetes Mellitus (DM). Pharmacological management of the condition is complex, as multiple drug groups have to be used, as the syndrome itself is multi faceted. Angiotensin Converting Enzyme Inhibitors (ACEIs) are chiefly used to manage the hypertensive component of the syndrome. However, recent studies have shown that these drugs may have a role in the non hypertensive aspects of the syndrome as well. AIM: To evaluate the therapeutic effect of enalapril on total body weight, random blood glucose and serum lipid profile in a rodent model of olanzapine induced MS. MATERIALS AND METHODS: Three different dosages (1 mg/kg/day, 10 mg/kg/day and 20 mg/kg/day) of oral enalapril were administered (for three weeks) in albino wistar rats, which received prior intra peritoneal olanzapine (for three weeks), and compared against control (normal saline) and standard (olanzapine only and enalapril only) groups. Parameters like total body weight, random blood glucose and serum lipid profile were measured at baseline, at three weeks and at six weeks. RESULTS: Enalapril at 20 mg/kg/day was found to be effective in reversing the weight gain, hyperglycaemia and hypercholesterolaemia, without any changes in triglycerides, High Density Lipoprotein (HDL) and Low Density Lipoprotein (LDL). 10 mg/kg/day of enalapril prevented any further rise in body weight, blood glucose, total cholesterol and serum triglycerides, after olanzapine was stopped. 1 mg/kg/day of enalapril was ineffective. CONCLUSION: High dose of enalapril may be considered as a component of therapeutic regimens to combat weight gain, hyperglycaemia and dyslipidaemia seen in MS, in addition to its antihypertensive utility. Further rodent and clinical studies may be required to ascertain the same.

Advances in pharmacovigilance initiatives surrounding antimicrobial resistance-Indian perspective.

INTRODUCTION: In recent years the development of antimicrobial resistance has been accelerating, the discovery of new antimicrobial agents has slowed substantially in past decades. AREA COVERED: This review mainly focuses on the problem of antimicrobial resistance(AMR); the various contributor mechanisms, consequences and future of AMR. The review also highlights the irrational use of antimicrobials, improving their usage and problems associated with pharmacovigilance of antimicrobial resistance. EXPERT OPINION: Pharmacovigilance in the form of surveillance of antibiotic use is being done in 90% of the countries worldwide through the WHONET program developed by WHO. However, the data comes from a limited area of the globe. Data from every part of the world is required, so that there is geographical representation of every region. A major hurdle in quantifying the extent of antimicrobial resistance is the fact that there are several known microbes, that may turn out to be resistant to one or more of the several known antimicrobial agents. The global action plan initiated by WHO, if implemented successfully will definitely reduce AMR and will help in evaluating treatment interventions.

Comparative Effect of Lisinopril and Fosinopril in Mitigating Learning and Memory Deficit in Scopolamine-Induced Amnesic Rats.

Lisinopril and fosinopril were compared on scopolamine-induced learning and memory deficits in rats. A total of eighty-four male Wistar rats were divided into seven groups. Group I received 2% gum acacia orally for 4 weeks, group II received normal saline, and group III received scopolamine (2 mg/kg/ip) as single dose. Groups IV and V received lisinopril ( 0.225 mg/kg and 0.45 mg/kg), while Groups VI and VII received fosinopril (0.90 mg/kg and 1.80 mg/kg), respectively, orally for four weeks, followed by scopolamine (2 mg/kg/ip) given 45 minutes prior to experimental procedure. Evaluation of learning and memory was assessed by using passive avoidance, Morris water maze, and elevated plus maze tests followed by analysis of hippocampal morphology and quantification of the number of surviving neurons. Scopolamine induced marked impairment of memory in behavioral tests which correlated with morphological changes in hippocampus. Pretreatment with fosinopril 1.80 mg/kg was found to significantly ameliorate the memory deficits and hippocampal degeneration induced by scopolamine. Fosinopril exhibits antiamnesic activity, indicating its possible role in preventing memory deficits seen in dementia though the precise mechanism underlying this effect needs to be further evaluated.

Capreomycin-induced optic neuritis in a case of multidrug resistant pulmonary tuberculosis.

A patient of multidrug-resistant pulmonary tuberculosis was prescribed an anti-tubercular regimen containing capreomycin. Patient developed optic neuritis 3 months after starting treatment. Investigations did not reveal any specific cause for this ocular condition and on discontinuing capreomycin his vision recovered. We conclude that capreomycin is the cause of reversible optic neuritis in our case.

Pedal edema with olanzepine.

Olanzapine, an atypical antipsychotic is considered superior to its conventional congeners. Here we report two cases of pedal edema secondary to olanzapine. In both cases the systemic causes of pedal edema were ruled out. On reducing the dose of olanzapine, pedal edema regressed and completely resolved after stopping the drug. So we attribute the edema to olanzapine therapy. As the definitive cause and further consequences of pedal edema are not known, hence stringent monitoring of adverse effects of this drug is required.

Antidepressant activity of fosinopril, ramipril and losartan, but not of lisinopril in depressive paradigms of albino rats and mice.

Fosinopril, ramipril and losartan significantly decreased the duration (sec) of immobility in forced swim test and were comparable to amitriptyline. The duration of immobility were significantly decreased in fosinopril, ramipril and losartan in the tail suspension test and were comparable to amitriptyline. Only losartan significantly increased the rearing number of entries, time spent (sec) in open arm and in light area in comparison to control animals. Fosinopril and ramipril and not lisinopril showed significant antidepressant activity while losartan showed a significant antidepressant and anxiolytic activity. Present findings suggest that these drugs could be better antihypertensives in hypertensive patients with comorbidity like depression or anxiety.

Transcranial magnetic stimulation and muscle contraction to enhance stroke recovery: a randomized proof-of-principle and feasibility investigation.

OBJECTIVE: To explore the efficacy of repetitive transcranial magnetic stimulation (rTMS) and voluntary muscle contraction (VMC) to improve corticospinal transmission, muscle function, and purposeful movement early after stroke. METHODS: Factorial 2 x 2 randomized single-blind trial. SUBJECTS: n = 27, mean age 75 years, mean 27 days after middle cerebral artery infarct (24 subjects completed outcome measures). PROCEDURE: after baseline measurement (day 1), subjects were randomized to 1 of 4 groups. Treatment was given for the next 8 working days, and outcome was measured on day 10. INTERVENTIONS: (a) Real-rTMS + RealVMC, (b) Real-rTMS + PlaceboVMC, (c) Placebo-rTMS + RealVMC, and (d) Placebo-rTMS + PlaceboVMC. Real-rTMS consisted of 200 1-Hz stimuli at 120% motor threshold in 5 blocks of 40 separated by 3 minutes delivered to the lesioned hemisphere. Placebo-rTMS used a dummy coil. In RealVMC, the paretic elbow was repeatedly flexed/extended for 5 minutes. In PlaceboVMC, subjects viewed pairs of drawings of upper limbs and reported their likeness. OUTCOMES: frequency of motor-evoked potentials in biceps and triceps, muscle function (torque about elbow), and purposeful movement (Action Research Arm Test). ANALYSIS: group mean changes (outcome - baseline) were compared. RESULTS: In the Real-rTMS + RealVMC group, motor-evoked potential frequency increased 14% for biceps and 20% for triceps, whereas in the Placebo-rTMS + PlaceboVMC group, it decreased 12% for biceps and 6% for triceps. For other groups, there were changes of intermediate values. No meaningful differences were found for secondary outcomes. CONCLUSIONS: A positive trend for motor-evoked potential frequency was found for Real-rTMS + RealVMC, whereas a negative trend for motor-evoked potential frequency was found for Placebo-rTMS + PlaceboVMC.