Pre-COVID and COVID experience of objective structured clinical examination (OSCE) as a learning tool for post-graduate residents in Obstetrics & Gynecology - a quality improvement study.

Objective: Due to its comprehensive, reliable, and valid format, the objective structured clinical examination (OSCE) is the gold standard for assessing the clinical competency of medical students. In the present study, we evaluated the importance of the OSCE as a learning tool for postgraduate (PG) residents assessing their junior undergraduate students. We further aimed to analyze quality improvement during the pre-coronavirus disease (COVID) and COVID periods. Methods: This quality-improvement interventional study was conducted at the Department of Obstetrics and Gynecology. The PG residents were trained to conduct the OSCE. A formal feedback form was distributed to 22 participants, and their responses were analyzed using a five-point Likert scale. Fishbone analysis was performed, and the 'plan-do-study-act' (PDSA) cycle was implemented to improve the OSCE. Results: Most of the residents (95%) believed that this examination system was extremely fair and covered a wide range of clinical skills and knowledge. Further, 4.5% believed it was more labor- and resource intensive and time-consuming. Eighteen (81.8%) residents stated that they had learned all three domains: communication skills, time management skills, and a stepwise approach to clinical scenarios. The PDSA cycle was run eight times, resulting in a dramatic improvement (from 30% to 70%) in the knowledge and clinical skills of PGs and the standard of OSCE. Conclusion: The OSCE can be used as a learning tool for young assessors who are receptive to novel tools. The involvement of PGs in the OSCE improved their communication skills and helped overcome human resource limitations while manning various OSCE stations.

Awareness and understanding of COVID-19 among pregnant woman in Northern India.

BACKGROUND: The severe acute respiratory syndrome coronavirus (SARS-CoV-2) has become a public health concern worldwide. It is important for pregnant women to know about the mode of transmission, symptoms, and preventive measures against COVID-19. The aim of this study was to evaluate the awareness and outlook of pregnant women and practical measures taken by them against COVID-19. MATERIALS AND METHODS: This cross-sectional questionnaire-based study was conducted for 1 month (June 10, 2020- July 10, 2020) in the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India. A prevalidated questionnaire was given to 109 pregnant women to assess the knowledge, attitude, and practice acquired against COVID-19 infection. The Chi-square test or Fischer's exact test was used to compare categorical data. RESULTS: Among 109 participants, 103 (94.5%) had good knowledge, 4 (3.7%) had average knowledge and 2 (1.8%) had poor knowledge about COVID-19. Majority of them had a positive attitude for the protective measures taken for the prevention of disease. CONCLUSIONS: Since there is no valid treatment for COVID-19, prevention is the only key to curve this infection. In the present study, 94.5% pregnant women had overall good knowledge score about the mode of transmission, symptoms, and preventive measures against COVID-19.

Impact of COVID-19 pandemic on obstetrics and gynecology residency training program in India: A national online survey.

OBJECTIVE: The goal of this study was to analyze how the COVID-19 pandemic affected the Obstetrics and Gynecology (OBG) residency program in India. STUDY DESIGN: This was a cross-sectional questionnaire-based online survey aimed to assess the impact of the pandemic on the residency training program in Obstetrics and Gynecology. The questionnaire consisted of five sections: demographic details, information regarding COVID-19 status, clinical work load, teaching and research, and psychological impact. RESULTS: The questionnaire was completed by 280 OBG trainees from different medical colleges from India. Training activity in general was reduced considerably during the pandemic, according to 79.6% (n = 223) respondents. According to 13.21% (n = 37) and 5% (n = 14) respondents, reduction in training activity were due to cancelation of elective operations and reduced patient foot fall respectively. In 74.3% (n = 208) of cases, trainees reported worry about meeting the goals of their specialty training. Logistic regression showed that the extent of training reduction was not significantly associated with residents' age (p = 0.806), gender (p = 0.982), marital status (p = 0.363), and status of their duty in COVID-19 dedicated hospitals (p = 0.110). However, year of residency was a significant predictor of the perception about degree of training reduction. CONCLUSION: The pandemic imposed a significant impact on OBG residency training in India. During the pandemic, exposure to learning opportunities, surgeries, and teaching were reduced, which may result in a decline in the quality of care offered to women in the future if training deficit is not overcome. At the same time, pandemic also gave birth to newer insights of learning and interaction by online mode.

The Relationship Between Vitamin D Levels and Severity in Illness in COVID-19 Patients: A Cross-Sectional Study.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic hit the world badly with high mortality. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection increased the COVID-19 burden among developed and developing countries due to the unavailability of proven treatment options. Vitamin D has many important anti-inflammatory, immunomodulator, and anti-viral functions. The present study was conducted to evaluate the relationship between Vitamin D in COVID-19. METHODS: A cross-sectional study was conducted at a tertiary care hospital in Patna, India. All the patients were enrolled during the period of 3.5 months. A chemiluminescence-based immunoassay analyzer was used to quantify Vitamin D among COVID-19 patients. The study compared Vitamin D deficiency and insufficiency among different groups, i.e., age, sex, BMI, comorbidity, etc. Diabetes and hypertension were evaluated as risk factors for mortality. RESULTS: A total of 225 patients were investigated. Of these, 13.6% had Vitamin D deficiency and 38.9% had insufficiency. Vitamin D level was statistically significant among different age groups, sex, and smokers. Patients aged >60 years were 23 times more likely to have a severe illness (adjusted OR (aOR) 23.53, 95%CI 4.67-118.61), whereas those aged 40 to 60 years were 11 times more likely to have a severe illness (aOR 10.86, 95%CI 2.39-49.31). Patients with many comorbidities, on the other hand, had a tenfold greater chance of severe COVID-19 (aOR 9.94, 95%CI 2.47-39.88). A deficiency of vitamin D increased the chance of a serious illness by nearly five times (aOR 4.72, 95%CI 1.31-17.03). CONCLUSION: Vitamin D level was associated with severity of illness; it can be used to estimate the prognosis of COIVD-19 patients and aid in the modification of treatment protocols.

Vitamin D deficiency and COVID-19: A case-control study at a tertiary care hospital in India.

BACKGROUND: As the pandemic COVID-19 affected developing and developed countries, there is no proven treatment options available yet. The anti-inflammatory, antiviral and immune modulator effect of Vitamin D could be beneficial to COVID-19. AIM: To find out the possible association between Vitamin D and COVID-19. METHODS: The present case-control study was conducted at tertiary care hospital, AIIMS, Patna, Bihar, India. Total 156 cases and 204 controls were enrolled in the study after obtaining informed consent. Categorization of the patients were done based on clinical severity and level of Vitamin D. The association between these categories with different variables were analyzed using regression analysis and other statistical tests. RESULTS: The status of Vitamin D (optimal, mild to moderate deficiency and severe deficiency) differed significantly among cases and controls. Diabetes and hypertension were most prevalent comorbidities among cases. On regression analysis, the difference in Vitamin D level was significant (aOR, 3.295; 95%CI, 1.25-8.685). The association between Vitamin D status and clinical severity group was statistically significant among cases. Among all variables, age, diabetes, hypertension and clinical severity were associated with worst outcome. CONCLUSION: Vitamin D status appears to be strongly associated with COVID-19 clinical severity. After COVID-19 confirmation, Vitamin D level should be measured in all patients and curative plus preventive therapy should be initiated.

The effect of the COVID-19 pandemic on maternal health due to delay in seeking health care: Experience from a tertiary center.

OBJECTIVE: To assess the effects of the COVID-19 pandemic on obstetric care and outcomes. METHODS: A prospective observational single-center study was performed, including all antenatal and parturient women admitted from April to August, 2020. Data were collected regarding number of admissions, deliveries, antenatal visits, reason for inaccessibility of health care, and complications during pregnancy, and compared with data from the pre-COVID period of October 2019 to February 2020. RESULTS: There was a reduction of 45.1% in institutional deliveries (P < 0.001), a percentage point increase of 7.2 in high-risk pregnancy, and 2.5-fold rise in admission to the intensive care unit of pregnant women during the pandemic. One-third of women had inadequate antenatal visits. The main reason for delayed health-seeking was lockdown and fear of contracting infection, resulting in 44.7% of pregnancies with complications. Thirty-two symptomatic women who tested positive for COVID-19 were managed at the center with good maternal and fetal outcomes. CONCLUSION: Although COVID-19 does not directly affect pregnancy outcomes, it has indirect adverse effects on maternal and child health. Emergency obstetric and antenatal care are essential services to be continued with awareness of people while maintaining social distancing and personal hygiene.

'How COVID 19 imposed a new normal outlook in reproductive health care of patients, research, teaching and assessment'- Perspective of a Gynecologist.

With the frequently changing guidelines on Pregnancy care, management of obstetric patients remains a major challenge during COVID-19 Pandemic. The department of Obstetrics and Gynecology had a huge responsibility to provide respectable maternity care to all women irrespective of their virologic status and at the same time protect the frontline warriors dealing with patient care during the COVID-19 pandemic. We would like to share our perspective regarding the challenges faced and the solutions sought for, in both patient care and teaching and research.

Role of birth companion in COVID-19: indispensable for her and an auxiliary hand for us.

The pandemic of COVID-19 has proved to be a global catastrophe. Pregnant females could be more vulnerable to the infection owing to the immune modulation. According to the World Health Organization (WHO), pregnant females including those with COVID-19 suspicion or confirmed status have right to 'safe and positive childbirth experience' which includes a companion. The birth companion, is present at all times with the patient, from the initiation of labor till breastfeeding. The COVID-19 crisis has taken its toll on the healthcare system. The number of infected antenatal females are expected to increase. If a birth companion is trained in basic intrapartum and postpartum observation and care, he/she can be utilised to minimize unnecessary patient-clinician interface and optimize manpower in this critical time.

Review of care and management of pregnant women during COVID-19 pandemic.

Coronavirus disease-19 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Covid-19 pandemic began in the end of 2019 and spread all over the world in a short duration of time. Measures have been taken such as social distancing, compulsory lockdown and restriction of activities so as to prevent spread of virus. It has posed problem to both the antenatal women and maternity care workers. The care and management of pregnant women is an essential service to identify high-risk mothers and also to have good pregnancy outcome for both mother and baby. Any delay in this may lead to catastrophe, hence this issue needs to be addressed properly. This review briefs about the literature available on antenatal care during covid-19 pandemic. Pregnancy is not very adversely affected by the virus itself but extra caution should be taken to prevent and complications should they arise. The norms of social distancing by patients and wearing personal protective equipment by hospital staff, testing of pregnant women should be followed as per regional and national guidelines. This will help ensure safety of all people along with care to the expecting mother. The presence of covid-19 infection should not deter women from receiving antenatal care nor should the obstetric treatment be delayed during labor. Decision for timing and mode of delivery should be individualised based on obstetric indications and maternal-fetal status.