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   Table of Contents - Current issue
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April-June 2020
Volume 6 | Issue 2
Page Nos. 49-162

Online since Monday, June 29, 2020

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EDITORIAL  

What's New in Academic International Medicine? Academic International Medicine and life after COVID-19 p. 49
Christina Bloem, Christine Butts, Annelies De Wulf, Manish Garg, Sona Garg, Ziad Sifri
DOI:10.4103/IJAM.IJAM_70_20  
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EXPERT COMMENTARY Top

Coronavirus disease 2019 pandemic: Improving hospital readiness to meet the rising health-related needs p. 54
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/IJAM.IJAM_26_20  
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REVIEW ARTICLES Top

Novel coronavirus infection and periodontal clinic: Are we prepared? p. 56
Malvika Singh
DOI:10.4103/IJAM.IJAM_20_20  
Coronavirus infection has become a matter of serious concern for the world these days. Signs and symptoms include dry cough, fatigue, coughing sputum, and shortness of breath. Due to the continuous production of aerosol in periodontal clinics and because of the fact that the virus remains alive for 12 h, periodontists are highly susceptibility risk for the same. This article is an attempt to throw light on coronavirus infection and enumerating certain preventive measures to be taken in a periodontal setup for the prevention of the same. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning, Systems-based practice.
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Hospital response plan for the city of Porto Alegre, Brazil, during the pandemic of COVID-19 p. 64
Bianca Bertuzzi, Silvana T Dal Ponte, Marcio Rodrigues, Christina Bloem
DOI:10.4103/IJAM.IJAM_66_20  
The objective of this article is to describe the response of the hospitals of the city of Porto Alegre, Brazil, in reference to the pandemic of coronavirus disease 2019 (COVID-19) up to the present moment. Data collected from publicly available case information from the municipal department of health database were compiled and public health measures were described. Based on the current information, Porto Alegre's slope of the curve for COVID-19 in Porto Alegre appears to be flattened, and may be correlated with the implementation of social distancing and other measures taken in the city. The following core competencies are addressed in this article: Systems-Based Practice.
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Role of social media during the COVID-19 pandemic: Beneficial, destructive, or reconstructive? Highly accessed article p. 70
Heena Sahni, Hunny Sharma
DOI:10.4103/IJAM.IJAM_50_20  
The world is facing the extensive spread of severe acute respiratory syndrome-coronavirus 2. This epidemic puts intensive pressure on healthcare, economic, and social structures. Commitment to implementing effective approaches for public health will take bold interventions by public health professionals and strong leadership by the nation's governing bodies. During this crisis, lack of awareness, knowledge, and preparedness would put people and health care staff at risk. The dilemma is how to pass the knowledge of current disease statistics and its prevention to the general population at a rate equivalent to or better than the spreading epidemic. At the same time, a huge amount of health-threatening misinformation is spreading at a faster rate than the disease itself. The major proportion of this false rumor is disseminated in the web-2 era through social media. Thus, delivering fast, accurate and reliable information addressing critical problems of infection control is, therefore, of key importance. This review outlines both the positive and negative impact of social media during coronavirus epidemic on health-care professionals and on the general population. However, if used wisely and prudently, social media serves as a powerful tool for changing people's behavior and to promote the well-being of individual and public health. The following core competencies are addressed in this article: Medical knowledge, Interpersonal and communication skills, Practice-based learning.
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Preservation of physical and mental health amid COVID-19 pandemic: Recommendations from the existing evidence of disease outbreaks p. 76
Hunny Sharma, Swati Verma
DOI:10.4103/IJAM.IJAM_47_20  
COVID-19 disease caused by the SARS-CoV-2 virus and originating in China's Wuhan City is now a pandemic. In the current situations where no certain prevention or treatment measures are available, and all countries have implemented travel bans, mass quarantine, and isolation measures to restrict the spread of the virus. It is anticipated that people will be likely to suffer from multiple negative psychological effects if not taken care of. The government and researchers must develop ways to determine these adverse effects of unprecedented long-term quarantine and develop various approaches to cope with those effects. Authors by this paper had tried to provide insight into why pandemic disease exposes individuals to physical and mental disorders, what can be done to prevent them among citizens, children, self-isolators, health care professionals, telemedicine in management of mental health burden, and some appreciable steps taken through the Indian government to elevate some of these adverse effects among Indians through unprecedented long-term lockdowns. Hence, this narrative review based on existing evidence from various outbreaks aims to recommend steps that can be considered to preserve the physical and mental health of the citizens amid the COVID-19 pandemic. The following core competencies are addressed in this article: Patient care, Medical knowledge, Practice-based learning and improvement.
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ORIGINAL ARTICLES Top

Modeling and forecasting of confirmed and recovered cases of COVID-19 in India p. 83
Anuradha Gautam, Jayant Jha, Ankit Kumar Singh
DOI:10.4103/IJAM.IJAM_45_20  
Context: The novel coronavirus was reported in the past few weeks of 2019 in the Wuhan city, China, and the spread and outbreaks of disease require an epidemiological analysis of the disease in the shortest time and increased awareness of effective interventions Aims: This article proposes an objective approach to predicting the continuation of the COVID-19 cases in India using a simple, but powerful time-series method. Settings and Design: Cumulative confirmed and cumulative recovered cases of COVID-19 in India are taken to forecast the prevalence of incoming 3 weeks. Subjects and Methods: The model is built to predict the number of confirmed cases and recovered cases based on the data available from March 14, 2020, to April 26, 2020. Statistical Analysis Used: The autoregressive-integrated moving average model was applied to predict the number of confirmed cases and recovered cases of COVID-19 during the next 3 weeks. Results: Our forecasts suggest a continuing increase in the confirmed COVID-19 cases with sizable associated uncertainty assuming that the data used are reliable and that the future will continue to follow the past pattern of the disease. Conclusions: The timeline of a live-forecasting exercise with potential implications for planning and decision making is described. The following core competencies are addressed in this article: Medical knowledge, Practice-based learning and improvement, Systems-based practice.
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A multistate ecological study comparing evolution of cumulative cases (trends) in top eight COVID-19 hit Indian states with regression modeling p. 91
Sudhir Bhandari, Ajit Singh Shaktawat, Amit Tak, Bhoopendra Patel, Kapil Gupta, Jitendra Gupta, Shivankan Kakkar, Amitabh Dube
DOI:10.4103/IJAM.IJAM_60_20  
Background: The global pandemic of coronavirus disease – 2019 (COVID-19) has wrecked the very fabric of mankind putting its survival at stake. The prior knowledge of trends of cumulative cases helps in management of disease epidemic by optimized allocation of logistics and human resources. Materials and Methods: An ecological study was undertaken to compare the standardized trends of cumulative cases of top eight highly COVID-19 affected states of India with linear regression modeling. The data were sourced from Kaggle repository and Unique Identification Authority of India. The coefficients of regression of linear regression models of all the eight states were compared using analysis of covariance (ANCOVA). Results: It was observed that evolution of COVID-19 was the highest in the state of Gujarat (b = 0.186, P < 0.001) followed by Madhya Pradesh (b = 0.166, P < 0.001), Maharashtra (b = 0.159, P < 0.001), Delhi (b = 0.156, P = 0.02), Rajasthan (b = 0.136, P = 0.98), Uttar Pradesh (b = 0.117, P < 0.001), Tamil Nadu (b = 0.091, P < 0.001), and Andhra Pradesh (b = 0.076, P < 0.001) respectively. Conclusion: It is seen that ranking of states on the basis of trends of evolution and the absolute number of cumulative cases are different. The trends of evolution assist public health authorities and governmental agencies in providing right picture of evolution and help in decision making process during management of epidemic. The following core competencies are addressed in this article: Medical knowledge, Practice-based learning and improvement, Systems-based practice.
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A personalized Institutional Review Board Liaison Service: Evaluation over its initial 30 months p. 96
Zainab Abedin, Alan Teller, Brenda Ruotolo, Kawthar Muhammad, Deborah F Stiles, Rui Ferreira, Nancy Green
DOI:10.4103/IJAM.IJAM_26_19  
Background: The aim of this study is to evaluate whether a dedicated Institutional Review Board (IRB) Liaison Service situated at our Institute's central location could provide additional useful staff support to the investigator community for interactions with the IRB at various levels of protocol submission and review. Materials and Methods: Over a period of 2½ years, from January 2015 to June 2017, a total of 501 in-person consultations were performed during office hours, usually 25–30 per month. Most requests concerned new protocol development, IRB policy questions, and strategies for compliance or assistance in addressing IRB comments on returned protocols. We analyzed the results of a user evaluation survey for in-person consults and performed a focused in-depth analysis of the impact of the IRB Liaison Service. Results: Survey response rate was 43%. Results of 215 completed satisfaction surveys were 100% positive. Users were primarily study coordinators and investigators. Of a randomly selected sample of consultations analyzed in-depth for 67 unique protocols, 73% were subsequently approved within 14 days. Conclusion: National concerns about IRB-related research delays have led to the re-assessment of IRB review processes at institutional levels. Overall, we have found the Liaison Service to be a popular, useful addition to research support for a meaningful number of researchers, enhancing our already research-friendly environment. We plan to continue the service and the evaluation going forward. We will focus in the next phase on exploring whether the Liaison Service can reduce IRB approval times for protocols using its services and on providing support for the use of single IRBs for multi-site studies. The following core competencies are addressed in this article: Practice-based learning and improvement.
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Determining the rate of obesity documentation in a division of general internal medicine at a tertiary care medical center p. 103
Salma Iftikhar, Jithinraj Edakkanambeth Varayil, Ryan T Hurt, Matthew S Salerno, Paul S Mueller
DOI:10.4103/IJAM.IJAM_6_20  
Background: Obesity is a leading cause of preventable deaths in the United States, likely second only to tobacco-related diseases. However, studies have shown that the formal diagnosis rate is low, at 19.9%. Furthermore, of the patients with a diagnosis of obesity, only 22.6% receive a treatment plan. Objective: The objective was to determine rates of identification and diagnosis of obesity and referral for counseling in an ambulatory general internal medicine practice. Design: The electronic health records (EHR)of patients seen and examined for a 6-month period were searched for obesity-related terms (ORTs) which included: obese, overweight, weight-related issues, and elevated body mass index (BMI). Patients: All patients with a documented BMI of more than 30 kg/m2 who underwent a medical examination in the Division of General Internal Medicine at Mayo Clinic in Rochester, Minnesota, from October 1, 2012, through March 31, 2013, constituted the study population. Main Measures: Of 7484 patients seen for a medical examination, 2044 (27.3%) had a BMI more than 30 kg/m2. Of these, 946 (46.3%) were female. Key Results: The mean BMI was 34.8 kg/m2 (range, 30.0–64.4), and the mean age was 60.7 years (range, 18.5–94.6). Only 473 patients (23.1%) had the International Classification of Disease, Ninth Revision (ICD-9), code for diagnosis of obesity: Class 1 in 192 (41%), class 2 in 162 (34%), and class 3 in 119 (25%). Of the remaining 1571 patients with a BMI more than 30 kg/m2 but without the diagnosis of obesity, 748 (47.6%) had ORTs in their medical notes. Those with an obesity diagnosis were more likely to be referred for nutrition counseling than those with ORTs (9.3% vs. 4.4%; P < 0.0006). Conclusions: Physicians are meaningfully identifying obesity and discussing its health consequences through the use of ORTs, but they are failing to document ICD diagnoses in the medical records. The following core competencies are addressed in this article: Medical knowledge, Practice-based learning, Systems-based practice.
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Flattening the curve of emotional distress during COVID-19 p. 110
Nicole Defenbaugh, Lorraine A Dickey
DOI:10.4103/IJAM.IJAM_69_20  
Aims: The aim of this article is to examine how the facilitation of narrative sessions aids in “flattening the curve” of distress and anxiety experienced by healthcare professionals during the COVID-19 pandemic. Methods and Material: Sixty-eight participants were surveyed. Quantitative and qualitative data were collected through postsession surveys, copies of stories submitted by participants, and de-identified statements captured by facilitators during the sessions. Two primary themes were used (i.e., difficult/challenging and uplifting/inspiring) to structure the writing prompt and to analyze participant stories. Using a layered account, the authors narrate their experiences as session facilitators and the anonymous experiences of session participants. Results: Results show that 90% of participants reported the ability to listen more closely, 92.5% reported improved resilience, and 92.5% reported the ability to immediately apply what they practiced or witnessed in the narrative sessions. Conclusion: Engaging in narrative writing and sharing stories verbatim in online sessions has the potential to address moral distress, increase active listening, and build resilience for health-care professionals. This article highlights the critical role of engaging health-care professionals in reflective practices to process, reflect, and share their personal and professional experiences related to the impact of COVID-19. The following core competencies are addressed in this article: Interpersonal and communication skills
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Traditional interviewing with Visual Analog Scale predicts emergency medicine resident performance and does not correlate to the standardized video interview: A prospective cohort and cross-sectional study p. 116
Anthony Moon, Anna Yang, Connie Lorenzo, Krista Morley, Scott Melanson, Rebecca Jeanmonod
DOI:10.4103/IJAM.IJAM_29_20  
Study Objective: We evaluate the validity of our internal resident applicant interview scoring system with actual resident performance after at least 2 years of training. We also compare our internal scoring system with the Standardized Video Interview (SVI) scores obtained by the Electronic Residency Application Service. Materials and Methods: The first phase of our study was a before-and-after cohort of six consecutive classes from a single emergency medicine residency program. Faculty members were blinded to each resident's interview score before starting residency and asked to assess their current performance on the same scoring system. The second phase of the study was a prospective cohort of 124 emergency medicine residency candidates interviewing during the 2017–2018 cycle. Results: Fifty-one residents at the postgraduate year 2 level or higher had scoring data available from their interviews and participated in the before-and-after phase of this study. Their mean interview score before starting their residencies was 69.2 on a 100-mm Visual Analog Scale (VAS), with a range of 38.5–94.3. Their performance VAS score after at least 2 years of training had a mean of 69.7 (standard deviation: 15.8), with a range of 13.2–90.1. Using Wilcoxon ranked-sum testing for repeated measures, there were no differences (P = 0.95). Only four residents' VAS scores dropped more than 2 cm. The second phase included a cohort of 124 total applicants from the 2017 to 2018 cycle. Applicant VAS scores ranged from 5 to 91.7 mm, with a mean of 60 mm. Their SVI scores ranged from 13 to 27, with an average of 19.4. The values had a weakly negative relationship, with a correlation coefficient of −0.1. Conclusions: Traditional interviews are a relatively accurate predictor of individual resident performance. There is no correlation between traditional interviews and SVI scores. Although the SVI was initiated to help demonstrate an applicant's interpersonal and communication skills, a face-to-face conversation is irreplaceable. The following core competency statement: Systems-based practice.
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NARRATIVE MEDICINE SYMPOSIUM ON COVID-19: OPENING STATEMENT Top

An introduction to narrative medicine p. 121
Matthew Krinock, Nicole Defenbaugh, Stephen DeTurk, Anna Ng Pellegrino
DOI:10.4103/IJAM.IJAM_68_20  
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NARRATIVE MEDICINE SYMPOSIUM ON COVID-19: PANEL DISCUSSION Top

Graduate medical education: A walk in our shoes during the COVID-19 pandemic p. 124
Alex Hoey, Nakosi J Stewart, Tony Xia, Alex Alers, Ric Baxter, Brian Hoey
DOI:10.4103/IJAM.IJAM_51_20  
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NARRATIVE MEDICINE SYMPOSIUM ON COVID-19: INDIVIDUAL CONTRIBUTIONS Top

COVID-19 in NYC: Emergency medicine resident perspective p. 132
William Haussner, Manish Garg
DOI:10.4103/IJAM.IJAM_41_20  
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It's all in your head p. 134
Christine Marchionni
DOI:10.4103/IJAM.IJAM_33_20  
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Being human p. 136
Diksha Mishra, Manish Garg
DOI:10.4103/IJAM.IJAM_42_20  
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Life is trouble, only death is not p. 139
Thomas John Papadimos
DOI:10.4103/IJAM.IJAM_58_20  
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COVID-19: Coming to terms with the absurd p. 142
Emerson Floyd, Manish Garg
DOI:10.4103/IJAM.IJAM_44_20  
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Acquiescence: Stoicism in medicine during COVID-19 p. 145
Andrew Goodbred
DOI:10.4103/IJAM.IJAM_48_20  
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The hidden curriculum of COVID-19 p. 148
Sara Raza Zaidi, Manish Garg
DOI:10.4103/IJAM.IJAM_54_20  
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The trenches p. 151
Adriana Carola Méndez-Suárez, Nicole Defenbaugh
DOI:10.4103/IJAM.IJAM_53_20  
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Interventional cardiology in the times of coronavirus: A fellow's perspective p. 153
Qasim Z Malik, David Prutzman
DOI:10.4103/IJAM.IJAM_65_20  
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FUTURE TRENDS Top

Could tracheo-bronchial ultraviolet C irradiation be a valuable adjunct in the management of severe COVID-19 pulmonary infections? p. 156
Stanislaw P Stawicki
DOI:10.4103/IJAM.IJAM_19_20  
The coronavirus pandemic is wreaking havoc as it mercilessly devastates communities around the world, disproportionately affecting the most vulnerable populations. Thus far, other than high-acuity mechanical ventilatory support and traditional critical care management strategies, there are no proven or effective ways of lessening the impact of COVID-19 pulmonary infection and the associated acute respiratory distress syndrome. This article outlines a proposal for repeated short-term tracheo-bronchial application of ultraviolet C irradiation as a potential adjunctive treatment option for tracheally intubated patients suffering from severe COVID-19 infections. The following core competencies are addressed in this article: Medical knowledge, Patient care.
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LETTERS TO EDITOR Top

Utilizing the framework of polio elimination for the containment of coronavirus disease 2019 outbreak in Nigeria p. 159
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/IJAM.IJAM_31_20  
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Emergency medicine: A story of comings and goings p. 161
Silvana Teixeira Dal Ponte
DOI:10.4103/IJAM.IJAM_64_20  
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