Imparting child nutritional assessment skills among medical students using hybrid problem-based learning approach in a community setting.

Background: Malnutrition affects up to a third of children in India, with severe and acute malnutrition prevalent among under five children. Nutritional assessment skills for detecting malnutrition in children in primary care settings are vital. Hybrid problem-based learning (HPBL) is an innovative, collaborative, and adaptable instructional learning strategy that can be used to teach medical students clinical skills in a community setting. Methods: A two-month quasi-experimental study was undertaken in a rural setting with third-year medical students. Faculty members were sensitized and subject experts developed a training module addressing the knowledge, attitude, communication, and practice domains. The students underwent a 3-week training module where pre-testing, case presentation, and group formation in first week, an anchoring lecture, tutorial and self-directed learning and role-play by students in subsequent week, and in last week, case discussion, post-testing, and feedback rounds were done. Results: In all domains, knowledge (3.8, 0.01), practice (4.3, 0.01), attitude and communication (3.7, 0.01), and proportional satisfactory responses, the HPBL approach resulted in a significant improvement in nutritional assessment competency. Teachers preferred the practical and engaging character of the approach, stating that doubts and questions were better addressed and that they would use it to teach similar topics. Conclusion: HPBL is an excellent teaching method for clinical skills, like nutritional assessment in simulated/field settings. The novel teaching-learning approach was well received by students and faculty members. Learning outcomes and satisfaction rates enhanced in students and faculty were encouraged to apply the approach to other topics.

Use of exemplars-based feedforward to improve the performance of medical students in constructed response assessment.

Background: Exemplars are the graded responses to theory questions from previous examinations and are considered as means to guide students about what is valued by assessors; hence giving feed forward to students before the exam and developing self-regulated learning among students. The present study was undertaken to compare the effect on performance of students between intervention (didactic lecture and exemplar) and control group (didactic lecture). Methods: This study was an interventional study conducted among 256 students of a medical college in Rajasthan, India. Participants were randomized to either the control group A or to the interventional group B. Outcomes included a post intervention test evaluating the knowledge gained after the session and students 'attitudes about the same. A focus group discussion was conducted investigating the perceptions. The feedback from faculty was also taken. Results: The mean post test score of intervention group was found to be 6.1 ± 1.74 and of the control group was 5.5 ± 1.6; significantly higher with p-value of 0.03. Out of 128 participants in group B, majority (n = 94,73%) believed that exemplars improve learning and created their interest in topic (n = 78, 60.9%). Most of students (66%) were of the opinion that exemplars should be regularly used with didactic lectures. Key themes identified from focus group were: advantages of the exemplars-based feedforward, challenges in implementation and ways to improve the method. Conclusion: Exemplars improved the performance of students. The faculty members and students agreed that they are an effective tool to enhance learning.

Blueprint designing and validation for competency-based curriculum for theory assessment in community medicine.

Background: Blueprint provides a base for assessment by assigning proportionate weightage to various content areas and helps the paper setter to construct a uniform and valid assessment. This study aimed to design and validate a blueprint for theory in Community Medicine as per the new curriculum for Medical Undergraduates in India. Methods: Blueprint in community medicine was designed by assigning impact score (I) and frequency score (F) for the competencies. Blueprint was validated using the Content Validity Index (CVI), and inter-rater agreement for subject experts using Fleiss' kappa statistics was calculated. Feedback from faculty and students was obtained afterward to assess the postimplementation response. Results: Blueprint was designed by an expert group where impact score and frequency score were assigned to 146 competencies in the theory of Community Medicine. In Delphi survey I, 63.2% of subject experts responded, while in Delphi survey II, a response rate of 58.3% was achieved. Value of the Fleiss' Kappa test for an inter-rater agreement was 0.68, i.e. "substantial agreement," while CVI among the raters came out to be 0.86, i.e. overall valid assessment. Feedback of faculty (n = 11) suggested that the blueprint was helpful and standardized the paper setting, whereas feedback from students (n = 138) depicted that it helped in preparing for exams, and they would recommend it to other students. Conclusion: Validated blueprint by consensus of subject experts has impact score and frequency score along with topic-wise distribution of marks for the convenience of faculty and its utility is well proven among learners too.

Correlation of D-Dimer Level with the Presence and Severity of Pulmonary Embolism on Computed Tomography Pulmonary Angiography.

INTRODUCTION: Early diagnosis of pulmonary embolism can reduce morbidity and motility. D-dimer is well known parameter having high negative prediction value. This study focused on role of D-dimer in early prediction of presence and severity of pulmonary embolism. MATERIAL AND METHODS: Thirty patients with clinical suspicion of pulmonary embolism along with high D-dimer value were included in this study. All selected patients underwent computed tomography pulmonary angiography assessment. D- dimer value was correlated with presence and proximity of pulmonary embolism. RESULTS: Out of thirty selected patients 50% had pulmonary embolism on computed tomography pulmonary angiography assessment. D-dimer value correlated well with presence and proximity of pulmonary embolism. CONCLUSION: D-dimer value more than 4000 ng/ml had high positive prediction value (79%) in suspected clinical cases. Value more than 8000 ng/ml further improve value to nearly 100% in suspected cases.

E-classroom as a Blended Learning Tool: A Structural Equation Modelling Analysis Using Modified Technology Acceptance Model.

BACKGROUND: E-classrooms help teachers save time, keep classes organized, and improve communication with students. This study aims to assess Google Classroom's usefulness in enhancing medical students' knowledge and acceptance of new technology for in-depth learning. MATERIAL AND METHOD: This educational interventional study was carried out on 100 students in the 3rd year of the M.B.B.S., Part 1. After a briefing about Google Classroom and educational topics, enrolled students and faculty were allowed to discuss the topic for two months. Following this, the descriptive approach was utilized to describe the respondents' technology acceptance through the administration of the technology acceptance model (TAM) survey questionnaire. RESULTS: Students were actively involved in discussion, with a 67% response rate. Nearly 85% of students agreed that Google Classroom is a satisfactory way for in-depth knowledge acquisition. On factor analysis, it was observed that the goodness of fit was 0.985, suggesting that the model is acceptable. It was also found that perceived usefulness (PU) had a significant positive effect on motivation towards self-directed learning (SDL), and perceived ease of use (PEOU) had a positive effect on both behavioural intention and actual use. CONCLUSION: Google Classroom is a valuable tool for learning that can enhance active self-learning and increase behavioural intention and actual use. It should be incorporated into day-to-day teaching activities to overcome time constraints.

Cine Medicine in Indian Scenario: A SWOT Analysis.

Cinema has the ability to convey important messages in an engaging and interesting manner. Cine medicine also known as cinema medicine or Cinemeducation has the potential to teach medical students and healthcare professionals about various aspects of medical conditions and illnesses. It is an innovative approach that can enhance empathy among the students and understanding toward patients with various medical conditions. Indian cinema has played a significant role in promoting health awareness and educating people about various medical conditions. Cinemeducation/Cine medicine can be instrumental in inculcating ethics and professionalism among budding clinicians. Of late, medical educationists have understood its importance and have introduced this innovative method in teaching not only medical humanities but medicine per se. This article aims to summarize the strengths, weaknesses opportunities, and threats analysis of the cine medicine along with reviews of Indian cinema for emphasizing the medical condition depicted in these cinemas/movies.

Correlation of non-invasive parameters with upper gastrointestinal endoscopy findings for presence and grading of gastroesophageal varices in liver cirrhosis patients.

Background: Development of esophageal varices is one of the major complications of liver cirrhosis, and endoscopy is used to see the presence, grading, and long-term monitoring of esophageal varices which is an invasive and unpleasant procedure. There is no adequate data available showing noninvasive methods can be used for the same. Methods: Seventy patients with liver cirrhosis participated in the study. Factors like portal vein diameter, spleen size, platelet count, serum bilirubin, Child-Pugh score, prothrombin time (PT), and PT INR were observed and correlated endoscopically with the presence and grading of esophageal varices in all patients. Results: The platelet count, portal vein diameter, serum bilirubin, spleen bipolar diameter, and PT had statistically significant correlations with the presence of varices. Among them, platelet count, portal vein diameter, and serum bilirubin also had statistically significant correlations with the grading of varices. Monitoring of these noninvasive parameters can help in monitoring variceal growth. Conclusions: Noninvasive parameters can be used effectively to predict the presence and grading of esophageal varices and at the same time keep the rate of undiagnosed varices acceptably low. By using noninvasive parameters, patients can be benefited by decreasing the requirement of repeated endoscopic evaluation which is an unpleasant procedure and availability is also limited.

Perspective Toward Complementary & Alternative Medicines in the Prevention of COVID-19 Infection.

Background: Across the globe, people are seeking integrative and holistic measures to prevent coronavirus (COVID-19) infection in the form of complementary and alternative medicines (CAM) with or without conventional medicines. This study was done to know the extent of CAM use for COVID-19 prophylaxis and to know beliefs and attitudes of people related to CAM use in India. Methodology: A pretested and prevalidated questionnaire was circulated on social media. Participants, who completed the online form and gave voluntary consent, were included. The questionnaire included demographic details and questions related to CAM use, preferences with reasons, preparations used, perceived role of CAM in prevention, immunity boosting and side effects, sources of information, etc. Results: Out of 514 responses, 495 were analyzed. 47.07% of respondents were males and 52.93% were females. 66.9% were using CAM for COVID-19 prophylaxis. The association between age, gender, and profession with CAM use was statistically significant (P < 0.05). 41.1% reported CAM use in the past. 36.6% of CAM users were taking "Kadha" and 33% were using ayurvedic medicines. Other frequently used CAM preparations were chyavanprash, giloy, tulsi, ginger, pepper, cloves, honey, sudarshanghanvati, arsenic-30, lemon juice, cinnamon, steam inhalation, ashwagandha, swasarivati, coronil, and warm saline water gargles. 46.9% of the CAM users were on self-medication and 52.3% preferred CAM over allopathy. Conclusion: Complementary and alternative medicine utilization for COVID-19 prophylaxis is widespread and self-medication is prevalent. As no specific cure is available in conventional systems, people believe in traditional medicines more than conventional, yet confusion exists. There is a need of increasing awareness regarding side effects, drug-drug interactions, and self-medication.

Effect of doxycycline and doxycycline with carica papaya on thrombocytopenia and leucopenia in acute dengue fever patients.

Background: Dengue fever is a mosquito borne disease commonly manifest leucopoenia and thrombocytopenia. Dengue fever and its complications like bleeding manifestation can be life threatening. This study was conducted to study the effect of doxycycline and doxycycline with carica papaya on thrombocytopenia and leucopoenia in acute dengue fever patients. Methods: This case control study was conducted amongst the patients suffering from dengue fever with thrombocytopenia. Cases were dengue patients with thrombocytopenia and leucopenia both. Controls were dengue patients with thrombocytopenia with normal leukocyte count. An effect of doxycycline and doxycycline with carica papaya was observed on platelet and leukocyte counts at baseline and first, second, fourth, and seventh day in cases and comparison was done. Results: The maximum improvement in mean platelet count and leukocyte count was observed in doxycycline with carica papaya group followed by doxycycline alone group followed by controls (conservative treatment) in decreasing order on day 4th and 7th day of admission. Reduced hospital stay was also in the same order. Conclusion: The study results indicate that doxycycline and carica papaya are useful modality to improve leucopenia and thrombocytopenia in dengue patients and to minimize hospital stay.

Predictors and Perceptions of Healthcare Workers Regarding Vaccines Safety in the Initial Phase of COVID-19 Vaccination Drive in Western Part of India: A Regression Analysis.

Background The COVID-19 vaccination was launched in a phased manner by the government of India prioritizing healthcare workers. This study assessed the perception of healthcare workers regarding COVID-19 vaccination. Methods This cross-sectional study was conducted among healthcare workers vaccinated at a tertiary care center of southern Rajasthan. Logistic regression analysis was used to note the association of perception regarding vaccine safety and other variables. Results Out of 3,102, 56.8% were male, and the majority (73.7%) were in the age range of 20-35 years. Out of the total, 80.7% and 73.2% of subjects perceived the vaccine as safe and effective, respectively. The perception regarding the timing of rolling out of vaccine and readiness for COVID-19 appropriate behavior after vaccination was statistically significant (p<0.001). The commonest undesirable effect following vaccination was pain at the injection site. Most of the subjects did not report undesirable effects following vaccination. Logistic regression analysis showed that the involvement in the direct care of COVID-19 patients (OR: 1.58; 95% CI: 1.29, 1.94), the experience of COVID-19 infection in the past (OR: 0.68; 95% CI: 0.50, 0.91), the timing of the rollout of vaccine (OR: 3.60; 95% CI: 3.24, 4.10) showed a significant association with perception of the safety of COVID-19 vaccine. Conclusions The vaccine was perceived safe and effective by healthcare workers and reported minimal undesirable effects. The COVID-19 vaccine safety is also dependent on the past COVID-19 infection, involvement in patient care, and time of rollout of the vaccine.

Understanding the phases of vaccine hesitancy during the COVID-19 pandemic.

Vaccine hesitancy is an important feature of every vaccination and COVID-19 vaccination is not an exception. During the COVID-19 pandemic, vaccine hesitancy has exhibited different phases and has shown both temporal and spatial variation in these phases. This has likely arisen due to varied socio-behavioural characteristics of humans and their response towards COVID 19 pandemic and its vaccination strategies. This commentary highlights that there are multiple phases of vaccine hesitancy: Vaccine Eagerness, Vaccine Ignorance, Vaccine Resistance, Vaccine Confidence, Vaccine Complacency and Vaccine Apathy. Though the phases seem to be sequential, they may co-exist at the same time in different regions and at different times in the same region. This may be attributed to several factors influencing the phases of vaccine hesitancy. The complexities of the societal reactions need to be understood in full to be addressed better. There is a dire need of different strategies of communication to deal with the various nuances of all of the phases. To address of vaccine hesitancy, an understanding of the societal reactions leading to various phases of vaccine hesitancy is of utmost importance.

Sociodemographic and clinical characteristics associated with COVID mortality among hospitalized patients in Rajasthan: A retrospective observational study.

BACKGROUND: It has been over a year since the declaration of novel coronavirus disease (COVID-19) as pandemic by World Health Organization on March 11, 2020. Although mortality in India is low, as compared to western countries, the steady increase in the number of cases is still a worrying sign. The objectives of this study were to identify and quantify the association between sociodemographic and clinical characteristics with mortality among patients, suffering from COVID-19 at a tertiary care hospital in Udaipur, Rajasthan. MATERIAL AND METHODS: This retrospective observational study involved 824 patients hospitalized for COVID 19 at a tertiary hospital in Udaipur, who were discharged or had died. Electronic health records of the patients were accessed to retrieve the sociodemographic information (age, gender, residence, religion, socioeconomic status), history of exposure, clinical characteristics on admission, comorbidities, and outcomes (recovery or death). The Cox regression model was used to calculate associations between mortality and baseline characteristics in the form of hazard ratios (HRs). RESULTS: Mortality in this study was found to be 5.82%. The mean age of the patients was 48.14 ± 16.2 years. The median time from time of admission to discharge was 8 days (interquartile range (IQR) 5-11), whereas the median time to death was 5 days (IQR 4-10). The variables found to be associated with higher mortality were age (HR 1.17; 95% confidence interval (CI) 1.15-1.24), residing in urban area (HR 1.29; 95% CI 1.17-2.15), diabetes mellitus (HR 1.3; CI 1.02-5.57), and patients having both diabetes and hypertension (HR 2.4; CI 1.69-3.14). CONCLUSION: Sociodemographic variables and comorbidities impact the mortality among COVID 19 patients. The variables most clearly associated with a greater hazard of death were older age, urban area, diabetes, and having both diabetes and hypertension.

Predictors of 'Out-of-Pocket Expenditure' on Routine Immunization of Under-Five Children: A Regression Analysis.

INTRODUCTION: 'Out-of-pocket expenditure' (OOPE) is the expenditures at the point of receiving health care directly by households which affects the economic stability of the household. When the expenditure on immunization of under-five children results in OOPE, it affects the motivation of parents for vaccination inversely. AIM: This study was planned to evaluate the out-of-pocket expenditure and to assess predictors of OOPE on routine immunization practices. SETTINGS AND DESIGN: This was a cross-sectional community-based study conducted from May to August 2019 at one of the immunization sites at primary health centers under a tertiary care institute of southern Rajasthan. MATERIAL AND METHODS: At the selected health facility, randomly 75% of beneficiaries of routine immunization were enrolled for the study. Data were collected using a pre-designed, pre-tested semi-structured questionnaire about direct and indirect expenses during the process of immunization incurred by the parents of the vaccinee by interview technique. RESULTS: In the study, 72.36% were infants, and 56.10% had first birth order. Mother accompanied nearly half of the vaccinee (49.6%) to the vaccination centre and the most used mode of transportation was the personal vehicle (63%). Mean loss of wages among parents/caretakers was 0.58 (±0.66) USD (median = 0.69; interquartile range (IQR) = 0.69; 95% confidence interval (CI) = 0.42-0.73) while average cost of transportation worn was 0.16 (±0.20) USD (median = 0.07; IQR = 0.21; 95% CI = 0.12-0.19) and mean duration of travelling to reach health facility was 11.87 (±7.53) minutes (median = 10; IQR = 10; 95% CI = 10.53-13.20). Vaccination at the centre was free of cost (zero USD) and no cost was incurred for drugs or registration. Average OPPE was 0.74 (±0.97) USD (median = 0.35; IQR = 0.62; 95% CI = 0.56-0.91) and regression analysis predicted significant contributors as age of vaccinee (p = 0.00; OR = 0.11; 95% CI = 0.04-0.34), religion (p = 0.04; OR = 0.34; 95% CI = 0.12-0.97) area of residence (p = 0.00; OR = 6.77; 95% CI = 2.37-19.32), birth order of vaccinee (p = 0.02; OR = 0.3; 95% CI = 0.11-0.85), longer waiting time (p = 0.03; OR = 0.16; 95% CI = 0.03-0.85), travelling time (p = 0.00; OR = 3.47; 95% CI = 1.49-8.09) and long distances (p = 0.00; OR = 10.40; 95% CI = 2.56-42.03) travelled to reach vaccination centre. CONCLUSION: The hidden cost of vaccination in the form of loss of wages and time, travel cost due to stretched distance traveled by family members to accompany vaccinee to immunization facility is experienced as OOPE by the families and could be one of the impediments in vaccination coverage. Amendments in the existing policies are required to reduce this invisible cost of vaccination.

Youngest Case of Allergic Broncho Pulmonary Aspergillosis in India: A Case Report from Arid Zone of India.

Allergic Broncho Pulmonary Aspergillosis (ABPA) is an immunological allergic disorder and asthmatic patients are predisposed to ABPA. Although, ABPA commonly develops in the third and fourth decades but no age group is unaffected from the disease. Youngest case of ABPA in India so far reported was four years of age. This case report is about a young child of bronchial asthma with ABPA aged four years and nine days only, from arid zone of country. Her diagnosis of ABPA was supported by clinical, serological and radiological findings. This case report concludes the importance of early diagnosis and treatment of ABPA along with general awareness for the disease.

Quality Assessment of Family Planning Sterilization Services at Health Care Facilities: Case Record Audit.

INTRODUCTION: Quality of sterilization services is a matter of concern in India because population control is a necessity. Family Planning Sterilization (FPS) services provided at public health care facilities need to be as per Standard Operating Procedures. AIM: To assess the quality of FPS services by audit of case records at selected health care facilities. MATERIALS AND METHODS: This cross-sectional study was conducted for two and a half year duration at selected public health care facilities of central India by simple random sampling where FPS services were provided. As per the standards of Government of India, case records were audited and compliance was calculated to assess the quality of services. RESULTS: Results of record audit were satisfactory but important criteria like previous contraceptive history and postoperative counselling were found to be deviated from standards. At Primary Health Centres (PHCs) only 89.5% and at Community Health Centres (CHCs) 58.7% of records were having details of previous contraceptive history. Other criteria like mental illness (only 70% at CHCs) assessment were also inadequate. Although informed consent was found to be having 100% compliance in all records. CONCLUSION: Quality of care in FPS services is the matter of concern in present scenario for better quality of services. This study may enlighten the policy makers regarding improvements needed for providing quality care.

Vaccine hesitancy: understanding better to address better.

Vaccine hesitancy is an emerging term in the socio-medical literature which describes an approach to vaccine decision making. It recognizes that there is a continuum between full acceptance and outright refusal of some or all vaccines and challenges the previous understanding of individuals or groups, as being either anti-vaccine or pro-vaccine. The behaviours responsible for vaccine hesitancy can be related to confidence, convenience and complacency. The causes of vaccine hesitancy can be described by the epidemiological triad i.e. the complex interaction of environmental- (i.e. external), agent- (i.e. vaccine) and host (or parent)- specific factors. Vaccine hesitancy is a complex and dynamic issue; future vaccination programs need to reflect and address these context-specific factors in both their design and evaluation. Many experts are of the view that it is best to counter vaccine hesitancy at the population level. They believe that it can be done by introducing more transparency into policy decision-making before immunization programs, providing up-to-date information to the public and health providers about the rigorous procedures undertaken before introduction of new vaccines, and through diversified post-marketing surveillance of vaccine-related events.