The National medical journal of India最新文献

A 61-year-old male presented with a history of fever and burning micturition for 1 week; 3 days after being started on nitrofurantoin 100 mg twice a day by a local practitioner, he developed rash over the body along with scrotal swelling and pain. Following admission to the local government hospital where he developed acute anterolateral myocardial infarction (MI), he was referred to our hospital. At admission, physical examination revealed reticular purpuric plaques with occasional ulceration over both lower limbs, upper limbs and abdomen with extensive scrotal purpura with necrosis. His pulse rate was 110/minute, oxygen saturation by pulse oximetry was 88% on ambient air and temperature was 101 °F. He was started on intravenous antibiotics and treatment for MI. Laboratory investigations revealed leucocytosis, thrombocytopenia, acute kidney injury and hepatic dysfunction. Scrotal ultrasound revealed epididymo-orchitis. The next day, the patient developed altered sensorium. Computed tomography of the brain showed an infarct in the right fronto-parietal region. Possibility of leukocytoclastic vasculitis (LCV) with systemic involvement as an adverse drug reaction to nitrofurantoin was considered; vasculitis-related blood work-up was inconclusive. Punch biopsy of the lesion showed LCV with subepidermal bulla formation. Patient was treated with intravenous corticosteroids (dexamethasone 8 mg thrice-daily), antibiotics and symptomatic management. He was discharged after 2 weeks on decreasing doses of corticosteroids.

Background Leave against medical advice (LAMA) is defined as a patient leaving the hospital against the doctor's advice, sometimes avoiding routine and potentially lifesaving procedures. The rate of LAMA can be a reflection of the effectiveness of communication, treatment and processes of the hospital. We aimed to identify the reasons for LAMA from an emergency department (ED) of a tertiary care hospital in New Delhi. Methods 400 consecutive patients going LAMA from the ED were enrolled in the study. Demographic data, triage category and reasons for LAMA were collected using questionnaires. Statistical analysis was performed and results analyzed. Results 103 (25.8%) patients went LAMA as they felt better after initial treatment and refused further in-hospital care. Other reasons for LAMA decisions included non-availability of intensive care unit (ICU) beds (82; 20.5%), financial constraints (69; 17.3%) and perceived risk of infection (59; 14.8%). Age, gender or triaging categories had no significant effect (p>0.05). Multiple logistic regression analysis revealed that the lack of health insurance and low family income were independent risk factors for LAMA decision. Conclusion In our study, the leading causes of LAMA were a patient feeling better after initial treatment, a lack of ICU beds, financial constraints and a perceived risk of infection.

Background Professionalism is an essential competence needed in the practice of dentistry. Teaching-learning and assessment of this competency is a part of the dental curriculum. We reviewed evidence in the literature regarding methods used for teaching, learning, evaluation and assessment of professional competency in undergraduate dental education. Methods Three different databases were searched for peer-reviewed full-text articles of studies relating to teaching- learning or evaluation of professionalism among dental undergraduate students. The evidence was then screened and the quality of the evidence was analysed by two different reviewers. Results A total of 573 articles were found relating to the topic and after removal of duplicates and initial title and abstract based screening using inclusion and exclusion criteria, 29 articles were shortlisted. Four more were excluded as the full-text of the articles could not be obtained. After full-text screening, 4 more articles were excluded due to variations in the abstract and methodologies in the full-text. Twenty-one articles were finally divided into 12 articles regarding teaching- learning and 9 articles regarding assessment methodologies and subjected to quality analysis. Conclusion Eleven methods for teaching and 8 methods for evaluation of professional competencies were found. The available literature on teaching, learning and assessing professionalism for dental undergraduate education is of moderate to low quality. Various authors have evaluated different methods but there is scope for improving the study designs to be more robust and the tools for assessment need to be refined.

Background Pelvic fractures are often a result of injuries caused by a major force and lead to considerable morbidity and mortality. Despite advances in acute management protocols involving angioembolization as a prime intervention, mortality in complex pelvic fractures remains high. We analysed our experience with the outcomes of a pelvic trauma management protocol using surgical haemostatic techniques over 5 years. Methods We did a retrospective analysis of all patients admitted with pelvic factures from January 2014 to December 2018. Demographic profile, clinical details, imaging findings, operative details and outcomes were analyzed. Logistic regression analysis was used to determine factors predicting poor outcomes in patients with pelvic fractures. Results A total of 501 patients with pelvic fractures were included, predominantly male (376; 75%), with a mean (SD) age of 34 (13.1) years. Road traffic accidents were the most common cause of injury (362; 72.3%). On presentation, 76 (15.2%) patients were haemodynamically unstable. The most common pattern of pelvic fractures was lateral compression in 320 (63.9%). Seventy-nine patients (15.7%) died. Haemorrhagic shock (251; 50%) and sepsis (86; 34.2%) were the predominant causes of death. Multivariate analysis predicted a higher class of haemorrhagic shock and a high injury severity score was associated with poor outcomes of pelvic fractures. Conclusions Management of pelvic trauma is complex due to haemodynamic instability and multiple organ involvement. Our goal-directed, resource-directed approach provided an overall favourable outcome in patients with pelvic fractures.

India has a well established and regulated traditional medicine system conducting undergraduate (UG), postgraduate (PG) and PhD courses. It has the highest network of colleges across the country among Ayush systems. In view of the growing demand for traditional and complementary medicine services at the global and national level, the need for regulatory and monitoring standards for quality assurance in education and training is pivotal. We aimed to determine the current status of Ayurveda education in India and its prospects. There are 450 UG Ayurveda colleges with 31 790 seats, whereas, 140 institutes are imparting PG Ayurveda courses with 4600 seats. There were many issues that existed in Ayurveda education and practice for a long time. Government of India has taken several initiatives to address these. These include skewed distribution of colleges across the States/Union territoies, less availability of seats in the public sector, gaps in clinical teaching methods, utilization of various available resources and non-availability of a streamlined National online register for Ayurveda practitioners, which needs to be addressed by the National Commission for Indian System of Medicine (NCISM). NCISM has to maintain the recent reforms and needs to operationalise the mandated reforms in a mission and time-bound manner to meet the current public healthcare requirements expected from the Ayurveda system. The roles and responsibilities of other stakeholder institutions, such as Ministry of Education, National Institution for Transformation of India Aayog, Universities and Research Councils, are also vital.

Background Blended learning (BL) for skill acquisition is an integral part of the undergraduate curriculum. Teachers may be trained in BL using physical or virtual platforms. Training of Trainers (ToT) using a virtual platform was adopted during the Covid-19 pandemic. We report our experience in conducting virtual training to impart hands-on knowledge to trainers about the BL technique. Methods We conducted a virtual ToT workshop to train trainers on a blended model for skill teaching. A moderator and a list of trainers were identified at the host institution. Invitations were sent to other institutions. The moderator briefed the participants through email. They were required to identify a topic for creating an e-learning module and asked to develop learning objectives, a standard operating procedure, and multiple-choice questions for the same. A 1.5-day programme was developed that included didactic lectures and small-group discussions on developing eModules. A feedback form using Google Forms was distributed among the participants to be completed after the programme. Results Thirty participants were enrolled. All were highly satisfied with the content of the workshop. Didactic lectures were completed on time. The duration in the breakout room for small group discussion was considered short. Twenty-eight participants felt that the workshop had sufficient learning points to keep the learner engaged for 1.5 days on a virtual platform. Only 3 participants were not satisfied with the use of a digital platform for this workshop. The content of the workshop regarding functioning and utility of the skill laboratory was perceived as useful for their institutional practice by 27 participants. Conclusion Virtual platforms can be used to conduct ToT workshops focusing on BL for skill acquisition.