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   Table of Contents - Current issue
April-June 2021
Volume 7 | Issue 2
Page Nos. 73-134

Online since Tuesday, June 29, 2021

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What's new in academic international medicine? Highlighting the importance of diversity, inclusion, and equity p. 73
Elisabeth Paul, Melissa Wilson, Laurel Erickson-Parsons, Shanaya Desai, Renata Carneiro, Neil D Belman
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Can the Hippocratic Oath survive medicine becoming healthcare? Highly accessed article p. 79
Nidal Moukaddam, Veronica Tucci
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COVID-19 clinical course and outcomes in a predominantly black, vulnerable patient population in New York City p. 81
Priyanka Parmar, Alecia James, Sabrina Rosengarten, Alvin Oommen, Michael A Joseph, Clara Wilson, Rohan Maini, Max Mecklenburg, Julie Kim, Jodi-Ann Edwards, Mohamed Nakeshbandi, Igal Breitman, Bonnie Arquilla, Pia Daniel
Introduction: A study examining the impact of social determinants of health on COVID-19 outcomes is necessary to identify which aspects of a vulnerable population make it more susceptible. We describe the epidemiological and clinical characteristics of a patient population disproportionately impacted by COVID-19 and situate the findings within the broader context of health determinants. Materials and Methods: A descriptive study of 527 laboratory-confirmed COVID-19 patients hospitalized from March 12 to April 13, 2020, evaluated patient demographics, comorbidities, presentation, and outcomes. The study took place at an academic medical center serving a low-income, Black community (predominantly Caribbean-born) in Brooklyn, New York. Results: Compared to previous studies, we report a higher median age of 70 (interquartile range 59–80), a higher percentage of Blacks (91%), a higher prevalence of comorbidities (hypertension [83%], diabetes [53%], and obesity [42%]), a higher prevalence of abnormal findings on presentation (altered mental status [30%], Quick sequential organ failure assessment score ≥2 [27%], elevated random-glucose [77%], elevated creatinine [57%]), and a higher incidence of negative in-hospital outcomes (intensive care unit admission [21%], mechanical ventilation [21%], acute kidney injury [31%], acute respiratory distress syndrome [17%] and acute cardiac injury [18%], and age-adjusted fatality rate [40%.]). Conclusions: This study shows the characteristics of a patient population disproportionately impacted by COVID-19. The intersectionality of the Black race, older age, a high prevalence of comorbidities, and residency in a locale severely affected by COVID-19, deserves further consideration to better address health outcomes in vulnerable patient groups. The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and Procedural skills, Systems-based practice.
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A cross-sectional online survey of relationship between the psychological impact of coronavirus disease 2019 and the resilience among postgraduate health sciences students from Maharashtra, India p. 89
Ajinkya Sureshrao Ghogare, Swapnil Arun Aloney, Mamidipalli Sai Spoorthy, Pradeep Shriram Patil, Ranjit S Ambad, Ashish Wasudeorao Bele
Introduction: Because of the rapid global spread, coronavirus disease 2019 (COVID-19) has caused a state of an emergency situation. Postgraduate (PG) health sciences students (HSSs) are the frontline healthcare workers who are susceptible to psychological issues like depression, anxiety and stress during such stressful pandemic period. The objective of this study was to assess the relationship between the psychological issues such as depression, anxiety and stress and the level of resilience among PG HSSs during the COVID-19 pandemic. Materials and Methods: The present cross-sectional online survey was conducted by the department of Psychiatry of tertiary health care center from Maharashtra state of India over a 10 days period (from April 15, 2020 to April 24, 2020), with a sample size of 195 which was calculated by using the formula of sample size calculation for the cross-sectional study design. Data were collected using the purposive sampling method from the PG HSSs. Data were recorded from the study participants in an online structured questionnaire prepared for the study using the sociodemographic details and the two scales namely Depression, Anxiety, and Stress Scale-21 item (DASS-21) and Brief Resilience Scale (BRS). DASS-21 scale was used to assess the presence and severity of depression, anxiety, and stress, while BRS scale was used to assess the level of resilience among the PG HSSs. Data were collected and analyzed using the SPSS software version 15.0, Fisher's exact test, and Pearson's correlation test. Results: Prevalence of depression, anxiety, and stress were 43.1%, 68.7%, and 11.3%, respectively. There was a high positive correlation between all three subscales of DASS-21 (depression, anxiety, and stress subscales). On BRS, 2 (1.0%) study participants had high resilience, 120 (61.5%) had normal resilience, and 73 (37.5%) Conclusion: Study concluded that significant proportion of PG HSSs had psychological impact of COVID-19 in the form of depression, anxiety and stress. Programs such as timely evaluation of mental health status and stress management to address these psychological issues should be a priority. In long terms, increasing the resilience of PG HSSs can have protective value against the psychological issues during the stressful events of infectious disease outbreaks like COVID-19 pandemic. The following core competencies are addressed in this article: Medical knowledge, Patient care, Professionalism, Practice based learning and improvement.
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Community surveillance of COVID-19 pandemic: Perspectives and experiences of medical trainees using mixed-methods research design p. 99
R Anil, B A Praveen Kumar, S Srikanth, NJ Priyadarisini, P Janakiraman, M Devivaraprasad, P Subramaniyan, Chitra Nagaraj
Introduction: COVID-19 is an ongoing pandemic and a global public health crisis. India has been setting up multiple strategies to contain this pandemic. Active community-level surveillance is a vital strategy to prevent, control, and manage the outbreak of COVID-19. This study explores the perspectives and describes budding doctors' field experience who worked in the community surveillance activity during the pandemic. Materials and Methods: We used a mixed-method research design wherein 67 medical interns of a tertiary care teaching institute participated in the COVID-19 pandemic surveillance activity were included in the study. Their field experience, perspectives, and opinions were captured using pretested questionnaires, participants' interviews, and focused group discussions. Results: More than one-third of medical interns (41.8%) felt that the government could better handle the surveillance process, while around two-thirds (65.6%) were satisfied with their work. Notably, 40 (59%) were not happy/clear with the training and orientation on the job before engaging in surveillance activity. A majority of 47 (70.1%) interns reported inadequate personal protective equipment, which raised the fear of transmission. While they felt that surveillance provided health services close to the community and addressed the public's pandemic concerns, they said the lack of basic training, an inadequate workforce, and resources were detrimental to the response. Conclusions: This pandemic has exposed the naive interns to the community health surveillance process's ground realities. This experience has changed their perception of the profession and given them the impetus to become a future workforce. Strength, weaknesses, opportunities, and threats analysis of the surveillance process provided vital inputs to act and prepare for future public health emergencies. The following core competencies are addressed in this article: Practice-based learning and improvement, Systems-based practice, Interpersonal and communication skills, and Professionalism.
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Knowledge, attitude, and practices regarding COVID-19 outbreak among the personnel providing emergency services in India p. 107
Vidya Bhushan, Shilpa Rai
Introduction: The threat of contracting coronavirus persists among individuals constantly coming in direct or indirect contact with positive cases. Therefore, this study was conducted to assess the knowledge, attitude, and practices (KAPs) regarding the COVID19 outbreak among the personnel providing emergency services in India and also assess their perception toward government measures during this pandemic. Materials and Methods: An online survey was conducted among individuals providing services during the period of COVID-19 outbreak. A total of 234 people consented to continue with the survey. Data collection was carried out from April 2020 to June 2020. Data analysis was carried out using Chi-square statistics and Fisher-Freeman-Halton test. The level of statistical significance was set at 0.05 with a confidence interval of 95%. Results: Majority of the participants were male and belonged to the age group of 18–54 years. Almost all were aware that COVID-19 is a virus and had knowledge regarding its mode of spread and modes of prevention. Precautions such as covering face with mask, avoiding shaking hands, and washing hands before touching the eyes, nose, and mouth were undertaken by 34.6% of the total participants. Around 70.5% of the males, 53.7% of the females, and 33.3% of the participants from the others' category felt that the funds released by the government to combat corona were efficiently reaching the poor or the needy. Some of the barriers preventing the fair distribution of funds/services to the poor and needy as reported by the participants were corruption, lack of knowledge, delay in delivery and lack of personal protective kits, limited workforce, and no bank account of poor people. Conclusion: KAP of personnel providing emergency services is crucial to the containment of this disease. Understanding of the barriers shall aid policymakers to assess the impact of their preventive programs and also take crucial decisions toward its management. The following core competencies are addressed in this article: Medical knowledge, practice-based learning and improvement, and systems-based practice.
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A cross-sectional study to evaluate the knowledge and attitude of medical students concerning antibiotic usage and antimicrobial resistance p. 113
Mohan B Sannathimmappa, Vinod Nambiar, Rajeev Aravindakshan
Introduction: Antimicrobial resistance (AMR) is a major global health problem, which is mainly promoted by injudicious antibiotic usage. The main strategy to control AMR is to emphasize the appropriate use of antibiotics, which can be achieved by creating awareness about AMR, changing the attitude of medical students who are the future prescribers. This study aimed to evaluate the knowledge and attitude of fifth-year medical students regarding antibiotic use and AMR. Materials and Methods: A descriptive cross-sectional study was conducted among 125 fifth-year medical students of the College of Medicine and Health Sciences, Sohar. A self-administered questionnaire was used to assess the knowledge and attitude regarding antibiotic use and AMR. The data were statistically analyzed and expressed as numbers and percentages. Results: Of 125 participants, the majority (>90%) were aware of AMR and its global impact. Nearly three in four knew that antibiotics are used to treat bacterial infection. However, most of the students had lacunae in their knowledge regarding contributing factors and consequences of AMR. A minority of students lack the right attitude toward rational antibiotic usage and adequate infection control practices. The majority of them were unaware of strict guidelines pertaining to judicious antibiotic usage and adequate infection control policies implemented in hospitals, as recommended by the World Health Organization. Conclusion: The results of our study reflect lacunae in students' knowledge regarding antibiotic usage and AMR. Therefore, there is a need for an implementation of effective medical curricula to improve medical students' knowledge regarding AMR and the appropriate use of antibiotics. The following core competencies are addressed in this article: Patient care, Medical knowledge, Professionalism, Systems-based practice, Practice-based learning and improvement, Interpersonal and communication skills.
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How do physicians and nurses assess and support patient medication adherence? An examination of a rural secondary care hospital in Delhi, India p. 120
Saurav Basu, Ruchira Pangtey, Bratati Banerjee, Saurabh Kumar
Introduction: Suboptimal medication adherence contributes enormously to patient mortality, morbidity, and related health-care costs. Health-care providers (HCPs) have a pivotal role in supporting medication adherence in their patients through appropriate health communication. We assessed the perspectives and practices of medical doctors and nurses toward the assessment and support for patient medication adherence in Indian health settings. Materials and Methods: We conducted a cross-sectional study at a secondary-care hospital in Delhi. Data were collected from medical doctors, interns, and nursing staff using a self-administered questionnaire on the following domains: Medication Adherence, frequency, methods and tools of assessment, high-risk patient identification and interventions applied to promote adherence. Results: We recruited a total of 117 HCPs. The common modes of assessment of medication adherence used by the HCPs included a general question (78.6%), observing missed appointments (43.6%), and querying for forgetfulness (29.9%). However, none of the HCPs were aware of validated questionnaire (scales) for the assessment of medication adherence. Drug-related adverse effects as a cause of nonadherence were evaluated by 38.3% HCPs only. Conclusions: The development of simple and validated methods for assessing medication adherence applicable in resource-constrained settings along with the curricular training of HCPs on patient adherence and related know-how needs urgent prioritization. The following core competencies are addressed in this article: Practice-based learning and improvement, Systems-based practice, and Interpersonal and communication skills.
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Adolescent trauma: Patterns and outcomes p. 126
Joanna Preritha Fernandes, Darpanarayan Hazra, Chinta Annie Jyothirmayi, Kundavaram Paul Prabhakar Abhilash
Introduction: Adolescence is the transitional stage of physical and psychological changes that occur from puberty to adulthood, and disruption in growth at this stage can have long-lasting effects. Our main aim was to profile these injuries treated in the emergency department (ED) and describe the etiology, patterns, and outcomes in such patients. Materials and Methods: We conducted a retrospective descriptive analysis of these victims who presented to us from January 2017 to December 2018. Among key factors studied were patient demographics, mechanism of trauma, injury severity, hospital admission status. In addition to descriptive statistics, we utilized univariate and multivariate analyses to help elucidate factors associated with severe injuries. Results: The data for a total of 693 patients were analyzed. Among these, 84.5% were male. The mean age was 17.2 ± 1.33 years. Based on their hemodynamic stability, the majority were triaged as priority 2 (49.6%). The most common causes of trauma were road traffic accidents (RTAs) (63.3%), followed by sports related injury (13.7%). Two-wheeler-related incidents accounted for 82.5% of RTA-related injuries. Extremities, face, and head were injured in 51.3%, 25.8%, and 13.5%, respectively. New injury severity score of more than 14 was noted in 82 (13.2%) cases. Approximately half of the study population, 374 (54%), were discharged stable from the ED, whereas 254 (37%) were admitted with 194 (28%) requiring major surgical intervention. Conclusions: Most of the traumas related to adolescents are RTAs, followed by sports-related injuries. Male gender and pedestrian-related injuries are independent predictors for high severity of injuries. The following core competencies are addressed in this article: Patient care, Systems-based practice, Medical knowledge, Practice-based learning and improvement.
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Clinical decision support and tele-mentorship as interventions for dissatisfaction and disengagement in intensive care unit training: The case of Libya p. 132
Mohamed Ben-Omran
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Annual disclosure of content contributions to the International Journal of Academic Medicine by Editorial Board members p. 134

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