Recent epidemiologic and demographic public health data highlight the growing need for emergency medicine (EM) services in India and highlight its importance as a recognized medical specialty. Developing a comprehensive and recognized EM program for training physicians in India is of utmost priority and should not be neglected at any point of time. This review article attempts to highlight the development of a post-graduate program in EM in the country.

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Introduction: Health care workers are mentors to general populations for a healthy life. Life style disorders are not just limited to the general population but even the doctors and nurses who guide them on their prevention are also getting victimized. The current study was carried out to collect the data on the lifestyle-associated disorders among health professionals in India. Objectives: The aim was to assess the prevalence and associated risk factors (modifiable and non-modifiable) of lifestyle disorders among Health professionals. Materials and Methods: This was a hospital-based cross-sectional study carried out in a secondary level/block level hospital of north-west Delhi. A study tool based on the World Health Organization (WHO) STEPS questionnaire for assessing non-communicable diseases and their risk factors was used. Fasting venous blood sample was collected to assess the lipid profile and fasting blood sugar. Anthropometric measurements of the participants were also taken. Data were analyzed using SPSS version 17. Results: Of the total 100 participants who consented to participate, 60% were females and 40% were males. The prevalence of diabetes and hypertension among health professionals were 5% and 10%, respectively. There were 52 participants who had abnormal waist-hip ratio. According to the WHO classification for Asians, 42% were overweight, while 22% were found to be obese. Alcohol intake (P=0.005), gender (P=0.00), occupation (P=0.018), total cholesterol levels (P=0.038), and triglycerides levels (P=0.046) had a significant association with waist-hip ratio, whereas alcohol intake (P=0.01), hypertension (P=0.05), moderate intensity sports (P=0.025) were significantly associated with body mass index. Conclusions: The prevalence of risk factors for lifestyle diseases was high among the health professionals. Thus, there is a need to motivate them to practice healthy lifestyle for prevention against lifestyle diseases and that they can advocate their patients.

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Introduction: Kangaroo Mother Care (KMC) is a nonconventional low-cost method of newborn care. We tried to understand the difficulties faced by mothers during KMC and profile the corrective action. Materials and Methods: Over 3½ years, mothers of inborn low birth weight babies were taught and motivated by clinical nurse researcher to implement KMC. Gross congenital abnormality or nonconsenting mothers were exclusion factors. After demonstration sessions, KMC was implemented for 1 h on 1st day, 2 h on 2nd day, 3 h on 3rd day and then scaled up for as long as a mother felt comfortable. After discharge, KMC was continued at home till the infant attained 2500 g weight or 40 weeks corrected gestational age. Difficulties being faced both in hospital and at home were probed and remedial measures suggested accordingly. Results: Of 300 mother-baby pairs studied, 35 (11.67%) mothers could not implement KMC satisfactorily in hospital itself. Causes of failure related to mother, infant or socioeconomic factors, such as mother not feeling well enough, need to visit toilet, feeling hungry, lack of self-motivation, soiling of nappies, and interfering family members (especially maternal grandmother). To overcome these problems, both mother and father, and when required, other family members were counseled. Mother was instructed to visit the toilet just before KMC session and to take adequate food beforehand. Before discharge family support person was identified. After discharge, 6 (2%) additional mothers faced problems from lack of privacy, discouragement by mother-in-law or neighbors, lack of time and uncomfortable summer environment. Motivation and counseling at every follow-up visit rescued the situation. Conclusion: Regular supervision and counseling along with adequate initial demonstration are necessary for successful implementation of KMC.

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For the evaluation of congenital heart diseases (CHDs), echocardiography is the initial diagnostic modality and Catheter angiography is the gold standard for delineation of the anomalies. Though echocardiography is the initial diagnostic modality in CHDs, it has its limitations and Catheter angiography is relatively invasive and should be reserved for therapeutic procedures. Multidetector computed tomography (MDCT) has emerged as an important tool for cardiac imaging owing to constant advancements in computed tomography scanners. With the judicious and innovative use of three-dimensional reconstructions, the depiction of congenital anomalies is more accurate and it is possible to perform a virtual surgery to aid the surgeon in planning the approach to the patient as a one or two step procedure, counseling the parents about the outcome and giving a fair estimate of the cost of treatment. MDCT acts as a one stop shop for a complete evaluation of the cardiac, extra-cardiac, visceral and skeletal anomalies; their combinations and subsequent effects on each other. Excellent delineation of the vascular compressions on the tracheo-bronchial tree, degree of main and branch pulmonary artery stenosis, anomalous drainage of pulmonary and systemic veins, interruptions and narrowing of the aorta, anomalies of origin and course of coronary arteries are unique to MDCT.

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Background: Hemangioblastomas are rare, benign, vascular neoplasm. According to the World Health Organization classification of tumors of the nervous system, hemangioblastomas are classified as meningeal tumors of uncertain origin and are Grade I neoplasm. Hemangioblastomas arise either in the setting of von Hippel-Lindau (vHL) disease or more often as solitary sporadic lesions. They account for 1-3% of primary central nervous system (CNS) tumors. The most common location is the cerebellum followed by spinal cord. Supratentorial lesions are rare. Aims: The aim was to study the prevalence of hemangioblastoma. Materials and Methods: A retrospective observational study of 7 years duration was carried out in the department of pathology of a tertiary referral center. The sample received was processed by standard formalin fixing, paraffin embedding method. Serial sections and special stains were studied as and when required. Results: During the period of 7 years, we reported total 679 cases of primary CNS tumors, of which 11 (1.62%) cases were of hemangioblastoma. Ten of them were intracranial, and one was spinal. There were seven male and four female patients that clearly indicate male preponderance. Conclusions: In our study, prevalence of hemangioblastoma was 1.62% (11 cases) out of 679 primary CNS tumors, which is low as per literature. There was a male predominance with male:female ratio 2:1. Cerebellum was the most frequent site (81.8%). No association with vHL disease was noted.

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Context: Challenges on community clinical placements for students from various medical streams has been reported over time. Physiotherapy students are exposed to community clinical placements during graduation course as part of training. This study was conducted to investigate the attitude of Physiotherapy students towards community clinical placements. Aims: To investigate attitude of Physiotherapy students towards community clinical placements. Settings and Design: A cross-sectional survey was conducted among 181 Physiotherapy students (103 final years and 78 interns) from three different Universities in Mumbai using purposive sampling. Materials and Methods: A validated questionnaire was designed to gather information on attitude and perception towards community clinical placements. Statistical analysis used: Data were analyzed using descriptive statistics in SPSS version 16. Results: Sixty-eight percentage of students reported keen interest in community clinical placements in which 78% were motivated by their past experiences in community services. Eighty percent of them reported that community clinical placements play a significant role in Physiotherapy education and training. The obstacles faced during community clinical placements were lack of interest in Physiotherapy among community members (80%), unavailability of local resources (57%), difficulty in communication in local language (48%), and unhygienic environment (33%). Conclusions: Physiotherapy students reported positive attitude towards community clinical placements as a part of curriculum and were keen in community services. However, lack of awareness about Physiotherapy among community pose barriers to this exposure.

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Background: Tele-health Centre at AIIMS Bhopal was established in January 2012 with the help of Information Technology Group and Department of Community and Family Medicine. High bandwidth connectivity was ensured through National Knowledge Network and Bharat Sanchar Nigam Limited that is the current provider of '104' telephone service free to the patient. Materials and Methods: Pilot data of 1000 calls of first phase simple telephonic voice-based service are reported using 3 internet protocol phones. A second phase model has been conceived, its cost analyzed and presented here. This led to designing of a scalable 3-tier system. Results: Ninety eight percent calls belonged to 12 clinical domains which include seasonal illnesses (29%), chronic and noncommunicable diseases (15.8%), depression and psychological problems (15%), sexual advises (11%), worried mother (7.5%), women health and sexual symptoms (7%), family planning related advise (5.0%), oro-dental (4.0%), acute illnesses (1.5%), child growth and vaccination (1.2%), critical illnesses (0.8%), and others (2.2%). The total cost of the tele-health center was calculated to be around ` 1.2 crores. Cost analysis showed that the cost for consultation provided to AIIMS Bhopal was ` 34 for 5 min and free to the caller. Conclusion: We identified 12 clinical domains for tele-consultation. The proposed 3 tier tele-health center shall curtail crowd of out-patients resulting in cost savings. Fiber to home enabling video conferencing, image transmission, assisted consultation, e-prescription, SMS, apps-based services and onsite camera-based emergency and disaster management will greatly enlarge its scope. Crank call elimination and cost reduction can be achieved by converting it to pay by caller service.

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Introduction: A tutorial is a class conducted by a tutor for one or a small number of students. Varied perspectives of different academicians about tutorials exist, which range from high effectivity to not-so-effective teacher-centered learning methods in which students are passive. But the perceptions of stakeholders (students, teachers) may vary as per their experience. This study was undertaken to determine the perception and acceptance of tutorial as teaching-learning method in preclinical sciences from the view of stakeholders. Methods: This was a descriptive survey where perceptions of second year MBBS students and teachers from the preclinical phase were collected using prevalidated questionnaires. Thematic areas that emerged were further explored through separate focus group discussions of students and tutors. Results: Maximum number of students were satisfied with the duration of tutorial sessions. But students opined that there was inadequate interaction; size of the group was not optimal, and tutorials did not help much in improving communication skills, confidence, and self-motivation. On the other hand, teachers narrated that students did not participate, prepare well or interact in tutorials. Conclusions: The current method of conducting tutorials did not meet the expectations of students and teachers and left them largely dissatisfied.

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Introduction: Currently, skill assessment methods for medical students in formative assessment are inconsistent. Our objective was to: (1) Develop an Objective Structured Clinical Examination (OSCE) assessing performance of basic clinical ophthalmic examination (2) remedy deficiencies in knowledge, skill. Materials and Methods: Objective Structured Clinical Examination stations and checklists were developed and validated following approval of institutional ethics committee. Postgraduate student volunteers served as both simulated patients and scorers; however, one station (eye drop instillation) used a mannequin with a faculty member as an observer, scorer. Third MBBS students (n = 61) were oriented. A four station pilot examination was done. After Posting#1 spanning 2 weeks, an eight-station OSCE (7 min. duration each) assessed examination of visual acuity, color vision, ocular motility, pupillary reaction; anterior chamber depth measurement; confrontation, digital tonometry, and eyedrop instillation. Common deficiencies identified were addressed through an interactive demonstration. Six weeks later, following Posting#2, the same test was repeated. Aggregated and paired scores were compared using Student's t-test. Feedback was obtained from students, simulated patients, and faculty. Results: Mean first session score was 22.4 ± 4.66 over 40 (56%); highest being for visual acuity; lowest for eyedrop instillation. Mean score in the second was 30.2 ± 4.3 (75.5%). Paired t-test showed t = 13.73 (P < 0.0001). 77.2% students preferred change in assessment methodology; 100% voting for OSCEs. Conclusions: Feed-back from initial assessment followed by the additional focused teaching session improved students' clinical skills. All were unanimously convinced of the need to change current assessment system. OSCEs are a simple, effective way to both learn and assess clinical examination skills.

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