Indian Physicians Research Articles

Current Practice of Hypertension in India: Focus on Blood Pressure Goals.

Recommended Blood Pressure (BP) goals in elderly and those with co-morbid conditions like Diabetes Mellitus (DM) and Chronic Kidney Disease (CKD) vary in different Hypertension (HTN) management guidelines. To understand currently followed BP goals and practices among the physicians involved in management of HTN in India. A cross-sectional, observational survey was conducted at 66th annual conference of Cardiological Society of India (CSICON-2014, Hyderabad). A structured questionnaire related to the BP goals and HTN practices was provided and responses from voluntarily participating physicians were collected. Data was analysed with descriptive statistics. Two-hundred sixty physicians completed this survey. In their routine clinical practice, physicians most frequently referred to Joint National Committee (JNC) guidelines (63.85%) followed by Indian guidelines on HTN (14.23%). In patients aged 60 years and above, BP goal <140/90mmHg and <150/90mmHg was aimed by 43.46% and 33.85% of the physicians respectively. In HTN with Type 2 DM (T2DM), most physicians (61.92%) had a BP goal of <130/80mmHg. A target BP <130/80mmHg was aimed by 48.08% physicians in CKD without proteinuria and 68.85% physicians in CKD with proteinuria. In newly diagnosed hypertensives, treatment modification was practiced after 15, 20 and 30 days by 37.31%, 16.15% and 35.77% of the physicians respectively. Beta-blockers were considered as third-line agents in HTN without co-morbidities by 45% physicians. Ambulatory BP Monitoring (ABPM) is practiced only in few patients (<5%) by most (71.93%) physicians. In practice, Indian physicians follow lower BP goals when compared to the recommendations from the most referred JNC guidelines. Increasing physicians' awareness to the changes in recommendations is the need.

Knowledge, attitude and practice of therapeutic fasting among naturopathy physicians: across sectional national survey

Introduction: Fasting is a common ingredient of naturopathic prescription in India. However no studies have been conducted to establish the use, approach of naturopathy physicians towards fasting. The present study, a cross sectional survey was conducted to assess the attitude, use, belief and understanding about therapeutic fasting among the naturopathy physicians in India. Methods: A 12 item e-mail based questionnaire was sent among 334 naturopathy physicians, which were designed to obtain demographic data, practice characteristics and multiple choice and multiple response close-ended questions along with an open-response final question. Survey questionnaire data was analyzed using descriptive statistics via frequency distribution and cross tabulations. Results: A convenient sample of total 257 participants was collected. Majority of the respondents were private practitioners with an average experience of 5 years. 50% of the total population confirms the use of fasting in their daily prescription which is mostly for 1-5 days (54%) and for all diseases (38.5%). Physicians mostly prescribe short term mono fasting with fruits or juices (42.8%) along with all other modalities (61.5%) to get desired effect. The end results of fasting therapy was quoted as satisfactory (51.7%) whereas the misconceptions of the patients was a challenge for 1/3 and most of them find it easy to administer in adults (85%). Conclusion: Naturopathy physicians use fasting as a first line management in almost all chronic and acute diseases. However there is a need for strengthening the evidence based practice to bestow better care.

An Empirical Analysis of Job Content and Contextual Factors: A Case Study of Indian Physicians

This paper attempts to identify the factors influencing the overall satisfaction of Indian physicians, using stepwise regression and ANOVA (Analysis of Variance).Understanding the physicians’ satis...

Early modern Goa: Indian trade, transcultural medicine, and the Inquisition

Portugal’s introduction of the Inquisition to India in 1560 placed the lives of Jews, New Christians, and selected others labelled ‘heretics’, in peril. Two such victims were Garcia da Orta, a Portuguese New Christian with a thriving medical practice in Goa, and Gabriel Dellon, a French merchant and physician. In scholarship, Garcia da Orta and Gabriel Dellon’s texts are often examined separately within the contexts of Portuguese and French literature respectively and in terms of medicine and religion in the early modern period. Despite the similarities of their training and experiences, da Orta and Dellon have not previously been studied jointly, as is attempted in this article, which expands upon da Orta and Dellon’s roles in Portuguese India’s international commerce, especially the trade in spices, and the collaborations between Indian and European physicians. Thus, the connection between religion and food is not limited to food’s religious and religio-cultural roles. Food in terms of spices has been at the foundations of power for ethno-religious groups in India, and when agents became detached from the spice trade, their downfalls were imminent, as seen in the histories of Garcia da Orta and Gabriel Dellon.

Mo1193 Malnutrition Enteropathy, an Inflammatory Condition in Children With Severe Acute Malnutrition

Little is known about cow's milk protein intolerance (CMPI) in developing countries where alternate formulas are sparse. We report a survey of Indian pediatricians on their attitudes and practices with CMPI. Methods :15,000 members of the Indian Academy of Pediatrics were invited to take an online survey on their opinions about association of CMPI with different clincal conditions as well as their response to a clinical scenario of a healthy infant with rectal bleeding. The data was compiled and statistically analyzed. Result :165 responses, 26 partial were obtained (1.1%). 5 were in general practice while rest were pediatricians, 73.68% practiced in urban or suburban settings. Common manifestations of CMPI noted in practices were Diarrhea (85.9%), Colic (83.9%), abdominal pain (73.6%), vomiting (73.4%), Asthma (66.6%), hematochezia (64.2%), constipation (63.6%) and atopic dermatitis (63.6%). In infants with colic 48.4% of Pediatricians considered (50% of more times) CMPI as the cause, 70% were likely (50% of more) to change formula or diet and 50% or more success were reported by 75.7%. Similar figures for gastro esophageal reflux were 44.9%, 63% and 62.1% respectively. For diarrhea 54.3% physicians were likely to consider CMPI, 68.9% changed diet and 74.5% reported 50% or more success rate. In a healthy infant under 6 months with hematochezia, 63.5% considered CMPI as the cause. In breast fed infants, 91% would have continued the infant on breast feed, half of them would have taken milk out of the mother's diet. In formula fed babies, 65.9% were likely to change formula; 58.7% preferred soy based formula while 45.5% used rice based liquid or diet. Only 4.8% considered elemental or semi elemental formulas. The physicians collectively reported a median percentage of 30% of such hematochezia resolving spontaneously, 50% with treatment, 10% continuing without complications and 5% had complications. There was no statistically significant difference in responses from physicians practicing in urban/suburban and rural/mixed settings. Conclusion: Indian physicians were aware of CMPI as the cause of various GI and non GI symptoms. Though they less readily considered CMPI as the cause of infantile hematochezia, management with locally sourced dietary changes was successful. Population based studies are indicated to provide cost effective guideline for management of CMPI to these physicians.

External validity & non-probability sampling

Sir, Apropos of the article on determinants of Indian physicians satisfaction and dissatisfaction from their job published recently1, the authors deserve credit for their efforts. As the title and the conclusions suggest, the aim was to study the job satisfaction and dissatisfaction levels among Indian physicians and compare it with levels across the world. The authors conclude that “the pattern of high proportion of satisfaction of the Indian physicians reported was similar to the physicians’ satisfaction working particularly in the developed countries”. I have a few concerns here as the methodology used for the purpose of this study may score low on external validity and, therefore, making a conclusion based on non-probability (convenience sampling in this case) sampling may not be correct. This keeping in view the fact that the two institutions chosen for the purpose of this study are not actually representative of institutions across India. One of the institutions chosen is a postgraduate institute only and fully autonomous and the second institution is a central government medical college. Now compare these institutions with other medical institutions across India [private, government (State and central), undergraduate, and undergraduate and postgraduate both, autonomous and non-autonomous, rural and urban] and we can understand the limits in generalizing the findings of this study to medical colleges across India. The question that needs to be addressed here is to what extent the results of a study conducted in one setting can be generalized to other settings. As pointed above, the situation in this study is not representative of other settings. Further, this representativeness can be expressed in two ways: experimental realism and mundane realism. Experimental realism is the degree to which participants’ psychological experience of a situation is representative of the experience they would have in other situations2. As is obvious, working in the above mentioned institutions is psychologically very different from other institutions across India. Experimental realism asks: Are participants feeling time pressure, or social rejection, or conformity pressure at levels similar to others? Mundane realism is the degree to which the physical setting in a study superficially resembles other physical settings2, again questionable in this study. Though the study has been done wonderfully well in its limited settings but may not be used as a surrogate for Indian physicians.

The emerging role of patient-centered outcomes research in shaping the future of healthcare delivery in India: A brief review

With the Indian patient becoming more empowered with regards to his disease and its treatment options, many Indian physicians still depend only on disease-related outcome measures to take health-care related decisions, and give minimal importance to patient-centered outcomes pertaining to the effect of the healthcare interventions on the patient's well-being. Thus, objective lab values and physician intuition are given more importance than the subjective feeling of well-being that the patient is experiencing following the introduction of the intervention. This review presents a concept of integrating patient-centered and patient-reported data with the existing disease-centered and doctor-reported data for making healthcare-related decisions. This concept, termed patient-centered outcomes research, has already become popular in the Western World.

Medical students and interns' knowledge about and attitude towards homosexuality.

Background and Rationale:Medical professionals’ attitude towards homosexuals affects health care offered to such patients with a different sexual orientation. There is absence of literature that explores the attitudes of Indian medical students or physicians towards homosexuality.Aim:This study aimed to evaluate Indian medical students and interns’ knowledge about homosexuality and attitude towards homosexuals.Materials and Methods:After IEC approval and written informed consent, a cross-sectional study was conducted on a purposive sample of undergraduate medical students and interns studying in one Indian medical college. The response rate was 80.5%. Only completely and validly filled responses (N = 244) were analyzed. The participants filled the Sex Education and Knowledge about Homosexuality Questionnaire (SEKHQ) and the Attitudes towards Homosexuals Questionnaire (AHQ). SEKHQ consisted of 32 statements with response chosen from ‘true’, ‘false’, or ‘don’t know’. AHQ consisted of 20 statements scorable on a 5-point Likert scale. Multiple linear regression was used to find the predictors of knowledge and attitude.Results:Medical students and interns had inadequate knowledge about homosexuality, although they endorsed a neutral stance insofar as their attitude towards homosexuals is concerned. Females had more positive attitudes towards homosexuals. Knowledge emerged as the most significant predictor of attitude; those having higher knowledge had more positive attitudes.Conclusion:Enhancing knowledge of medical students by incorporation of homosexuality related health issues in the curriculum could help reduce prejudice towards the sexual minority and thus impact their future clinical practice.

High in the Nursing Home

High in the Nursing Home

Suicide prevention competencies among urban Indian physicians: A needs assessment.

Introduction:India accounts for the highest estimated number of suicides in the World. In 2012, more than 258,000 of the 804,000 suicide deaths worldwide occurred in India. Early identification and effective management of suicidal ideation and behavior are paramount to saving lives. However, mental health resources are often scarce and limited. Throughout India, there is a severe shortage in mental health professions trained, which results in a treatment gap of about 90%. A comprehensive needs assessment was undertaken to identify the nature of the deficits in suicide prevention training for physicians in three Indian cities: Mumbai, Ahmedabad, and Mysore.Materials and Methods:The study was carried out in several concurrent phases and used a mixed-method approach of converging quantitative and qualitative methodologies. Data were collected using survey questionnaires, focus groups, consultations, and environmental scans. A total of 46 physicians completed the questionnaire. Focus groups were conducted in Mumbai and Ahmedabad with 40 physicians. Consultations were carried out with psychiatrists and psychiatric residents from hospitals and clinics in Mumbai, Ahmedabad, and Mysore.Results:Training gaps in suicide prevention exist across the health care professions. Existing training lacks in both quality and quantity and result in critical deficits in core competencies needed to detect and treat patients presenting with suicidal ideation and behavior. Only 43% of the surveyed physicians felt they were competent to treat suicidal patients. The majority of surveyed physicians believed they would greatly benefit from additional training to enhance their suicide risk assessment and intervention skills.Conclusions:There is a dire need for medical schools to incorporate suicide prevention training as a core component in their medical curricula and for continuing medical education training programs for physicians to enhance competencies in early detection and management of suicidal behavior.

Effect of practice management softwares among physicians of developing countries with special reference to Indian scenario by Mixed Method Technique.

Introduction:Currently, many cheaper “practice management software” (PMS) are available in developing countries including India; despite their availability and benefits, its penetration and usage vary from low to moderate level, justifying the importance of this study area.Materials and Methods:First preferred reporting items for systematic-review and meta-analysis (2009) guidelines were considered; followed by an extensive systematic-review of available studies in literature related to developing countries, on key search term from main abstracting databases: PubMed, EMBASE, EBSCO, BIO-MED Central, Cochrane Library, world CAT-library till 15 June 2014; where any kind of article whether published or unpublished, in any sort or form or any language indicating the software usage were included. Thereafter, meta-analysis on Indian studies revealing the magnitude of usage in Indian scenario by Open Meta-(analyst) software using binary random effects (REs) model was done. Studies from developed countries were excluded in our study.Results:Of 57 studies included in a systematic review from developing countries, only 4 Indian studies were found eligible for meta-analysis. RE model revealed although not-significant results (total participants = 243,526; range: 100–226,228, overall odds ratio = 2.85, 95% confidence interval = P < 0.05 and tests for heterogeneity: Q [df = 3] = 0.8 Het. P = 0.85). The overall magnitude of usage of PMS on Indian physicians practice was however found between 10% and 45%.Conclusion:Although variable and nonsignificant effect of usage of PM software on practice of physicians in developing countries like India was found; there is a need to recognize the hidden potential of this system. Hence, more in-depth research in future needs to be done, in order to find a real impact of this system.

Religion, Spirituality, or Existentiality in Bad News Interactions: The Perspectives and Practices of Physicians in India

A qualitative study was conducted to identify the role of religion, spirituality, or existentiality in clinical interactions. Grounded theory design was used to generate narrative data from 27 physicians working in four teaching hospitals in Karnataka, India, using a semi-structured interview schedule. Physicians reported that they explored religious, spiritual, and existential beliefs and practices of patients, along with other psychosocial and disease aspects, to assess their tolerance to bad news, to make decisions about delivering it, and to address the distress that might emerge from receiving bad news. They also reported taking recourse to religious or spiritual practices to cope with their own stress and feelings of failure.

Global Standardization of Surgical Training.

Global Standardization of Surgical Training.

Intuitive weights of harm for therapeutic decision making in smear-negative pulmonary Tuberculosis: an interview study of physicians in India, Pakistan and Bangladesh.

BackgroundTo estimate the amount of regret and weights of harm by omission and commission during therapeutic decisions for smear-negative pulmonary Tuberculosis.MethodsAn interviewer-administered survey was done among young physicians in India, Pakistan and Bangladesh with a previously used questionnaire. The physicians were asked to estimate probabilities of morbidity and mortality related with disease and treatment and intuitive weights of omission and commission for treatment of suspected pulmonary Tuberculosis. A comparison with weights based on literature data was made.ResultsA total of 242 physicians completed the interview. Their mean age was 28 years, 158 (65.3%) were males. Median probability (%) of mortality and morbidity of disease was estimated at 65% (inter quartile range [IQR] 50-75) and 20% (IQR 8-30) respectively. Median probability of morbidity and mortality in case of occurrence of side effects was 15% (IQR 10-30) and 8% (IQR 5-20) respectively. Probability of absolute treatment mortality was 0.7% which was nearly eight times higher than 0.09% reported in the literature data. The omission vs. commission harm ratios based on intuitive weights, weights calculated with literature data, weights calculated with intuitive estimates of determinants adjusted without and with regret were 3.0 (1.4-5.0), 16 (11-26), 33 (11-98) and 48 (11-132) respectively. Thresholds based on pure regret and hybrid model (clinicians’ intuitive estimates and regret) were 25 (16.7-41.7), and 2(0.75-7.5) respectively but utility-based thresholds for clinicians’ estimates and literature data were 2.9 (1-8.3) and 5.9 (3.7-7.7) respectively.ConclusionIntuitive weight of harm related to false-negatives was estimated higher than that to false-positives. The mortality related to treatment was eightfold overestimated. Adjusting expected utility thresholds for subjective regret had little effect.

Factors Influencing Adoption of E-detailing as a Communication Tool

In India, the concept of Electronic detailing (E-detailing) as a marketing communication tool is getting momentum in recent times. However, to ensure wide acceptance and long term sustainability of this tool, pharma companies should well aware about the factors that influence adoption of E-detailing by Indian Physicians. Still, to the best of our knowledge, there is limited academic research in this area. In this backdrop, the objective of this study is to unearth factors that influence adoption of E-detailing by Physicians of India. Research outcome may help pharma companies to draw a strategic communication roadmap for effective use of E-detailing for product message communication to the Physicians. The study is based on primary data collected from the Delhi/ National Capital Region (NCR) area from India. To analyze the data, an attempt is made to identify latent factors that influencing various measurable characteristics. Approach of Gonzalez et al. (2002) is used in factor analyzing the responses to identify prominent influencing factors behind the adoption of E-detailing by Physicians. As viewed by the physicians, communication credibility and convenient communication are two most important impetuses for adoption of E-detailing. Other important motivating factors are managing Professional Service Representatives (PSRs), information accessibility and empowered decision making.

Religious/spiritual characteristics of indian and indonesian physicians and their acceptance of spirituality in health care: a cross-cultural comparison.

Religious/spiritual (r/s) characteristics of physicians influence their attitude toward integrative medicine and spiritual care. Indonesia physicians collaborate with traditional, complementary, and alternative medicine (TCAM) professionals within modern healthcare system, while Indian physicians are not reported to do so. The aim of the study was to understand the r/s characteristics and their influence on Indian and Indonesian physicians' acceptance of TCAM/spirituality in modern healthcare system. An exploratory, pilot, cross-cultural, cross-sectional study, using Religion and Spirituality in Medicine, and Physician Perspectives (RSMPP) survey questionnaire, compared r/s characteristics and perspectives on integrative medicine of 169 physicians from two allopathic, Sweekar-Osmania University (Sweekar-OU), India, University of Airlanga (UNAIR), Indonesia, and a TCAM/Central Research Institute of Unani Medicine (CRIUM) institute from India. More physicians from UNAIR and CRIUM (89.1 %) described themselves as "very"/"moderately" religious, compared to 63.5 % Sweekar-OU (p = 0.0000). Greater number of (84.6 %) UNAIR physicians described themselves as "very" spiritual and also significantly high (p < 0.05) in intrinsic religiosity as compared to Sweekar-OU and TCAM physicians; 38.6 % of UNAIR and 32.6 % of CRIUM participants reported life-changing spiritual experiences in clinical settings as against 19.7 % of Sweekar-OU; 92.3 % of UNAIR, compared to CRIUM (78.3 %) and Sweekar-OU (62 %), felt comfortable attending to patients' spiritual needs, (p = 0.0001). Clinical comfort and not r/s characteristics of participants was the significant (p = 0.05) variable in full regression models, predictive of primary outcome criteria; "TCAM or r/s healing as complementary to allopathic treatment." In conclusion, mainstreaming TCAM into healthcare system may be an initial step toward both integrative medicine and also improving r/s care interventions by allopathic physicians.

PW271 Implementation of educational training program in Gestational Diabetes Mellitus Management for obstetricians / gynecologist and primary care physicians in India

PW271 Implementation of educational training program in Gestational Diabetes Mellitus Management for obstetricians / gynecologist and primary care physicians in India

Reviving community medicine in India: The need to perform our primary role

Community medicine broadly comprises of family medicine and public health; and community physicians are those trained in both. The primary professional role of a community physician is to manage a health center. Provision of primary healthcare: Curative, preventive, and promotive are an integral part of community medicine practice. Despite being a clinical specialty, community physicians in India are not performing this role and Rural and Urban Health Training Centers have become ornamental exhibits. Most departments of community medicine have restricted themselves to teaching undergraduates and postgraduate training has taken a back seat. Instead of pondering upon why this cadre of social/community physicians was prepared, we are hastily opening up other public health courses. Clinical subspecialties of community medicine should be given equal importance at par with academics and research. Community physicians should fulfill their primary role which would enable them to advocate public health policy with authority.

A survey of patterns of practice and perception of minimal hepatic encephalopathy: a nationwide survey in India.

Background/Aim:Minimal hepatic encephalopathy (MHE) leads to overt hepatic encephalopathy (HE) and impairs quality of life in patients with cirrhosis. Awareness of MHE and its management among physicians is not known.Patients and Methods:We conducted a survey among 673 physicians in India from academic and nonacademic institutes to understand the clinical burden, perceived severity, management patterns, and the barriers to providing care for this condition.Results:Overall awareness of MHE in this survey was 75% (n = 504). Awareness of MHE was significantly higher in physicians working in teaching hospitals compared with those in nonteaching hospitals (79% vs 71%, P = 0.02). Similarly, gastroenterologists were more aware of MHE compared with nongastroenterologists (91% vs 66%, P = 0.001). Only 6.3% physicians screened all of their patients for MHE, whereas frequency of testing for MHE, either being nil or less than 10% of their patients was 64.7%. The most common test was paper and pencil test (86%) and the reason for nonscreening was nonavailability of time to test and also equipment or method (81%). A majority of physicians (88%) think that MHE affects quality of life. Physicians (61%) had an opinion that there should be some registry of MHE regardless of the cost and effort involved. Lactulose was used in 93% of cases, followed by rifaximin (82%) in the management of MHE.Conclusion:The overall awareness of MHE was 75% and it was significantly more in physicians of academic institutes. Despite awareness of its effect on quality of life, a majority of physicians did not test for MHE in their day-to-day practice.

Development of post graduate program in emergency medicine in India: Current status, scope and career pathways

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.