Singh R, Saurabh G, Bhat R
… +21 more, Fahad S, Vindal A, Madhavan S, Aggarwal R, Sokhal N, Goyal K, Shetty G, Lal P, Jain A, Roy D, Kalluri C, Kumar A, Sharma H, Singh S, Nirmalan M, Bhattacharjya S, Sagar A, Kumar S, Bhoi S, Sharma A, Misra MC
Natl Med J India
· 2025 · PMID 41645958
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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...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.
Contractor JB, Modi C, Mirza N
… +2 more, Shah HD, Kharod U
Natl Med J India
· 2025 · PMID 41645953
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Background Medical humanities encompass an integrated and interdisciplinary approach that spans the literary arts, visual and performing arts, the history of medicine, and bioethics, among many others. Its purpose is to...Background Medical humanities encompass an integrated and interdisciplinary approach that spans the literary arts, visual and performing arts, the history of medicine, and bioethics, among many others. Its purpose is to document and understand human encounters with illness, disability and medical procedures, aiming to cultivate empathy, compassion, and a broader perspective in doctors by emphasizing human interaction and creativity, leading to a more holistic view of healthcare. Methods We designed and introduced a 14-hour, choice-based coursework in the fields of literature, photography, painting, film studies, and dramatics to 150 medical undergraduate students during their 1st and 2nd professional years. A "Humanities Mahotsav" was celebrated as a culmination of the work done by the students at the end of the coursework followed by student feedback. Results We received encouraging feedback and majority of the students believed that medical colleges should provide a structured program to demonstrate their work in the field of arts and found the humanities coursework interesting. Most of the students were not in favor of assessment for humanities but perceived that the coursework makes them think more empathetically and help them become better doctors in future. Conclusion We believe that while the humanities too have to work within the parameters of medical education, it is imperative to explore and seek clarity on how to integrate the subject of humanities along with medical training process so that both 'medical' and 'humanities' find equal validity and weightage to actualize the true potential of the field.
D A S S, Malik A, Tripathy SK
… +5 more, Venugopal V, Arya AP, Patra SR, Varshney S, Gupta P
Natl Med J India
· 2025 · PMID 41645952
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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 it...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.
Natl Med J India
· 2025 · PMID 41645951
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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 thrombosi...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.
Kumari H, Prabhakar K, Abraham RA
… +3 more, Lakshmy R, Kalaivani K, Ramachandran P
Natl Med J India
· 2025 · PMID 41645950
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Background National surveys report that more than 90% of families in India access iodised salt (IS). Surveys of school children reported that median urinary iodine (UI) excretion was satisfactory in around 80% and high i...Background National surveys report that more than 90% of families in India access iodised salt (IS). Surveys of school children reported that median urinary iodine (UI) excretion was satisfactory in around 80% and high in 20% of the districts. Methods Between 2017 and 2021, based on data from 2 separate studies (A and B), UI was estimated in urban low-middle income families residing in South Delhi who had purchased IS from the market and used it for >1 year, or received IS or iron-fortified IS (DFS) from the research team and used it for >1 year. Spot urine samples were collected in the morning in both these groups; UI excretion was estimated using the microplate method based on the Sandell-Kolthoff reaction. Results Median baseline UI in those who purchased IS in the market was 234 µg/L in 2017 (Study A) and 235 µg/L in 2019 (Study B). In those who received the salt from the research team and used it in Study A, median UI in 2019 was 183 µg/L in IS users and 182 µg/L in DFS users; while in Study B, median UI in 2021 was 139 µg/L in IS users and 125 µg/L in DFS users. In both studies, UI after intervention was significantly different (lower) from baseline but not different between the IS and DFS groups. Conclusion There was a decrease in median UI between 2019 and 2021. This might be due to increasing awareness of the adverse consequences of excess iodine intake, and the salt industry complying with the Food Safety and Standards Authority of India's revised standards, which require the iodine content of salt at the manufacturer level to be between 20 and 30 ppm.
Natl Med J India
· 2025 · PMID 41645948
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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....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.
Yadav S, Sharma V, Gupta N
… +3 more, Parashar N, Ramachandran R, Roy A
Natl Med J India
· 2025 · PMID 41645947
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Background Critically ill cardiac patients may decompensate suddenly owing to arrhythmias and worsening haemodynamics, often necessitating emergent endotracheal intubation. Training in airway management is usually neglec...Background Critically ill cardiac patients may decompensate suddenly owing to arrhythmias and worsening haemodynamics, often necessitating emergent endotracheal intubation. Training in airway management is usually neglected for residents in the cardiac intensive care unit (ICU). There is an unmet need to train cardiology residents in the swift management of airways in the acute setting of a cardiac arrest. Methods In this manikin-based cross-over study, we compared King's vision channelled (KVC) and non-channelled video laryngoscopes (King's vision [KV]) with Macintosh direct laryngoscopes (DL) for endotracheal intubation by 89 resident doctors, predominantly cardiology residents. All participants performed endotracheal intubation by all three types of laryngoscopes after a didactic training session. The primary endpoint of the study was time to endotracheal intubation. Other parameters assessed were best glottic view, time to glottic view, ease of use of the device, failed attempts and retention of skills over 6 months. Results Total time to tracheal intubation was least with KVC, 10.0 (interquartile range [IQR] 6.0-10.0) seconds, as compared to KV, 15.0 (IQR 12.0-17.5) or DL, 24.0 (IQR 22.0-30.0) seconds (p<0.001). Both types of video laryngoscopes provided superior glottic view and had lower failure rates (p<0.001). KVC video laryngoscope and Macintosh DL were relatively easier to use (p<0.001). KVC and KV provided better retention of skills at 6 months. Conclusion Cardiology residents who were novices in endotracheal intubation took the least time for intubation on manikin with the KVC video laryngoscope when compared with the KV video laryngoscope and Macintosh DL. Further, real-life studies are needed to assess any difference in clinical situations.
Shah SA, Charan BD, Sebastian LJD
… +2 more, Kedia S, Garg A
Natl Med J India
· 2025 · PMID 41645946
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Spinal extradural arachnoid cyst is a rare condition, commonly located in the thoracic spine. It can be asymptomatic or present with symptoms of myelopathy due to spinal cord or nerve root compression. MRI is the initial...Spinal extradural arachnoid cyst is a rare condition, commonly located in the thoracic spine. It can be asymptomatic or present with symptoms of myelopathy due to spinal cord or nerve root compression. MRI is the initial imaging modality to diagnose this condition. CT myelography is the imaging modality of choice for detecting the actual site of communication between the subarachnoid space and arachnoid cysts; hence, it plays a pivotal role in surgical planning. We describe the imaging features of a symptomatic large spinal extradural arachnoid cyst and cord changes in a 12-year-old boy, who presented with paraparesis. CT and MR myelography helped in surgical planning by delineating the cyst morphology and the dural defect. It is an uncommon cause of myelopathy and must be accurately identified through imaging.
Sugathan V, Sivadasanpillai H, Ganapathi S
… +4 more, Gopalakrishnan A, Valaparambil A, Krishnamoorthy KM, Stanley A
Natl Med J India
· 2025 · PMID 41100423
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Background There is a paucity of newer studies focusing on survival patterns in the era of targeted pulmonary vasodilators in Eisenmenger syndrome (ES). We aimed to study the survival pattern, mortality predictors and ou...Background There is a paucity of newer studies focusing on survival patterns in the era of targeted pulmonary vasodilators in Eisenmenger syndrome (ES). We aimed to study the survival pattern, mortality predictors and outcome of targeted pulmonary vasodilator therapy in patients with ES. Methods This was a single-centre retrospective observational study of patients treated between January 2000 and January 2020. Consecutive patients with clinical and echo- cardiographic and/or cardiac catheterization diagnoses of ES were included in the study. Shunt types were classified into pre-tricuspid shunts, post-tricuspid shunts and complex lesions. Clinical outcomes and treatment data of all patients were assessed. Results Of 206 patients, 139 were female with a mean (SD) age of 23.4 (14.3) years. Pre-tricuspid shunts were the most common shunt type, with atrial septal defect being the most common anatomical defect. During a mean (SD) follow-up of 7.1 (6.2) years, a significant decline in mean resting systemic saturation and WHO functional class on follow-up was observed. Atrial arrhythmias and right ventricular dysfunction were the most common in pretricuspid shunt lesions. ES secondary to complex defects had the worst prognosis with early attrition. Survival patterns were equally poor in complex defects and pre-tricuspid defects after the onset of Eisenmenger physiology. Targeted pulmonary vasodilator therapy was associated with better survival, irrespective of monotherapy or dual therapy. Congestive heart failure was the most common cause of death. Survival at 5 and 10 years in the disease modifier treatment group was 84% and 69% while in the treatment naïve group was 66% and 44%. Resting systemic saturation <80% on follow-up, the presence of atrial arrhythmias and the absence of disease-targeted therapy were independently associated with mortality. Conclusion The long-term survival of patients with ES remains poor in the era of targeted pulmonary vasodilator therapy. ES resulting from complex cyanotic congenital heart diseases has the worst survival outcomes. Although pretricuspid shunt ES patients survived longer, they tended to decompensate at lower mean pulmonary artery pressure than all other subgroups with ES. Targeted pulmonary vasodilator therapy may be associated with improved functional class and survival benefits in ES.
Natl Med J India
· 2025 · PMID 41100421
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Background Competency-based curriculum has opened new opportunities for teaching appropriate attitudes and clinical skills to medical students by focusing on one-to-one training. Foundation training in social responsibil...Background Competency-based curriculum has opened new opportunities for teaching appropriate attitudes and clinical skills to medical students by focusing on one-to-one training. Foundation training in social responsibility (SR) sets the stage towards integrating SR in the longitudinal training course. Adapting principles of SR during clinical visits to field practice areas alongside vertical integration of community medicine departments with clinical departments with a blueprint of assessment can achieve the integration. Methods We describe the concept of social responsiveness, its contribution to medical ethics and professionalism and the opportunities for SR training within the competency-based curriculum. Socially relevant medical services established per local societal needs by individual medical colleges are discussed with methods of integrating SR training and assessment in the curriculum. Barriers to implementing such a curriculum with suggestions for opportunities are also highlighted. Results Integration of SR values within learning domains, careful selection of learning objectives and devising appropriate teaching strategies, together with incorporating elements of SR during the summative assessment, can work towards integrating SR in the curriculum. Conclusion A socially responsible competency-based curriculum should be able to create future doctors with a first contact with global standards of clinical skills sensitive to local social, cultural and financial needs.
Wu Y, Zhu Y, Zhao Y
… +7 more, Wang Y, Zhao J, Yang L, Dai M, Wang F, Xu X, Qu F
Natl Med J India
· 2025 · PMID 41100420
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Background As an important part of the internationalization of traditional Chinese medicine (TCM), internationalization of TCM education is an effective way to spread TCM worldwide. We investigated the perceptions and le...Background As an important part of the internationalization of traditional Chinese medicine (TCM), internationalization of TCM education is an effective way to spread TCM worldwide. We investigated the perceptions and learning situations of TCM among Chinese medical and non-medical students who received TCM courses taught in English. Methods This cross-sectional study was done at four universities in China. A structured, self-reported online questionnaire was completed by both medical and nonmedical students enrolled in the all-English-taught TCM course. The questionnaire primarily assessed their perceptions of traditional Chinese culture, clinical applications and modern research of TCM, their interest in TCM, and their learning situation regarding the TCM course. Results There were many similarities between the medical and non-medical students in TCM, as well as their preferences for the teaching method of the TCM course. Both believed that TCM had significant importance in clinical practice and that traditional Chinese culture should be fully integrated into the TCM curriculum. Additionally, they recognized the value of modern research in TCM. Both medical and non-medical students could understand the theoretical concept of TCM and establish TCM thinking through the TCM internationalization course. In addition, medical students were more interested in moxibustion, massage, cupping, and transcutaneous electrical acupoint stimulation, while non-medical students were more interested in exercise, a medicated diet, and traditional Chinese music. Conclusion Teaching TCM in English to Chinese medical and non-medical students is an important part of the internationalization of TCM education. Traditional Chinese culture, modern TCM research, and the development of various TCM forms are likely to be helpful in the global expansion of the use of TCM.