The National medical journal of India最新文献

Background We aimed to evaluate the efficacy and safety of anticoagulant therapy, especially direct oral anticoagulant (DOAC) therapy, for primary prevention of venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism (PE), in non-bedridden cancer patients undergoing chemotherapy. Methods English and Chinese literature published from the inception of the databases up to December 2022 was extracted from five databases: PubMed, Embase, MEDLINE, Wanfang Medical and CNKI. Statistical analysis was done using Stata/SE 16.0 software. Results Eight randomized controlled trials were included in this meta-analysis. The results showed that DOACs were effective in preventing symptomatic PE in cancer patients (Log risk ratio [RR]=-0.89, 95% confidence interval [CI]: -1.73, -0.05). Moreover, compared to the control group, DOACs did not increase the risk of major bleeding (Log RR 0.55, 95% CI -0.20, 1.30). Conclusion The meta-analysis indicates that in cancer patients, DOACs have a significant effect on the prevention of PE, with good safety profile and no increased risk of major bleeding.

Background Formal skill-based critical care competency development for non-anaesthetists or non-intensivists is variable in India at the undergraduate and postgraduate levels. This review aims to understand the barriers to the implementation of a simulation-based acute critical care course (ACCC) for clinicians. Methods We reviewed published articles that consist essentially of qualitative data, although some quantitative data is also included. For the stratification of articles, three instruments were used for the critical appraisal of published literature: (i) Guba's four parameters, (ii) ConQual rating and (iii) critical appraisal of the study programme. Results To effect a change in enabling clinicians to manage deteriorating patients safely, it is crucial to equip them with the necessary skills (technical and non-technical). It is important to introduce simulation-based courses, such as ACCC, to enable undergraduate and postgraduate medical and surgical trainees to gain the right balance of competence and confidence in managing complex situations before specialists, who are experts in critical care, take over. Conclusion An executive decision made by those at the helm of medical training and monitoring is necessary in medical education at both the undergraduate and postgraduate levels. The regulatory authorities (National Medical Commission and State Medical Councils) have a responsibility to address a plethora of challenges in the implementation of a scientific approach to simulation-based training. Life-saving skill development, rather than lecture-based education, is the key to equipping all clinicians in managing patients who are at risk of dying.

Manual scavenging, a perilous and degrading practice, profoundly impacts the health and overall welfare of those involved. Manual scavengers face major health risks and unsafe working conditions due to their occupation. To address and reform the prohibition of manual scavenging, two important acts, the 1993 Employment of Manual Scavengers and Construction of Dry Latrines (Prohibition) Act and the 2013 Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, aim to eradicate manual scavenging by imposing strict regulations, prohibiting the practice of employing manual scavengers, manually cleaning sewers and septic tanks without adequate protective equipment and constructing unsanitary latrines. Wearing suitable protective attire and using necessary equipment exempts individuals from being classified as manual scavengers under these laws. We report a man who was brought to the mortuary for a postmortem examination by an investigating officer. He had reportedly fallen into a sewage hole while cleaning a sewage line at a steel factory, resulting in death due to methane gas poisoning. Despite existing laws and regulations, this inhumane practice persists as a deeply rooted problem, necessitating a collective and persistent effort from governments, civil society and international organizations for its complete eradication.

Background Flipped classroom (FC) teaching is a distinctive method in which a reversal occurs between lecture and homework components. This model differs entirely from traditional classroom teaching and data regarding its effectiveness are sparse. Our primary objective was to evaluate the improvement in post-session test scores and self-acquired confidence between the FC and traditional lecture-based classroom (TLC) among undergraduate students in the clinical diagnosis and management of severe acute malnutrition (SAM) in children. Our secondary objective was to compare, among both groups, the perception regarding their assigned teaching methods. Methods Our study was conducted among the fourth-semester MBBS students. Fifty-nine students were included and randomly allocated into the FC/intervention (n=29) group and a traditional lecture-based classroom (TLC)/ control group (n=30). The topic of the teaching module was SAM among children. Teaching sessions were conducted in both groups at the same time. Both groups underwent pre-session and post-session tests. In addition, students were asked about their self-perceived confidence and feedback on teaching methods in a structured questionnaire. Results The post-session scores (20.9 [3.6], 20.6 [3.1]) were significantly higher than the pre-test scores (16.7 [3.1], 18.8 [2.1]), with p values of <0.001 and <0.004, respectively. Self-perceived confidence was, however, similar in the two groups. Concerns like feeling pressurized, drained out, and lost leisure time were more prevalent in the FC group. Regarding feedback, students strongly agreed that FC teaching helped in self-directed learning and independent learning skills. Conclusion The FC model encourages learning interest among students, enhances their achievement in the final assessment, and strengthens their clinical approach, communication skills, and confidence in patient management.