ABSTRACT
Breast imaging is a prerequisite for providing high quality breast health care. Choosing the appropriate investigation is central to diagnosing breast disease in patients who present to health professionals for treatment. These patients present to doctors of different subspecialties as well as to general practitioners in our country. It is important, therefore, to provide uniform guidance to doctors in different healthcare setups of our country, urban and rural, government and private, for optimal management of breast diseases. These guidelines framed by the task group set up by the Breast Imaging Society, India, have been formulated focusing primarily on the Indian patients and health care infrastructures. They aim to provide a framework for the referring doctors and practicing radiologists to enable them to choose the appropriate investigation for patients with breast symptoms and signs. The aim has been to keep this framework simple and practical so that it can guide not only subspecialists in breast care but also help doctors who do not routinely deal with breast diseases, so that breast cancer is not missed. Overall, the aim of this document is to provide a holistic approach to standardize breast care imaging services in India. Part 2 of these guidelines focuses on the best practice principles for breast interventions and provides algorithms for the investigation of specific common breast symptoms and signs. Ultrasound is the preferred imaging modality for image-guided breast interventions due to real-time needle visualization, easy availability, patient comfort and absence of radiation. Stereotactic mammography guided procedures are performed if the lesion is visualized on mammography but not visualized on ultrasound. 14-gauge automated core biopsy device is preferred for breast biopsies although vacuum assisted biopsy devices are useful for biopsy of certain abnormalities as well as for imaging guided excision of some pathologies. MRI guided biopsy is reserved for suspicious lesions seen only on MRI. Algorithms for investigation of patients presenting with mastalgia, breast lumps, suspicious nipple discharge, infections and inflammation of the breast have been provided. For early breast cancers routine use of investigations to detect occult distant metastasis is not advised. Metastatic work up for advanced breast cancer is required for selection of appropriate treatment options.
ABSTRACT
Breast imaging is one of the prerequisites for providing high quality breast health care. Choosing the appropriate investigation is central to diagnosing breast disease in women and men who present to health professionals for treatment. Patients with breast disease present to doctors of different subspecialties as well as general practitioners in our country. It is important therefore to provide uniform guidance to doctors in different health care setups of our country, urban and rural, government and private, for breast diseases to be diagnosed and treated optimally. These guidelines framed by the task group set up by the Breast Imaging Society, India have been formulated focusing primarily on the Indian patients and health care infrastructures. These guidelines aim to provide a framework for the referring doctors and practicing radiologists, to enable them to choose the appropriate investigation for patients with breast symptoms and signs. The aim has been to keep this framework simple and practical so that it can guide not only subspecialists in breast care but also help doctors who do not routinely deal with breast diseases, so that breast cancer is not missed. Overall, the aim of this document is to provide a holistic approach to standardize breast care imaging services in India. Part 1 of these guidelines focuses on the best practice principles for mammography, breast ultrasound and breast magnetic resonance imaging. In the absence of a population-based screening program in India, the guidelines to be followed for those women who wish to be screened by mammography have been provided. The key points of these guidelines include the recommendations that mammography is the modality of choice for breast screening and investigation of symptomatic women aged over forty years. Screening is advised annually from the age of forty. Ultrasound is the investigation of choice for pregnant and lactating women and women less than thirty years of age. For women between thirty to thirty-nine years of age, ultrasound can be used initially followed by mammography in presence of clinical or sonographic suspicion of breast cancer. All women diagnosed with breast cancer should have ultrasound and mammography. Breast MRI is useful for assessment of disease extent, problem solving, evaluation of response to neo-adjuvant chemotherapy, identifying occult breast primary and evaluation of augmented breasts.
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BACKGROUND: Epithelial ovarian cancer is the second most common gynecological cancer. Human Epididymis Protein 4 is a novel biomarker for ovarian cancer. This study aims to explore the role of HE4 in monitoring recurrence and prognostication of ovarian cancer by predicting overall survival (OS) and progression-free survival (PFS). MATERIALS AND METHODS: In total, 149 patients with ovarian carcinoma were enrolled in the study. Baseline and post-treatment 3 monthly biomarker levels were recorded. For analysis, patients were divided into primary debulking surgery (PDS) and interval debulking surgery (IDS) groups. Statistical analysis was done using SPSS 24. RESULTS: Median age of patients at diagnosis was 45 (19–75) years. Recurrence was seen in 68.5% (n = 102) patients. The sensitivity of serum HE4 in detecting recurrence was 85.3% (95%CI: 76.95%–91.5%) and specificity was 91.5% (95%CI: 89.5%–98.2%). A >80% decline in HE4 levels during treatment indicated a better PFS, which was statistically significant in both groups (P = 0.04 in PDS and P = <0.001 in IDS group). Multivariate analysis suggested that OS was influenced by optimal cytoreduction in both groups of patients and stage in the IDS group. On the contrary, PFS was influenced by stage and response in HE4 levels in both groups. CONCLUSION: HE4 levels have similar sensitivity but more specificity when compared with CA125 in diagnosing recurrent ovarian cancer. A >80% decline in HE4 levels during treatment predicts better PFS and can help in prognostication
ABSTRACT
Background: Only recently health professionals have started recognizing sleep disorders as one of the commonest cause of morbidity. Only in the last 50 years have scientists and physicians attempted a systematic study of the physiology and disorders of sleep. The situation is changing in India too. About a decade ago the sleep medicine started developing but remained in the domain of Pulmonary Medicine. Through various societies, meetings, workshops it has now percolated to physiologists, neurologists, psychiatrists and allied specialists. However, there is still a gap in the awareness about sleep and its disorders among health professionals. Limited information is available regarding sleep education in current medical curriculum in India and globally. Aims: (i) To find out the existence of a course or module on sleep medicine in any of Government medical colleges in India. (ii) To explore feasibility of using Learning Resource Material (LRM) on CDs for Continuing Medical Education. Methods: As an outcome of Sleep Symposium held at National Academy of Medical Sciences (India) conference at AIIMS, Jodhpur, a survey was carried out among 100 Government Medical Colleges in India along with Resource Material consisting of didactic teaching material distributed through Compact Disc (CD) to explore utility of the method. Results: Response rate from medical colleges was 41 %. Ninety five percent of medical colleges denied of having any structured course or module on sleep medicine. Fifty percent felt that such module should be included for both UG and PG while 70 % agreed for PG only. Regarding cost effective delivery methods for the content of such a module, majority responded in favour for an online or DVD based with one of the content experts as a resource person with his physical presence. All respondent were highly satisfied by the content of CD. Conclusion: Sleep education is almost non-existent in most of medical schools in India. Survey elicited average response from academic community. However, sleep education has been perceived by 70 % participants to be included in PG curriculum. The content of PowerPoint presentations was considered highly satisfying and using multi-modal technology for sleep education is regarded to be an effective delivery method by majority. It can be concluded that there is felt but unmet need of a course on sleep medicine in our existing medical curriculum using information technology.
ABSTRACT
Continuing Medical Education is an integral ingredient of professional development of health care providers. The educational activity can be delivered by different modes. Here we share our experience of using Digital Video Disc (DVD) of a CME on Sleep Medicine as an alternative and cost effective mode. Objective: To assess improvement in knowledge and competencies in terms of comparative effectiveness of a model CME program using validated non-print medium for medical education. Methods: Recorded and validated DVD of talks delivered at NAMS-AIIMS Regional Symposium on Sleep Medicine was played to the participants in presence of one of the content experts. Video scripts of talk were also distributed to the participants. The assessment of participants and program evaluation of this CME was compared to the previously held live CME. Results: Eighty nine participants completed both pre and post test. Mean score increased from 9.91± 3.5 to 14.09 ± 2.85. Pass percentage based on an arbitrary cut off of 50%, increased from 8.3 to 43.8 (p< 0.001). Among the live CME group, mean score improved from 12.1±4.6 to 18.3 ± 3.8. Comparative analysis between live and DVD based CME showed improvement in scores of 6.17 and 4.18 respectively while pass percentage of 84.7 and 43.8 post CME among two modes were significant. The program evaluation showed identical level of satisfaction in all parameters except they were less satisfied vis-a-vis 'organizers made use of any critical comments I made' since all locally available resource persons were not present. Activity could be completed at just half the cost of live CME. Conclusions: The educational background and selection process of UG students between two medical institutes were strikingly different. While students at one institute were selected by highly competitive exam at All India level, the students at other institute were selected through state level competitive examination. In spite of that, results showed comparative impact on knowledge and competencies among the participants and hence proves this to be a cost-effective mode of delivery of educational assignment.
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Background: Personal development is an ongoing but complex process and it is crucial for the medical educator to recognize the trait and design the training for optimal development of students. Though importance of human personality is widely recognized for functional efficiency of an individual and organization, but its recognition is grossly missing from medical curriculum. Aim: To organize and evaluate the 'Personality Development Program' for medical and nursing students. Methods: First year medical and nursing students were recruited through total enumeration method. 'Personality development program' was conducted by a trained psychologist and it was evaluated through 'partially open ended anonymous structured feedback'. Results: Majority of the students found this program relevant, comprehensive and purposeful. Again majority had perceived some improvement in their confidence and level of communication, interpersonal relationships, planned time schedule, emotional confidence, and better stress management. They have also narrated shortcomings of the program along with some constructive suggestions. Conclusion: This preliminary attempt for personality development was highly appreciated by the students as well as their supervisors as a means to professional development. It further emphasizes the vital need of ongoing programs both for enhancing personality and professionalism.
ABSTRACT
Planning organisation and delivery of educational program(s), culminating in purposeful learning require strong basis of principles of adult learning along with a sound knowledge and requisite skills in both psychology as well as technology of medical education. Assessing effectiveness of a CME program is as important as the organization of learning activities and delivery of academic program as these may provide further directions for enhancing the efficacy of the CME delivery system. Objective: (i) The purpose of this study was to investigate the effectiveness of well planned and conducted CME program in terms of enhancing knowledge and competence of the participants. (ii) To explore if the gain in knowledge and competence, if any, can be attributed to the interactive design of the educational process. Methods: The study was conducted during NAMS-AIIMS Regional Symposium on Sleep Medicine at AIIMS, Jodhpur as part of NAMSCON 2013. After explaining the objectives of the study to the participants and assurance of confidentiality, a validated and pre-tested questionnaire consisting of 30 multiple choice, single response questions, was administered to 103 participants. Following intervention consisting of didactic lectures by experts in different aspects of sleep medicine, interactive sessions and problem triggered sessions consisting of clinical data, participants were readministered post test questions which were, however, different from pre-test but had similar difficulty level. Result: The response rate of participants was 89%. Pre-intervention scores were 11.76 ± 4.4, with only 26 % of participants achieving an arbitrary pass score of 50 %. Comparison of paired score of participants who attempted both pre and post tests (n=59) showed improvement from 12.1 ±4.6 to 18.3 ± 3.8 which was significant (p <0.05). 84.7 % of participants secured above pre decided 50% score. The mean increase in the score was 6.2 with 95% CIs 4.8; 7.5 (P <0.001). Higher gain in knowledge and competencies is attributed to intense interactive involvement of participants during the problem triggered sessions, feedback provided during interaction and system of reward and incentive introduced at time of sessions. The study concludes that well designed educational intervention based on the principles of adult learning brings positive gain in the knowledge and enhances competence of the participants.
ABSTRACT
Continuing Medical Education is an indispensable part of physician's learning. Well designed program based on andragogy principles can enhance learning by motivating the learner and providing platform to encourage self directed learning. The present study aimed to explore the impact of program “NAMS-AIIMS Regional Symposium on Sleep Medicine” in changing the behavior and attitude of participants using “Satisfaction Index” and descriptive analysis of responses as evaluation tools for program effectiveness. This descriptive cross sectional study captured the response of participants through a pre-tested and validated questionnaire administered at the end of symposium. The result showed almost equal sex distribution (M: F- 27: 34) with majority being UG students (86%). Reliability of data showed Cronbach's Alpha of 0.98 indicating high reliability. Satisfaction index (SI) calculated as per WHO Educational Handbook for Health Personnel showed highest satisfaction for conducive environment of symposium (87.87 %) followed by provision for time to seek clarifications (87.21%), provision of appropriate Learning Resource material (85.90 %) and handling of critical comments by organizers (85.57%). Descriptive analysis showed majority responses as highly positive to our questionnaire with suggestions for more such activity, inclusion of clinical cases and other aspects of practical relevance.