Effectiveness of Medical Student Counseling for Hospitalized Patients Addicted to Tobacco (MS-CHAT): a Randomized Controlled Trial.

BACKGROUND: Low-middle-income countries face an enormous burden of tobacco-related illnesses. Counseling for tobacco cessation increases the chance of achieving quit outcomes, yet it remains underutilized in healthcare settings. OBJECTIVE: We tested the hypothesis that utilizing trained medical students to counsel hospitalized patients who use tobacco will lead to an increase in patient quit rates, while also improving medical student knowledge regarding smoking cessation counseling. DESIGN: Investigator-initiated, two-armed, multicenter randomized controlled trial conducted in three medical schools in India. PARTICIPANTS: Eligibility criteria included age 18-70 years, active admission to the hospital, and current smoking. INTERVENTION: A medical student-guided smoking cessation program, initiated in hospitalized patients and continued for 2 months after discharge. MAIN MEASURES: The primary outcome was self-reported 7-day point prevalence of smoking cessation at 6 months. Changes in medical student knowledge were assessed using a pre- and post-questionnaire delivered prior to and 12 months after training. KEY RESULTS: Among 688 patients randomized across three medical schools, 343 were assigned to the intervention group and 345 to the control group. After 6 months of follow up, the primary outcome occurred in 188 patients (54.8%) in the intervention group, and 145 patients (42.0%) in the control group (absolute difference, 12.8%; relative risk, 1.67; 95% confidence interval, 1.24-2.26; p < 0.001). Among 70 medical students for whom data was available, knowledge increased from a mean score of 14.8 (± 0.8) (out of a maximum score of 25) at baseline to a score of 18.1 (± 0.8) at 12 months, an absolute mean difference of 3.3 (95% CI, 2.3-4.3; p < 0.001). CONCLUSIONS: Medical students can be trained to effectively provide smoking cessation counseling to hospitalized patients. Incorporating this program into the medical curriculum can provide experiential training to medical students while improving patient quit rates. TRIAL REGISTRATION: URL: http://www. CLINICALTRIALS: gov . Unique identifier: NCT03521466.

Rationale and Design of a Randomized Controlled Trial to Evaluate the Effectiveness of Medical Student Counseling for Hospitalized Patients Addicted to Tobacco (the MS-CHAT Trial).

Globally, India is the second largest consumer of tobacco. However, Indian medical students do not receive adequate training in smoking cessation counseling. Each patient hospitalization is an opportunity to counsel smokers. Medical Student Counseling for Hospitalized patients Addicted to Tobacco (MS-CHAT) is a 2-arm multicenter randomized controlled trial (RCT) that compares the effectiveness of a medical student-guided smoking cessation program initiated in inpatients and continued for two months after discharge versus standard hospital practice. Current smokers admitted to the hospital are randomized to receive either usual care or the intervention. The intervention group receives inpatient counseling and longitudinal postdischarge telephone follow-up by medical students. The control group receives counseling at the discretion of the treating physician. The primary outcome is biochemically verified 7-day point prevalence of smoking cessation at 6 months after enrollment. Changes in medical student knowledge and attitude will also be studied using a pre- and postquestionnaire delivered prior to and 12 months after training. This trial tests a unique model that seeks to provide hands-on experience in smoking cessation counseling to medical students while simultaneously improving cessation outcomes among hospitalized smokers in India.

A time-efficient model of spreading health awareness which also provides good experiential learning to medical students.

Background: Although alcohol and tobacco are leading causes of mortality and morbidity, their use continues to be common. We hypothesized that awareness about this issue can be spread in a time-efficient way if health talks are conducted within hospital premises itself. Furthermore, this could potentially provide good experiential learning to medical students. Methods: In this longitudinal study, we implemented such an awareness activity and evaluated the outcome. Students who showed interest to volunteer were helped to develop an in-depth understanding of the issue, through detailed presentation and discussions. They conducted health talks near the wards, with patients and their relatives, after routine college hours. An iterative process was used to improve the health talk, based on self-reflection and formative feedback. A pre- and post-self-assessment of students regarding their knowledge and skills on this issue was obtained. A structured, anonymous questionnaire was administered to the audience before and after three of the educational talks. Results: In 29 days, our team of 24 students gave 21 health talks reaching out to 1090 rural people. Pre-post analysis of audience showed improvement in their awareness level and many developed the motivation to quit their addictions. Self-rating of students across all knowledge domains increased by at least 2 points (scale of 1-7) and across all skill domains, it increased by 3 points (P < 0.0001). Conclusion: This model of conducting health talks in hospital premises can enable us to spread health awareness effectively, in a time-efficient and cost-effective way. Furthermore, this model can prove to be a novel and effective academic tool for grooming medical students.

Cannabis induced psychosis and subsequent psychiatric disorders.

INTRODUCTION: Long term change in diagnosis of patients having Cannabis induced psychosis (CIP) at the index evaluation is well recognised. Some patients are known to achieve complete remission while others go on to develop independent schizophrenia or mood disorders. AIMS: To study the long-term course of CIP and factors influencing it. METHOD: Patients diagnosed as CIP (ICD 10: F12.5), admitted at NIMHANS, a tertiary neuropsychiatry centre at Bangalore, over the past 10 years were identified from medical records. 200 case records were identified and screened in detail. 57 met inclusion criteria and 35 patients could be followed up. Mean follow up duration was 5.75 years. RESULTS: Patients who completely abstained from cannabis after the 1st episode had no relapse of psychiatric illness. They showed marked improvement in socio-occupational functioning as well. All those who relapsed to cannabis use had a recurrence of illness. Half the patients with predominantly non-affective psychosis progressed to an independent psychiatric disorder; while only 7.7% patients with predominantly affective psychosis developed an independent disorder (p=0.01). Besides this, early onset of cannabis use (≤18years), younger age at onset of 1st episode, positive family history of psychiatric illness, being unmarried and lower socio-economic status were associated with poor prognosis. Abstinence later in the course of illness did not improve outcome significantly. CONCLUSION: Abstaining from cannabis early in the course of illness is critical for good recovery. The course of CIP is variable and categorising CIP into affective vs. non-affective psychosis can be useful in clinical practice.

Awakening to the alcohol epidemic - need of the hour.

Globally, alcohol has become the most common risk factor for death and disability in the young age group of 15-49 years. Its use has been rapidly increasing in developing countries. It is a critical time wherein if effective preventive measures are not undertaken urgently, damage done will be difficult to reverse. However, health professionals are not responding to the alcohol epidemic in the manner that they responded to the tobacco epidemic. The article discusses two beliefs which are making us accept the use of alcohol as normal. Recent evidence indicates that it is not advisable to drink alcohol even in moderation. Furthermore, social drinking has failed to decrease alcohol-related harm in western countries. Because of its addictive nature, many people end up drinking excessively though they do not intend to. Hence, we need to shift our focus from only "reducing harmful use of alcohol" to "reducing use of alcohol" in general.

Social Determinants of Dementia and Caregivers' Perspectives in the Field Practice Villages of Rural Health Training Centre, Thiruvennainallur.

OBJECTIVES: (1) To find out the prevalence of dementia in the study population and its social determinants. (2) To explore the family caregivers' perceptions and their support needs. MATERIALS AND METHODS - STUDY SETTING: This study was undertaken in the field practice area of 55 villages of three Primary Health Centres in Villupuram District of Tamil Nadu. STUDY DESIGN: An exploratory mixed-methods study design, where a qualitative method (key informant interview) was followed by a quantitative method (survey). SAMPLE SIZE: A representative sample of 1300 respondents was selected by two-stage sampling. ANALYSIS: Manual content analysis was done for qualitative data. Multiple logistic regression was performed on quantitative data. RESULTS: The prevalence of dementia among study sample was found to be 3.1%. The determinants for dementia were age, sex, socioeconomic status, and previous involvement in family decision making and cardiovascular risk factors. The family caregivers strongly felt that caregiving interferes with their personal and professional life; they also felt that caregiving is an integral part of Indian culture, and the elderly prefer home-based care. Caregivers preferred government owned public health facility for medical care. All the responding caregivers strongly felt that they are not adequately trained in caregiving. CONCLUSIONS AND RECOMMENDATIONS: Routine screening of elderly for early identification of dementia and its medical and social risk factors should be initiated in primary health care facility. Care of caregivers should be seen as an integral part of dementia care program.