The National medical journal of India最新文献

Background The scarcity of specialists to treat mental disorders in highly populated low and middle-income countries like India has always remained an important public health problem. Recently, a collaborative training model was developed to train primary care physicians (PCPs) for the management of mental disorders in India. We document the effectiveness of capacity building in enhancing PCPs knowledge, behaviour, and practice in managing common mental disorders. Methods We did a cross-sectional study across India from June to November 2020, utilizing both quantitative and qualitative data collection methods. The study tools and programme were designed and developed based on the Kirkpatrick model and Andragogy theory, respectively. A total of 143 enrolled PCPs were included in the study. The baseline-end of study, pre and post-intervention assessments, and the overall programme evaluation were done for knowledge, attitude, and practice (KAP). A paired sample t-test with p values was done to test the differences between baseline-end of study and pre and post-test values. In addition, the mean and standard deviation of the responses were calculated. Qualitative data and open-ended responses were analyzed using an inductive content analysis technique. Results The study showed a significant improvement in the KAP of trained physicians as measured by the post-intervention survey (p<0.05). This collaborative training intervention has a high potential for scaling up while optimally addressing the scarcity of trained mental health professionals in similar settings, such as India. Conclusion The collaborative training model showed notable improvements in the knowledge, attitude, and practices of primary care physicians when managing common mental disorders. These results emphasize the effectiveness and practicality of structured, theory-based training in enhancing mental health services at the primary care level. The model's success suggests that it could be expanded and scaled up in other low-resource settings that face comparable workforce issues in mental health care.

Background Medicine is a rapidly evolving field, so medical education aims to instill in students a commitment to ongoing learning and professional development promoting lifelong learning. To determine the role of a specific module in motivating medical educators to promote self-directed learning (SDL) in Medical Education. Methods The present study was conducted after obtaining institutional ethical clearance and informed consent from the participants. One-month mentor-learner web sessions on SDL using Google Group were arranged after administrative approval was obtained. There were 42 participants in the study. The whole module was conducted online. Study materials were provided to the participants using the Google Group and the WhatsApp Group, and for group activities learners were divided into five groups. Results Faculty members were motivated to apply their acquired skills as per feedback responses, reflection writing analysis, responses to motivational scale scores (Mean of importance and effort items were between 4.07-4.48 on a 5-point scale), and program evaluation (Kirkpatrick Level 1) was satisfactory. Conclusion The present faculty development program conducted online focused on SDL providing educators with essential tools and strategies to foster SDL among medical students. The program encompassed various elements, including peer review, hands-on training sessions, and collaborative learning, aimed at enhancing faculty members' understanding of SDL principles and their practical implementation in medical curricula. The combination of intrinsic and extrinsic motivators, coupled with a well-designed faculty development program, contributed to the success of the initiative in promoting SDL in medical education.

Infective endocarditis (IE) is caused by viral, bacterial or fungal pathogens, with high morbidity and mortality. Fungal endocarditis is rare and is associated with severe complications with poor prognosis despite combined medical and surgical treatment. Although Candida albicans is the most common fungal agent of this severe form of endocarditis, Candida parapsilosis is the most common non-albicans causative species. A 17-year-old patient who had had a liver transplant was referred to our paediatric cardiovascular surgery ward with a diagnosis of right heart failure. He had had coronary artery bypass graft and aortic valve replacement in 2021. He came to the outpatient clinic with complaints of fever, weakness, nausea and vomiting. On physical examination, he had pallor, dyspnoea and tachycardia. His fever was 38 °C and a grade 2/6 systolic ejection murmur was detected on auscultation. Amphotericin B in a dose of 4 mg/kg/day was started based on the antifungal sensitivity test.

Background We evaluated the effect of 6 months of regular training, tele-monitoring and daily text message to remind medication intake on treatment adherence in tuberculosis (TB) patients and their contacts. Methods This randomized, controlled study with pre- test and post-test design was conducted with the following groups: TB Intervention, TB control, contacted intervention and contacted control group, a total of 66 patients and 87 contacted people. The data of study were collected with 'Patient and Contact Question Form', Tuberculosis Adherence Determination Questionnaire (TADQ) and 'Morisky 8-Item Adherence to Drug Questionnaire' (MMAS-8). Results TADQ scores of the TB intervention group in the beginning, 1st, 3rd and 6th months were 80.4 (7.9), 117.8 (6.3), 137.7 (7.5), 143.2 (4.5), respectively, and TADQ scores of the TB control group in the beginning, 1st, 3rd and 6th months were 88.1 (7.1), 84.5 (9.8), 75.9 (7.9), 65.2 (9.2), respectively. MMAS-8 scores of the contacted intervention group in the beginning, 1st, 3rd and 6th months were 3.6 (1.3), 5.5 (0.7), 7.2 (0.8) and 7.7 (0.7), and those of the control group were 5.7 (1.4), 4.3 (1.4), 1.8 (1.5) and 0.7 (1.4), respectively. Conclusion As a result of 6 months of regular training, tele-monitoring and daily text message, adherence of the patients to TB treatment increased, and the adherence of the contacted people to the medication increased. Nurses should take an active role in the management of TB, determine the patients who do not use drugs correctly in the early period and apply the required interventions as soon as possible to improve treatment adherence of TB patients and contacts.

Background Automation of the procurement process through e-procurement is a key strategy for enhancing industrial operations management. E-procurement in the supply chain allows companies to use the internet to procure materials and handle value-added services. The Government of India, in the year 2016, introduced the government e-marketplace (GeM) for public sector procurement. Any new intervention faces challenges, and stakeholder feedback can help improve the system. Our study uses stakeholder satisfaction to assess the implementation of GeM compared to traditional/other purchase methods. Methods We undertook a prospective study in the procurement division of a tertiary care institute over 1 year. The study tool was a questionnaire containing 28 questions to analyse the stakeholders' satisfaction. Results Of the total participants in the study, 40.6% were secondary buyers, 37.5% were storekeepers and 21.9% were dealing hand/hospital purchase division clerks. The stakeholders opined ease in process, time bound and transparency as the parameters in which GeM is better than the conventional platform. Conclusion A public procurement process should ensure efficiency, economy and accountability in the system. Given the findings, the GeM platform is a welcome addition to the public procurement landscape. While the platform has definite advantages, there is a need to strengthen it further to meet the specific needs of the healthcare industry.

The major clinical manifestations of orbitofrontal cortex lesions include disinhibition, perseveration and obsessive-compulsive and antisocial behaviours. Some patients with orbitofrontal cortex lesion can show mood elevation. We report a 69-year-old female who presented with manic and inappropriate emotional responses caused by a large olfactory groove meningioma. Magnetic resonance imaging showed a large, extra-axial mass with homogenous enhancement in the olfactory groove, compressing the orbitofrontal cortex. She showed no focal or lateralising neurological signs. We did standardized neuropsychological batteries, including the Young Mania rating scale to evaluate her manic symptoms. After removal of the tumour, her manic symptoms and abnormal behaviours gradually disappeared. These findings suggest that her manic symptoms might have resulted from compression of the orbitofrontal cortex due to the olfactory groove meningioma. Clinicians must have an index of suspicion for organic brain lesion compressing the orbitofrontal area when a patient without a history of psychiatric disease develops progressive manic symptoms.

Background Medical students' attitude towards psychiatry (ATP) and mental illness will impact their choice of psychiatry as a future specialization and the quality of mental healthcare that they deliver to their patients. There is a paucity of longitudinal research on students' ATP and mental illness at different periods during medical school. We aimed to assess the attitudes of a cohort of medical undergraduates towards psychiatry and mental illness, before and after a clinical psychiatry rotation. Methods Medical students, in their second clinical year, underwent the first assessment on the 1st day of the psychiatry rotation. Socio-demographic information was collected. ATP and mental illness were assessed using the ATP-30 and the attitudes towards mental illness (AMI) scale, respectively. Assessments were repeated on the last day of the rotation and again 1 year later. Results One hundred and three medical students completed the pre- and immediate post-rotation survey questionnaire. One student withdrew consent for the 1-year assessment. There was an increase in ATP-30 and AMI scores after the rotation, and this persisted at the 1-year assessment. However, only the increase in ATP-30 scores was statistically significant. There was a significant reduction in the number of students with an overall negative attitude towards psychiatry and mental illness at 1 year. Conclusion Students generally had positive attitudes towards psychiatry and mental illness before the rotation. This improved further by the end of the rotation and persisted at 1 year of follow-up.

Haemoglobinopathies, the most prevalent haemolytic disease in India, make up the majority of patients in most haematology outpatient clinics. The most prevalent hereditary haemolytic anaemia is beta-thalassaemia trait (βTT). It often remains undiagnosed as it has an asymptomatic clinical course. However, βTT needs be identified to provide genetic counselling to the affected families and to reduce the number of affected children born, which will lower their overall financial burden. Better screening methods for haemoglobinopathies have increased the detection of mixed haemolytic anaemia. We report a patient with combined βTT and hereditary spherocytosis.

Background We aimed to assess the knowledge and attitude about cannabis use among college students in India, compare the perspective among users and non-users and lay a framework for development of effective primary prevention strategies in future. Methods This cross-sectional study was done in different colleges of Mumbai. Two hundred and sixty students of both sexes aged between 18 and 25 years were selected by systematic random sampling. Participants had to fill a sociodemographic questionnaire and a self-administered questionnaire that was analysed using the Statistical Package for the Social Sciences software. Results About 11.2% of the participants were users of cannabis and around 15% of them expressed a desire to take cannabis in the future. About 72% users were introduced to cannabis by their friends. The most common reasons for consumption of cannabis were peer pressure (29.6%), followed by stress reduction (23.5%) and experimentation (21.9%). The majority of participants (81%) did not favour legalization of cannabis use. However, more than half the participants were unaware of cannabis-related legal issues. Non-users considered cannabis to be more harmful and addictive than users who held a more permissive view regarding effects of taking cannabis. Conclusion The knowledge regarding harmful and legal implications of cannabis is relatively low amongst college students. Peer pressure, stress reduction and experimentation remain the commonest reasons for consumption. Imparting knowledge in early adolescence remains crucial in mitigating ignorant attitudes towards harmful cannabis use.