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Ananth K, Majumdar A, Singh T. Inflammatory arthritis post-COVID-19 infection affecting the temporomandibular joint. Br Dent J 2024; 236:615. [PMID: 38671113 DOI: 10.1038/s41415-024-7356-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/04/2024] [Indexed: 04/28/2024]
Affiliation(s)
- K Ananth
- Waikato Hospital, Hamilton, New Zealand.
| | - A Majumdar
- Waikato Hospital, Hamilton, New Zealand.
| | - T Singh
- Waikato Hospital, Hamilton, New Zealand.
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Benfor B, Singh T, Puppala R, Peden EK. Midterm outcomes of arteriovenous fistula aneurysm repair with simultaneous inflow revision or outflow tract revascularization. J Vasc Surg 2024; 79:671-678.e2. [PMID: 37956959 DOI: 10.1016/j.jvs.2023.11.014] [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] [Received: 09/19/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the 2-year outcomes of extensive revisions aimed at simultaneously addressing arteriovenous fistula (AVF) aneurysms, outflow stenosis, and/or high flow volumes. METHODS This was a retrospective cohort study in a tertiary referral center. The study population comprised hemodialysis patients with aneurysmal AVFs requiring revision. Subjects were eligible if they were ≥18 years of age and had aneurysm repair associated with inflow revision or treatment of outflow lesions. Patients were followed-up for a minimum of 2 years, and the primary outcome measure was cumulative patency. RESULTS Our cohort comprised 93 patients with a mean age of 56 ± 12 years. The most frequent access type was brachiocephalic fistula (61%), and the median access age at the time of revision was 66 months (interquartile range, 46-93 months). The median access flow volume was 2300 ml/min (interquartile range, 1281-2900), and 31 subjects (33%) presented aneurysms associated with both high flow and venous obstruction. Aneurysm repair consisted of aneurysmorraphy in the overwhelming majority (95%). Inflow revision was performed in a total of 49 cases (53%), and outflow tract obstruction was treated in 71 patients (72%), with 27 patients (29%) receiving a simultaneous 3-component revision. At 2 years, the primary, primary assisted, and cumulative patencies were 60% ± 1%, 91% ± 3%, and 94% ± 3%, respectively. The most frequent indication for first-time reinterventions was outflow tract stenosis (24%). Aneurysm recurrence was observed in 13 subjects (14%) during the entire follow-up and was responsible for reinterventions in seven of them (8%), with a 2-year freedom from aneurysm-related reintervention rate of 95% ± 3%. CONCLUSIONS Extensive AVF revision with simultaneous aneurysm repair, inflow revision, and outflow tract revascularization is feasible, safe, and associated with favorable 2-year patency rates.
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Affiliation(s)
- Bright Benfor
- Division of Vascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Tarundeep Singh
- Division of Vascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Rishik Puppala
- School of Engineering Medicine, Texas A&M University, Houston, TX
| | - Eric K Peden
- Division of Vascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX.
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Kapahi C, Silva AE, Cory DG, Kulmaganbetov M, Mungalsingh MA, Pushin DA, Singh T, Thompson B, Sarenac D. Measuring the visual angle of polarization-related entoptic phenomena using structured light. Biomed Opt Express 2024; 15:1278-1287. [PMID: 38404299 PMCID: PMC10890886 DOI: 10.1364/boe.507519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/27/2024]
Abstract
The ability to perceive polarization-related entoptic phenomena arises from the dichroism of macular pigments held in Henle's fiber layer of the retina and can be inhibited by retinal diseases, such as age-related macular degeneration, which alters the structure of the macula. Structured light tools enable the direct probing of macular pigment density and retinal structure through the perception of polarization-dependent entoptic patterns. Here, we directly measure the visual angle of an entoptic pattern created through the illumination of the retina with a structured state of light and a perception task that is insensitive to corneal birefringence. The central region of the structured light stimuli was obstructed, with the size of the obstruction varying according to a psychophysical staircase. Two stimuli, one producing 11 azimuthal fringes and the other three azimuthal fringes, were presented to 24 healthy participants. The pattern with 11 azimuthal fringes produced an average visual angle threshold of 10° ± 1° and a 95% confidence interval (C.I.) of [6°, 14°]. For the pattern with three azimuthal fringes, a threshold extent of 3.6° ± 0.3° C.I. = [1.3°, 5.8°] was measured, a value similar to the published extent of Haidinger's brush (4°). The increase in apparent size and clarity of entoptic phenomena produced by the presented structured light stimuli offers the potential to detect the early signs of macular disease over perception tasks using uniform polarization stimuli.
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Affiliation(s)
- C Kapahi
- Institute for Quantum Computing, University of Waterloo, Waterloo, ON, N2L3G1, Canada
- Department of Physics, University of Waterloo, Waterloo, ON, N2L3G1, Canada
| | - A E Silva
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, N2L3G1, Canada
| | - D G Cory
- Institute for Quantum Computing, University of Waterloo, Waterloo, ON, N2L3G1, Canada
- Department of Chemistry, University of Waterloo, Waterloo, ON, N2L3G1, Canada
| | | | - M A Mungalsingh
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, N2L3G1, Canada
| | - D A Pushin
- Institute for Quantum Computing, University of Waterloo, Waterloo, ON, N2L3G1, Canada
- Department of Physics, University of Waterloo, Waterloo, ON, N2L3G1, Canada
- Centre for Eye and Vision Research, Hong Kong, SAR, China
| | - T Singh
- Centre for Eye and Vision Research, Hong Kong, SAR, China
| | - B Thompson
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, N2L3G1, Canada
- Centre for Eye and Vision Research, Hong Kong, SAR, China
| | - D Sarenac
- Institute for Quantum Computing, University of Waterloo, Waterloo, ON, N2L3G1, Canada
- Centre for Eye and Vision Research, Hong Kong, SAR, China
- Department of Physics, University at Buffalo, State University of New York, Buffalo, New York 14260, USA
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Madan R, Kumar N, Singh T, Yadav J, Kumar R, Sachdeva N, Jain R, Goyal S, Khosla D, Jayapalan S, Sahoo S, M K, Tripathi M. Early Bone Mineral Density Changes and Endocrinal Dysfunction in Childhood Brain Tumor Patients: A Prospective Study. Int J Radiat Oncol Biol Phys 2023; 117:e134. [PMID: 37784699 DOI: 10.1016/j.ijrobp.2023.06.937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Reduced bone mineral density (BMD) and hormonal dysfunction are considered as a late effect of cranial radiation (RT). Only few studies have reported the occurrence of these problems soon after the diagnosis of brain tumor or RT initiation, emphasizing that these are not necessarily the late effects of RT. Thus, we conducted the study to analyze the incidence of low BMD and hormonal dysfunction prior to or within 6 months of RT (early change) in children with brain tumors. MATERIALS/METHODS The study was conducted as a part of intramural funding program at a tertiary care center in India. Childhood and adolescent brain tumor patients were advised for dual energy X-ray absorptiometry scan (DXA) and hormonal evaluation prior to RT. In some patients, first DXA was done within 6 months of RT due to logistics. To see the effect of radiation, we have planned to repeat hormonal evaluation after 6 and 12 months and DXA after 12 months of RT. RESULTS Twenty-five patients were analyzed. Median age at diagnosis was 11 years with a male to female ratio of 5.2:1. Medulloblastoma was the commonest diagnosis (n = 12), followed by glioma (n = 8), pineal tumors (n = 3) and ependymoma (n = 2). Nineteen and six patients underwent DXA before RT and within 6 months of RT respectively. For BMD assessment, Z score was calculated at hip and lumbar spine. BMD was defined as low (Z score = -1 to-1.99), very low (Z score = -2 to -2.5) and secondary osteoporosis (Z score ≤ -2.5). Median Z score at femur neck and spine was -2 and -1.9 respectively. Overall; 6, 3 and 9 patients had normal, low and very low BMD respectively. Seven patients had secondary osteoporosis (Table 1). Two patients with secondary osteoporosis had low vitamin D levels. None of the patient had compression fracture. On statistical analysis, no correlation was found between BMD changes and age, sex and site of the tumor. Pre RT endocrinal assessment (N = 25) was done by tanner staging and serum hormonal levels (GH, T3/T4/TSH, ACTH, cortisol and prolactin). Gonadal hormonal assessment was done in children with early or delayed puberty. Three patients were found to have endocrinal abnormality before RT (precautious puberty, central hypothyroidism and low sex hormones in 1 patient each). Follow up DXA and hormonal evaluation are awaited to see the effect of RT. CONCLUSION The index study is one of the very few studies evaluating the early changes in BMD and hormonal dysfunction soon after brain tumor diagnosis or within 6 months of RT. We observed that a significant proportion of children had reduced BMD and hormonal dysfunction before RT, highlighting the importance of early assessment and referral to the specialist for better quality of life. Table 1: BMD and endocrinal dysfunction before or within 6 months of RT.
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Affiliation(s)
| | | | | | | | | | | | - R Jain
- PGIMER, Chandigarh, India
| | - S Goyal
- PGIMER, Chandigarh, India; Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | - K M
- PGIMER, Chandigarh, India
| | - M Tripathi
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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English KK, Singh T, McNutt TR, Lee EE, Bae HJ, Yenokyan G, DeWeese TL, Song D. Sexual Function and Dosimetric Relationships to Erectile Structures among Patients Treated Definitively with Pd-103 LDR Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2023; 117:e228-e229. [PMID: 37784920 DOI: 10.1016/j.ijrobp.2023.06.1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Sexual potency and erectile function are important quality of life metrics for many men and is a significant consideration when planning and treating prostate cancer. There are limited long-term data correlating post-implant dosimetry with patient-reported sexual toxicity outcomes following LDR prostate brachytherapy using Pd-103, specifically as it pertains to genital substructures. Our aim was to correlate dosimetric patterns with quality-of-life outcomes to determine if dose to the pudendal arteries and neurovascular bundles is a significant consideration when planning prostate LDR brachytherapy. MATERIALS/METHODS We analyzed a prospectively collected IRB-approved database of men receiving LDR prostate brachytherapy between 11/2014-04/2019 at our institution. Patients received either LDR brachytherapy only, or combined with intensity-modulated radiation therapy (IMRT) to the prostate with or without pelvic lymph node coverage. Patients were given quality of life questionnaires at consultation and at subsequent follow up visits. Outcomes data related to sexual toxicity were evaluated based on the Sexual Health Inventory (SHIM) Questionnaire. The right/left pudendal arteries, and right/left neurovascular bundles (NVB) were contoured retrospectively on CT-MRI fusion sequences. Dosimetric data for each of the erectile substructures was analyzed. Statistical analyses included generalized linear mixed effects models with random intercept for patient to explore the association between dose and SHIM confidence. RESULTS A total of 50 patients met criteria for inclusion in the analysis. 5 patients received combined IMRT to 45 Gy with Pd-103 (90-100 Gy) and 45 patients received Pd-103 monotherapy (125 Gy). Median follow-up was 18 months for 50 patients; 40 (80%) patients had follow-up greater than 2 years, and 15 (30%) greater than 5 years. There were 344 individual questionnaires completed. 28% of records reported low or very low confidence level (Question #1 of SHIM questionnaire). Likelihood of moderate-very high confidence increased up to 2 years after beginning of treatment (p = 0.052) and then subsequently decreased between 2- and 5 years post treatment (p = 0.042). NVB doses were not associated with SHIM confidence level. D100 greater than 150 cGy to either pudendal artery was associated with worse SHIM confidence score after treatment (p = 0.003). CONCLUSION Sexual function is variable in the post treatment setting following definitive prostate radiation with Pd-103 LDR-brachytherapy. Avoiding pudendal artery dose may improve sexual outcomes and should be considered when planning prostate brachytherapy. Further investigation with a larger prospective, cohort may be warranted.
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Affiliation(s)
| | - T Singh
- Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD
| | - T R McNutt
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - E E Lee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - H J Bae
- University of Maryland, Baltimore, MD
| | - G Yenokyan
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - T L DeWeese
- Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD
| | - D Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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Faujdar DS, Prinja S, Singh T, Sahay S, Kumar R. Costing analysis of an information & communications technology-enabled primary healthcare facility in India. Indian J Med Res 2023; 157:231-238. [PMID: 37282386 PMCID: PMC10438417 DOI: 10.4103/ijmr.ijmr_454_20] [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] [Received: 02/22/2020] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND & OBJECTIVES Information and communications technology (ICT) has often been endorsed as an effective tool to improve primary healthcare. However, evidence on the cost of ICT-enabled primary health centre (PHC) is lacking. The present study aimed at estimating the costs for customization and implementation of an integrated health information system for primary healthcare at a public sector urban primary healthcare facility in Chandigarh. METHODS We undertook economic costing of an ICT-enabled PHC based on health system perspective and bottom-up costing. All the resources used for the provision of ICT-enabled PHC, capital and recurrent, were identified, measured and valued. The capital items were annualized over their estimated life using a discount rate of 3 per cent. A sensitivity analysis was undertaken to assess the effect of parameter uncertainties. Finally, we assessed the cost of scaling up ICT-enabled PHC at the state level. RESULTS The estimated overall annual cost of delivering health services through PHC in the public sector was ₹ 7.88 million. The additional economic cost of ICT was ₹ 1.39 million i.e. 17.7 per cent over and above a non-ICT PHC cost. In a PHC with ICT, the cost per capita increased by ₹ 56. On scaling up to the state level (with 400 PHCs), the economic cost of ICT was estimated to be ₹ 0.47 million per year per PHC, which equates to approximately six per cent expenditure over and above the economic cost of a regular PHC. INTERPRETATION & CONCLUSIONS Implementing a model of information technology-PHC in a state of India would require an augmentation of cost by about six per cent, which seems fiscally sustainable. However, contextual factors related to the availability of infrastructure, human resources and medical supplies for delivering quality PHC services will also need to be considered.
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Affiliation(s)
| | - Shankar Prinja
- Department of Community Medicine & School of Public Health, Chandigarh, India
| | - Tarundeep Singh
- Department of Community Medicine & School of Public Health, Chandigarh, India
| | - Sundeep Sahay
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Rajesh Kumar
- Department of Community Medicine & School of Public Health, Chandigarh, India
- Former Dean (Academic), Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Hartje-Dunn C, Blume E, Bastardi H, Clark M, Daly K, Fynn-Thompson F, Gauvreau K, Singh T. Steroid Avoidance in Pediatric Heart Transplant. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.203] [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] [Indexed: 04/05/2023] Open
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Milligan C, Singh T, Nava G, Kobayashi R, Esteso P, Daly K. The Molecular Microscope Diagnostic System (MMDx) Fails to Detect Early Antibody Mediated Rejection after Flow Crossmatch Positive Pediatric Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1317] [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] [Indexed: 04/05/2023] Open
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Milligan C, Wong A, Bastardi H, Daly K, Singh T, Esteso P. Treatment of Antibody-Mediated Rejection in Adolescent Heart Transplant Recipients with Daratumumab. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1321] [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] [Indexed: 04/05/2023] Open
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Khanna P, Kaur M, Varma N, Sharma S, Sehgal R, Singh T, Srivastava R, Kushwaha S, Jain R. Impact of Community Based Nutrition Intervention in the Prevention and Control of Anaemia Among Reproductive Aged Women of India. Matern Child Health J 2023:10.1007/s10995-023-03656-x. [PMID: 36988792 DOI: 10.1007/s10995-023-03656-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Maternal and child under-nutrition is particularly widespread in low and middle-income nations, increasing the overall disease burden due to poor nutritional status. The aim of this study was to develop nutrition intervention for the prevention and control of anaemia among women of reproductive age. METHODS Community-based intervention study was conducted among 443 women of reproductive age group (15-49 years) to determine the effectiveness of a 6-month nutrition intervention package. The nutrition intervention was developed by using Precede-Proceed model and the trans-theoretical model of behavior change. Multi-channel communication approach was adopted and nutrition intervention package was provided. Assessment of haemoglobin, red blood cells, platelet, ferritin, folate, vitamin B12, haematocrit test, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, red cell distribution width and total leucocyte count was compared at the baseline and endline after the intervention among the participants. The chi-square test of independence and t-test were performed. RESULTS The only mean ferritin level shows significant improvement (p < 0.001). A significant decrease (~ 15%, p = 0.027) in anaemia was observed after the intervention. CONCLUSIONS Improvement in anaemic status of women was observed. National schemes and programs require a more robust strategical implementation like food fortification/bio fortification and behaviour change communication at village level to enhance the availability and accessibility of fortified food.
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Affiliation(s)
- Poonam Khanna
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Manmeet Kaur
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Neelam Varma
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sadhna Sharma
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Rakesh Sehgal
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Tarundeep Singh
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Rachana Srivastava
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Savitesh Kushwaha
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Rachita Jain
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Singh T, Shah N. Reply to Letter to Editor regarding the article, "Competency-based medical education and the McNamara fallacy: Assessing the important or making the assessed important?". J Postgrad Med 2023; 69:124. [PMID: 36930545 DOI: 10.4103/jpgm.jpgm_919_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Affiliation(s)
- T Singh
- Center for Health Professions Education, Adesh University, Bathinda, India
| | - N Shah
- Department of Psychiatry, Smt. NHL Municipal Medical College and SVPIMSR, Ahmedabad, India
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Singh T, Lavikainen L, Halme A, Aaltonen R, Agarwal A, Blanker M, Bolsunovskyi K, Cartwright R, García-Perdomo H, Gutschon R, Lee Y, Pourjamal N, Vernooij R, Violette P, Haukka J, Guyatt G, Tikkinen K. Timing of symptomatic venous thromboembolism after surgery: A systematic review and meta-analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01049-7] [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] [Indexed: 02/12/2023]
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Singh T, Shah N. Competency-based medical education and the McNamara fallacy: Assessing the important or making the assessed important? J Postgrad Med 2023; 69:35-40. [PMID: 36255018 PMCID: PMC9997611 DOI: 10.4103/jpgm.jpgm_337_22] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The McNamara fallacy refers to the tendency to focus on numbers, metrics, and quantifiable data while disregarding the meaningful qualitative aspects. The existence of such a fallacy in medical education is reviewed in this paper. Competency-based medical education (CBME) has been introduced in India with the goal of having Indian Medical Graduates competent in five different roles - Clinician, Communicator, Leader and member of the health care team, Professional, and Lifelong learner. If we only focus on numbers and structure to assess the competencies pertaining to these roles, we would be falling prey to the McNamara fallacy. To assess these roles in the real sense, we need to embrace the qualitative assessment methods and appreciate their value in competency-based education. This can be done by using various workplace-based assessments, choosing tools based on educational impact rather than psychometric properties, using narratives and descriptive evaluation, giving grades instead of marks, and improving the quality of the questions asked in various exams. There are challenges in adopting qualitative assessment starting with being able to move past the objective-subjective debate, to developing expertise in conducting and documenting such assessment, and adding the rigor of qualitative research methods to enhance its credibility. The perspective on assessment thus needs a paradigm shift - we need to assess the important rather than just making the assessed important; and this would be crucial for the success of the CBME curriculum.
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Affiliation(s)
- T Singh
- Center for Health Professions Education, Adesh University, Bathinda, Punjab, India
| | - N Shah
- Department of Psychiatry, Smt. NHL Municipal Medical College and SVPIMSR, Ahmedabad, Gujarat, India
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Chaudhary S, Walia R, Bhansali A, Dayal D, Sachdeva N, Singh T, Bhadada SK. Unravelling a novel, promising and convenient tool for differential diagnosis of delayed puberty: GnRHa-stimulated inhibin B (GnRH-iB). J Endocrinol Invest 2022; 45:2265-2273. [PMID: 35841519 DOI: 10.1007/s40618-022-01858-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Etiological diagnosis of delayed puberty is difficult. Despite availability of various basal and stimulation tests differentiation between constitutional delay in puberty and hypogonadotropic hypogonadism is still challenging. OBJECTIVE To elucidate the role of GnRH agonist-stimulated inhibin B (GnRH-iB) for the differential diagnosis of delayed puberty. STUDY DESIGN Participants were recruited into "exploratory cohort" (n = 39) and "validation cohort" (n = 16). "Exploratory cohort" included children with spontaneous puberty and patients with hypogonadotropic hypogonadism. "Validation cohort" constituted children who presented with delayed puberty. INTERVENTION AND OUTCOME GnRHa (Triptorelin) stimulation test along with measurement of inhibin B level at 24 h after GnRHa injection was performed in all the study participants. Cut-offs for GnRH-iB were derived from the "exploratory cohort". These cut-offs were applied to the "validation cohort". Basal LH, basal inhibin B(INH-B), GnRHa-stimulated LH at 4 h (GnRH-LH) and GnRH-iB were evaluated for the prediction of onset of puberty on prospective follow-up. RESULTS GnRH-iB at a cut-off value of 113.5 pg/ml in boys and 72.6 pg/ml in girls had 100% sensitivity and specificity for the documentation of puberty. In the "validation cohort" basal LH, basal INH-B, GnRH-LH, and GnRH-iB had a diagnostic accuracy of 68.75%, 81.25%, 68.75% and 93.75% respectively, for the prediction of onset of puberty. Basal LH, basal INH-B and GnRH-LH used alone or in combination were inferior to GnRH-iB used alone. CONCLUSION GnRHa-stimulated inhibin B (GnRH-iB) is a convenient and easily employable test for the differentiation of constitutional delay in puberty from hypogonadotropic hypogonadism. CTRI REGISTRATION NO CTRI/2019/10/021570.
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Affiliation(s)
- S Chaudhary
- Department of Endocrinology, PGIMER, Chandigarh, 160012, India
| | - R Walia
- Department of Endocrinology, PGIMER, Chandigarh, 160012, India.
| | - A Bhansali
- Department of Endocrinology, PGIMER, Chandigarh, 160012, India
| | - D Dayal
- Department of Paediatrics, PGIMER, Chandigarh, 160012, India
| | - N Sachdeva
- Department of Endocrinology, PGIMER, Chandigarh, 160012, India
| | - T Singh
- Department of Radiology, PGIMER, Chandigarh, 160012, India
| | - S K Bhadada
- Department of Endocrinology, PGIMER, Chandigarh, 160012, India
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Hooshmand S, Kumar S, Bahadur I, Singh T, Varma RS. Deep eutectic solvents as reusable catalysts and promoter for the greener syntheses of small molecules: Recent advances. J Mol Liq 2022. [DOI: 10.1016/j.molliq.2022.121013] [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] [Indexed: 12/14/2022]
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Patel R, Singh T. P02 Systematic review of mutational signature analysis in HPV positive oropharyngeal squamous cell carcinoma. Oral Oncol 2022. [DOI: 10.1016/j.oraloncology.2022.106143] [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] [Indexed: 11/10/2022]
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17
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Joshi S, Singh T, Kershaw LE, Spath N, Dattani A, Gulsin GS, Semple SI, Williams MW, Gibb F, Forbes S, Reynolds RP, McCann GP, Dweck MR, Newby DE. Manganese enhanced magnetic resonance imaging in type 1 and type 2 diabetes mellitus. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The pathophysiology of diabetic cardiomyopathy has yet to be established although pre-clinical studies suggest a role for altered myocardial calcium handling. Manganese-enhanced magnetic resonance imaging (MEMRI) is a novel non-invasive method of assessing in vivo myocardial calcium handling.
Purpose
To investigate whether myocardial calcium handling is impaired in patients with either type 1 or type 2 diabetes mellitus in the absence of underlying heart disease.
Methods
In a prospective case-control study, patients with type 1 (n=19) or type 2 (n=10) diabetes mellitus and healthy volunteers (n=15) underwent MEMRI. Participants with prior coronary artery disease, cardiomyopathy or an abnormal electrocardiogram were excluded. Manganese dipyridoxyl diphosphate (0.1 mL/kg) was administered over 10 min and myocardial T1 mapping was performed prior to and every 2.5 min for 30 min after contrast infusion (Figure 1). Quantitative manganese uptake analysis was performed by measuring T1 relaxation times in a region of interest within the interventricular septum and compared to the left ventricular blood pool. The rate of myocardial manganese uptake was determined by Patlak modelling [1].
Results
Participants with type 1 and type 2 diabetes mellitus were older (50±13 and 55±15.3 years) than the healthy volunteers (32±10 years). All participants had preserved left ventricular ejection fraction (type 1 diabetes mellitus, 67.7±6.1%; type 2 diabetes mellitus, 66.8±3.2%; healthy volunteers, 65±3.5%). Mean myocardial manganese uptake was reduced in participants with both type 1 (6.4±0.6 mL/100 g of tissue/min) and type 2 (6.4±0.5 mL/100 g of tissue/min) diabetes mellitus compared with healthy volunteers (8.3±0.5 mL/100 g of tissue/min; p<0.0001 for both, Figure 2). There were no differences in myocardial manganese uptake between those with type 1 or type 2 diabetes mellitus (p=0.22). There was no statistically significant correlation between myocardial manganese uptake and age in the study population (r=−0.28, p=0.07).
Conclusion
Using MEMRI, we have demonstrated that myocardial calcium handling is impaired in patients with either type 1 or type 2 diabetes mellitus even in the absence of left ventricular systolic dysfunction. This suggests altered myocardial calcium handling may underlie, or contribute to, diabetic cardiomyopathy which has implications developing novel therapeutic targets for the prevention and treatment of diabetic cardiomyopathy.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): British Heart Foundation - Clinical Research Training Fellowship (FS/CRTF/20/24087)AstraZeneca - Investigator initiated award (ESR-19-20118)
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Affiliation(s)
- S Joshi
- University of Edinburgh , Edinburgh , United Kingdom
| | - T Singh
- University of Edinburgh , Edinburgh , United Kingdom
| | - L E Kershaw
- University of Edinburgh , Edinburgh , United Kingdom
| | - N Spath
- University of Edinburgh , Edinburgh , United Kingdom
| | - A Dattani
- University of Leicester, Cardiovascular Research Unit , Leicester , United Kingdom
| | - G S Gulsin
- University of Leicester, Cardiovascular Research Unit , Leicester , United Kingdom
| | - S I Semple
- University of Edinburgh , Edinburgh , United Kingdom
| | - M W Williams
- University of Edinburgh , Edinburgh , United Kingdom
| | - F Gibb
- University of Edinburgh , Edinburgh , United Kingdom
| | - S Forbes
- University of Edinburgh , Edinburgh , United Kingdom
| | - R P Reynolds
- University of Edinburgh , Edinburgh , United Kingdom
| | - G P McCann
- University of Leicester, Cardiovascular Research Unit , Leicester , United Kingdom
| | - M R Dweck
- University of Edinburgh , Edinburgh , United Kingdom
| | - D E Newby
- University of Edinburgh , Edinburgh , United Kingdom
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18
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Singh T, Joshi S, Kersahw LE, Baker AH, Dawson DK, Dweck MR, Semple SI, Newby DE. Manganese-enhanced magnetic resonance imaging in Takotsubo syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Takotsubo syndrome is an increasingly common acute cardiac emergency characterised by profound transient left ventricular systolic dysfunction following a stressful event. Its pathophysiology remains poorly understood and a third of patients will have a major adverse cardiac or cerebrovascular event by 5 years [1]. Defective myocardial calcium homeostasis is central to contractile dysfunction and may be implicated in its pathophysiology. Manganese-enhanced magnetic resonance imaging is a novel non-invasive imaging technique that assesses myocardial manganese uptake as a measure of myocardial calcium handling [2]. Our aim was to investigate myocardial calcium handling using manganese-enhanced magnetic resonance imaging during the acute and recovery phase of takotsubo syndrome.
Methods
This single centre case-controlled observational longitudinal cohort study was conducted in accordance with the Declaration of Helsinki and ethical committee approval with written informed consent. Twenty patients with takotsubo syndrome and 20 age, sex and cardiovascular risk factor matched volunteers were recruited between March 2020 and September 2021. Patients underwent gadolinium and manganese-enhanced magnetic resonance imaging during the index event with repeat manganese-enhanced magnetic resonance imaging after 3 months. Myocardial manganese uptake was characterised by Patlak modelling.
Results
During the acute presentation, most patients had an “apical” pattern of takotsubo syndrome with reduced left ventricular ejection fraction (51±11 versus 67±8%, P<0.001, Figure 1), elevated left ventricular mass (89±11 versus 57±14 g/m2, P<0.01) and native T1 (1358±49 versus 1211±28 ms, P<0.001) and T2 (60±7 versus 38±3 ms, P<0.001) values compared to matched volunteers. Patlak modelling demonstrated reduced myocardial manganese uptake (5.1±0.5 versus 8.0±1.0 mL/100g of tissue/min, P<0.0001) consistent with a major abnormality of myocardial calcium handling. Reduced myocardial manganese uptake attributable to apical takotsubo syndrome could be seen in one patient, scanned 18 days after symptom onset despite apparent resolution of cardiac function. Beyond 3 months of convalescence, left ventricular mass, ejection fraction, native T1 and T2 values were comparable to matched volunteers. Despite this, myocardial calcium handling remained abnormal compared to matched volunteers (6.7±0.7 versus 8.0±1.0 mL/100 g of tissue/min, P<0.001, Figure 2).
Conclusions
In patients with takotsubo syndrome, there is a profound perturbation of myocardial calcium handling which is most marked acutely but persists after apparent recovery of left ventricular ejection fraction and resolution of myocardial oedema. Abnormal myocardial calcium handling is implicated in the pathophysiology of takotsubo syndrome and manganese-enhanced magnetic resonance imaging could play a major role in the diagnosis and risk stratification of patients with takotsubo syndrome.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Medical Research CouncilBritish Heart Foundation
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Affiliation(s)
- T Singh
- University of Edinburgh, BHF/University Centre for Cardiovascular Science , Edinburgh , United Kingdom
| | - S Joshi
- University of Edinburgh, BHF/University Centre for Cardiovascular Science , Edinburgh , United Kingdom
| | - L E Kersahw
- University of Edinburgh, BHF/University Centre for Cardiovascular Science , Edinburgh , United Kingdom
| | - A H Baker
- University of Edinburgh, BHF/University Centre for Cardiovascular Science , Edinburgh , United Kingdom
| | - D K Dawson
- University of Aberdeen, Aberdeen Cardiovascular and Diabetes Centre , Aberdeen , United Kingdom
| | - M R Dweck
- University of Edinburgh, BHF/University Centre for Cardiovascular Science , Edinburgh , United Kingdom
| | - S I Semple
- University of Edinburgh, BHF/University Centre for Cardiovascular Science , Edinburgh , United Kingdom
| | - D E Newby
- University of Edinburgh, BHF/University Centre for Cardiovascular Science , Edinburgh , United Kingdom
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19
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Dattani A, Gulsin GS, Yeo JL, Joshi S, Singh A, Brady EM, Parke KS, Arnold JR, Singh T, Kershaw LE, Spath NB, Semple SI, Dweck MR, Newby DE, McCann GP. Impaired myocardial calcium handling in people with type 2 diabetes: an in vivo manganese-enhanced magnetic resonance imaging study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There is a high prevalence of subclinical cardiac dysfunction in people with type 2 diabetes (T2D) which is associated with subsequent development of heart failure. Dysregulated myocardial calcium handling has been demonstrated in animal models of T2D and may be a key mechanism driving the development of heart failure. Manganese-enhanced cardiac magnetic resonance imaging (MEMRI) provides a unique method to assess in vivo myocardial calcium handling.
Purpose
To determine whether myocardial calcium handling is perturbed in people with T2D with no history of cardiovascular disease. We hypothesised that myocardial manganese uptake would be reduced in people with T2D compared with healthy volunteers.
Methods
Cross-sectional case-control study, adults with (n=20) and without (n=9) T2D underwent both gadolinium-enhanced MRI and MEMRI. Standard gadolinium-enhanced MRI was used to assess cardiac structure, function and tissue characteristics. MEMRI scans were performed within two weeks of the initial scan. Native T1 maps were obtained in the mid-short axis slice position using a Modified Look-Locker Inversion recovery sequence. An intravenous infusion of manganese dipyridoxyl diphosphate (5 μmol/kg (0.1 mL/kg) at 1 mL/min) was administered and T1 maps at the same location were repetitively acquired every 2.5 min for 30 min. Regions of interest were drawn in the inferoseptal segment and blood pool for all T1 maps from 0 to 30 min by a single observer. The primary outcome was the rate of manganese uptake which was assessed by Patlak modelling as a measure of myocardial calcium handling. Manganese uptake constants were compared using analysis of co-variance, with age, sex and body mass index as co-variates.
Results
Subjects with T2D were older (62±7 vs. 57±5 years, p=0.046) but body mass index (29.0±4.5 vs. 26.2±3.4 kg/m2, p=0.106), systolic (135±16 vs. 134±17 mmHg, p=0.809) and diastolic (81±10 vs. 83±9 mmHg, p=0.736) blood pressures were similar. Compared to control subjects, participants with T2D had normal systolic function but more concentric left ventricular remodelling (mass/volume ratio 0.90±0.14 vs. 0.71±0.06 g/mL, p<0.001) and reduced peak early diastolic strain rate (0.64±0.17 vs. 0.91±0.26 s–1, p=0.002). Myocardial manganese uptake was substantially reduced in people with T2D compared with controls (6.51±1.46 vs. 8.45±2.52 ml/100 g of tissue/min, p=0.003) (Figure 1).
Conclusions
For the first time, we have demonstrated in vivo that despite no history of cardiovascular disease and normal systolic function, patients with T2D have marked impairment of myocardial calcium handling. This has potential major implications for the pathogenesis, diagnosis and treatment of diabetic cardiomyopathy.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation and National Institute for Health Research
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Affiliation(s)
- A Dattani
- University of Leicester , Leicester , United Kingdom
| | - G S Gulsin
- University of Leicester , Leicester , United Kingdom
| | - J L Yeo
- University of Leicester , Leicester , United Kingdom
| | - S Joshi
- University of Edinburgh , Edinburgh , United Kingdom
| | - A Singh
- University of Leicester , Leicester , United Kingdom
| | - E M Brady
- University of Leicester , Leicester , United Kingdom
| | - K S Parke
- University of Leicester , Leicester , United Kingdom
| | - J R Arnold
- University of Leicester , Leicester , United Kingdom
| | - T Singh
- University of Edinburgh , Edinburgh , United Kingdom
| | - L E Kershaw
- University of Edinburgh , Edinburgh , United Kingdom
| | - N B Spath
- University of Edinburgh , Edinburgh , United Kingdom
| | - S I Semple
- University of Edinburgh , Edinburgh , United Kingdom
| | - M R Dweck
- University of Edinburgh , Edinburgh , United Kingdom
| | - D E Newby
- University of Edinburgh , Edinburgh , United Kingdom
| | - G P McCann
- University of Leicester , Leicester , United Kingdom
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20
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Zaidman C, Shieh P, Proud C, McDonald C, Day J, Mason S, Guridi M, Hu L, Yu L, Reid C, Darton E, Wandel C, Richardson J, Malhotra J, Singh T, Rodino-Klapac L, Mendell J. P.128 Integrated analyses of data from clinical trials of delandistrogene moxeparvovec in DMD. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.244] [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] [Indexed: 11/07/2022]
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21
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Sharma RK, Bush N, Rana SS, Srinivasan R, Nada R, Gupta R, Rana S, Singh T. Lower cyst fluid carcinoembryonic antigen cutoff is helpful in the differential diagnosis of mucinous versus non-mucinous pancreatic cysts. Indian J Gastroenterol 2022; 41:397-404. [PMID: 36057043 DOI: 10.1007/s12664-022-01269-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/02/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Pancreatic cystic lesions (PCLs) are being diagnosed with increased frequency and have varying neoplastic potential. We conducted this multimodal, prospective study to evaluate the role of tumor cytology and molecular markers to differentiate PCL subtypes. METHODS Consecutive undiagnosed patients with PCLs (n = 100, mean age: 50.37 years; 41% males) were prospectively studied. Cyst fluid carcinoembryonic antigen (CEA), CA19.9, CA125, CA72.4, and vascular endothelial growth factor-alpha (VEGF-α) levels were measured by quantitative enzyme-linked immunosorbent assay (ELISA) method. Mutational analysis of the KRAS gene (exon 2, Codon 12 and 13) and GNAS gene (Exon 8, Codon 201) were performed by Sanger's sequencing. RESULTS The mean cyst size was 4.32 ± 2.4 cm. Fluid cytology revealed definitive diagnosis in 21 (22.3%) patients. All malignant PCLs could be identified on cytology whereas 10/14 (71%) non-malignant mucinous PCLs could also be identified on cytology based on mucin staining. Among the tested tumor markers, cyst fluid CEA had the best diagnostic performance for differentiation between mucinous and non-mucinous PCLs (AUC 0.933 [95% CI 0.86-0.91]). At a cyst fluid CEA cutoff level of 45.0 ng/mL, the sensitivity, specificity, positive predictive value, and negative predictive value for differentiation between mucinous and non-mucinous cysts were 88.5%, 96.8%, 92.0%, and 95.3%, respectively (p < 0.05). KRAS and GNAS mutation had no significant diagnostic benefit in comparison to fluid cytology and CEA levels. CONCLUSIONS Fluid CEA at a lower cutoff of 45 ng/mL is the most accurate marker to differentiate between mucinous and non-mucinous PCL. The KRAS and GNAS mutational analysis does not improve upon the diagnostic performance of fluid cytology and tumor markers.
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Affiliation(s)
- Ravi Kumar Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Nikhil Bush
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Surinder Singh Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
| | - Radhika Srinivasan
- Department of Cytology and Gynecology Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Ritambhra Nada
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Rajesh Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Satyavati Rana
- Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Tarundeep Singh
- Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
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22
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Pradhan S, Ranjan R, Verma A, Singh T, Aggarwal L, Singh R, Shahi U. PD-0906 Functional MRI as an Assessment Tool in Carcinoma Cervix Patients Undergoing Chemoradiation. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02985-1] [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] [Indexed: 11/17/2022]
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23
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Iyengar K, Gupta M, Pal S, Kaur K, Singla N, Verma M, Dhiman A, Singla R, Rohilla M, Suri V, Aggarwal N, Singh T, Goel P, Goel NK, Pant R, Gaur KL, Gehlot H, Bhati I, Verma M, Agarwal S, Acharya R, Singh K, Chauhan M, Rastogi R, Bedi R, Pancholi P, Nayak B, Modi B, Nakum K, Trivedi A, Aggarwal S, Patel S. Baseline Assessment of Evidence-Based Intrapartum Care Practices in Medical Schools in 3 States in India: A Mixed-Methods Study. Glob Health Sci Pract 2022; 10:e2100590. [PMID: 35487543 PMCID: PMC9053154 DOI: 10.9745/ghsp-d-21-00590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Implementation research with pre- and post-comparison was planned to improve the quality of evidence-based intrapartum care services in Indian medical schools. We present the baseline study results to assess the status of adherence to intrapartum evidence-based practices (IP-EBP) in study schools in 3 states in India and the perception of the faculty. METHODS A concurrent mixed-methods approach was used to conduct the baseline assessment in 9 medical schools in Rajasthan, Gujarat, and Union Territory from October 2018 to June 2019. IP-EBP among pregnant women in uncomplicated first (n=135), second (n=120), and third stage (n=120) of labor were observed using a predesigned, pretested checklist quantitatively. We conducted in-depth interviews with 33 obstetrics and gynecology faculty to understand their perceptions of intrapartum practices. Quantitative data were analyzed using SPSS (version 22). COM-B (Capability, Opportunity, and Motivation Behavior) model was used to understand the behaviors, and thematic analysis was done for the qualitative data. FINDINGS Unindicated augmentation of labor was done in 64.4%, fundal pressure applied in 50.8%, episiotomy done in 58.3%, and delivery in lithotomy position was performed in 86.7% of women in labor. CONCLUSIONS Intrapartum practices that are not recommended were routinely practiced in the study medical schools due to a lack of staff awareness of evidence-based practices and incorrect beliefs about their impact.
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Affiliation(s)
| | - Madhu Gupta
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Swarnika Pal
- Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Kiranjit Kaur
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Neena Singla
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Madhur Verma
- All India Institute Medical Science, Bathinda, Punjab, India
| | - Anchal Dhiman
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rimpi Singla
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Minakshi Rohilla
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vanita Suri
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Neelam Aggarwal
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Tarundeep Singh
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Poonam Goel
- Government Medical College and Hospital, Chandigarh, India
| | - N K Goel
- Government Medical College and Hospital, Chandigarh, India
| | - Reena Pant
- Swai Maan Singh Medical College, Jaipur, Rajasthan, India
| | | | - Hanslata Gehlot
- Dr. Sampurnanand Medical College and Hospital, Jodhpur, Rajasthan, India
| | - Indra Bhati
- Dr. Sampurnanand Medical College and Hospital, Jodhpur, Rajasthan, India
| | - Manoj Verma
- Dr. Sampurnanand Medical College and Hospital, Jodhpur, Rajasthan, India
| | - Sudesh Agarwal
- Sardar Patel Medical College and PBM Hospital, Bikaner Rajasthan, India
| | - Rekha Acharya
- Sardar Patel Medical College and PBM Hospital, Bikaner Rajasthan, India
| | - Keerti Singh
- Rabindranath Tagore Medical College and Hospital, Udaipur, Rajasthan, India
| | - Madhubala Chauhan
- Rabindranath Tagore Medical College and Hospital, Udaipur, Rajasthan, India
| | - Radha Rastogi
- Rabindranath Tagore Medical College and Hospital, Udaipur, Rajasthan, India
| | - Renu Bedi
- Jawaharlal Nehru Medical College and Hospital, Ajmer Rajasthan, India
| | - Poornima Pancholi
- Jawaharlal Nehru Medical College and Hospital, Ajmer Rajasthan, India
| | - Bipin Nayak
- GMERS Medical College and Hospital, Gandhinagar, Gujarat, India
| | - Bhavesh Modi
- GMERS Medical College and Hospital, Gandhinagar, Gujarat, India
| | - Kanaklata Nakum
- Government Medical College and Hospital, Bhavnagar, Gujarat, India
| | - Atul Trivedi
- Government Medical College and Hospital, Bhavnagar, Gujarat, India
| | | | - Sangita Patel
- Government Medical College and Hospital, Baroda, Gujarat, India
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24
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Elerian S, El Tagy H, Munuswamy S, Singh T, De C. 38 Virtual Trauma Meeting-the Game Changer During COVID 19 Era. A Quantitative Comparative Analysis. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
In an orthopaedic department, majority of plans and decision-making cases occur at the daily trauma meeting. With the advent of COVID-19 pandemic, it was challenging to deliver the standard care maintaining social distancing guidelines. Therefore, virtual trauma handover replaced the traditional face-to-face handover as a standalone solution. This study has tried to report on effectivity of the new virtual trauma handover process.
Method
This single centre observational study compared retrospectively collected data during pre-COVID-19 period (2019) and prospectively followed data from virtual trauma meetings during COVID 19 pandemic. The study analysed comparison of meeting start and finish time, attendance of key members, punctuality of attendees and interruptions during the handover process.
Results
Changing from face-to-face to virtual trauma meetings, average participation doubled from 9 to 18 with increased consultant attendance (Mean: 7.5 vs 2) -statistically significant (p < 0.05). Enhanced senior clinician participation helped in multidisciplinary decision making promptly. Punctuality of attendance noted as declining late arrivals in 28/34 face-to-face to 4/34 virtual meetings. Although meetings start-time remained similar overall, there was less interruptions during virtual handover and mean meeting span reduced by 13 minutes.
Conclusions
As part of adaptive changes during COVID-19 pandemic, virtual trauma handover meetings have introduced changes in delivery of existing acute trauma services. Within very few limitations, it could be an aid to improve clinician participation, easiness of having multidisciplinary opinion and decision making. Moreover, it helped to practice social distancing guidelines. Educational activities are also effectively managed through virtual meetings.
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Affiliation(s)
- S. Elerian
- Sandwell and West Birmingham NHS Trust Hospitals, Birmingham, United Kingdom
| | - H. El Tagy
- Sandwell and West Birmingham NHS Trust Hospitals, Birmingham, United Kingdom
| | - S. Munuswamy
- Sandwell and West Birmingham NHS Trust Hospitals, Birmingham, United Kingdom
| | - T. Singh
- Sandwell and West Birmingham NHS Trust Hospitals, Birmingham, United Kingdom
| | - C. De
- Sandwell and West Birmingham NHS Trust Hospitals, Birmingham, United Kingdom
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25
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Cheng LJ, Sanguansri L, Hlaing MM, Singh T, Shrestha P, Augustin MA. Use of vegetables for enhancing oxidative stability of omega-3 oils in the powdered state. Food Chem 2022; 370:131340. [PMID: 34662791 DOI: 10.1016/j.foodchem.2021.131340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/10/2021] [Accepted: 10/02/2021] [Indexed: 01/05/2023]
Abstract
The preliminary study examined the effectiveness of various vegetables for the stabilisation of omega-3 oil powders against oxidative deterioration. Purees made from different vegetables (mushroom, brussels sprouts, broccoli, cauliflower, snow peas, tomato, and garlic) were employed for preparation of vegetable-tuna oil emulsions, which were subsequently freeze-dried into powders. Oxipres® data showed that vegetable-tuna oil powders had longer induction periods than neat tuna oil. During accelerated oxidation storage (40 °C/4weeks), eicosapentaenoic and docosahexaenoic acids in the vegetable-tuna oil powders were protected against oxidation, and there were lower levels of headspace secondary and tertiary oxidation products. Whole vegetable purees were suitable protective matrices for omega-3 oils. Of the various vegetable purees examined for protective effects against omega-3 oxidation, mushroom, brussels sprouts, broccoli, and cauliflower were superior to snow peas, garlic and tomato. The antioxidant properties of phytonutrients inherent in various vegetables are likely contributors to protection of omega-3 oil powders against oxidation.
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Affiliation(s)
- L J Cheng
- CSIRO Agriculture & Food, 671 Sneydes Road, Werribee, VIC 3030, Australia
| | - L Sanguansri
- CSIRO Agriculture & Food, 671 Sneydes Road, Werribee, VIC 3030, Australia
| | - M M Hlaing
- CSIRO Agriculture & Food, 671 Sneydes Road, Werribee, VIC 3030, Australia
| | - T Singh
- CSIRO Agriculture & Food, 671 Sneydes Road, Werribee, VIC 3030, Australia
| | - P Shrestha
- CSIRO Agriculture & Food, Clunies Ross Street, Black Mountain, ACT 2601, Australia
| | - M A Augustin
- CSIRO Agriculture & Food, 671 Sneydes Road, Werribee, VIC 3030, Australia.
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26
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Singh T, Aulakh R, Gupta P, Chhatwal J, Gupta P. Developing a competency-based undergraduate logbook for pediatrics: Process and lessons. J Postgrad Med 2022; 68:31-34. [PMID: 35042315 PMCID: PMC8860119 DOI: 10.4103/jpgm.jpgm_617_21] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
With the first MBBS batch admitted under the new National Medical Commission (NMC) undergraduate curriculum entering pediatric clinical posting soon, creation of a Pediatric logbook in consonance with this competency-based curriculum was felt to be a need of the hour. No such document is yet available in the public domain. The logbook template, created after enormous brainstorming amongst authors, includes 176 Shows (S), Shows How (SH) and Perform (P) level competencies. These were further segregated into certifiable (23), affective domain (25) and clinic/field visits (9) leaving 51 as documentable competencies. The institutions may use this template to build their own institute-specific logbook based on the infrastructure, faculty strength, clinical patient load, student intake and preferred assessment method(s). It would also be worthwhile to integrate this with the internship logbook (and later the postgraduate one for students opting for post-graduation in pediatrics) to provide a longitudinal record of each student's trajectory of learning.
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Affiliation(s)
- T Singh
- Departments of Pediatrics and Medical Education, SGRD Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - R Aulakh
- Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India
| | - P Gupta
- Department of Pediatrics, ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - J Chhatwal
- Department of Pediatrics, Kalpana Chawla Govt Medical College, Karnal, Haryana, India
| | - P Gupta
- Department of Pediatrics, University College of Medical Sciences, New Delhi, India
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Webb MM, Bridges P, Aruparayil N, Chugh C, Beacon T, Singh T, Sawhney SS, Bains L, Hall R, Jayne D, Gnanaraj J, Mishra A, Culmer PR. The RAIS Device for Global Surgery: Using a Participatory Design Approach to Navigate the Translational Pathway to Clinical Use. IEEE J Transl Eng Health Med 2022; 10:3700212. [PMID: 35865752 PMCID: PMC9292337 DOI: 10.1109/jtehm.2022.3177313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 11/19/2022]
Abstract
Background: Over 5 billion people worldwide have no access to surgery worldwide, typically in low-resource settings, despite it being a primary life-saving treatment. Gas Insufflation-Less Laparoscopic Surgery (GILLS) can address this inequity, by improving current GILLS instrumentation to modern surgical standards. Objective: to develop and translate a new Retractor for Abdominal Insufflation-less Surgery (RAIS) into clinical use and thus provide a context-appropriate system to advance GILLS surgery. Methods: A collaborative multidisciplinary team from the UK and India was formed, embedding local clinical stakeholders and an industry partner in defining user and contextual needs. System development was based on a phased roadmap for ‘surgical device design in low resource settings’ and embedded participatory and frugal design principles in an iterative process supported by traditional medical device design methodologies. Each phase of development was evaluated by the stakeholder team through interactive workshops using cadaveric surgical simulations. A Commercialisation phase undertook Design to Manufacture and regulatory approval activities. Clinical validation was then conducted with rural surgeons performing GILLS procedures using the RAIS system. Semi-structured questionnaires and interviews were used to evaluate device performance. Results: A set of user needs and contextual requirements were defined and formalised. System development occurred across five iterations. Stakeholder participation was instrumental in converging on a design which met user requirements. A commercial RAIS system was then produced by an industry partner under Indian regulatory approval. This was successfully used in clinical validation to conduct 12 surgical procedures at two locations in rural India. Surgical feedback showed that the RAIS system provided a valuable and usable surgical instrument which was appropriate for use in low-resource contexts. Conclusions: Using a context-specific development approach with close engagement of stakeholders was crucial to develop the RAIS system for low-resource regions. The outcome is translation from global health need into a fully realized commercial instrument which can be used by surgeons in low-resource regions across India.
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Affiliation(s)
- M. Marriott Webb
- School of Mechanical Engineering, University of Leeds, Leeds, U.K
| | | | - N. Aruparayil
- Leeds Institute of Medical Research, University of Leeds, Leeds, U.K
| | - C. Chugh
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - T. Beacon
- Medical Aid International, Bedford, U.K
| | - T. Singh
- XLO Ortho Life Systems, New Delhi, India
| | | | - L. Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - R. Hall
- Pd-m International, Thirsk, U.K
| | - D. Jayne
- Department of Academic Surgery, University of Leeds, Leeds, U.K
| | - J. Gnanaraj
- Department of Electronics and Instrumentation Engineering, Karunya University, Coimbatore, India
| | - A. Mishra
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - P. R. Culmer
- School of Mechanical Engineering, University of Leeds, Leeds, U.K
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Faujdar D, Kaur M, Singh T, Sahay S, Kumar R. Evaluating scope of mobile technology for bridging health care gaps in impoverished population in LMICs. J Family Med Prim Care 2022; 11:90-96. [PMID: 35309632 PMCID: PMC8930115 DOI: 10.4103/jfmpc.jfmpc_809_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 11/04/2022] Open
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Gandhi AP, Thakur JS, Gupta M, Kathirvel S, Goel K, Singh T. COVID-19 vaccination uptake and adverse events following COVID-19 immunization in pregnant women in Northern India: a prospective, comparative, cohort study. J Rural Med 2022; 17:228-235. [DOI: 10.2185/jrm.2022-025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/24/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Aravind P. Gandhi
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - JS Thakur
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhu Gupta
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Soundappan Kathirvel
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kapil Goel
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarundeep Singh
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Singh T, Muscroft N, Collier N, England A. A comparison of effective dose and risk for different collimation options used in AP shoulder radiography. Radiography (Lond) 2021; 28:394-399. [PMID: 34887196 DOI: 10.1016/j.radi.2021.11.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/01/2021] [Accepted: 11/19/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Radiography forms the cornerstone of the evaluation of shoulder disorders. While the benefits of radiography exceed the risks, there continues to be a compelling case for reduction of radiation exposure from diagnostic radiography. The aim of this project was to evaluate the radiation dose and risk for a variety of collimation settings used during anteroposterior (AP) shoulder radiography. METHODS This was a phantom based study where an ATOM adult dosimetry phantom was loaded with 272 thermoluminescent dosimeters (TLDs). Following loading, the phantom was setup for an AP shoulder X-ray projection with standard 25 × 30 cm rectangular collimation. The phantom was exposed three times and then the TLDs were removed and read. The experiment was repeated using a diamond shaped collimation and rectangular collimation with a minimum field of view to portray only relevant anatomy. Using the TLD dose measurements the effective doses and radiation risks were determined and compared. RESULTS As expected, organs neighbouring the shoulder experienced the highest absorbed doses (greater than 0.01 mGy); these organs included breast, lung and thyroid gland. The effective doses for standard rectangular, small rectangular and diamond collimation were 0.011, 0.008 and 0.016 mSv, respectively. When compared to standard collimation, a small field of view reduced effective dose by 27.3% and when moving to a diamond shape there was a 45.5% increase. The differences are likely driven by differences in the coverage of the radiosensitive lung and breast tissue. CONCLUSION By utilising a variety of different collimation settings, effective dose can be reduced. Reducing the radiation dose is both financially beneficial and results in a lower stochastic risk for patients. Image quality must also be considered when choosing different collimation settings. It stands to reason that by reducing the field size, dose will be reduced, and our study has served to quantify the effects in a practical situation. IMPLICATIONS FOR PRACTICE The utilisation of smaller/tight collimation is recommended as it offers the lowest dose when compared with other types of collimations. Although well-known this study serves to remind practitioners of the practical importance of collimation and is associated effect on effective dose and risk.
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Affiliation(s)
- T Singh
- School of Allied Health Professions, Keele University, Keele, Staffordshire, UK
| | - N Muscroft
- Warrington & Halton Teaching Hospitals NHS Trust, Warrington, UK
| | - N Collier
- Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - A England
- School of Allied Health Professions, Keele University, Keele, Staffordshire, UK; Discipline of Medical Imaging, School of Medicine, University College Cork, Ireland.
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Faujdar DS, Singh T, Kaur M, Sahay S, Kumar R. Stakeholders' Perceptions of the Implementation of a Patient-Centric Digital Health Application for Primary Healthcare in India. Healthc Inform Res 2021; 27:315-324. [PMID: 34788912 PMCID: PMC8654332 DOI: 10.4258/hir.2021.27.4.315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/23/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Health systems are shifting from traditional methods of healthcare delivery to delivery using digital applications. This change was introduced at a primary care centre in Chandigarh, India that served a marginalised population. After establishing the digital health system, we explored stakeholders' perceptions regarding its implementation. METHODS Ethnographic methods were used to explore stakeholders' perceptions regarding the implementation of the Integrated Health Information System for Primary Health Care (IHIS4PHC), which was developed as a patient-centric digital health application. Data were collected using focus group discussions and in-depth interviews. Participatory observations were made of day-to-day activities including outpatient visits, outreach field visits, and methods of health practice. The collected information was analysed using thematic coding. RESULTS Healthcare workers highlighted that working with the digital health system was initially arduous, but they later realised its usefulness, as the digital system made it easier to search records and generate reports, rapidly providing evidence to make decisions. Auxiliary nurse midwives reported that recording information on computers saved time when generating reports; however, systematic and mandatory data entry made recording tedious. Staff were apprehensive about the use of computer-based data for monitoring their work performance. Patients appreciated that their previous records were now available on the computer for easy retrieval. CONCLUSIONS The usefulness of the digital health application was appreciated by various primary healthcare stakeholders. Barriers persisted due to perceived needs for flexibility in delivering healthcare services, and apprehensions continued because of increased transparency, accountability, and dependence on computers and digital technicians.
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Affiliation(s)
- Dharamjeet Singh Faujdar
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarundeep Singh
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sundeep Sahay
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Rajesh Kumar
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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McGunigal M, Singh T, Amarell K, Aghdam N, Paudel N, Lischalk J. Association Between Travel Distance and Use of Postoperative Radiation Therapy for Incompletely Resected Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1001] [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] [Indexed: 11/29/2022]
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Ahlawat P, Singh T, Gairola M, Tandon S, Purohit S, Sachdeva N, Ismail Sharief M, Dobriyal K, Krishnan A. Inter-Correlations Between Various High-Risk Pathological Factors in Resected Buccal Mucosal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1137] [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] [Indexed: 11/16/2022]
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Bularga A, Wereski R, Taggart C, Lowry M, Singh T, Lee KK, Anand A, Shah ASV, Ross DA, Perry MR, Dweck MR, Newby DE, Chapman AR, Mills NL. Mechanisms of myocardial injury and clinical outcomes in patients hospitalised with suspected COVID-19. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Myocardial injury is associated with adverse outcomes in patients with COVID-19. However, the prognostic role of myocardial injury in COVID-19 compared to other acute illnesses and the underlying mechanisms of injury are poorly understood.
Methods
In a prospective, multi-centre, cohort study conducted in secondary and tertiary care hospitals in Scotland, all consecutive patients with suspected COVID-19 underwent cardiac troponin (ARCHITECTSTAT high-sensitive troponin I (hs-cTnI) assay; Abbott Laboratories) testing in plasma that was surplus to clinical requirements. The results were not reported unless required by the attending clinician. We evaluated the prevalence of myocardial injury, mechanisms and outcomes in all patients. In those with any hs-cTnI concentration above the sex-specific 99th centile the diagnosis was adjudicated according to the 4th Universal Definition of Myocardial Infarction. The primary outcome of all-cause mortality was compared in those with and without myocardial injury and COVID-19 by cox regression adjusted for age, sex, renal function and co-morbidities.
Results
A total of 2,916 (median age 69 [interquartile range, IQR 54–79] years, 53% women) consecutive patients with suspected COVID-19 were followed up for 228 [IQR 203–249] days. Myocardial injury occurred in 26% (750/2,916) with a median troponin concentration of 66 [35–178] ng/L; the prevalence was 41% (46/112) and 25% (704/2,804) in those with and without COVID-19, respectively. The most common mechanism was acute non-ischaemic myocardial injury occurring in 80% (37/46) and 71% (502/704) of patients with and without COVID-19, respectively. Type 1 myocardial infarction (2% and 4%), type 2 myocardial infarction (7% and 14%) and chronic myocardial injury (11% and 11%) were less common and only one patient had confirmed myocarditis. In patients with myocardial injury mortality was increased compared to those without (P<0.001 log rank), whether they had COVID-19 (54% [25/46] versus 26% [17/66]) or not (35% [248/704] versus 14% [294/2100]). Myocardial injury was an independent predictor of death in all patients (adjusted hazard ratio [aHR] 2.04, 95% confidence interval [CI] 1.71 to 2.43), but this excess risk was not higher in patients with COVID-19 (aHR 1.58, 95% CI 0.75 to 3.15) compared to those without the condition (aHR 2.01, 95% CI 1.81 to 2.49).
Conclusion
Myocardial injury is common in hospitalised patients with suspected COVID-19 whether or not COVID-19 was the cause of their presentation. The majority of patients had acute non-ischaemic myocardial injury rather than a defined cardiac condition. Despite this the presence of myocardial injury was an independent predictor of death in all hospitalised patients.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation Kaplan-Meier curve for all-cause death
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Affiliation(s)
- A Bularga
- University of Edinburgh, Edinburgh, United Kingdom
| | - R Wereski
- University of Edinburgh, Edinburgh, United Kingdom
| | - C Taggart
- University of Edinburgh, Edinburgh, United Kingdom
| | - M Lowry
- University of Edinburgh, Edinburgh, United Kingdom
| | - T Singh
- University of Edinburgh, Edinburgh, United Kingdom
| | - K K Lee
- University of Edinburgh, Edinburgh, United Kingdom
| | - A Anand
- University of Edinburgh, Edinburgh, United Kingdom
| | - A S V Shah
- London School of Hygiene and Tropical Medicine, Department of Cardiology, London, United Kingdom
| | - D A Ross
- Western General Hospital, Regional Infectious Disease Unit, Edinburgh, United Kingdom
| | - M R Perry
- Western General Hospital, Regional Infectious Disease Unit, Edinburgh, United Kingdom
| | - M R Dweck
- University of Edinburgh, Edinburgh, United Kingdom
| | - D E Newby
- University of Edinburgh, Edinburgh, United Kingdom
| | - A R Chapman
- University of Edinburgh, Edinburgh, United Kingdom
| | - N L Mills
- University of Edinburgh, Edinburgh, United Kingdom
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Mendell J, Shieh P, Sahenk Z, Lehman K, Lowes L, Reash N, Iammarino M, Alfano L, Powers B, Woods J, Skura C, Mao H, Staudt L, Potter R, Griffin D, Lewis S, Hu L, Upadhyay S, Singh T, Rodino-Klapac L. CLINICAL TRIAL HIGHLIGHTS. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.383] [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] [Indexed: 10/20/2022]
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Ahlawat P, Tiwari S, Gairola M, Tandon S, Purohit S, Dobriyal K, Singh T, Krishnan A. PO-0950 Comparison between two-dose levels versus three-dose levels IMRT in head and neck cancers. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07401-6] [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] [Indexed: 12/01/2022]
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Sachdeva N, Ahlawat P, Gairola M, Tandon S, Purohit S, Sharief M, Dobriyal K, Singh T, Krishnan A. PO-0953 Impact of human papilloma virus on treatment outcomes in oropharyngeal cancer in India. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07404-1] [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] [Indexed: 10/20/2022]
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Ahlawat P, Krishnan A, Gairola M, Tandon S, Purohit S, Sachdeva N, Sharief M, Dobriyal K, Singh T. PO-1028 Inter-correlations between various high-risk pathological factors in squamous cell carcinoma tongue. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07479-x] [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] [Indexed: 10/20/2022]
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Ahlawat P, Gairola M, Purohit S, Tandon S, Sachdeva N, Sharief M, Singh T, Dobriyal K, Krishnan A. PO-0984 Impact of anterior commissure involvement in early glottic cancer treated with radical IMRT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07435-1] [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] [Indexed: 10/20/2022]
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Grover S, Verma M, Singh T, Dahiya N, Nehra R. Screening for Abuse of Older Adults: A Study Done at Primary Health Care Level in Punjab, India. Indian J Psychol Med 2021; 43:312-318. [PMID: 34385724 PMCID: PMC8327867 DOI: 10.1177/0253717620928782] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Little is known about elder abuse in the domestic environment. In lower-middle income countries like India, the demographic transition is throwing novel challenges. The older adults are relatively more vulnerable because of coexisting medical and psychological problems. Any form of abuse affects mental health and increases the chances of anxiety and depression among the older adults. The study aimed to assess the burden of abuse amongst older adults visiting a primary health care center of north India. METHODS This is secondary data analysis conducted on the data collected in the primary study between September 2017 and June 2018 in northern India among 311 older adult patients attending the noncommunicable disease clinic. Diabetes mellitus and hypertension were diagnosed as per standard guidelines. Vulnerability to Abuse Screening Scale (VASS) was used to assess elder abuse. Depression, anxiety, and loneliness were assessed by using the Patient Health Questionnaire (PHQ)-9, Generalized Anxiety Disorder (GAD)-7, and University of California, Los Angeles (UCLA) loneliness 20-item scale, respectively. Multiple logistic regression was carried out to explore the factors associated with elder abuse after ruling out collinearity between independent variables. RESULTS About 24% of older adults experienced abuse in the last 12 months. One-fourth of the older adults reported vulnerability, nearly half reported coercion and dejection, and most of them reported experiencing dependence. Participants also had a high prevalence of anxiety (39%), depression (54%), and features suggestive of loneliness (38.6%). Multiple logistic regression analysis showed that abuse was predicted by educational status, per-capita income, and loneliness. CONCLUSION About one-fourth of the older adults experience abuse. This highlights the importance of routine screening of older adults at the primary care level.
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Affiliation(s)
- Sandeep Grover
- Dept. of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhur Verma
- Dept. of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India
- Dept. of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarundeep Singh
- Dept. of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neha Dahiya
- Dept. of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritu Nehra
- Dept. of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Hussain SA, Uppal SK, Singh T. Ultrasonographic assessment of change in omasal position during the last month of gestation and first month of lactation in buffaloes. SCHWEIZ ARCH TIERH 2021; 163:411-418. [PMID: 34097635 DOI: 10.17236/sat00305] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION This study was aimed to determine the effect of advanced pregnancy on the topography and size of the omasum in 22 healthy Murrah buffaloes. The omasum was scanned 15-20 days before and after parturition, as per the standard procedure. The dorsal and ventral margins of the omasum were identified and marked at each intercostal space (ICS). The dorsal and ventral limits up to the dorsal midline were measured. The omasum was scanned in 6th to 11th ICS during advanced pregnancy and 7th to 11th ICS after the parturition. Irrespective of the pregnancy, the dorsal and ventral margins of the omasum were located farther dorsal and close to the spine in the 6th, 7th and 11th ICS. Except in one buffalo, the omasum was scanned in four consecutive ICS during the advanced pregnancy. After parturition the omasum was scanned in four and five consecutive ICS in 17 and five buffaloes, respectively. The mean dorsal and ventral limits of the omasum increased significantly (P .
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Affiliation(s)
- S A Hussain
- Division of Veterinary Clinical Medicine Ethics & Jurisprudence, Faculty of veterinary Sciences and Animal Husbandry, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, India
| | - S K Uppal
- Department of Veterinary Medicine, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, India
| | - T Singh
- Department of Veterinary Medicine, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, India
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Elerian S, Singh T, Jagodzinski NA, Norris R, Tan S, Power D, Jones J, Rajaratnam V. 173 Early Results of a Variable-Angle Volar Locking Plate for Distal Radius Fractures: A Bi-Centre Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
This study examines the clinical, functional and radiological outcomes of distal radius fracture fixation with the Aptus® (Medartis, Pennsylvania) locking plate in order to determine its efficacy and to identify notable findings related to treatment variations.
Method
This is a retrospective bi-centre study collecting patient details from a District General Hospital and a Regional Hand Unit. We assessed 61 consecutive patients with distal radius fractures (AO grade A = 19, B = 9, C = 33) fixed using Aptus® plate with a minimum of six months follow-up. Outcome measures included the DASH score, wrist range of movement and grip strength, and complications. Radiographs were reviewed to assess restoration of anatomy and union.
Results
All but two fractures united within six weeks. Mean ranges of movement were only mildly restricted compared to the normal wrist (flexion/extension = 102°; radial/ulna deviation = 53°; pronation/supination = 169°). Mean postoperative grip strength was 23.8kg which was comparable to the contralateral side at 31.5kg. The mean DASH score was 18.2. Seven patients had screws misplaced outside the distal radius although three of these remained asymptomatic.
Conclusions
Variable-angle locking systems benefit from flexibility of implant positioning and may allow enhanced inter-fragmentary reduction for accurate fixation of intra-articular fractures.
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Affiliation(s)
- S Elerian
- Sandwell & West Birmingham NHS Trust Hospitals, Birmingham, United Kingdom
| | - T Singh
- Sandwell & West Birmingham NHS Trust Hospitals, Birmingham, United Kingdom
- Birmingham University Hospitals, Birmingham, United Kingdom
| | | | - R Norris
- Peterborough District Hospital, Cambridgeshire, United Kingdom
| | - S Tan
- Birmingham University Hospitals, Birmingham, United Kingdom
| | - D Power
- Birmingham University Hospitals, Birmingham, United Kingdom
| | - J Jones
- Peterborough District Hospital, Cambridgeshire, United Kingdom
| | - V Rajaratnam
- Birmingham University Hospitals, Birmingham, United Kingdom
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Laroiya I, Khare S, Irrinki S, Singh G, S.S.N., Baal A, Singh T. The significance of skin edema in advanced breast cancer and its response to neoadjuvant chemotherapy. Breast 2021. [DOI: 10.1016/s0960-9776(21)00146-6] [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] [Indexed: 10/21/2022] Open
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Kumar J, Singh T, Singh A. Technology connects patients to tertiary care for non-COVID illnesses in pandemic times: A case study from India. Indian J Community Health 2021. [DOI: 10.47203/ijch.2021.v33i01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
During the COVID-19 pandemic times, non-COVID patients faced many difficulties to access health care because of diversion of health resources to manage the pandemic, partial or complete closure of routine OPD services and travel restrictions due to lockdown. Increased use of technology enhanced the effectiveness of the healthcare system to maintain treatment avenues in this challenging time. Also, the pandemic accelerated diffusion of technological innovations like teleconsultation among healthcare workers and patients. The present case study is about a young, breast cancer, female patient from rural India who was diagnosed with the disease just before the pandemic times. She was put on neo-adjuvent chemotherapy in a tertiary care hospital about 150 kms away from her native place but meanwhile lockdown was imposed in India to control COVID-19 spread. She was maintained on follow up through teleconsultation services. She was facilitated through travel restrictions for chemotherapy cycles by e-pass. Her concerns regarding disease, treatment options, follow ups, effect of treatment on her fertility and adverse effects of chemotherapy during her treatment course were satisfactorily addressed through teleconsultation. Necessary investigations done nearby were sent digitally to treating doctor that minimized her visits. After completion of chemotherapy she underwent breast conservation surgery.
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Virk A, Joshi A, Mahajan R, Singh T. Reply to Letter to Editor regarding the article, "The power of subjectivity in competency-based assessment". J Postgrad Med 2021; 67:59-60. [PMID: 33565475 PMCID: PMC8098875 DOI: 10.4103/jpgm.jpgm_1269_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- A Virk
- Adesh Medical College & Hospital, Shahabad (M), Haryana, India
| | - A Joshi
- Pramukhswami Medical College, Karamsad, Gujarat, India
| | - R Mahajan
- Adesh Institute of Medical Sciences & Research, Bathinda, Punjab, India
| | - T Singh
- SGRD Institute of Medical Sciences and Research, Amritsar, Punjab, India
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Abstract
The uncertainty in all spheres of higher education due to the COVID-19 pandemic has had an unprecedented impact on teaching-learning and assessments in medical colleges across the globe. The conventional ways of assessment are now neither possible nor practical for certifying medical graduates. This has necessitated thoughtful considerations in making adjustments to the assessment system, with most institutions transitioning to online assessments that so far have remained underutilized. Programmatic assessment encourages the deliberate and longitudinal use of diverse assessment methods to maximize learning and assessment and at present can be utilized optimally as it ensures the collection of multiple low-stake assessment data which can be aggregated for high-stake pass/fail decisions by making use of every opportunity for formative feedback to improve performance. Though efforts have been made to introduce programmatic assessment in the competency-based undergraduate curriculum, transitioning to online assessment can be a potential opportunity if the basic tenets of programmatic assessment, choice of online assessment tools, strategies, good practices of online assessments and challenges are understood and explored explicitly for designing and implementing online assessments. This paper explores the possibility of introducing online assessment with face-to-face assessment and structuring a blended programmatic assessment in competency-based medical education.
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Affiliation(s)
- R Mahajan
- Department of Pharmacology, Adesh Institute of Medical Sciences and Research, Bathinda, Gujarat, India
| | - S Saiyad
- Department of Physiology, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - A Virk
- Department of Community Medicine, Adesh Medical College and Hospital, Mohri, Kurukshetra, Haryana, India
| | - A Joshi
- Department of Pharmacology, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
| | - T Singh
- Department of Medical Education, Sri Guru Ram Das University of Health Sciences, Amritsar, Punjab, India
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Rehman T, Singh T, Sharma S, Kumar J, Govindan D, Singh SM. Prevalence of Depression and Anxiety during the COVID-19 Pandemic among the Residents of an Urban Slum in North India. J Neurosci Rural Pract 2021; 12:153-158. [PMID: 33531775 PMCID: PMC7846337 DOI: 10.1055/s-0040-1721623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objectives
This study aimed to estimate the prevalence of depression and anxiety, and assess the knowledge, practice, and concerns regarding coronavirus disease 2019 (COVID-19) among the residents of an urban slum in Chandigarh, India.
Materials and Methods
Participants were screened using Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scales.
Results
The mean (standard deviation) age of 200 enrolled participants was 33 (13) years with 83% (
n
= 166) being females. The prevalence of depression and anxiety was 3.5% (95% confidence interval [CI]: 0.95–6.05) and 2.5% (95% CI: 0.34–4.66), respectively. Of total, 46% (
n
= 92) knew that COVID-19 can transmit through droplets and 30.5% (
n
= 61) were concerned that they might get infected with disease. Half of the participants (
n
= 100) believed that there was unnecessary worry regarding COVID-19 and 78% (
n
= 156) covered mouth while coughing or sneezing.
Conclusion
To cope with this critical situation, it is necessary to strengthen the awareness programs targeting the mental health issues of the people.
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Affiliation(s)
- Tanveer Rehman
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarundeep Singh
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sugandhi Sharma
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitender Kumar
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dhanajayan Govindan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Shubh Mohan Singh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Singh T. Reproducibility of Thrombus Volume Quantification and Aortic Wall Stress in Abdominal Aortic Aneurysm. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.240] [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] [Indexed: 11/26/2022]
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Singh T, Moxon J, Meehan M, Jones R, James Y, Golledge J. Survival and Factors Predicting Mortality in Patients Undergoing Major Lower Limb Amputations. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.397] [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] [Indexed: 12/01/2022]
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Kumar R, Gupta M, M. Lakshmi PV, Prinja S, Singh T, Sirari T, Rao C. Comparative performance of verbal autopsy methods in identifying causes of adult mortality: A case study in India. Indian J Med Res 2021; 154:631-640. [PMID: 35435349 PMCID: PMC9205010 DOI: 10.4103/ijmr.ijmr_14_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background & objectives: Cause of death assignment from verbal autopsy (VA) questionnaires is conventionally accomplished through physician review. However, since recently, computer softwares have been developed to assign the cause of death. The present study evaluated the performance of computer software in assigning the cause of death from the VA, as compared to physician review. Methods: VA of 600 adult deaths was conducted using open- and close-ended questionnaires in Nandpur Kalour Block of Punjab, India. Entire VA forms were used by two physicians independently to assign the cause of death using the International Statistical Classification of Diseases and Related Health Problems (ICD)-10 codes. In case of disagreement between them, reconciliation was done, and in cases of persistent disagreements finally, adjudication was done by a third physician. InterVA-4-generated causes from close-ended questionnaires were compared using Kappa statistics with causes assigned by physicians using a questionnaire having both open- and close-ended questions. At the population level, Cause-Specific Mortality Fraction (CSMF) accuracy and P-value from McNemar’s paired Chi-square were calculated. CSMF accuracy indicates the absolute deviation of a set of proportions of causes of death out of the total number of deaths between the two methods. Results: The overall agreement between InterVA-4 and physician coding was ‘fair’ (κ=0.42; 95% confidence interval 0.38, 0.46). CSMF accuracy was found to be 0.71. The differences in proportions from the two methods were statistically different as per McNemar’s paired Chi-square test for ischaemic heart diseases, liver cirrhosis and maternal deaths. Interpretation & conclusions: In comparison to physicians, assignment of causes of death by InterVA- 4 was only ‘fair’. Hence, it may be appropriate to continue with physician review as the optimal option available in the current scenario.
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