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Factors affecting our diagnostic accuracy 影响我们诊断准确性的因素
Pub Date : 2023-01-01 DOI: 10.4103/cmrp.cmrp_110_22
Harish Gupta, SunilKumar Verma
“Diagnostics and treatment are interdependent – but diagnostics are:-under-recognised-under-resourced-under-funded Policymakers and funders must prioritise #diagnostics to reduce the diagnostics gap and prevent premature deaths.” –The Lancet, Oct 7, 2021[1] Dear Editor, Nabi et al. analyse the discrepancy between admission diagnosis in emergency and final diagnosis in ward and then make its correlation with the length of hospital stay and mortality in their original article published in September–October 2022 issue of the journal.[2] They make a bar chart of the rate of diagnostic discrepancy amongst various organ systems and discover that at their hospital, such incoherence is the maximum amongst group of certain infections. Moreover, when they compared various organ system diseases, they found that circulatory disorders were the group where such correlation – or the lack of it – was the highest. While describing salient features of their study results, the investigators underscore that the highest discrepancy was seen in myocarditis (62.5%) group of patients. Therefore, as this is the – or one of the – most important findings of the article, let us discuss it hereupon. Viral infections are one of the most common causes of myocarditis.[3] Moreover, such diseases evolve sometimes after admission to a healthcare facility. For example, when a patient experiences chest pain, he presents to a clinic with variable symptoms[4] and after repeated examinations,[5] he may be correctly diagnosed. Under these circumstances, if one physician examines a patient when he has had a different presentation (at emergency department) and later, his symptoms evolve to a different one (in wards), and there is diagnostic discrepancy, we think that it simply represents evolution of the pathological rather than a diagnostic discrepancy in emergency. The study results has a heading – Baseline and clinical characteristics. There the writers highlight that the average length of hospital stay (days) for concordant diagnosis was 5.16 and for discordant lot was 7.05. Here, we want to add that shorter stay of the concordance group may be due to presentation of the patients at a later stage when some (provisional) diagnosis was already made at a peripheral centre. Hence, early discharge of such patients may be there because as now, we have their previous reports available, and we can compare the latest one with the baseline one. At this stage, either presence or its absence may be somewhat an easy task. Moreover, it may not have a relationship with baseline accuracy of diagnostic workup of the assessing physician – one who made a different diagnosis in the emergency department. Although the physicians state under a heading – Materials and Methods – that patients received from other health-care centres after being treated as inpatients were excluded from the study, it is possible that those treated as outpatients were there under study here. Hence, if they have some medical recor
“诊断和治疗是相互依存的,但诊断得不到充分认识,资源不足,资金不足,政策制定者和资助者必须优先考虑诊断,以缩小诊断差距,防止过早死亡。——《柳叶刀》,2021年10月7日[1]尊敬的编辑,Nabi等人在《柳叶刀》杂志2022年9 - 10月刊上发表了他们的原创文章,分析了急诊入院诊断与病房最终诊断的差异,并将其与住院时间和死亡率进行了相关性分析[2]。他们制作了一个不同器官系统诊断差异率的柱状图,发现在他们医院,这种不一致性在某些感染组中是最大的。此外,当他们比较各种器官系统疾病时,他们发现循环系统疾病是这种相关性(或缺乏这种相关性)最高的一组。在描述其研究结果的显著特征时,研究人员强调在心肌炎组(62.5%)患者中差异最大。因此,由于这是本文最重要的发现之一,让我们就此进行讨论。病毒感染是心肌炎最常见的原因之一。[3]此外,这些疾病有时在进入医疗机构后发展。例如,当患者出现胸痛时,他以不同的症状来到诊所[4],经过反复检查[5],他可能被正确诊断。在这种情况下,如果一个医生检查一个病人时,他有不同的表现(在急诊科),后来,他的症状发展到不同的一个(病房),并有诊断差异,我们认为这只是代表病理的演变,而不是诊断的差异在紧急情况下。研究结果有一个标题-基线和临床特征。作者强调,一致诊断的平均住院时间(天)为5.16,不一致诊断的平均住院时间为7.05。在这里,我们想补充的是,一致性组的住院时间较短可能是由于患者在较晚的阶段出现,而在外围中心已经做出了一些(临时)诊断。因此,这些患者可能会提前出院,因为到目前为止,我们有他们以前的报告,我们可以将最新的报告与基线报告进行比较。在这个阶段,存在或不存在在某种程度上可能是一件容易的事情。此外,它可能与评估医生的诊断工作的基线准确性没有关系-一个在急诊科做出不同诊断的医生。尽管医生在“材料和方法”标题下声明,在作为住院病人接受治疗后从其他保健中心接收的病人被排除在研究之外,但作为门诊病人接受治疗的病人有可能是在那里接受研究的。因此,如果他们有这样的访问的一些医疗记录,它可能有不同的效果,以作出诊断比没有。在我院辖区,中毒是一种常见的自杀方式,而celphos是妇女在决定结束生命时常用的毒药。当这些病人出现在急诊科时,心肌炎是一种与有毒物质有关的并发症。这里有一个病例报告,病人在入院期间出现了心脏毒性。[6]因此,我们可能会争辩说,如果心脏受累的标志在发病时没有出现,那可能是因为当时没有。因此,在某些阶段的诊断差异可能会出现,这表明已知的病程和致病过程的关联。然而,如果我们仔细观察研究时间(从2018年10月到2020年2月,近1年半),它主要属于COVID-19大流行传播之前。在大流行期间,COVID-19与心肌炎的风险增加2 - 3倍有关,出乎意料的是,心力衰竭诊断率较低:由于患者出现两个器官系统衰竭,一个干扰了对另一个的准确评估。[7]此外,过度依赖调查,忽视病史和体格检查,会导致急诊科和内科病房的诊断不一致。一些心脏病学检查如心电图、心肌酶(CPK MB[肌酸磷酸激酶]和肌钙蛋白T)、超声心动图(有时是床边超声心动图)、胸部高分辨率计算机断层扫描(CT)和CT/侵入性冠状动脉造影等快速、广泛的可用性和快速的结果可能会抑制我们的临床敏锐度。正如作者在数据分析结果中提到的那样,仅次于循环系统疾病的是呼吸系统疾病,其中诊断差异较大,在ARDS类别中名列前茅。
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引用次数: 0
Research ethical committees and ethics dumping 研究伦理委员会与伦理倾销
Pub Date : 2022-11-01 DOI: 10.4103/cmrp.cmrp_100_22
N. Uvais
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引用次数: 0
Menstrual hygiene management in India: An unsolved challenge 印度的月经卫生管理:一个未解决的挑战
Pub Date : 2022-11-01 DOI: 10.4103/cmrp.cmrp_133_22
Latika Bhalla
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引用次数: 0
Association of internet addiction with anxiety, stress and quality of life among undergraduate students 大学生网络成瘾与焦虑、压力和生活质量的关系
Pub Date : 2022-11-01 DOI: 10.4103/cmrp.cmrp_54_22
Panneerselvam Periasamy, Vajiravelu Suganthi, S. Gunasekaran, Jayaraman Narenkumar, V. Ramachandran, Ajitha Kannabiran
Background: This study examined undergraduate MBBS and nursing students' quality of life with internet addiction and the association of anxiety and stress. Aim: We aimed to partially replicate the participant's online activities, changes in behaviour by internet addiction, quality of life when internet access was not possible and frequency of internet use. Materials and Methods: A cross-sectional study was applied in included university involving 400 MBBS and nursing students. World Health Organization Quality of Life-BREF Questionnaire (WHOQOL-BREF) scale for assessment of the personal quality of life. Scores of internet addiction test, Beck Anxiety Inventory and WHOQOL-BREF were compared by using the Mann–Whitney test or Kruskal–Wallis test. Results: The main findings revealed various risk factors associated with internet addictions, such as psychological distress, anxiety, mood disorders, suicidality, aggression, stress and sleep problems. Most of the intervention studies used an invariant behavioural therapy approach, although other interventions appeared effective in reducing addiction symptoms. Conclusion: Based on the students' addiction finding of an association between quality of life with internet addiction and anxiety and stress problems across combination with high prevalence rates amongst adolescents and university students, the individuals will use these tools. The implication of these findings is further discussed, and research is needed to develop and implement prevention strategies and treatment offers.
背景:本研究考察了本科MBBS和护生网络成瘾的生活质量及其与焦虑和压力的关系。目的:我们的目的是部分复制参与者的在线活动、网络成瘾导致的行为变化、无法上网时的生活质量和使用互联网的频率。材料与方法:采用横断面研究方法,在纳入的大学中选取400名MBBS和护理专业学生。世界卫生组织生活质量问卷(WHOQOL-BREF)用于评估个人生活质量的量表。采用Mann-Whitney测验或Kruskal-Wallis测验比较网络成瘾测试、Beck焦虑量表和WHOQOL-BREF得分。结果:主要发现揭示了与网络成瘾相关的各种风险因素,如心理困扰、焦虑、情绪障碍、自杀倾向、攻击性、压力和睡眠问题。大多数干预研究使用不变的行为治疗方法,尽管其他干预措施在减少成瘾症状方面似乎有效。结论:基于学生成瘾的发现,生活质量与网络成瘾、焦虑和压力问题之间存在关联,并结合青少年和大学生的高患病率,个人将使用这些工具。进一步讨论了这些发现的含义,需要进行研究以制定和实施预防策略和治疗方案。
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引用次数: 0
Immediate effects of Pranayama on the cardiovascular parameters in hypertensive patients: A review 调息对高血压患者心血管参数的直接影响:综述
Pub Date : 2022-11-01 DOI: 10.4103/cmrp.cmrp_63_22
Shivani Batra, Rameswar Pal
Many clinical trials and studies have already been conducted and published to find out the effects of yogic practice as well as pranayama on cardiovascular system of hypertensive patients. Many studies also conducted to find out the immediate effects of yogic practice on hypertensive patients. However, a review is rarely been published to find out the immediate effects of pranayama on hypertensive patients. Searching was made through PubMed, Google Scholar, PsychINFO and Scopus using the keywords pranayama and hypertension. A total of seven studies were selected for this review from a 17 articles. Patients of essential hypertension performed different pranayama and showed a result of a significant decrease in various cardiovascular parameters such as heart rate (HR) and blood pressure (BP). It may be concluded that pranayama practice immediately reduce BP and HR.
许多临床试验和研究已经进行并发表,以找出瑜伽练习和调息对高血压患者心血管系统的影响。许多研究也发现了瑜伽练习对高血压患者的直接影响。然而,很少有研究表明调息对高血压患者有直接影响。通过PubMed、Google Scholar、PsychINFO和Scopus进行搜索,关键词是调息和高血压。本综述从17篇文献中选取了7篇研究。原发性高血压患者进行不同的调息后,心率(HR)和血压(BP)等各项心血管参数均有显著降低。可以得出结论,调息练习可以立即降低血压和心率。
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引用次数: 0
Surfactant administration via laryngeal mask or supraglottic airway 表面活性剂经喉罩或声门上气道给药
Pub Date : 2022-11-01 DOI: 10.4103/cmrp.cmrp_109_22
S. Saluja, P. Kansakar, Manoj Modi, Anup Thakur, A. Soni
Surfactant therapy has been the mainstay of treatment in preterm neonates with respiratory distress syndrome. Delivery of surfactant through endotracheal intubation has been the commonly used technique. Intubation requires expertise and is associated with complications. In addition, there is also an increased future risk of chronic lung disease. Newer techniques of surfactant delivery abating the need of intubation have been reported. One such minimally invasive technique is surfactant administration through a supraglottic airway device. In this report, we describe the delivery of surfactants using this technique.
表面活性剂治疗一直是治疗呼吸窘迫综合征早产儿的主要方法。经气管插管给予表面活性剂是常用的技术。插管需要专业知识,并伴有并发症。此外,未来患慢性肺病的风险也会增加。新的表面活性剂输送技术减少了插管的需要。其中一种微创技术是通过声门上气道装置给药表面活性剂。在本报告中,我们描述了使用这种技术的表面活性剂的递送。
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引用次数: 2
Revisiting conventional microbiology techniques in the era of molecular testing 回顾分子检测时代的传统微生物学技术
Pub Date : 2022-11-01 DOI: 10.4103/cmrp.cmrp_60_22
A. Vidyarthi, Arghya Das, Ankit Gupta
The diagnosis of infectious diseases has always been a matter of concern for clinicians worldwide. Although the conventional techniques like microscopy and culture have served the purpose since ages, they have been found to be inadequate now with the advent of modern technology including automated identification systems and molecular testing. The newer technology including Matrix-Assisted Laser Desorption Ionization – Time of Flight and molecular tests such as multiplex polymerase chain reactions and Next Generation Sequencing, has undoubtedly paved the way for diagnosis and discovery of various novel pathogens. This has subsequently given rise to a mindset that the conventional techniques are redundant and hence, should be abandoned. The authors, through the current review, would like to present a perspective in favour of the conventional techniques which still are one of the simplest, most inexpensive methods for diagnosing infectious diseases and provide us with the precious antimicrobial susceptibility data to guide our antimicrobial stewardship programmes. Further, considering the limited availability of the state-of-the-art molecular testing facilities across the country, it is recommended that rather than using them exclusively or separately, conventional methods and the molecular tests be used in conjunction wherever available and feasible.
传染病的诊断一直是全世界临床医生关注的问题。尽管像显微镜和培养这样的传统技术自古以来就起到了作用,但随着包括自动识别系统和分子测试在内的现代技术的出现,它们已经被发现是不够的。新的技术,包括基质辅助激光解吸电离-飞行时间和分子测试,如多重聚合酶链反应和下一代测序,无疑为诊断和发现各种新型病原体铺平了道路。这就产生了一种观念,认为传统的技术是多余的,因此应该被抛弃。作者希望通过目前的综述,提出一个有利于传统技术的观点,因为传统技术仍然是诊断传染病最简单、最便宜的方法之一,并为我们提供宝贵的抗菌药物敏感性数据,以指导我们的抗菌药物管理规划。此外,考虑到全国最先进的分子检测设施有限,建议在有条件和可行的情况下将常规方法和分子检测结合起来使用,而不是单独或单独使用。
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引用次数: 0
Newer equations for calculation of low-density lipoprotein cholesterol – Their significance and utility 计算低密度脂蛋白胆固醇的新公式-它们的意义和效用
Pub Date : 2022-11-01 DOI: 10.4103/cmrp.cmrp_66_22
A. Manocha, S. Bhargava
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引用次数: 0
Awareness and practices about menstruation among adolescent girls: A cross-sectional study 青春期女孩对月经的认识和实践:一项横断面研究
Pub Date : 2022-11-01 DOI: 10.4103/cmrp.cmrp_92_22
Priyanka Parmar, S. Deshpande
Introduction: Menstruation is still a taboo in India and it is common for people across society to feel uncomfortable about the subject. It is a normal physiological process. Objectives: The objective of this study was to assess awareness and hygiene practices amongst adolescent girls and to study the menarche age of respondents in comparison to their mother's age at menarche. Materials and Methods: A cross-sectional, observational and prospective study was carried out in two private high schools of Mehsana city, Gujarat. Data were collected in a form of a structured questionnaire. Adolescent girls from 10 to 19 years were enrolled in the study. Ethical approval was obtained before initiating data collection. IBM SPSS version 2.0 was used for the analysis of the data. Results: Out of a total of 454 screened, 398 adolescents were enrolled in the study with an 87.76% response rate. The mean menarche age of adolescent girls was 13.33 ± 1.18 years. Mothers 316 (78.4%) were the first source of information. Majority of study respondents (68.5%) rated menstruation as a part of the physiologic process caused by hormonal changes. About 18.6% knew the uterus as a source of bleeding. About 59.8% of adolescent girls were scared and discomforted at their menarche. Most (93.5%) were using sanitary pads as absorbent material. Half of the respondents were using water to clean their genitals. Nearly half of the respondents felt hesitation for discussing their menstrual-related problems with others. The mean menarche age of the participants was 13.33 ± 1.18 years with a minimum of 10 years and a maximum of 18 years, while their mother's age at menarche was 14.58 ± 1.27 years. Conclusion: Menstrual hygiene education must be provided to adolescent girls. Need to solve taboos and misconception amongst adolescent girls of India.
导读:在印度,月经仍然是一个禁忌,整个社会的人们对这个话题感到不舒服是很常见的。这是一个正常的生理过程。目的:本研究的目的是评估青春期女孩的意识和卫生习惯,并研究受访者的月经初潮年龄与其母亲的月经初潮年龄的比较。材料与方法:在古吉拉特邦梅哈萨纳市的两所私立高中进行了横断面、观察性和前瞻性研究。数据以结构化问卷的形式收集。10至19岁的青春期女孩参加了这项研究。在开始数据收集之前获得伦理批准。采用IBM SPSS 2.0对数据进行分析。结果:在454名筛查对象中,398名青少年入组,有效率为87.76%。少女初潮平均年龄为13.33±1.18岁。316名母亲(78.4%)是第一信息来源。大多数受访者(68.5%)认为月经是由激素变化引起的生理过程的一部分。约18.6%的人知道子宫是出血的来源。约59.8%的青春期女孩在月经初潮时感到害怕和不适。大多数(93.5%)使用卫生巾作为吸水材料。一半的受访者用水清洗生殖器。近一半的受访者对与他人讨论与月经有关的问题感到犹豫。受试者初潮平均年龄为13.33±1.18岁,最小10岁,最大18岁,母亲初潮平均年龄为14.58±1.27岁。结论:对少女进行经期卫生教育是必要的。需要解决印度青春期女孩的禁忌和误解。
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引用次数: 0
Health care utilization among geriatric patients with respiratory diseases – An Indian perspective 患有呼吸系统疾病的老年患者的医疗保健利用——印度人的观点
Pub Date : 2022-11-01 DOI: 10.4103/cmrp.cmrp_36_22
Sonisha Gupta, S. Asthana, A. Gupta
Background: The elderly population is continuously growing and respiratory diseases account for 20% of chronic diseases among ageing people; these diseases are often treated imprecisely. Thus, the health-care system should adapt to the growing health needs of the elderly population. Aims: To study health care utilisation by geriatric patients with respiratory diseases. Material and Methods: A cross-sectional study of the elderly aged 60 years and over was conducted in the urban and rural areas of the National Capital Region and the Ghaziabad district of Uttar Pradesh. The first part of the study included socio-demographic characteristics and self-reported co-morbidities. In this first part, suspected respiratory cases were screened out, and a questionnaire regarding health-care utilisation was administered. The effect of socio-demographic factors on health-care utilisation was analysed. Results: In urban areas, 282/1522 (18.5%) and in rural areas, 298/1503 (19.8%) were found to suffer from respiratory illnesses. Health-care utilisation among elderly patients was significantly higher in urban areas compared to rural areas. In both areas, a large number of elderly people (70.5% rural and 61.7% urban) were insufficiently utilising health-care services. The socio-economic status (P = 0.034) and the source of income (P = 0.002) of urban residents were found to be significant factors. Among rural residents, health security (P = 0.05) and source of income (P = 0.002) were found to be statistically significant. Among the combined population (580), socio-economic status (P = 0.020) and source of income (P = 0.002) were found to be statistically significant. Conclusion: Health-care utilisation was better in urban residents than in rural elderly. However, majority of the elderly were utilising health-care services insufficiently in both areas. Socio-economic status and source of income had a significant effect on health-care utilisation.
背景:老年人口持续增长,呼吸系统疾病占老年人慢性病的20%;这些疾病的治疗往往不准确。因此,保健系统应适应老年人口日益增长的保健需要。目的:了解老年呼吸系统疾病患者的卫生保健利用情况。材料与方法:在国家首都地区和北方邦加济阿巴德地区的城市和农村地区进行了一项60岁及以上老年人的横断面研究。研究的第一部分包括社会人口统计学特征和自我报告的合并症。在第一部分中,筛选了疑似呼吸道病例,并对医疗保健利用情况进行了问卷调查。分析了社会人口因素对保健利用的影响。结果:城区有282/1522人(18.5%),农村有298/1503人(19.8%)。与农村地区相比,城市地区老年患者对保健服务的利用明显更高。在这两个地区,大量老年人(70.5%为农村老年人,61.7%为城市老年人)没有充分利用保健服务。城镇居民的社会经济地位(P = 0.034)和收入来源(P = 0.002)是影响其健康的显著因素。在农村居民中,健康保障(P = 0.05)和收入来源(P = 0.002)具有统计学意义。在合计人口(580人)中,社会经济地位(P = 0.020)和收入来源(P = 0.002)具有统计学意义。结论:城镇老年人对医疗保健的利用程度高于农村老年人。然而,在这两个地区,大多数老年人都没有充分利用保健服务。社会经济地位和收入来源对保健服务的利用有重大影响。
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引用次数: 0
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Current medicine research and practice
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