Navigating merits and limits on the current perspectives and ethical challenges in the utilization of artificial intelligence in psychiatry - An exploratory mixed methods study.

BACKGROUND: The integration of Artificial Intelligence (AI) in psychiatry presents opportunities for enhancing patient care but raises significant ethical concerns and challenges in clinical application. Addressing these challenges necessitates an informed and ethically aware psychiatric workforce capable of integrating AI into practice responsibly. METHODS: A mixed-methods study was conducted to assess the outcomes of the "CONNECT with AI" - (Collaborative Opportunity to Navigate and Negotiate Ethical Challenges and Trials with Artificial Intelligence) workshop, aimed at exploring AI's ethical implications and applications in psychiatry. This workshop featured presentations, discussions, and scenario analyses focusing on AI's role in mental health care. Pre- and post-workshop questionnaires and focus group discussions evaluated participants' perspectives, and ethical understanding regarding AI in psychiatry. RESULTS: Participants exhibited a cautious optimism towards AI, recognizing its potential to augment mental health care while expressing concerns over ethical usage, patient-doctor relationships, and AI's practical application in patient care. The workshop significantly improved participants' ethical understanding, highlighting a substantial knowledge gap and the need for further education in AI among psychiatrists. CONCLUSION: The study underscores the necessity of continuous education and ethical guideline development for psychiatrists in the era of AI, emphasizing collaborative efforts in AI system design to ensure they meet clinical needs ethically and effectively. Future initiatives should aim to broaden psychiatrists' exposure to AI, fostering a deeper understanding and integration of AI technologies in psychiatric practice.

Ethical and moral principles for oncology healthcare workers: A brief report from a Bioethics consortium emphasizing on need for education.

The medical sub-specialty of Oncology presents diverse ethical dilemmas, often challenging cancer healthcare workers with difficult-to-handle clinical scenarios that are tough from a personal and professional perspective. Making decisions on patient care in various circumstances is a defining obligation of an oncologist and those duty-based judgments entail more than just selecting the best treatment or solution. Ethics is an essential and inseparable aspect of clinical medicine and the oncologists as well as the allied health care workers are ethically committed to helping the patient, avoiding or minimizing harm, and respecting the patient's values and choices. This review provides an overview of ethics and clinical ethics and the four main ethical principles of autonomy, beneficence, non-maleficence, and justice are stated and explained. At times there are frequently contradictions between ethical principles in patient care scenarios, especially between beneficence and autonomy. In addition, truth-telling, professionalism, empathy, and cultural competence; which are recently considered important in cancer care, are also addressed from an Indian perspective.

Dietary agents in the prevention of radiation-induced nausea and vomiting (RINV): review addressing the scientific observations, benefits, lacunae and future direction.

PURPOSE: Radiation-induced Nausea and Vomiting (RINV) is an important side effect and conservative estimates are that 50-80% of the patients undergoing curative radiotherapy (RT) will experience some sought of retching, nausea, and/or vomiting during the course of their treatment. Conventionally, antiemetic drugs like the 5-hydroxytryptamine receptor antagonists and steroids are the mainstay of treatment. However, the use of these agents, especially steroids, can cause side effects and thereby negate the proposed benefits. The antiemetic effects of Centella asiatica (Indian pennywort), Hippophae rhamnoides (Sea buckthorn), oil of Mentha spicata (Spearmint) and the rhizomes of Zingiber officinale (ginger) have been addressed. CONCLUSIONS: Results indicate that Indian pennywort, Sea buckthorn, Spearmint oil and ginger are beneficial in mitigating RINV. Also, of the four plants investigated in preclinical models of study, mint oil and ginger seem to be more useful and merit structured systematic translational studies to ascertain the benefit of these two agents.

Pharmacoeconomic Appraisal of Treating Head and Neck Cancer with Various Chemotherapy and Chemoirradiation Regimens Using Branded and Jan-aushadhi Drugs in India.

According to recent studies, head and neck cancers (HNC) make up a substantial proportion of all cancers in India and are proportionately high in the lower socioeconomic people practising tobacco and alcohol. Chemotherapy is a crucial component of treating HNC, and this study was carried out to determine the Cost Minimization Analysis (CMA) by comparing the price of the high and least expensive branded drugs marketed in India. This study was performed to understand the cost difference (CD), Cost ratio (CR) and percentage of cost variation (PCV) of both individual drugs and the standard anticancer regimens. The Current Index of Medical Stores was used to determine the costs of the most and least expensive branded medications and analysed. The results indicated that Paclitaxel-Cisplatin-5 Fluoruracil chemotherapy regimen exhibited the greatest variance in cost, with the Jan Aushadhi brand of medicine costing 8.1 times and 4.3 times less than the most expensive and cheapest branded drugs, respectively. The cost of the concurrent cisplatin regimen with Jan Aushadi Medicine was Rs 1764, Rs 3489.64 with the lowest branded drug, and Rs 8477 with the most expensive branded drug. Also when compared to Jan Aushadhi medication, the cost of Ciplatin was 4.8 times higher with the most expensive branded drug and 2 times higher with the least expensive branded drug. As far as the authors are aware of this is the first study that addresses the pharmacoeconomic appraisal of treating HNC with various chemotherapy and chemoirradiation regimens. This study will help oncologists, pharmacists, and healthcare workers comprehend the financial advantages of treating breast cancer with less expensive chemotherapeutic agents instead of brand-name medications.

Social, Ethical and Treatment Related Problems Faced by Healthcare Workers in the Care of Head and Neck Cancer Patients: A Narrative Review from the Bioethics Consortium from India.

Head and neck cancer (HNC) presents a variety of ethical difficulties for an oncologist involved in screening, diagnosis, treatment, and rehabilitation that are challenging to address, especially for those professionals/people who are not trained in medical ethics. The bioethics department has spent the last ten years compiling information and rating the seriousness of numerous niche ethical concerns and their effects on healthcare professionals practising in India. Based on these findings, the current analysis makes an effort to outline the different challenges faced by oncologists when screening, diagnosing, treating, and rehabilitating people affected with HNC, particularly in a traditional nation like India. According to the authors, this is the first overview to address these issues from an Indian viewpoint, and it represents a small effort to document a crucial but unaddressed component of cancer treatment. It is hoped that these endeavours would aid in educating upcoming healthcare professionals on how to effectively handle the difficulties.

Adverse events associated with Covishield vaccination among healthcare workers in a tertiary hospital in South India.

Background: Vaccination is the most important prophylactic measure taken to curb COVID-19 pandemics. This study was undertaken to throw light on the safety of Covishield vaccine among health care workers (HCWs) and to assess the co-variates associated with incidence of adverse events. Methods: This prospective observational study was conducted in a tertiary care center in South India as part of the HCW vaccination drive. All consenting HCWs who received the first dose of Covishield vaccine and developed ADRs were included in this study. After vaccination, all beneficiaries were monitored for AEFI for a period of half an hour and later followed up through telephone and google survey forms on day 2 and day 7 of vaccination. The data was subsequently collated into spreadsheet format and analyzed. Results: The study included 1264 consenting healthcare workers who were predominantly youth, aged 15-24 years (n = 583, 46 %) and with a female preponderance of 76 % (n = 960). Past history of COVID-19 infections was reported among 4.6 % (58) of the study population. Postvaccination symptoms were majorly reported during the first (40 %) and second day (44 %) after vaccination with a high prevalence of both local (n = 1083, 85 %) and systemic symptoms (n = 1065, 84 %). The mean duration of symptoms was observed to be 1.4 ± 0.81 days post vaccination. Symptoms were observed significantly high among females (76.7 %, p = 0.013). The prevalence of systemic (88 % vs 80 %) (p < 0.001) and allergic symptoms (7 % vs 3 %; p = 0.03) were observed to be significantly high among respondents with <25 years of age. The systemic and allergic symptoms following vaccination were reported to be low among healthcare workers who had a previous history of COVID-19 infection. Conclusion: COVID vaccination has been observed to be safe and well tolerated with more systemic symptoms reported among younger age group and females.

Adverse reaction profile of sulfasalazine and its persistence in chronic therapy of rheumatoid arthritis and spondyloarthritis: A multicentric observational study.

OBJECTIVES: Sulfasalazine has been widely used in treatment of rheumatoid arthritis and spondyloarthritis. This study aims to assess persistence with sulfasalazine and also frequency and severity of adverse drug reactions (ADRs) encountered with this very well-established disease-modifying anti-rheumatoid drug. MATERIALS AND METHODS: This retrospective study was done in 1,114 patients from medicine and rheumatology outpatient departments of six centers across India. The inclusion criteria was patients taking sulfasalazine. Patients receiving sulfasalazine for rheumatoid arthritis or spondyloarthritis were selected and details on drugs used, duration of taking sulfasalazine, ADRs to sulfasalazine and whether sulfasalazine had to be stopped due to ADRs were analyzed. RESULTS: Of the total of patients included in the study, 10.1% had ADRs with sulfasalazine, and stopped the drug. Gastritis, deranged liver enzymes, hepatitis, skin rashes were the most commonly encountered ADRs. Of the total number of patients recruited for the study, 11% were lost to follow-up, as most of the centers were army hospitals and the officers and staff were posted to other places. Sulfasalazine was taken for less than 1 month by 3.8% patients while 12.5% had taken the drug for less than 6 months. Of the study patients, 28.6% had taken the drug for 24 - 60 months and 4.6% (51 patients) had taken it for more than 5 years. It was found that ADRs were most commonly encountered within the first year of using the drug, and persistence was seen in patients on long-term therapy. CONCLUSION: Sulfasalazine is a safe option in chronic therapy of rheumatoid arthritis and spondyloarthritis. Although frequency of ADRs with patients taking sulfasalazine is minimal, it did necessitate the stoppage of drug. If not well tolerated, sulfasalazine would not have been continued for more than 12 months as evidenced from this study.

Evaluation of the anti-hyperlipidemic effects of Triphala in high fat diet fed rats: Studies with two combinations.

Background: Hyperlipidemia is one of the major risk factors for coronary heart disease and stroke. Triphala, a polyherbal Ayurvedic formulation made from dried fruits of Haritaki (Terminalia chebula Retz.), Bibhitaki (Terminalia bellirica Roxb.), and Amalaki (Phyllanthus emblica Gaertn.) has been suggested to be useful in mitigating hyperlipidemia. In the Ayurveda texts, depending on the patient's condition and body type, Triphala is formulated and used in one of the two combination (1:1:1 and 1:2:4 of individual constituents) forms. Aims: The present study aimed at evaluating the efficacy of two combinations (1:1:1 and 1:2:4 of individual constituents) of Triphala against high fat diet induced-hyperlipidemia in rats. Materials and method: Hyperlipidemia was induced in Spraque-Dawley albino rats by feeding them with high fat diet. The animals were concomitantly administered with graded dose of one of the two combination (combination of Haritaki, Bibhitaki, and Amalaki in ratio of 1:1:1 or 1:2:4, respectively) of Triphala (250, 500, or 1000 mg/kg body wt.) or atorvastatin. The animals were sacrificed on day 22 and serum was processed for lipid profile and the liver for lipid peroxidation. The statistical analysis was performed by the mean analysis of variance followed by Dunnet's test. Results: The results indicated that when compared to placebo group, levels of serum total cholesterol, and triglyceride were significantly lower, while high-density lipoprotein cholesterol increased in both the Triphala combination and atorvastatin groups. Of the two groups of Triphala, the formulation having 1:2:4 ratio was better than the 1:1:1. The group having highest drug dose (1000 mg/kg body wt.) of 1:2:4 formulation was better than atorvastatin in rectifying high fat diet-induced dyslipidemia and the atherogenic index was equal to that of atorvastatin. Conclusions: The results of the study indicate that of the two Triphala formulations, the 1:2:4 ratio was better than the 1:1:1 ratio for anti-hyper-lipidemic effects.

Audit of drug-drug interactions and adverse drug reactions due to polypharmacy in older cancer patients: First report from India.

BACKGROUND: In elderly people, the body's metabolic processes are not optimal and pharmacokinetics and pharmacodynamic profile of drugs are compromised or reduced. Under these conditions, the concomitant use of diverse classes of drugs can potentially increase the risk of adverse reactions and drug interactions. This will consequentially affect the already debilitated organ system. As far as the authors are aware, there are no studies addressing the drug-drug interactions and adverse drug reactions due to polypharmacy in older patients with cancer and therefore, we conducted this study. METHODS: This was an observational chart-based study and was carried out in a tertiary care cancer hospital. The data concerning prescription of all prescribed medications were noted down from the medication chart of the patient in the wards. RESULTS: The most common drug-to-drug interaction that could have happened was due to the combination of theophylline with budesonide (26.10%). Adverse drug reactions were noted during the course of time, the most common being nausea and vomiting (71.9%). CONCLUSIONS: As the geriatric population is increasing, the need to address medical problems among aged patients with cancer is the need of the hour. The adverse drug reactions and drug interactions that have occurred were lesser when compared to published observations.

Financial audit of wastage of anticancer drugs: Pilot study from a tertiary care center in India.

PURPOSE: Drug wastage is a major concern in oncology where costs of antineoplastic drugs are exorbitant, and the disposal of toxic drugs increases the chances of occupational hazards to healthcare and sanitary workers and environmental pollution at the site of disposal. The principal objective of this study was to ascertain the extent of drug wastage and calculate its financial costs. MATERIALS AND METHODS: This was a prospective pilot study conducted to ascertain the quantity of drug wastage in a tertiary care hospital. This pilot study was conducted in day care and inpatient facilities in February 2016. The prescription of cytotoxic drugs, recommended dose, the quantity used, and remainder (waste) left were recorded from the nurses and pharmacy files of the hospital. Cost evaluation of the actual use and the waste was undertaken and an audit was conducted to understand in which anticancer drug the maximum wastage was generated. RESULTS: The results of this study indicated that 6.1% of the total amount of reconstituted drugs was wasted. The highest drug wastage was observed in trastuzumab (29.55%), followed by etoposide (20.4%), dacarbazine (17.14%), daunorubicin (16.67%), and carboplatin (11.29%). Cost analysis showed that the total cost of the drug issued during the study period was Rs. 1,294,975 and the cost of drug wastage amounted to Rs. 143,820 (11.1%). CONCLUSION: To the best of authors' knowledge, this is the first study from India and the results indicate that the financial impact of anticancer drug wastage was substantial. Attempts should be directed at minimizing the wastage and cost savings without risking patients' treatment regimen and administering effective dose schedule.

Theory Content, Question-Behavior Effects, or Form of Delivery Effects for Intention to Become an Organ Donor? Two Randomized Trials.

Eliciting different attitudes with survey questionnaires may impact on intention to donate organs. Previous research used varying numbers of questionnaire items, or different modes of intervention delivery, when comparing groups. We aimed to determine whether intention to donate organs differed among groups exposed to different theoretical content, but similar questionnaire length, in different countries. We tested the effect of excluding affective attitudinal items on intention to donate, using constant item numbers in two modes of intervention delivery. Study 1: A multi-country, interviewer-led, cross-sectional randomized trial recruited 1007 participants, who completed questionnaires as per group assignment: including all affective attitude items, affective attitude items replaced, negatively-worded affective attitude items replaced. Study 2 recruited a UK-representative, cross-sectional sample of 616 participants using an online methodology, randomly assigned to the same conditions. Multilevel models assessed effects of group membership on outcomes: intention to donate (primary), taking a donor card, following a web-link (secondary). In study 1, intention to donate did not differ among groups. Study 2 found a small, significantly higher intention to donate in the negatively-worded affective attitudes replaced group. Combining data yielded no group differences. No differences were seen for secondary outcomes. Ancillary analyses suggest significant interviewer effects. Contrary to previous research, theoretical content may be less relevant than number or valence of questionnaire items, or form of intervention delivery, for increasing intention to donate organs.

Novel horizontal and vertical integrated bioethics curriculum for medical courses.

Studies conducted by the University of Haifa, Israel in 2001, evaluating the effectiveness of bioethics being taught in medical colleges, suggested that there was a significant lack of translation in clinical care. Analysis also revealed, ineffectiveness with the teaching methodology used, lack of longitudinal integration of bioethics into the undergraduate medical curriculum, and the limited exposure to the technology in decision making when confronting ethical dilemmas. A modern novel bioethics curriculum and innovative methodology for teaching bioethics for the medical course was developed by the UNESCO Chair in Bioethics, Haifa. The horizontal (subject-wise) curriculum was vertically integrated seamlessly through the entire course. An innovative bioethics teaching methodology was employed to implement the curriculum. This new curriculum was piloted in a few medical colleges in India from 2011 to 2015 and the outcomes were evaluated. The evaluation confirmed gains over the earlier identified translation gap with added high student acceptability and satisfaction. This integrated curriculum is now formally implemented in the Indian program's Health Science Universities which is affiliated with over 200 medical schools in India. This article offers insights from the evaluated novel integrated bioethics curriculum and the innovative bioethics teaching methodology that was used in the pilot program.

Honey Mitigates Radiation-Induced Oral Mucositis in Head and Neck Cancer Patients without Affecting the Tumor Response.

Radiation-induced mucositis is a dose-limiting factor in the effective treatment of head and neck (H & N) cancers. The objective of this study was to understand the efficacy of honey in mitigating radiation-induced mucositis and whether it would interfere with tumor control. This was a single-blinded, randomized, controlled study and was carried out in patients with H & N cancer requiring curative radiotherapy (>62 Gy (Gray)). The patients meeting the inclusion criteria were randomly assigned to receive either honey ( n = 25) or povidone-iodine (active comparator) ( n = 25) during radiotherapy. Oral mucositis was assessed using the RTOG (Radiation Therapy Oncology Group) grading system before the start, during, and at the end of the treatment by an investigator unaware of the treatment. The results indicate that when compared with the active comparator, honey reduced the radiation-induced oral mucositis, decreased the incidence of intolerable mucositis, treatment breaks, loss of treatment days ( p < 0.0001 and < 0.0003) and did not affect the radiation-induced tumor response. The clinical observations indicate that honey mitigates the radiation-induced mucositis and does not interfere with tumor cell killing.

An Aloe Vera-Based Cosmeceutical Cream Delays and Mitigates Ionizing Radiation-Induced Dermatitis in Head and Neck Cancer Patients Undergoing Curative Radiotherapy: A Clinical Study.

Background: This study was planned to evaluate the efficacy of topical application of an Aloe vera-based cream (AVC) for the prevention of ionizing radiation (X ray)-induced dermatitis in head and neck cancer patients requiring therapeutic radiation treatment (>62 Gy). Methods: From July 2012 to December 2012, a total of 60 head and neck cancer patients requiring curative radiotherapy (RT) of more than 66 Gy were prospectively enrolled and treated with AVC or a comparator Johnson's Baby Oil (JBO). Acute skin reaction was monitored and classified according to the Radiation Therapy Oncology Group (RTOG) four-point rating scale on a weekly basis. Results: The results indicate that there was a statistically significant delay in the incidence (p = 0.04) of dermatitis at week three in the AVC application group. Application of AVC reduced the incidence of Grade 1, 2, and 3 dermatitis at subsequent time points, while Grade 4 dermatitis was not seen in either cohort. The other most important observation was that the continued application of AVC two weeks after the completion of RT was effective in reducing the average grade of dermatitis and was statistically significant (p < 0.02). Conclusions: Prophylactic use of an AVC-based cream is thus effective in delaying radiation dermatitis in head and neck cancer.

Sandalwood Oil and Turmeric-Based Cream Prevents Ionizing Radiation-Induced Dermatitis in Breast Cancer Patients: Clinical Study.

Background: The primary objective of this study was to ascertain the benefit of Vicco turmeric Ayurvedic cream (VTC; Vicco Laboratories, Mumbai, India) sandalwood oil and turmeric-based cream in preventing radiodermatitis in women undergoing curative radiotherapy for their breast cancer. Methods and Materials: The study was an investigator-blinded randomized study with Johnsons Baby Oil (JBO; Johnson & Johnson Ltd., Baddi, India) as a comparator, administered daily from the start of radiation therapy for 5 weeks in women receiving breast radiation therapy, 50 Gy in 2 Gy fractions daily for 5 weeks. The endpoints were to ascertain the delay in the appearance and the degree of severity of dermatitis throughout the study period in accordance to the Therapy Oncology Group (RTOG) score. Results: The results indicated that the topical application of VTC delayed and mitigated the radiodermatitis. When compared to the Johnson's Baby Oil, a significant decrease (p = 0.025) in the incidence of grade 1 was seen at week two, and also in grade 2 and 3 at week 3 (p = 0.003) and week 4 (p = 0.02), respectively, in the VTC cohort. A concomitant decrease in the average severity was also observed at week 2 (p = 0.02), week 3 (p = 0.05) and week 4 (p = 0.03). CONCLUSIONS: The results indicate that VTC cream significantly reduces radiation dermatitis when applied to the breast during and after radiation therapy. The result of this study indicates the beneficial effects. Double blind randomized control studies are required to further confirm the beneficial effects of VTC in mitigating radiodermatitis is people undergoing radiation treatment for their cancer.

The phytochemistry, traditional uses and pharmacology of Piper Betel. linn (Betel Leaf): A pan-asiatic medicinal plant.

Since antiquity, Piper betel. Linn, commonly known as betel vine, has been used as a religious, recreational and medicinal plant in Southeast Asia. The leaves, which are the most commonly used plant part, are pungent with aromatic flavor and are widely consumed as a mouth freshener. It is carminative, stimulant, astringent and is effective against parasitic worms. Experimental studies have shown that it possess diverse biological and pharmacological effects, which includes antibacterial, antifungal, larvicidal, antiprotozal, anticaries, gastroprotective effects, free radical scavenging, antioxidant, anti-inflammatory hepatoprotective, immunomodulatory, antiulcer and chemopreventive activities. The active principles hydroxychavicol, allylpyrocatechol and eugenol with their plethora of pharmacological properties may also have the potential to develop as bioactive lead molecule. In this review, an attempt is made to summarize the religious, traditional uses, phytochemical composition and experimentally validated pharmacological properties of Piper betel. Emphasis is also placed on aspects warranting detail studies for it to be of pharmaceutical/clinical use to humans.

Clinical evaluation of Viscum album mother tincture as an antihypertensive: a pilot study.

Viscum album, an infrequently used antihypertensive in homeopathy, is evaluated by 1-group pretest-posttest model in primary hypertension. The drug was administered for 12 weeks at a dosage of 10 drops 3 times a day. Using paired t test, a significant drop in blood pressure (P < .0001) and serum triglyceride (P < .0001) was observed in the treatment group. This dual effect of Viscum album shows promise in optimizing therapy for primary hypertension.

The medicinal use of venoms and toxins.

Venoms have long since been known to have therapeutic value. Venoms have been characterised into their individual components and each of their functions extensively studied. These components of venoms and toxins show potential as antihypertensive, anticoagulant, fibrinolytic, anticancerous, immunomodulators, muscle relaxant, etc. Only the most promising and FDA approved and therapeutic options have been discussed here eg, hannalgesin, epibatidine, ancrod, lepirudin, fibrolase, lebecetin, pseutarin, captopril, eristostatin, botox.

Rasayana drugs from the Ayurvedic system of medicine as possible radioprotective agents in cancer treatment.

The use of ionizing radiation, which is the cornerstone of cancer treatment, is compromised by the radiosensitivity of normal tissues. A chemical that can give selective benefit to the normal cells against the deleterious effects of ionizing radiation has been a long-sought goal. However, most of the compounds studied have shown inadequate clinical application owing to their inherent toxicity, undesirable side effects, and high cost. Studies carried out in the past 2 decades have shown that some of the classical Indian Ayurvedic drugs (Amritaprasham, Ashwagandha Rasayana, Brahma Rasayana, Chyavanprasha, Narasimha Rasayana, and Triphala Churna) possess radioprotective effects. In the current review, an attempt is made to summarize the radioprotective observations of these Ayurvedic drugs and the mechanisms responsible for the radioprotective effects.

Ginger in the prevention of nausea and vomiting: a review.

Nausea and vomiting are physiological processes experienced by every human being at some stage of their life. They are complex protective mechanisms and the symptoms are influenced by the emetogenic response and stimuli. However, when these symptoms recur frequently, they can significantly reduce the quality of life and can also be detrimental to health. The existing antiemetic agents are ineffective against certain stimuli, are expensive, and possess side effects. Herbal medicines have been shown to be effective antiemetics, and among the various plants studied, the rhizome of Zingiber officinale, commonly known as ginger, has been used as a broad-spectrum antiemetic in the various traditional systems of medicine for over 2000 years. Various preclinical and clinical studies have shown ginger to possess antiemetic effects against different emetogenic stimuli. However, conflicting reports especially in the prevention of chemotherapy-induced nausea and vomiting and motion sickness prevent us from drawing any firm conclusion. The current review for the first time summarizes the results. An attempt is also made to address the lacunae in these published studies and emphasize aspects that need further investigations for it to be of use in clinics in the future.