Willingness to Quit and Associated Factors Among Tobacco Users Attending Outpatient Departments of a Tertiary Care Hospital in Delhi, India.

Background: Tobacco use has become a modern-day epidemic which significantly impacts health, socioeconomic status, and environmental sustainability. The readiness to quit or stop using tobacco is a crucial first step in changing one's behavior. Hence, the current study sought to assess the prevalence of willingness to quit and associated factors among tobacco users. Methods: This study was conducted on 425 tobacco users selected using multi-stage random sampling from the outpatient departments (OPDs) of a tertiary care hospital in Delhi, India. A pre-designed, interviewer-administered questionnaire was used to elicit information. Logistic regression was performed to assess the effect of independent factors on the willingness to quit. Findings: The mean age of the study participants was 39.37 years (S.D.=±12.99). The majority of the participants were male (400, 94.1%), and 25 (6.9%) were female. Overall, the prevalence of willingness to quit in the current study was 70% among the study participants. The results of the multivariable analysis showed that those belonging to urban areas, tobacco users with a duration of≤10 years, and those who received advice from a doctor to quit had a significantly higher willingness to quit than their counterparts. However, age, gender, marital status, education, religion, age of initiation of tobacco use, and nicotine dependence were not found to have a statistically significant relationship with the willingness to quit tobacco products. Conclusion: Willingness to quit was high among the study participants. The data in this study suggested that belonging to urban areas, duration of tobacco use, and doctor's advice to quit are important factors which need to be considered when framing future tobacco cessation programs.

The Prevalence of Violence Against Resident Doctors and Its Subsequent Effects on Patient Management in a Tertiary Care Hospital in Delhi, India.

Introduction Workplace violence (WPV) is a significant problem for healthcare professionals across the world, regardless of whether they work in developed or developing countries. Studies have shown that in India, up to 75% of doctors have experienced some form of violence in the workplace. The purpose of the present study was to examine the extent of violence against doctors and its impact on patient management. Methodology This cross-sectional study was conducted in a tertiary care hospital in New Delhi in June 2022. A total of 326 resident doctors from six departments were selected using stratified random sampling. Data were collected using a semi-structured interview schedule and a pre-validated questionnaire. Statistical analysis was done using Stata 17, and ethical clearance was obtained from the Institute Ethical Committee. Result Workplace violence was prevalent among healthcare professionals, with 80.4% (95% confidence interval (CI): 75.6%-84.5%) experiencing verbal abuse and 21.7% (95% CI: 17.4%-84.5%) experiencing physical violence. Perceived delays in treatment and patient deaths were the most common causes of violence. Most participants were hesitant to report WPV due to time-consuming reporting processes and a lack of organisational support. WPV had a negative impact on doctors' mental and personal well-being, with 73.3% reporting its negative impact. WPV has led to a decrease in the provision of surgical and medical interventions. Conclusion The study findings suggest that a significant proportion of doctors in a tertiary care hospital in Delhi encounter some form of workplace violence. Despite the high incidence of WPV, reporting of these events remains low due to inadequate support and deficient reporting procedures within healthcare organisations. The negative impact of WPV is not limited to the physicians' psycho-social well-being but extends to their approach to patient care as well. Therefore, taking appropriate actions to prevent WPV is crucial for ensuring the safety and well-being of healthcare professionals and improving patient outcomes.

Awareness, perspectives and satisfaction levels among patients with psoriatic arthritis: a multicentric cross-sectional survey.

Perception of the disease and its management impacts patients with Psoriatic arthritis (PsA) to a great degree. Studies examining patients' viewpoints and perception of their disease and its management are scarce. This multicentric cross-sectional survey was undertaken to understand the perspectives of patients with PsA. A survey questionnaire with items on demographics, awareness about their disease, treatment, physical therapy, quality of life and satisfaction with the care received was designed. After internal and external validation, a pilot survey was conducted, and the questionnaire was finalized. The final survey (with translations in local languages) was carried out at 17 centres across India. There were 262 respondents (56% males) with mean age of 45.14 ± 12.89 years. In 40%, the time lag between onset of symptoms and medical assessment for it was more than a year. In most of the patients, the diagnosis of PsA was made by a rheumatologist. Over 83% of patients were consulting their rheumatologist periodically as advised and fully compliant with the treatment. Lack of time and cost of therapy were the most common reasons for non-adherence to therapy. Eighty-eight patients (34%) were not fully satisfied with their current treatment. Over two-third of patients had never seen a physiotherapist due to barriers including a lack of time, pain, and fatigue. The daily activities and employment status were affected in nearly 50% of patients with PsA. The current survey has identified a gap in patients' awareness levels and helps healthcare providers in understanding the varied perceptions of patients with PsA. Addressing these issues in a systematic manner would potentially improve the treatment approaches, outcomes, and patient satisfaction levels.

Assessment of Nutritional Status of Under-Five Children in an Urban Area of South Delhi, India.

Introduction Malnutrition among children continues to be a severe public health problem worldwide, whether in a developing country like India or a developed nation. Correct estimation of the problem is a prerequisite to planning the measures to control it. Objective To estimate the prevalence of undernutrition among children under five years of age by utilizing the Composite Index of Anthropometric Failure and the WHO growth charts. Methods From January to March 2020, 1332 children under the age of five years participated in a facility-based, descriptive, cross-sectional study at Fatehpur Beri, Urban Primary Health Center. An anthropometric assessment for each participant was done as per the WHO criteria. The data were entered into a Microsoft Office Excel spreadsheet (Microsoft Corporation, Redmond, WA) and analyzed with WHO Anthro software (WHO, Geneva, Switzerland) and a licensed version of SPSS 21 (IBM Corp., Armonk, NY). Continuous data were expressed using appropriate measures of central tendency, while categorical data were expressed in either frequency or proportions. Results The mean age of the study participants was 23.04 ± 18.24 months, and males (53.3%) were more than (46.7%) females. The prevalence of being underweight was 24.5% (327/1332), of which 24.1% (79/327) of children were severely underweight. Of the total study participants, 27.3% (362/1332) were stunted, and 17.8% (237/1332) were wasted, of which 29.1% (69/237) were severely wasted. The prevalence of anthropometric failure was 45%. Conclusions According to the findings of this study, the prevalence of undernutrition among the study participants was substantial. Furthermore, considering weight for age as the sole criterion may underestimate the true prevalence of malnutrition. The findings have critical implications for future interventions and initiatives among children in India.

Venous Thromboembolism in the Inflammatory Rheumatic Diseases.

Venous thromboembolism (VTE), which includes deep venous thrombosis and pulmonary embolism, is a cardiovascular event whose risk is increased in most inflammatory rheumatic diseases (IRDs). Mechanisms that increase VTE risk include antiphospholipid antibodies (APLs), particularly anticardiolipin antibodies, anti-beta2glycoprotein I antibodies and lupus anticoagulant present together, and inflammation-mediated endothelial injury. Patients with IRDs should receive long-term anticoagulation drugs when the risk of VTE recurrence is high. In the light of recent warnings from regulatory agencies regarding heightened VTE risk with Janus kinase inhibitors, these drugs should be initiated only after a careful assessment of VTE risk in those with IRDs.

Prevalence of Road Risk Behaviors and Associated Factors Among Undergraduate College Students in Delhi: Findings From the Health Risk Behavior Survey.

BACKGROUND:  Youth constitute one of the most vulnerable groups for practicing risky road behaviors. Road traffic accidents (RTAs) are one of the leading preventable causes of disability and mortality among children and young adults across the globe.  Objective: To estimate the prevalence of road risk behaviors among college students of Delhi and to determine the factors associated with it. METHODS: A cross-sectional study was conducted from January 2020 to September 2021 across five administrative zones in Delhi, India. Six hundred seventy-five undergraduate college students were selected across five colleges using stratified random sampling.  Results: The mean age of the study participants was 19.62 years (S.D. = ± 1.328). Among the study participants, more females (52.6%) were present than males (47.4%). Almost one-fifth of the participants reported not wearing a seat belt while driving or riding in a car during the past 30 days. Some 37.2% of the participants reported using a mobile phone while driving a car within the past 30 days. The prevalence of riding in a car driven by a person after drinking alcohol was 17.4%. Similarly, the prevalence of drinking and driving was 17.2% amongst the study participants. The prevalence of not wearing a helmet while driving or riding a two-wheeler vehicle was 42.6%. The overall prevalence of risky road behaviors was 16.7%. The multivariate analysis results revealed the odds of road risk behaviors to be significantly higher among those who were alcohol users (adjusted odds ratio, aOR=7.3, confidence interval, CI=3.8-13.8), substance abusers (aOR=2.4, CI=1.4-4.3), and those belonging to rural areas (aOR=4.2, CI=2.4-7.3). CONCLUSION: The prevalence of road safety-related risky health behaviors was high among the study participants. The significant road-risk behaviors were not wearing a helmet while riding or driving a two-wheeler vehicle, texting or talking while driving, and driving a car under the influence of alcohol or drugs.

JIND: joint integration and discrimination for automated single-cell annotation.

MOTIVATION: An important step in the transcriptomic analysis of individual cells involves manually determining the cellular identities. To ease this labor-intensive annotation of cell-types, there has been a growing interest in automated cell annotation, which can be achieved by training classification algorithms on previously annotated datasets. Existing pipelines employ dataset integration methods to remove potential batch effects between source (annotated) and target (unannotated) datasets. However, the integration and classification steps are usually independent of each other and performed by different tools. We propose JIND (joint integration and discrimination for automated single-cell annotation), a neural-network-based framework for automated cell-type identification that performs integration in a space suitably chosen to facilitate cell classification. To account for batch effects, JIND performs a novel asymmetric alignment in which unseen cells are mapped onto the previously learned latent space, avoiding the need of retraining the classification model for new datasets. JIND also learns cell-type-specific confidence thresholds to identify cells that cannot be reliably classified. RESULTS: We show on several batched datasets that the joint approach to integration and classification of JIND outperforms in accuracy existing pipelines, and a smaller fraction of cells is rejected as unlabeled as a result of the cell-specific confidence thresholds. Moreover, we investigate cells misclassified by JIND and provide evidence suggesting that they could be due to outliers in the annotated datasets or errors in the original approach used for annotation of the target batch. AVAILABILITY AND IMPLEMENTATION: Implementation for JIND is available at https://github.com/mohit1997/JIND and the data underlying this article can be accessed at https://doi.org/10.5281/zenodo.6246322. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Safety of long-term use of four common conventional disease modifying anti-rheumatic drugs in rheumatoid arthritis.

Conventional disease-modifying antirheumatic drugs (DMARDs) have been used in the management of rheumatoid arthritis for a long time. Whereas methotrexate (MTX) is the anchor drug, leflunomide, hydroxychloroquine and sulfasalazine are used along with MTX either in combination or sequentially. Together these four drugs are the most commonly used DMARDs. They are also used in combination with biological DMARDs (bDMARDs) to enhance their efficacy and MTX in particular to reduce antibodies against anti-tumour necrosis factor. Despite their widespread use, concerns regarding their safety especially when used long-term hinder their optimum use in clinical medicine. In this narrative review we have critically appraised the available literature regarding the safety of these four DMARDs when used long-term.

Usefulness of a workshop on scientific writing and publication in improving the baseline knowledge deficit among postgraduates.

BACKGROUND: A well-written manuscript published in a reputable journal is the deserved end-point of good research. It is important for postgraduates to be trained in scientific writing for their academic progression as well as the advancement of science. METHODS: A day-long workshop on scientific writing and publication was conducted at Raipur, India in February 2020. The medical postgraduate (UK equivalent: Core Medical Trainee) participants were engaged with lectures, discussions and a practical session requiring critical appraisal of a manuscript. The lectures also discussed publication ethics and the perils of falling prey to predatory journals. Pre and post-workshop surveys were given to the participants to assess the impact of the workshop on the baseline knowledge of scientific writing and publishing. RESULTS: Out of 69 participants, there were 67 (response rate 97%) and 41 (response rate 59%) respondents to the pre and post-workshop surveys respectively. The former identified a lack of baseline knowledge ranging from 6% for determining the components of the individual sections of the manuscript such as Introduction or Methods, 40% for the use of acronyms, and 55% for knowledge of different referencing styles, to 61% for knowledge of indexing agencies. The post-workshop survey revealed improvement in participants' knowledge of the contents of various sections of the manuscript and their knowledge about referencing styles and indexing agencies. In the post-workshop survey, 20% of respondents said that they would be open to engaging with predatory journals, which underscored the need to educate them continuously regarding the demerits of such practice. Participants expressed the need for longer workshops, preferably spread over two days, with discussion on research methodology and statistical analysis, and more 'hands-on' sessions. CONCLUSION: This survey underscores the need for structured training in scientific writing. Its inclusion in the medical postgraduate curriculum appears desirable.

Retrospective studies - utility and caveats.

A thorough understanding of the pros and cons of the various study designs is critical to correct interpretation of their results. Retrospective studies are an important tool to study rare diseases, manifestations and outcomes. Findings of these studies can form the basis on which prospective studies are planned. Retrospective studies however have several limitations owing to their design. Since they depend on review of charts that were originally not designed to collect data for research, some information is bound to be missing. Selection and recall biases also affect the results and reasons for differences in treatment between patients and lost follow ups can often not be ascertained and may lead to bias. Readers need to critically evaluate the methods and carefully interpret the results of retrospective studies before they put them to practice. Researchers should avoid over generalisation of results and be cautious in claiming cause-effect relationship in retrospective studies.

Impact of Educational and Training Programs on Knowledge of Healthcare Students Regarding Nosocomial Infections, Standard Precautions and Hand Hygiene: A Study at Tertiary Care Hospital.

BACKGROUND AND OBJECTIVES: Nosocomial infections are significant public health problems in developed as well as developing countries. To tackle this problem, it is vital to sensitize healthcare students (HCSs) at early period of their clinical practise. Thus, this study was conducted to access the existing knowledge among HCSs and determine the impact of educational and training programs regarding nosocomial infections, standard precautions, and hand hygiene. METHODS: This was a cross-sectional cum interventional, questionnaire based, single center study. Total 728 MBBS, BDS and BSC nursing students were targeted for workshop on nosocomial infections, standard precautions, and hand hygiene based on the Centers for Disease Control and prevention (CDC) and World Health Organization (WHO) guidelines. Infection control standardized questionnaire (ICSQ) was administered as a pretest and posttest. Results were analyzed by SPSS software. RESULTS: A paired-samples t-test was conducted to access the impact of educational and training programs on knowledge of HCS. There was a significant difference in the scores of pretests (M = 37.30, SD = 4.81) and posttests (M = 42.03, SD = 4.55); t (727) = 22.162, p ≤0.005 and also statistically significant difference in scores of all 3 domains- 1. Nosocomial infections: Pretest (M = 6.61, SD = 1.57) and Posttest (M = 7.98, SD = 4.65); t (727) = 20.589, p ≤ 0.005; 2. Standard Precautions: Pretest (M = 20.81, SD = 3.06) and Posttest (M = 41.88, SD = 4.30); t (727) = 4.584, p ≤ 0.005; 3. Hand Hygiene: Pretest (M = 9.88, SD = 2.68) and Posttest (M = 12.54, SD = 2.92); t (727) = 19.527, p ≤ 0.005. The results suggest that educational and training programs have positive impact on knowledge of HCS. CONCLUSION: This study highlighted the need for regular educational and training programs in primary training time for retention of knowledge regarding nosocomial infections and reinforcement of the principals of standard precautions and hand hygiene. HOW TO CITE THIS ARTICLE: Goyal M, Chaudhry D. Impact of Educational and Training Programs on Knowledge of Healthcare Students Regarding Nosocomial Infections, Standard Precautions and Hand Hygiene: A Study at Tertiary Care Hospital. Indian J Crit Care Med 2019;23(2):227-231.

Iatrogenic gastric perforation in a misdiagnosed case of late presenting congenital diaphragmatic hernia: Report of an avoidable complication.

INTRODUCTION: Congenital diaphragmatic hernia (CDH) is a defect in diaphragm which usually presents with severe respiratory distress in neonatal period. PRESENTATION OF CASE: We present a case of congenital diaphragmatic hernia presenting at an age of 2.5 years in a male child. It was misdiagnosed as a case of pyothorax for which chest tube was attempted on left side resulting in iatrogenic gastric perforation. The patient was managed by early and prompt surgery. DISCUSSION: Late presentation is usually rare with vast array of respiratory and gastrointestinal symptoms. It often leads to clinical and radiological misdiagnosis. CONCLUSION: Surgical intervention in misdiagnosed cases can lead to catastrophic iatrogenic complications.

Methods Matter: Tracking Health Disparities in Alternative High Schools.

Alternative high school (AHS) students are at-risk for school dropout and engage in high levels of health-risk behaviors that should be monitored over time. They are excluded from most public health surveillance efforts (e.g., Youth Risk Behavior Survey; YRBS), hindering our ability to monitor health disparities and allocate scarce resources to the areas of greatest need. Using active parental consent, we recruited 515 students from 14 AHSs in Texas to take a modified YRBS. We calculated three different participation rates, tracked participation by age of legal consent (≥18 and <18 years), and identified other considerations for obtaining quality data. Being required to use active consent resulted in a much lower cooperation rate among students <18 years (32%) versus those who were ≥18 years and could provide their own consent (57%). Because chronic truancy is prevalent in AHS students, cooperation rates may be more accurate than participation rates based off of enrollment or attendance. Requiring active consent and not having accurate participation rates may result in surveillance data that are of disparate quality. This threatens to mask the needs of AHS students and perpetuate disparities because we are likely missing the highest-risk students within a high-risk sample and cannot generalize findings.

Report of two cases of subcutaneous lipoma over the finger and review of literature: case series: benign tumour.

We are reporting two rare cases of subcutaneous lipoma. One was present over the dorsal aspect of the right index finger, and another was over the volar aspect of the middle finger. In first case, it was extending proximally from the proximal interphalangeal joint. Surgical excision of the tumour was done. In follow-up, patient is doing well with normal finger movements. Although, it is not the only case reported, lipoma of the index finger is very uncommon.