Acute critical care course for interns to develop competence

BACKGROUND All medical graduates must know how to stabilize and manage critically ill patients. A 2-day intensive course, called the acute critical care course (ACCC), was conducted to train interns in technical and non-technical skills for managing a patient whose condition is deteriorating. This analysis aims to assess the feasibility and effectiveness of ACCC for interns. METHODS We developed and conducted the ACCC to train interns. It included lectures and skill stations. Twenty-four interns participated in the course. Immediate, post-course, quantitative and qualitative feedback was taken online. Qualitative information was also collected verbally and later by email. These data were analysed both quantitatively and qualitatively. Thematic analysis was used to identify, analyse and report the patterns of responses and behaviour. RESULTS The average score for the utility of the course was 4.7 and for the skill stations it was 4.6 on a scale of 5. The qualitative analysis of the feedback emphasized the need for the course before the clinical posting and more skill-based modules rather than lectures. The interactive style of teaching and training in communication using role-play was appreciated. Few suggestions to improve the course were provided. CONCLUSIONS Implementing the ACCC needed simulation, interactive discussions, role-play, modified Pendleton’s feedback, and reflective exercise that form the basis of a range of educational principles. The blended learning set of objectives of ACCC were the pillars for this successful internship training programme.

Communication skills training through ‘role play’ in an acute critical care course

Background. Effective patient–doctor communication is a key component of patient-centred care, which is one of the six pillars of quality healthcare delivery. Structured and effective communication skills training for healthcare providers is the need of hour in medical education. We assessed the efficacy of role play and simulation in developing communication skills. Methods. As a key component of an acute critical care course (ACCC), communication skills are taught using role play models and simulation. Live feedback is critical in learning during this course as per the principles of adult learning (andragogy). Quantitative and qualitative data were collected to assess the efficacy of ACCC. Results. The 19th ACCC was introduced to interns at the All India Institute of Medical Sciences, New Delhi in December 2018. The teaching methodology and objective-oriented structured training in ACCC were much appreciated for training in human factors with emphasis on communication. A positive response was obtained from the candidates 3 weeks after they completed the course to assess whether interns are able to make use of this training in their day-to-day clinical practice amounting to a reliable evidence level of Kirkpatrick's ‘return of investment’. Conclusion. The use of ‘role play’ to teach communication skills is effective and superior to lecture-based teaching. Further structured and interactive programmes in communication skills training will improve patient care, relatives’ satisfaction and the image of medical profession.

Ultrasonographic Examination of Peripheral Nerves in Diabetic Peripheral Neuropathy.

Diabetes has been a major problem in India. Its slow growth is associated with many complications, most common being peripheral neuropathy. An easy and cheap investigation to diagnose the neuropathy may help in early diagnosis and decrease the economic burden on the society. The purpose of the study was to assess the usefulness of ultrasonography (USG) in the evaluation of diabetic peripheral neuropathy (DPN).METHODSFifty adult diabetic patients with clinically diagnosed DPN and 50 diabetics without DPN were included in the study. USG of the medial, ulnar, and common peroneal nerves was done. The mean cross-sectional area (CSA) of the involved nerves was measured in the two groups at identical positions. The CSA was compared between the two groups, and Student t-test was applied to assess statistical significance.RESULTSThe mean thickness of median nerve among diabetics without DPN was significantly less at 5 cms proximal to wrist (7.34 ± 1.24 vs 11.12 ± 1.56, p<0.0001); was significantly less at mid-forearm (6.84 ± 0.77 vs 10.36 ± 1.72, p<0.0001); and was significantly less at elbow (7.36 ± 0.75 vs 10.2 ± 1.64, p<0.0001). The mean thickness of ulnar nerve among diabetics without DPN was significantly less at wrist joint (6.98 ± 0.89 vs 8.44 ± 1.34, p<0.0001); and was significantly less behind medial epicondyle (7.44 ± 0.93 vs 9.36 ± 0.98, p<0.0001). The mean thickness of common peroneal nerve among diabetics without DPN was significantly less at neck of fibula (7.26 ± 1.34 vs 9.3 ± 1.67, P<0.0001); and the mean thickness of posterior tibial nerve was also significantly less at 5 cms above medial malleolus (7.06 ± 1.25 vs 9.16 ± 1.61, P<0.0001). There was a significant increase in the CSA of the median, ulnar, posterior tibial and common peroneal, in DPN patients as compared to diabetics without DPN (p<0.05).CONCLUSIONSUSG demonstrates a morphological change in patients with DPN in the form of an increase in CSAs, which was statistically significant. USG can objectively complement other diagnostic investigations such as nerve conduction studies. High resolution ultrasonography of peripheral nerves has the potential to become the investigation of first choice for the evaluation of DPN.

Megalencephalic Leukoencephalopathy with Subcortical Cysts.

Megalencephalic Leukoencephalopathy is a rare entity which was first described by Van Der Knaap et al in 1995.[1] It is a progressive neurodegenerative disorder characterized by slow progression of mental deterioration. Megalencephaly sets in early in the disease usually in first year and can be more than 4 standard deviation above the mean. Seizures are present in almost all the patients. [2] We present typical MRI findings in a case of megalencephalic leukodystrophy with sub-cortical cysts.Megalencephalic leukoencephalopathy with sub-cortical cysts is a rare entity that presents with macrocephaly and seizures. Mental deterioration is often mild with slow progression. Macrocephaly may be present at birth or develops in first year. Typical magnetic resonance imaging (MRI) findings help to clinch the diagnosis.

An Observational Study Of Dosha And Dushya In The Manifestation Of Vatakantaka

The health of the human body depends on the equilibrium state of Dosha, Dhatu and Mala. Knowledge of disturbance in equilibrium of the Dosha and Dushya helps us to know the diagnosis, prognosis and treatment of the disease. The term “Vatakantaka” denotes a disease of Vata in which the pain is experienced at heel by the patient. Even though Vatakantaka has been mentioned under Vatavyadhi, the Samprapti Ghatakas and detailed pathogenesis is not available in any classical text. Such details are essential for proper planning of treatment. This study is intended to assess the Dosha and Dushya that are involved in the manifestation of Vatakantaka. 30 individuals were diagnosed as Vatakantaka were taken for the study. The Dosha and Dushya assessment were done with the help of questioner. The statistical analysis shows involvement of Vata Dosha and Asthi Dhatu in the pathogenesis of Vatakantaka.

Analysis Of Effect Of Amla Rasa (sour Food) In Different Concentrations On Mamsa Dhatu (muscle Tissue)

It is said that one should consume Shad-Rasayuktha Ahara for better nourishment. The nutritive value of the 6 Rasas (taste) has been explained in the classics of Ayurveda along with their harmful effects when used in excess. When Amla Rasa is taken in excess it produces Dantaharsha (Morbid sensation of teeth), Trishna (thirst) etc. Objectives - The present study is designed by administering Amla Rasa Pradhana Drvya given in different concentration 10% and 15% and effect on the Mamsa Dhatu is assessed by certain blood parameters. Material and Methods -Wistar strain albino rats of either sex, weighing of 200-300 g. Obtained from S.D.M Centre for Research in Ayurveda, Udupi, Karnataka. 5Groups were taken and Group 1 is Control, Group-2 is 15% Chincha, Group-3 is 15% Vrukshamla, Group-4 is 10% Chincha, Group-5 is 10% Vrukshamla which receives drug and laboratory food for 28days, next day blood was collected by supra-orbital puncture with the help of micro capillary tubes under mild ether anesthesia. Results - There was increase in the Total Protein, Serum Albumin and serum creatinine levels and decrease in Serum globulin, Serum Urea level and Body weight. Conclusion – the study suggests that there is catabolic action of the Amla Rasa on the Mamsa Dhatu and anabolic act action on serum protein especially at the level of liver, so there will be a loss of muscle tissue which suggests Mamsa Vidhahyati action.