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Krishnan S V, Kunju SA, Nayak SS, Gopinathan V, Sirur FM, Kumara V, Balakrishnan JM. Evaluating the Use of E-Learning in Indian Emergency Medicine Residency Programs During the COVID-19 Pandemic: A National Cross-Sectional Survey. Disaster Med Public Health Prep 2023; 17:e491. [PMID: 37711031 DOI: 10.1017/dmp.2023.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
OBJECTIVE The coronavirus disease (COVID-19) pandemic has necessitated e-learning strategies in academic emergency medicine (EM) programs. A study was conducted during the COVID-19 pandemic to understand e-learning in the Indian EM context. METHODS After IEC/IRB approval, we conducted a multicenter national survey validated by experts and underwent multiple reviews by the research team. The final survey was converted into Google Forms for dissemination via email to National Medical Commission (NMC) approved EM residency program as of 2020-2021. Data were exported into Excel format and analyzed. RESULTS Residents and faculty comprised 41.5% and 58.5% of 94 respondents. The COVID-19 pandemic's second wave in India significantly impacted response rates. Internet connectivity was cited as a significant barrier to e-learning, while flexible timings and better engagement were facilitators identified by the survey. The attitude among residents and faculty toward e-learning was also evaluated. CONCLUSION This survey reveals a significant positive shift in medical education from conventional teaching strategies toward e-learning, specifically during the pandemic. It also shows the need for all stakeholders (learners/educators) to better understand e-learning and adapt to its requirements. We need more data on the efficacy of e-learning compared to traditional methods. Until then, innovative hybrid/blended strategies would be the way forward.
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Affiliation(s)
- Vimal Krishnan S
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
- Department of Medical Education, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Sanjan Asanaru Kunju
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
- Department of Emergency Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Sachin Sujir Nayak
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Vivek Gopinathan
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
- Department of Emergency Medicine, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
| | - Freston Marc Sirur
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Vijaya Kumara
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
- Department of Emergency Medicine, Kanachur Institute of Medical Science, Natekal, Mangaluru, Karnataka, India
| | - Jayaraj M Balakrishnan
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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Sirur FM, Balakrishnan JM, Lath V. Hump-Nosed Pit Viper Envenomation in Western Coastal India: A Case Series. Wilderness Environ Med 2022; 33:399-405. [DOI: 10.1016/j.wem.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 11/21/2022]
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Balakrishnan JM, Kunju SA, Wilson W, Sujir SN, Bhat R, Vandana KE. MIST (Modified Intubating Sequence for Transmissibility) Bundle for Infectious Diseases with Aerosol Hazard. West J Emerg Med 2020; 21:1076-1079. [PMID: 32970557 PMCID: PMC7514411 DOI: 10.5811/westjem.2020.7.47473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/15/2020] [Indexed: 01/28/2023] Open
Abstract
The current global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has magnified the risk to healthcare providers when inititiating airway management, and safe tracheal intubation has become of paramount importance. Mitigation of risk to frontline providers requires airway management to be an orchestrated exercise based on training and purposeful simulation. Role allocation and closed-loop communication form the foundation of this exercise. We describe a methodical, 10-step approach from decision-making and meticulous drug and equipment choices to donning of personal protective equipment, and procedural concerns. This bundled approach will help reduce unplanned actions, which in turn may reduce the risk of aerosol transmission during airway management in resource-limited settings.
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Affiliation(s)
- Jayaraj M Balakrishnan
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sanjan Asanaru Kunju
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - William Wilson
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sachin Nayak Sujir
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rachana Bhat
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - K E Vandana
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Kent A, Patil P, Davila V, Bailey JK, Jones C, Evans DC, Boulger CT, Adkins E, Balakrishnan JM, Valiyaveedan S, Galwankar SC, Bahner DP, Stawicki SP. Sonographic evaluation of intravascular volume status: Can internal jugular or femoral vein collapsibility be used in the absence of IVC visualization? Ann Thorac Med 2015; 10:44-9. [PMID: 25593607 PMCID: PMC4286845 DOI: 10.4103/1817-1737.146872] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/28/2014] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Inferior vena cava collapsibility index (IVC-CI) has been shown to correlate with both clinical and invasive assessment of intravascular volume status, but has important limitations such as the requirement for advanced sonographic skills, the degree of difficulty in obtaining those skills, and often challenging visualization of the IVC in the postoperative patient. The current study aims to explore the potential for using femoral (FV) or internal jugular (IJV) vein collapsibility as alternative sonographic options in the absence of adequate IVC visualization. METHODS A prospective, observational study comparing IVC-CI and Fem- and/or IJV-CI was performed in two intensive care units (ICU) between January 2012 and April 2014. Concurrent M-mode measurements of IVC-CI and FV- and/or IJV-CI were collected during each sonographic session. Measurements of IVC were obtained using standard technique. IJV-CI and FV-CI were measured using high-frequency, linear array ultrasound probe placed in the corresponding anatomic areas. Paired data were analyzed using coefficient of correlation/determination and Bland-Altman determination of measurement bias. RESULTS We performed paired ultrasound examination of IVC-IJV (n = 39) and IVC-FV (n = 22), in 40 patients (mean age 54.1; 40% women). Both FV-CI and IJV-CI scans took less time to complete than IVC-CI scans (both, P < 0.02). Correlations between IVC-CI/FV-CI (R(2) = 0.41) and IVC-CI/IJV-CI (R(2) = 0.38) were weak. There was a mean -3.5% measurement bias between IVC-CI and IJV-CI, with trend toward overestimation for IJV-CI with increasing collapsibility. In contrast, FV-CI underestimated collapsibility by approximately 3.8% across the measured collapsibility range. CONCLUSION Despite small measurement biases, correlations between IVC-CI and FV-/IJV-CI are weak. These results indicate that IJ-CI and FV-CI should not be used as a primary intravascular volume assessment tool for clinical decision support in the ICU. The authors propose that IJV-CI and FV-CI be reserved for clinical scenarios where sonographic acquisition of both IVC-CI or subclavian collapsibility are not feasible, especially when trended over time. Sonographers should be aware that IJV-CI tends to overestimate collapsibility when compared to IVC-CI, and FV-CI tends to underestimates collapsibility relative to IVC-CI.
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Affiliation(s)
- Alistair Kent
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Prabhav Patil
- Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Victor Davila
- Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - J. Kevin Bailey
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Christian Jones
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - David C. Evans
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
- OPUS 12 Foundation Multi-Center Trials Group, Inc, USA
| | - Creagh T. Boulger
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Eric Adkins
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jayaraj M. Balakrishnan
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Kerala, India
| | - Sebastian Valiyaveedan
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Kerala, India
| | - Sagar C. Galwankar
- OPUS 12 Foundation Multi-Center Trials Group, Inc, USA
- Global Hospital Group, Mumbai, Maharashtra, India
| | - David P. Bahner
- OPUS 12 Foundation Multi-Center Trials Group, Inc, USA
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Stanislaw P. Stawicki
- OPUS 12 Foundation Multi-Center Trials Group, Inc, USA
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
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Stawicki SPA, Adkins EJ, Eiferman DS, Evans DC, Ali NA, Njoku C, Lindsey DE, Cook CH, Balakrishnan JM, Valiaveedan S, Galwankar SC, Boulger CT, Springer AN, Bahner DP. Prospective evaluation of intravascular volume status in critically ill patients: does inferior vena cava collapsibility correlate with central venous pressure? J Trauma Acute Care Surg 2014; 76:956-63; discussion 963-4. [PMID: 24662857 DOI: 10.1097/ta.0000000000000152] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In search of a standardized noninvasive assessment of intravascular volume status, we prospectively compared the sonographic inferior vena cava collapsibility index (IVC-CI) and central venous pressures (CVPs). Our goals included the determination of CVP behavior across clinically relevant IVC-CI ranges, examination of unitary behavior of IVC-CI with changes in CVP, and estimation of the effect of positive end-expiratory pressure (PEEP) on the IVC-CI/CVP relationship. METHODS Prospective, observational study was performed in surgical/medical intensive care unit patients between October 2009 and July 2013. Patients underwent repeated sonographic evaluations of IVC-CI. Demographics, illness severity, ventilatory support, CVP, and patient positioning were recorded. Correlations were made between CVP groupings (<7, 7-12, 12-18, 19+) and IVC-CI ranges (<25, 25-49, 50-74, 75+). Comparison of CVP (2-unit quanta) and IVC-CI (5-unit quanta) was performed, followed by assessment of per-unit ΔIVC-CI/ΔCVP behavior as well as examination of the effect of PEEP on the IVC-CI/CVP relationship. RESULTS We analyzed 320 IVC-CI/CVP measurement pairs from 79 patients (mean [SD] age, 55.8 [16.8] years; 64.6% male; mean [SD] Acute Physiology and Chronic Health Evaluation II, 11.7 [6.21]). Continuous data for IVC-CI/CVP correlated poorly (R = 0.177, p < 0.01) and were inversely proportional, with CVP less than 7 noted in approximately 10% of the patients for IVC-CIs less than 25% and CVP less than 7 observed in approximately 85% of patients for IVC-CIs greater than or equal to 75%. Median ΔIVC-CI per unit CVP was 3.25%. Most measurements (361 of 320) were collected in mechanically ventilated patients (mean [SD] PEEP, 7.76 [4.11] cm H2O). PEEP-related CVP increase was approximately 2 mm Hg to 2.5 mm Hg for IVC-CIs greater than 60% and approximately 3 mm Hg to 3.5 mm Hg for IVC-CIs less than 30%. PEEP also resulted in lower IVC-CIs at low CVPs, which reversed with increasing CVPs. When IVC-CI was examined across increasing PEEP ranges, we noted an inverse relationship between the two variables, but this failed to reach statistical significance. CONCLUSION IVC-CI and CVP correlate inversely, with each 1 mm Hg of CVP corresponding to 3.3% median ΔIVC-CI. Low IVC-CI (<25%) is consistent with euvolemia/hypervolemia, while IVC-CI greater than 75% suggests intravascular volume depletion. The presence of PEEP results in 2 mm Hg to 3.5 mm Hg of CVP increase across the IVC-CI spectrum and lower collapsibility at low CVPs. Although IVC-CI decreased with increasing degrees of PEEP, this failed to reach statistical significance. While this study represents a step forward in the area of intravascular volume estimation using IVC-CI, our findings must be applied with caution owing to some methodologic limitations. LEVEL OF EVIDENCE Diagnostic study, level III. Prognostic study, level III.
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Affiliation(s)
- Stanislaw P A Stawicki
- From the Division of Trauma, Critical Care, and Burn (S.P.A.S., D.S.E., D.C.E., C.N., D.E.L., C.H.C.), Department of Surgery, Department of Emergency Medicine (E.J.A.,CTB., D.P.B.), and Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine (N.A.A.), Department of Internal Medicine, The Ohio State University College of Medicine; Department of Anesthesiology (A.N.S.), The Ohio State College of Medicine; and OPUS 12 Foundation Multi-Center Trials Group (S.P.A.S., D.C.E., D.E.L., C.H.C., S.C.G., D.P.B.), Columbus, Ohio; Department of Anaesthesiology and Critical Care (J.M.B., S.V.), Jubilee Mission Medical College and Research Institute, Thrissur, Kerala; and Department of Emergency Medicine (S.C.G.), Global Hospital Group, Mumbai, India
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Swaroop M, Galwankar SC, Stawicki SPA, Balakrishnan JM, Worlton T, Tripathi RS, Bahner DP, Bhoi S, Kaide C, Papadimos TJ. The 9th annual INDUS-EM 2013 Emergency Medicine Summit, "Principles, Practices, and Patients," a level one international meeting, Kerala University of Health Sciences and Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India, October 23-27, 2013. Philos Ethics Humanit Med 2014; 9:8. [PMID: 24884923 PMCID: PMC4017084 DOI: 10.1186/1747-5341-9-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/28/2014] [Indexed: 06/03/2023] Open
Abstract
INDUS-EM is India's only level one conference imparting and exchanging quality knowledge in acute care. Specifically, in general and specialized emergency care and training in trauma, burns, cardiac, stroke, environmental and disaster medicine. It provides a series of exchanges regarding academic development and implementation of training tools related to developing future academic faculty and residents in Emergency Medicine in India. The INDUS-EM leadership and board of directors invited scholars from multiple institutions to participate in this advanced educational symposium that was held in Thrissur, Kerala in October 2013.
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Affiliation(s)
- Mamta Swaroop
- Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Chicago, IL 60611, USA
| | - Sagar C Galwankar
- Faculty of Medicine and Global Health, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL, USA
| | - Stanislaw PA Stawicki
- Department of Surgery, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH 43210, USA
| | - Jayaraj M Balakrishnan
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Tamara Worlton
- Department of Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Ravi S Tripathi
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, Ohio 43210, USA
| | - David P Bahner
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, Ohio 43210, USA
| | - Sanjeev Bhoi
- Department of Emergency Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - Colin Kaide
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, Ohio 43210, USA
| | - Thomas J Papadimos
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, Ohio 43210, USA
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Kent A, Bahner DP, Boulger CT, Eiferman DS, Adkins EJ, Evans DC, Springer AN, Balakrishnan JM, Valiyaveedan S, Galwankar SC, Njoku C, Lindsey DE, Yeager S, Roelant GJ, Stawicki SPA. Sonographic evaluation of intravascular volume status in the surgical intensive care unit: a prospective comparison of subclavian vein and inferior vena cava collapsibility index. J Surg Res 2013; 184:561-6. [PMID: 23764308 DOI: 10.1016/j.jss.2013.05.040] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 04/03/2013] [Accepted: 05/09/2013] [Indexed: 01/13/2023]
Abstract
BACKGROUND Traditional methods for intravascular volume status assessment are invasive and are associated significant complications. While focused bedside sonography of the inferior vena cava (IVC) has been shown to be useful in estimating intravascular volume status, it may be technically difficult and limited by patient factors such as obesity, bowel gas, or postoperative surgical dressings. The goal of this investigation is to determine the feasibility of subclavian vein (SCV) collapsibility as an adjunct to IVC collapsibility in intravascular volume status assessment. METHODS A prospective study was conducted on a convenience sample of surgical intensive care unit patients to evaluate interchangeability of IVC collapsibility index (IVC-CI) and SCV-CI. After demographic and acuity of illness information was collected, all patients underwent serial, paired assessments of IVC-CI and SCV-CI using portable ultrasound device (M-Turbo; Sonosite, Bothell, WA). Vein collapsibility was calculated using the formula [collapsibility (%) = (max diameter - min diameter)/max diameter × 100%]. Paired measurements from each method were compared using correlation coefficient and Bland-Altman measurement bias analysis. RESULTS Thirty-four patients (mean age 56 y, 38% female) underwent a total of 94 paired SCV-CI and IVC-CI sonographic measurements. Mean acute physiology and chronic health evaluation II score was 12. Paired SCV- and IVC-CI showed acceptable correlation (R(2) = 0.61, P < 0.01) with acceptable overall measurement bias [Bland-Altman mean collapsibility difference (IVC-CI minus SCV-CI) of -3.2%]. In addition, time needed to acquire and measure venous diameters was shorter for the SCV-CI (70 s) when compared to IVC-CI (99 s, P < 0.02). CONCLUSIONS SCV collapsibility assessment appears to be a reasonable adjunct to IVC-CI in the surgical intensive care unit patient population. The correlation between the two techniques is acceptable and the overall measurement bias is low. In addition, SCV-CI measurements took less time to acquire than IVC-CI measurements, although the clinical relevance of the measured time difference is unclear.
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Affiliation(s)
- Alistair Kent
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio 43210, USA
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