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   Table of Contents - Current issue
January-March 2022
Volume 8 | Issue 1
Page Nos. 1-70

Online since Wednesday, March 30, 2022

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What is new in academic international medicine? The importance of collaboration in postpandemic times p. 1
Daniel Ujakow Correa Schubert, Ian Ward Abdalla Maia, Lucas Oliveira J. e Silva, Hélio Penna Guimarães
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Descriptive analysis of adverse drug reactions to antiretroviral therapy: Causality, severity, and preventability assessment at a tertiary care teaching hospital p. 4
Charu Jain, Lokendra Sharma, Neha Sharma, Abhishek Agrawal, Amit Tak, Munesh Kumar
Introduction: Antiretroviral therapy (ART) is highly toxic, may cause various adverse drug reactions (ADRs). Hence, regular monitoring and reporting of ADRs to ART are essential to ensure the maximum benefit from these medications. The aim/objective of this study is to evaluate the pattern, causality, severity, and preventability of ADRs due to antiretroviral drugs. Materials and Methods: A descriptive observational study was carried out on people living with human immunodeficiency virus (HIV), at ART center of SMS Medical College and attached group of hospitals, Jaipur, after due approval from the Institutional Ethics Committee. ADRs due to various ART regimens were studied over a period of 12 months. Clinical information of ADRs and other relevant details was collected on predesigned pro forma and causality, severity, and preventability of reported ADRs were duly assessed. Results: Five hundred and twenty-four HIV patients taking ART presented with a total of 996 ADRs. Maximum ADRs were implicated by tenofovir + lamivudine + efavirenz and were related to the central nervous system (35.3%) and gastrointestinal system (19.6%). Other ART caused ADRs of anemia, rashes, renal impairment, hepatobiliary impairment, and rare ADR of Steven–Johnson Syndrome (S-J Syndrome) and gynecomastia. Among encountered ADRs, 73.8% were preventable, whereas 26.2% were not preventable. Causality assessment was found to be possible, probable, and certain in 72.7%, 24.9%, and 2.4% of ADRs, respectively. Conclusion: ART is associated with a broad range of ADRs, ranging from mild to life-threatening adverse reactions. The activities of pharmacovigilance, ADR monitoring, and reporting are mandatory to improve the drug safety. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning and improvement, and Systems-based practice.
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Outpatient antibiotic prescribing behavior and their psychosocial predictors among early-career clinicians in Delhi, India p. 11
Saurav Basu, Sahadev Santra, Nidhi Bhatnagar, Anish Laul
Introduction: Psychosocial factors are significant drivers of inappropriate antibiotic prescription leading to antibiotic resistance. We ascertained the psychosocial predictors of outpatient antibiotic prescribing (OAP) behavior among early-career clinicians in India. Materials and Methods: We enrolled 200 early-career clinicians, including 100 medical interns and 100 junior residents (postgraduate student doctors) in six clinical departments, and collected data using a self-administered questionnaire. Response options were coded on five-item Likert scales. Results: Antimicrobial resistance was viewed as a significant public health problem by most (95%) participants. Presumptive antibiotic prescribing was reported by 84% of participants, although the participant attitude indicated a slight disinclination against the presumptive use of antibiotics (mean = 2.8, standard deviation = 0.72). The majority (52.5%) of the participant's perceived social pressure frequently influenced their decision to prescribe antibiotics to the outpatients. Furthermore, the maximum social pressure was perceived as driven by patient expectation for antibiotics and the existing antibiotic prescribing behavior of their peers and colleagues. The perception of increased social pressure stipulating antibiotic prescribing negatively correlated with the participant's intention to reduce antibiotic use in outpatients (r= −0.124, P < 0.001). Social pressure was reported to be higher when treating adult patients reporting diarrheal symptoms and children having cough. Conclusions: OAP practices among early-career clinicians working in the government health sector in India are mediated by considerable social pressure despite behavioral intention for reducing antibiotic use. The following core competencies are addressed in this article: Practice-based learning and improvement, Professionalism.
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Impacting pediatric cardiologist burnout: The role of targeted work unit interventions p. 16
Chelsea Parsons, Soham Dasgupta, Larry Mohl, Ritu Sachdeva, William Border
Introduction: Burnout among physicians may impact productivity and result in suboptimal patient care. Studies looking at burnout in a specific pediatric subspecialty are extremely limited. In a previous study, the authors evaluated the work–life balance and burnout among pediatric cardiology attending at our institution. This demonstrated early signs of reduced work engagement and possible burnout in the near future. To address this, the authors implemented a number of targeted interventions and conducted a follow-up survey to assess the effects of such changes. The objective of this study was to evaluate the current status of work–life balance and burnout among pediatric cardiologists at the author's institution compared to the general population and to the prior survey. Materials and Methods: Pediatric cardiology attending physicians were surveyed at the author's institution to assess their perception of burnout and work–life balance using the Maslach burnout inventory and the areas of work–life survey. Results: Forty-seven of the 52 pediatric cardiologists responded to the survey. They were divided into groups by their respective subspecialty: interventional/electrophysiology (n = 2), cardiac intensive care unit/inpatient (n = 9), noninvasive imaging (n = 6), outpatient (n = 22), and other (n = 8). When compared to the previous survey, the Maslach burnout inventory scores were significantly lower in the area of emotional exhaustion. However, most scores in the areas of work–life survey were lower than the prior survey. Conclusion: This follow-up study focusing on pediatric cardiology attending physicians demonstrated worsening burnout and signs of reduced work engagement compared to the previous survey 4 years ago. Interventions did not include bolstering our physician support systems and developing resiliency training for our physicians, which is an area the authors are going to focus on going forward. The following core competencies are addressed in this article: Medical knowledge, Practice-based learning, Systems-based practice.
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Evaluating the impact of social distancing on COVID-19 hospitalizations using interrupted time series regression p. 24
Alecia James, Rikki Malagón-Morris, Shari Gurusinghe, Patricia Roblin, Christina Bloem, Tyler Wise, Michael A Joseph, Bonnie Arquilla, Pia Daniel
Introduction: The quasi-experimental approach of interrupted time series analysis has been used to assess public health interventions by statistically comparing preintervention and postintervention rates. In this study, we apply interrupted time series to assess the effectiveness of social distancing on COVID-19 hospitalizations in a patient population in New York City. Materials and Methods: An interrupted time series design was used to evaluate the impact of the New York State on PAUSE executive order (social distancing measure), on admitted COVID-19 patients, and patients on ventilators, at a single center hospital in Brooklyn, NY. Time series data were collected from March 10, 2020 to April 28, 2020 and were modeled using segmented regression analysis, assuming a 2-week delay in the intervention's effect. ARIMA forecasting was also performed to determine the projected COVID-19 hospitalizations and ventilator use in the absence of social distancing. Results: There was a significant change (decrease) in the upward daily trend in the mean number of COVID-19 admissions and patients on ventilators after the assumed effective date of the New York State on PAUSE mandate. For admitted patients, the coefficient of the variable “time after intervention,” or change in slope, was − 9.30 (P = 0.0009), and the corresponding value was − 2.27 (P < 0.0001) for patients on ventilators. Conclusion: The assumed effective period of the implementation of the New York State on PAUSE executive order was shown to be significantly correlated with decreased COVID-19 hospitalizations and ventilator use in the population measured. Similar social distancing measures should be adopted in other cities and locales that are currently seeing a surge in COVID-19 transmissions with an assumption of a 2-week delay in impact. The following core competencies are addressed in this article: Medical knowledge, Systems-based practice.
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A cross-sectional study to assess knowledge, attitude, and practices regarding Zika virus among nursing students in a tertiary care center of central India p. 32
Rakesh Mahore Kumar, Vikas Gupta, Ram Panika Kumar, Subramani Palaniyandi, Anitha Palaniyandi
Introduction: Recently, the Zika virus (ZIKV) has become a major concern across the world. ZIKV can primarily spread through the bite of infected Aedes aegypti mosquitoes. Till now, ZIKV is considered an incurable infectious disease. As Zika is an emerging disease of an international concern with the ongoing speculation about a potential outbreak in India in the future, the present study was conducted with an aim to assess knowledge, attitude, and practices regarding ZIKV among nursing students. Materials and Methods: This hospital-based cross-sectional study was conducted among 240 nursing students during 2019, and data were collected using a pretested, predesigned, standardized, and self-administered questionnaire. The ethical approval was obtained from the Institutional Ethical committee before the conduct of the study. All tests were performed at 5% level of significance. Results: The present study has included 240 nursing students (228 female students and 12 male students). The most common source of information related to ZIKV was social media among 75.6% of the students and 46.7% of the participants has low knowledge regarding ZIKV. Surprisingly, about one-tenth of the participants (14.2%) made an attempt to gain more knowledge about ZIKV, and nearly one-fifth of the participants were not using any method at all (17.1%) to prevent mosquito bites. Conclusion: This study showed inadequate knowledge among nursing students which will be future health care providers about ZIKV infection. The awareness about ZIKV infection should be ensured and maintained among health care providers to face any possible emergence in the region. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning, and Systems-based practice.
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Anesthesia-related perioperative patient safety services in Indian public and private hospitals with or without teaching programs: A matched analysis of qualitative survey data p. 38
Habib Md Reazaul Karim, Mayank Kumar, Mamta Sinha
Introduction: The World Health Organization is emphasizing global patient safety for more than a decade. However, very less is known about the patient safety environment in the perioperative settings in developing countries. The present secondary analysis aimed to compare the anesthesia-related patient safety measures and services in Indian public versus private and teaching versus nonteaching hospitals. Materials and Methods: The present study is a post hoc, subgroup analysis of a previously conducted cross-sectional, questionnaire-based, online survey during February–May 2019. Responses from the postgraduate trainee and consultant/qualified practitioners were included. Data related to the practice pattern and availability of standard, advanced monitoring, and equipment were then categorized based on the hospital funding source and availability of teaching program; compared using the Fisher's exact test, and P < 0.05 was considered statistically significant. Results: Six hundred responses were included. The majority (60.7%) were from the private sector; 57.3% worked in teaching hospitals. Overall, anesthesia-related patient safety and equipment were deficient across the entire range of hospitals. However, there was no difference between matched public and private hospitals (P > 0.05 for most), except the anonymous incident reporting, which was significantly higher in the corporate teaching hospitals (P < 0.0001). Teaching hospitals had significantly better safety measures (P < 0.0001 for most parameters) than nonteaching hospitals. Conclusion: Public sector hospitals in India are not having significantly different anesthesia services related to patient safety monitoring and equipment than private sector hospitals. However, the safety measures are relatively low in many aspects across all sectors, which need attention. The following core competencies are addressed in this article: Patient care, Systems-based practice.
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Selected long abstracts from the St. Luke's university health network quality awards program (2019-2020) p. 47
Diana M Tarone, Anna Ng Pellegrino
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