Pub Date : 2019-07-01DOI: 10.4103/IJAMR.IJAMR_113_19
Gopisree Peringeth, P. Mohan, R. Dhodapkar, B. Dubashi, R. Swaminathan
Background: Acute lymphoblastic leukemia (ALL) patients are susceptible to hepatitis B infection due to profound immunosuppression and repeated transfusions. However, the comparative effectiveness of hepatitis B vaccination in different phases of chemotherapy has not been studied. Aim: In this comparative interventional study (CTRI/2017/08/009402), vaccination in the induction phase (IP) was compared to that in the maintenance phase (MP). Materials and Methods: The participating ALL patients in both groups (29 per group) were vaccinated with double the dose of hepatitis B vaccine at 0, 1, and 2 months. The proportion of patients with seroprotective anti-hepatitis B surface titers (>10 IU/ml) was compared between the two groups after each dose. Results: The seroprotection rates between both the phases were similar following the first (relative risk [RR] = 4, confidence interval [CI]: 0.47–33.65) and third (RR = 1.4, CI: 0.73-2.84) doses of vaccination, whereas following the second dose of vaccination, the seroprotection rate in IP was significantly higher than that of MP (RR = 1.9, CI: 1.07–3.35). Conclusion: This study concluded that a 0, 1, and 2 schedule of hepatitis B vaccination has similar efficacy in both the IP and the MP of chemotherapy in ALL patients. As the IP has a higher trend of seroprotection rates compared to MP, vaccination in IP followed by revaccination postchemotherapy may be preferred in countries with a high prevalence of hepatitis B infection.
{"title":"Comparison of efficacy of hepatitis B vaccination during induction versus maintenance phase of chemotherapy in acute lymphoblastic leukemia: A nonrandomized clinical trial","authors":"Gopisree Peringeth, P. Mohan, R. Dhodapkar, B. Dubashi, R. Swaminathan","doi":"10.4103/IJAMR.IJAMR_113_19","DOIUrl":"https://doi.org/10.4103/IJAMR.IJAMR_113_19","url":null,"abstract":"Background: Acute lymphoblastic leukemia (ALL) patients are susceptible to hepatitis B infection due to profound immunosuppression and repeated transfusions. However, the comparative effectiveness of hepatitis B vaccination in different phases of chemotherapy has not been studied. Aim: In this comparative interventional study (CTRI/2017/08/009402), vaccination in the induction phase (IP) was compared to that in the maintenance phase (MP). Materials and Methods: The participating ALL patients in both groups (29 per group) were vaccinated with double the dose of hepatitis B vaccine at 0, 1, and 2 months. The proportion of patients with seroprotective anti-hepatitis B surface titers (>10 IU/ml) was compared between the two groups after each dose. Results: The seroprotection rates between both the phases were similar following the first (relative risk [RR] = 4, confidence interval [CI]: 0.47–33.65) and third (RR = 1.4, CI: 0.73-2.84) doses of vaccination, whereas following the second dose of vaccination, the seroprotection rate in IP was significantly higher than that of MP (RR = 1.9, CI: 1.07–3.35). Conclusion: This study concluded that a 0, 1, and 2 schedule of hepatitis B vaccination has similar efficacy in both the IP and the MP of chemotherapy in ALL patients. As the IP has a higher trend of seroprotection rates compared to MP, vaccination in IP followed by revaccination postchemotherapy may be preferred in countries with a high prevalence of hepatitis B infection.","PeriodicalId":32355,"journal":{"name":"International Journal of Advanced Medical and Health Research","volume":"6 1","pages":"68 - 73"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46958225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.4103/IJAMR.IJAMR_48_19
Anjali Rajkumar, A. Bhattacharjee, R. Selvaraj
Background: Screening for asymptomatic atrial fibrillation (AF) can identify patients at risk of stroke and help initiate treatment. Apex-pulse deficit, the difference between apex beat rate and peripheral pulse rate, has been described as a clinical sign to identify AF. However, the accuracy of this measure to identify AF has not been studied before. Aims: The primary aim of this study was to determine the sensitivity and specificity of apex-pulse deficit more than 10, measured over 1 min, to identify AF using 12-lead electrocardiogram (ECG) as the gold standard. Methods: This was a prospective cross-sectional study. Subjects were those above 30 years of age with known AF (cases) or not in AF (controls). Apex-pulse deficit was measured in each of them and correlated with rhythm detected in 12-lead ECG. Results: A total of 70 patients were studied, 35 cases and 35 controls. Apex-pulse deficit was significantly larger for cases as compared to controls and was a good discriminant to identify AF. Receiver operating characteristic curve analysis showed an area under the curve of 0.86. With a cutoff of 10, sensitivity and specificity to identify AF were 62.8% and 85.7%, respectively. Using a cutoff of 5 increased the sensitivity to 80%. Counting over 30 s was significantly less accurate than counting over one full minute. Conclusion: Apex-pulse deficit is a low-cost method to identify AF and may be useful for screening. A cutoff of 5 may enhance the sensitivity of measurement as compared to the traditional cutoff of 10.
{"title":"Diagnostic accuracy of apex-pulse deficit for detecting atrial fibrillation","authors":"Anjali Rajkumar, A. Bhattacharjee, R. Selvaraj","doi":"10.4103/IJAMR.IJAMR_48_19","DOIUrl":"https://doi.org/10.4103/IJAMR.IJAMR_48_19","url":null,"abstract":"Background: Screening for asymptomatic atrial fibrillation (AF) can identify patients at risk of stroke and help initiate treatment. Apex-pulse deficit, the difference between apex beat rate and peripheral pulse rate, has been described as a clinical sign to identify AF. However, the accuracy of this measure to identify AF has not been studied before. Aims: The primary aim of this study was to determine the sensitivity and specificity of apex-pulse deficit more than 10, measured over 1 min, to identify AF using 12-lead electrocardiogram (ECG) as the gold standard. Methods: This was a prospective cross-sectional study. Subjects were those above 30 years of age with known AF (cases) or not in AF (controls). Apex-pulse deficit was measured in each of them and correlated with rhythm detected in 12-lead ECG. Results: A total of 70 patients were studied, 35 cases and 35 controls. Apex-pulse deficit was significantly larger for cases as compared to controls and was a good discriminant to identify AF. Receiver operating characteristic curve analysis showed an area under the curve of 0.86. With a cutoff of 10, sensitivity and specificity to identify AF were 62.8% and 85.7%, respectively. Using a cutoff of 5 increased the sensitivity to 80%. Counting over 30 s was significantly less accurate than counting over one full minute. Conclusion: Apex-pulse deficit is a low-cost method to identify AF and may be useful for screening. A cutoff of 5 may enhance the sensitivity of measurement as compared to the traditional cutoff of 10.","PeriodicalId":32355,"journal":{"name":"International Journal of Advanced Medical and Health Research","volume":"6 1","pages":"52 - 55"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48107425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.4103/IJAMR.IJAMR_53_19
A. Abera, N. Asseffa, Mohammed Obssa, Elazar Balla, M. Koyira
Introduction: Antenatal care is a medical service provided to women during pregnancy with the aim of improving the pregnancy outcome. The approach considers that every pregnancy has the potential to be complicated. Objective: This study aimed to assess the utilization and factors associated with attending focused antenatal care (FANC) service in Wolaita Zone, Southern Ethiopia. Materials and Methods: A community-based cross-sectional study was conducted among 551 women who gave birth in the last 2 years. In this study, multistage cluster sampling technique was employed to select primary and secondary sampling units. Univariate and multivariable logistic regressions were done to determine associated factors. P < 0.05 and 95% confidence interval were considered to declare statistical significance. Results: The mean age of the respondents was 26.4 ± 4.9 years. The overall utilization of FANC was 85%. Among 540 interviewed mothers, 243 (45%) followed four and above times antenatal care visits during their last pregnancy, whereas 297 (55%) mothers followed <4 times. Mother's educational status, travel time, knowledge of danger signs, plan for last pregnancy, and knowledge on starting FANC were associated with FANC utilization. Conclusion: The findings of this study showed low utilization of recommended FANC. Efforts to improve utilization of FANC must strengthen initiatives that promote pregnant mothers' awareness on benefits of antenatal care, promote pregnancy planning, and reduction of travel time to health facility.
{"title":"Utilization of focused antenatal care service and associated factors among women in Southern Ethiopia","authors":"A. Abera, N. Asseffa, Mohammed Obssa, Elazar Balla, M. Koyira","doi":"10.4103/IJAMR.IJAMR_53_19","DOIUrl":"https://doi.org/10.4103/IJAMR.IJAMR_53_19","url":null,"abstract":"Introduction: Antenatal care is a medical service provided to women during pregnancy with the aim of improving the pregnancy outcome. The approach considers that every pregnancy has the potential to be complicated. Objective: This study aimed to assess the utilization and factors associated with attending focused antenatal care (FANC) service in Wolaita Zone, Southern Ethiopia. Materials and Methods: A community-based cross-sectional study was conducted among 551 women who gave birth in the last 2 years. In this study, multistage cluster sampling technique was employed to select primary and secondary sampling units. Univariate and multivariable logistic regressions were done to determine associated factors. P < 0.05 and 95% confidence interval were considered to declare statistical significance. Results: The mean age of the respondents was 26.4 ± 4.9 years. The overall utilization of FANC was 85%. Among 540 interviewed mothers, 243 (45%) followed four and above times antenatal care visits during their last pregnancy, whereas 297 (55%) mothers followed <4 times. Mother's educational status, travel time, knowledge of danger signs, plan for last pregnancy, and knowledge on starting FANC were associated with FANC utilization. Conclusion: The findings of this study showed low utilization of recommended FANC. Efforts to improve utilization of FANC must strengthen initiatives that promote pregnant mothers' awareness on benefits of antenatal care, promote pregnancy planning, and reduction of travel time to health facility.","PeriodicalId":32355,"journal":{"name":"International Journal of Advanced Medical and Health Research","volume":"6 1","pages":"56 - 61"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70740061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.4103/IJAMR.IJAMR_89_19
M. Girish, G. Subramaniam
In tackling the unconscionably high neonatal mortality rate much has been done, but much more remains to be done. The 1st minute after birth sets the foundation for the individual's future quality of life, and any intervention which facilitates the smooth transition from the cocooned fetal life to the independent adult life will quickly find worldwide acceptance. However, it is imperative that we also look for resource neutral interventions so that a neonate even in the most resource-challenged setting gets an opportunity to smile. The interventions we have elaborated upon in this article fall in this category. They are simple, easily applied in all settings, and are evidence-based.
{"title":"The golden minute after birth – beyond resuscitation","authors":"M. Girish, G. Subramaniam","doi":"10.4103/IJAMR.IJAMR_89_19","DOIUrl":"https://doi.org/10.4103/IJAMR.IJAMR_89_19","url":null,"abstract":"In tackling the unconscionably high neonatal mortality rate much has been done, but much more remains to be done. The 1st minute after birth sets the foundation for the individual's future quality of life, and any intervention which facilitates the smooth transition from the cocooned fetal life to the independent adult life will quickly find worldwide acceptance. However, it is imperative that we also look for resource neutral interventions so that a neonate even in the most resource-challenged setting gets an opportunity to smile. The interventions we have elaborated upon in this article fall in this category. They are simple, easily applied in all settings, and are evidence-based.","PeriodicalId":32355,"journal":{"name":"International Journal of Advanced Medical and Health Research","volume":"6 1","pages":"41 - 45"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46848525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.4103/IJAMR.IJAMR_126_19
J. Sejal, A. Pranavi, S. Mohsina, S. Sureshkumar, Debasis Naik, V. Kate
Gastric outlet obstruction is one of the most common clinical presentations of carcinoma of the stomach, especially in South-West Asia. Although gross gastric dilatation is common in benign obstruction of the pylorus due to peptic ulcer disease, a hugely dilated and distended stomach can be a very rare presentation in a patient with malignancy. A 65-year-old female patient presented with recurrent episodes of vomiting immediately after food, ball-rolling movements in the abdomen, and loss of appetite and significant weight loss in the past 1 month. Upper gastrointestinal endoscopy revealed a dilated stomach and an ulceroproliferative growth in the antropyloric region. A biopsy of the growth revealed moderately differentiated adenocarcinoma of the stomach. Contrast-enhanced computed tomography of the abdomen and pelvis showed proliferative growth at antrum and the hugely dilated stomach reaching up to the pelvis. The patient underwent exploratory laparotomy. Intraoperative findings were that of a dilated and thickened stomach with growth at the antropyloric region of the stomach. Metastatic omental deposits were also seen, and thus, palliative gastrojejunostomy was carried out. This case is being reported to highlight that occasionally malignant gastric outlet obstruction may lead to a massive dilatation of the stomach.
{"title":"Massive gastric dilatation in outlet obstruction – is it always benign?","authors":"J. Sejal, A. Pranavi, S. Mohsina, S. Sureshkumar, Debasis Naik, V. Kate","doi":"10.4103/IJAMR.IJAMR_126_19","DOIUrl":"https://doi.org/10.4103/IJAMR.IJAMR_126_19","url":null,"abstract":"Gastric outlet obstruction is one of the most common clinical presentations of carcinoma of the stomach, especially in South-West Asia. Although gross gastric dilatation is common in benign obstruction of the pylorus due to peptic ulcer disease, a hugely dilated and distended stomach can be a very rare presentation in a patient with malignancy. A 65-year-old female patient presented with recurrent episodes of vomiting immediately after food, ball-rolling movements in the abdomen, and loss of appetite and significant weight loss in the past 1 month. Upper gastrointestinal endoscopy revealed a dilated stomach and an ulceroproliferative growth in the antropyloric region. A biopsy of the growth revealed moderately differentiated adenocarcinoma of the stomach. Contrast-enhanced computed tomography of the abdomen and pelvis showed proliferative growth at antrum and the hugely dilated stomach reaching up to the pelvis. The patient underwent exploratory laparotomy. Intraoperative findings were that of a dilated and thickened stomach with growth at the antropyloric region of the stomach. Metastatic omental deposits were also seen, and thus, palliative gastrojejunostomy was carried out. This case is being reported to highlight that occasionally malignant gastric outlet obstruction may lead to a massive dilatation of the stomach.","PeriodicalId":32355,"journal":{"name":"International Journal of Advanced Medical and Health Research","volume":"59 32 1","pages":"74 - 76"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70739252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.4103/IJAMR.IJAMR_69_18
Sourav Goswami, Anupriya Jha, Sarinkumar Siven, A. Mundra, Subodh S. Gupta, D. Dambhare, A. Raut, A. Mehendale
Background: Dengue is a common vector-borne disease in countries like India, where it occurs in specific pockets including many in Maharashtra. During July–August 2018, an outbreak of dengue was suspected in a village of Wardha district, following an increase in the number of fever cases from the village, which demanded an urgent outbreak investigation to be carried out before it progressed into an epidemic/larger outbreak. Objectives: The aim of this study was to find out more cases, source of infection and to recommend necessary actions to control the dengue outbreak. Materials and Methods: This was a cross-sectional epidemiological study, where we used pre-tested, pre-designed epidemiological case sheets obtained from Integrated Disease Surveillance Program (IDSP). A case definition was proposed before beginning the investigation. Line listing, collection of blood samples, distribution of paracetamol tablets to fever cases, and making a spot map were some of the important steps carried out during the investigation. Results: Out of a total of 64 suspected fever cases, 36 cases fulfilled the case definition of dengue, set for the purpose of outbreak investigation. Twenty-three of them got admitted in different hospitals among whom two of them died. Apart from that, four of them were found to be positive for both dengue IgM and NS1 antigen in their blood samples. It was age group of 21–30 years which was mostly affected. Compared to males, the female population suffered more from the illness. House, container, and Breteau index were found to be 0.26, 0.09, and 0.32, respectively. Conclusion: Following the investigation, a detailed report was made, which was shared with the district health authority. The report also contained recommendations for necessary actions to be taken to control this outbreak and to further prevent such outbreaks in future.
{"title":"Outbreak investigation and containment measures of dengue fever in rural Wardha: A field epidemiological study","authors":"Sourav Goswami, Anupriya Jha, Sarinkumar Siven, A. Mundra, Subodh S. Gupta, D. Dambhare, A. Raut, A. Mehendale","doi":"10.4103/IJAMR.IJAMR_69_18","DOIUrl":"https://doi.org/10.4103/IJAMR.IJAMR_69_18","url":null,"abstract":"Background: Dengue is a common vector-borne disease in countries like India, where it occurs in specific pockets including many in Maharashtra. During July–August 2018, an outbreak of dengue was suspected in a village of Wardha district, following an increase in the number of fever cases from the village, which demanded an urgent outbreak investigation to be carried out before it progressed into an epidemic/larger outbreak. Objectives: The aim of this study was to find out more cases, source of infection and to recommend necessary actions to control the dengue outbreak. Materials and Methods: This was a cross-sectional epidemiological study, where we used pre-tested, pre-designed epidemiological case sheets obtained from Integrated Disease Surveillance Program (IDSP). A case definition was proposed before beginning the investigation. Line listing, collection of blood samples, distribution of paracetamol tablets to fever cases, and making a spot map were some of the important steps carried out during the investigation. Results: Out of a total of 64 suspected fever cases, 36 cases fulfilled the case definition of dengue, set for the purpose of outbreak investigation. Twenty-three of them got admitted in different hospitals among whom two of them died. Apart from that, four of them were found to be positive for both dengue IgM and NS1 antigen in their blood samples. It was age group of 21–30 years which was mostly affected. Compared to males, the female population suffered more from the illness. House, container, and Breteau index were found to be 0.26, 0.09, and 0.32, respectively. Conclusion: Following the investigation, a detailed report was made, which was shared with the district health authority. The report also contained recommendations for necessary actions to be taken to control this outbreak and to further prevent such outbreaks in future.","PeriodicalId":32355,"journal":{"name":"International Journal of Advanced Medical and Health Research","volume":"32 1","pages":"32 - 36"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70739617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.4103/IJAMR.IJAMR_16_19
V. Kumar, S. Rajasekhar
{"title":"Handling the transition: What is needed for effectively embracing competency-based undergraduate medical education?","authors":"V. Kumar, S. Rajasekhar","doi":"10.4103/IJAMR.IJAMR_16_19","DOIUrl":"https://doi.org/10.4103/IJAMR.IJAMR_16_19","url":null,"abstract":"","PeriodicalId":32355,"journal":{"name":"International Journal of Advanced Medical and Health Research","volume":"12 1","pages":"3 - 4"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70739324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.4103/IJAMR.IJAMR_25_19
S. Shrivastava, P. Shrivastava
IntRoductIon Competency‐based medical education (CBME) has been acknowledged as the need of the hour owing to the multiple benefits associated with it over traditional curriculum.[1] CBME is a learner‐driven process, with teachers serving the role of facilitator, and it allows a learner to acquire the desired skills at their own pace.[1] Competency refers to the habitual and judicious use of various attributes required to improve the health of an individual patient and the community. In general, competency is always more than one domain (viz., comprises knowledge, skills, and attitudes in varying combinations), whereas entrustable professional activities (EPAs) comprise more than one competencies.[1,2]
{"title":"Implementation of competency-based medical education for postgraduate courses in India","authors":"S. Shrivastava, P. Shrivastava","doi":"10.4103/IJAMR.IJAMR_25_19","DOIUrl":"https://doi.org/10.4103/IJAMR.IJAMR_25_19","url":null,"abstract":"IntRoductIon Competency‐based medical education (CBME) has been acknowledged as the need of the hour owing to the multiple benefits associated with it over traditional curriculum.[1] CBME is a learner‐driven process, with teachers serving the role of facilitator, and it allows a learner to acquire the desired skills at their own pace.[1] Competency refers to the habitual and judicious use of various attributes required to improve the health of an individual patient and the community. In general, competency is always more than one domain (viz., comprises knowledge, skills, and attitudes in varying combinations), whereas entrustable professional activities (EPAs) comprise more than one competencies.[1,2]","PeriodicalId":32355,"journal":{"name":"International Journal of Advanced Medical and Health Research","volume":"6 1","pages":"5 - 6"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70740024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.4103/IJAMR.IJAMR_39_18
Sujiv Akkilagunta, S. Kar, K. Premarajan, S. Lakshminarayanan, A. Ramalingam, T. Chacko, S. Bhandary
Background: The concept of self-directedness is defined by the active participation of students in all phases of learning, from framing the learning objectives to the assessment process. Various scales have been developed to measure self-directed learning (SDL) among students. Fishers' SDL readiness scale (SDLRS) was validated among nursing students. The present study assessed the reliability of Fisher's SDLRS among medical students in India. Factor analysis was carried out to reduce the total number of items in the scale. Materials and Methods: The SDLRS used in the study consisted of 52 items classified under three domains. The scale was administered to a sample of 367 medical students between the first and seventh semesters. Cronbach's alpha was used to measure the reliability of the scale. For item-reduction and further abridgment, factor analysis was done using principal component analysis. Results: Cronbach's alpha was found to be 0.93 for Fisher's 52-item scale. Satisfactory reliability was observed across each domain (≥0.7). Factor analysis enabled the reduction of scale to 29 items with three domains. Conclusion: Fisher's 52-item SDLRS is a reliable scale for use among medical students in India. We propose the use of a reliable and shortened 29-item scale.
{"title":"Assessment of reliability and adaptation of fisher's 52-item self-directed learning readiness scale among medical students in Southern India","authors":"Sujiv Akkilagunta, S. Kar, K. Premarajan, S. Lakshminarayanan, A. Ramalingam, T. Chacko, S. Bhandary","doi":"10.4103/IJAMR.IJAMR_39_18","DOIUrl":"https://doi.org/10.4103/IJAMR.IJAMR_39_18","url":null,"abstract":"Background: The concept of self-directedness is defined by the active participation of students in all phases of learning, from framing the learning objectives to the assessment process. Various scales have been developed to measure self-directed learning (SDL) among students. Fishers' SDL readiness scale (SDLRS) was validated among nursing students. The present study assessed the reliability of Fisher's SDLRS among medical students in India. Factor analysis was carried out to reduce the total number of items in the scale. Materials and Methods: The SDLRS used in the study consisted of 52 items classified under three domains. The scale was administered to a sample of 367 medical students between the first and seventh semesters. Cronbach's alpha was used to measure the reliability of the scale. For item-reduction and further abridgment, factor analysis was done using principal component analysis. Results: Cronbach's alpha was found to be 0.93 for Fisher's 52-item scale. Satisfactory reliability was observed across each domain (≥0.7). Factor analysis enabled the reduction of scale to 29 items with three domains. Conclusion: Fisher's 52-item SDLRS is a reliable scale for use among medical students in India. We propose the use of a reliable and shortened 29-item scale.","PeriodicalId":32355,"journal":{"name":"International Journal of Advanced Medical and Health Research","volume":"6 1","pages":"7 - 11"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70739645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.4103/IJAMR.IJAMR_50_18
Ishwari Bhombe, A. Raut, M. Taywade, P. Deshmukh
Introduction: In the rural health-care delivery system of India, auxiliary nurse midwife (ANM) is the key frontline field-level functionary who interacts directly with the community. A heavy responsibility of implementation of health programs rests on the shoulders of ANMs. As ANMs are central to the delivery of services under the National Rural health Mission including supervision of the work done by the accredited social health activist, we thought it prudent to analyze their work pattern so that their efficiency could be improved upon. Objective: The objective was to study the workload and work pattern of ANMs and identify the causes for improving work efficiency of ANMs. Materials and Methods: This was an observational cross-sectional study conducted among four purposively chosen ANMs from a primary health center (PHC) in Central India using time-motion study as the tool. An ANM's work pattern and workload were studied by constructing 24-h recall. One ANM was followed for a week, similarly the other ANM for another week so that the activities of entire month were covered. To ensure quality, work schedules reported by the ANMs each day were cross-checked with the concerned supervisor or medical officer PHC. Results: A free-listing and pile-sorting exercise was performed with the ANMs, and the 41 activities reported by them were clubbed in to five major categories. It was found that on meeting day, meeting and record keeping were the most performed tasks, whereas other tasks were hardly performed. On the day of home visits, ANMs performed the disease-related activity for most of their time, and record keeping or supporting tasks were the second most performed activities. Majority of ANM's time spent over the week was on supporting tasks which were not directly related to their job profile. Conclusion: We conclude that clarity about job responsibilities of ANMs is lacking and available working time is not effectively utilized. Time spent on supporting tasks such as travel and waiting is maximum. Training to manage time for priority tasks and to improve skills is required.
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