Intern Doctors Research Articles

Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES).

This is a consensus document of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES). These three entities have brought together a multidisciplinary group of experts that includes anaesthesiologists, cardiac and cardiothoracic surgeons, clinical microbiologists, infectious diseases and intensive care specialists, internal medicine doctors and radiologists. Despite the clinical and economic consequences of sternal wound infections, to date, there are no specific guidelines for the prevention, diagnosis and management of mediastinitis based on a multidisciplinary consensus. The purpose of the present document is to provide evidence-based guidance on the most effective diagnosis and management of patients who have experienced or are at risk of developing a post-surgical mediastinitis infection in order to optimise patient outcomes and the process of care. The intended users of the document are health care providers who help patients make decisions regarding their treatment, aiming to optimise the benefits and minimise any harm as well as the workload.

Transitional challenges faced by medical intern doctors (IDs) in Vanuatu: a qualitative study

ABSTRACT The transition from being a medical student to a fully qualified registered doctor is a challenging time in the lives of intern doctors (IDs). Throughout those challenging times they face many challenges which significantly impact their professional lives as well as their transitional experience. This study aimed to identify the transitional challenges experienced by IDs in Vanuatu. This qualitative study was conducted using a phenomenological approach whereby data collection is done through semi-structured in-depth interviews. Ethical approval was obtained before the commencement of this study. Twenty-seven participants were IDs of Vila Central Hospital and Northern Provincial Hospital in Vanuatu who were either current IDs and had worked for more than 6 months or had completed internship within the past 2 years. The willing IDs were consented on paper before they participated in the interview. The interview data was then transcribed verbatim and interpreted thematically. The participating IDs in the study were between the ages of 27 and 36 years old. Twenty two were current interns while the remaining five had recently completed their internship and now working as registered doctors. Three subthemes were identified as challenges through thematic analysis in this study; intern’s welfare not met; different medical training institution; and transitional shock. Those subthemes were later categorized. The study findings have identified that intern’s welfare needs improvement along with diverse training medical schools, and the transitional internship encounters were significant challenges experienced by IDs. There is indeed a need for healthcare providers, medical leaders, and relevant stakeholders to recognize and address these challenges.

Mental Health Concerns, Insomnia, and Loneliness Among Intern Doctors Amidst the COVID-19 Pandemic: Evidence from a Large Tertiary Care Hospital in Bangladesh.

Precisely how intern doctors (or trainee physicians) have been impacted during the COVID-19 pandemic is currently poorly understood. The present study aimed to investigate the mental health consequences (i.e., depression, anxiety, and stress), insomnia, and loneliness among intern doctors in Bangladesh amidst the pandemic. A cross-sectional offline survey of 108 intern doctors (53.7 % female; mean age = 24.80 ± 1.08; age range = 23–29 years) in a large tertiary care hospital in Bangladesh was conducted. The participants were surveyed randomly from respective wards during their duties with an anonymous and self-reported questionnaire assessing socio-demographics, COVID-19-related consideration, mental health, insomnia, loneliness, and other measures. Hierarchical regression analyses were conducted to examine relationships. The prevalence estimates of mild to extremely severe depression, anxiety, and stress were 53.7 %, 63.9 %, and 38.9 %, respectively. Sub-threshold to severe insomnia was acknowledged by 53.7 % and loneliness by 43.5 %. Depression was associated with not receiving mental health counseling during the pandemic, anxiety, stress, and loneliness; anxiety was associated with depression and stress; stress was associated with depression, anxiety, and loneliness; insomnia was associated with being married; and loneliness was associated with poorer quality of life, depression, and stress. Depression, but not anxiety and insomnia, fully mediated the relationship between loneliness and regret regarding choice of profession because of the pandemic and its many unexpected experiences. The findings showed considerable mental health concerns, insomnia, and loneliness among intern doctors in Bangladesh during the COVID-19 pandemic. Future studies should further explore the role of mental health concerns in healthcare providers and perceptions of their profession during the pandemic, and examine interventions to help this vulnerable population.

Інструментальна імпедансометрія як складова загально-клінічного обстеження задля визначення складу тіла у хворих на неінфекційні захворювання

The purpose of the study is to assess the clinical feasibility and indicators of instrumental impedance measurement in patients who are at various stages of the cardiovascular continuum, in order to increase the effectiveness of measures for the prevention and treatment of non-communicable diseases in Ukraine by improving the diagnosis and prevention of non-communicable diseases through the introduction of modern science-intensive technologies into medical practice. Materials and methods. An open, non-randomized controlled study was performed with the assessment of examination on a BF 500 body composition monitor (model HBF-500-E, Omron Healthcare, Japan) in 186 functionally healthy individuals (control; in 75 respondents of professional athletes (group K1), in 111 respondents – intern doctors (group K2)) and in 253 patients with non-communicable diseases (main group). The patients were divided into four subgroups (Pg1, Pg2, Pg3, Pg4) depending on the stage of the cardiovascular continuum. Results and discussion. Non-compliance with the norm of body composition was found in 83% of respondents in group K2 and in 100% of patients. 83% of people were deficient in muscle, 23% had preobesity, 6% were obese, and 5% had visceral obesity. Overweight by body mass index was in 30% of Pg1 patients, in 31% of Pg2 patients, in 30% of Pg3 patients, in 37% of Pg4 patients and obesity was in 32% of Pg1 patients, in 31% of Pg2 patients, in 25% of Pg3 patients, in 35% of Pg4 patients. Overweight in the percentage of fat was diagnosed in 17% of Pg1 patients, in 31% of Pg2 patients, in 21% of Pg3 patients, in 37% of Pg4 patients; obesity was in 37% of Pg1 patients, in 48% of Pg2 patients, in 56% of Pg3 patients, in 51% of Pg4 patients. Visceral obesity was diagnosed in 35% of Pg1 patients, in 56% of Pg2 patients, in 60% of Pg3 patients, in 77% of Pg4 patients. Deficiency of muscle percentage was found in 85% of Pg1 patients, in 91% of Pg2 patients, in 89% of Pg3 patients, and in 88% of Pg4 patients. Conclusion. Instrumental impedance measurement shows clinical significance and should become a mandatory method of Objective Structured Clinical Examination. The body composition of patients with non-communicable diseases is characterized by an increase in energy expenditure of the main metabolism, general and visceral obesity, muscle deficiency. The degree and number of cases of violation of body composition increases with the progression of the cardiovascular continuum

Knowledge and practices towards road safety measures among intern and resident doctors: a cross-sectional study

Background: In spite of ongoing commitment and efforts, road traffic accidents continue to be a leading cause of death and disabilities in India. Adequate knowledge on road safety measures among budding doctors can create awareness and provide preventive counselling to their clients. An attempt was made to assess the knowledge and practices about road safety measures among intern and resident doctors working in tertiary care setting.Methods: An institution based cross-sectional study was conducted among 168 young doctors of Jorhat Medical College, Jorhat, Assam.Results: Among the enrolled study participants 54% were intern and 46% were resident doctors. More than half of the participants were male. Knowledge on different, road signs among the young doctors ranges in between 68% to 99%. The dangerous effects of alcohol consumption while driving/riding were known to 93% of the participants. While riding two wheels, only 58% always use helmet with belt and 33% sometimes use mobile phone. Regarding exceed in speed limit in two wheels, 11 (17%) participants informed that they surpass the speed limit and among them 10 (26%) were males which was found to be statistically significant. Among four-wheelers, 48% always use seat belt and 49% sometimes use mobile phone while driving. During four-wheel driving, 21% participants were involved in occasional drinking/smoking and it was found significantly higher in males.Conclusions: The study revealed that in spite of having adequate knowledge about road safety measures, intern and resident doctors are poor in practicing which warrant motivational and counselling intervention.

Transurethral Catheterization in Early Training: The Impact of Peer-Led Mentorship.

Introduction Transurethral catheterization (TUC) is a common hospital procedure. According to the literature, junior doctors contribute to the majority of TUC-related injuries. Our aim is to evaluate the immediate and long-term impact of a short procedure-centric TUC workshop on junior doctor's confidence, procedural knowledge, and ability to identify potential complications of catheterization. Materials and Methods Intern doctors were invited to attend a one-hour workshop on TUC. A questionnaire was completed before and after the workshop. Three months later, the questionnaire was readministered to assess the workshop's long-term impact. The questionnaire consisted of three domains. A: experience, training, and confidence levels (using 5-point Likert scales), B: procedural knowledge (the highest possible score was 10 points), and C: identification of TUC-related complications (the highest possible score was 3 points). Results 81 interns participated and reported a confidence level of 3.03 ± 1.05 in performing a straightforward TUC. Preworkshop domain B and domain C were 3.92 ± 1.63 and 1.75 ± 0.69 points, respectively. After the workshop, reported confidence levels improved to 3.71 + 1.02 (p < 0.05). Likewise, the scores in domains B and C increased significantly to 8.85 ± 1.40 (p < 0.005) and 2.65 ± 0.6 (p < 0.005), respectively. Three months later, the same parameters were evaluated, and confidence levels were higher than those of the preworkshop levels at 3.83 ± 0.77 (p < 0.05). The average domain B score was 7.85 ± 1.88 (p < 0.005), and domain C score was 2.69 ± 0.53 (p < 0.005). All scores reported after three months were significantly better than the preworkshop levels (p < 0.005), but there were no statistically significant differences when compared to the immediate postworkshop scores (p > 0.05). Conclusion Short peer-led TUC workshops positively impact intern doctors' confidence levels, procedural knowledge, and identifying complications.

The Role of Family Medicine Training in Addressing Workforce Challenges in Rural Liberia - Early Implementation Experience.

Background:Liberia has a severe shortage in the health workforce, which is amplified in rural areas. Many talented Liberians leave the country for post-graduate education; those physicians who do stay are concentrated in Monrovia.Objective:We initiated a family medicine specialty training program (FMSTP) to increase the number of well-trained physicians who have the knowledge, skills, and commitment to meet the health needs of the Liberian people.Methods:The Liberian College of Physicians and Surgeons (LCPS) family medicine program is a three-year post-graduate course that follows the West African College of Physician (WACP) curriculum. The program has a longitudinal rural training component supported by Partners in Health in Maryland county, where residents gain experience in a remote and under-served region. The program is evaluated through resident evaluations and ultimately bench-marked by accreditation and exam pass rates.Findings:The FMSTP commenced in July 2017, and the first rural rotation was in January 2018. To-date 13 residents have completed a total of 43 rotations in Maryland. Residents surveyed highly rated the faculty and their rural rotations. They identify more hands-on involvement in patient care, exposure to community health, and one-on-one time with faculty as the greatest assets of the rural training experience. Accreditation from the WACP was granted in December 2018. One of the graduating residents from the first class in 2020 is now serving as the first Liberian family medicine specialist in Maryland County.Discussion:Investing in a strong rural training component in our FMSTP has not only strengthened the program but has also built the infrastructure to establish our rural site as an attractive teaching hospital for intern doctors and nursing students. As the program continues to grow, success will be measured by the proportion of Liberian medical students entering the family medicine training program, retention of family medicine physicians in rural areas, and ultimately progress towards universal health coverage (UHC).

Evaluation of Perceived Social Stigma and Burnout, among Health-Care Workers Working in COVID-19 Designated Hospital of India

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has notably changed the working and community environment for health-care workers (HCWs) leading to burnout and feeling of being stigmatized by the community due to their work. This study aims at assessing the prevalence of burnout, perceived social stigma, and their demographic and work-related predictors. Methods: A cross-sectional study using Oldenburg Burnout Inventory and perceived stigma scale was carried out among 348 HCWs in COVID-19 designated hospital at Ahmedabad about 6 months after the onset of the outbreak in September 2020. The prevalence of burnout was assessed in two dimensions: disengagement and exhaustion. Severity of each was measured on low, moderate, and high levels. Results: Total 348 HCWs participated in study with a mean age of 28.05 ± 6.75 years. Two hundred and sixty-five (76.15%) HCWs experienced burnout and 200 (57.47%) high levels of perceived stigma. The level of burnout was measured on three severities. Factors which predict high burnout are female gender, lower education, unmarried status, living in a nuclear family, and high perceived stigma. Work characteristics such as duty hours, days of working, monthly income, and work experience does not predict burnout. Intern doctors had high burnout (87.25%, χ 2 = 28.067, P &lt; 0.001) while nurses had high perceived stigma (70.97%, χ 2 = 14.307, P &lt; 0.05). Perceived stigma is positively correlated with burnout (r = 0.26, P &lt; 0.001) with its both components, disengagement (r = 0.19, P &lt; 0.001) and exhaustion (r = 0.30, P &lt; 0.001). Conclusion: Burnout and stigmatization are prevalent among HCWs. Psychological interventions needed to reduce their burden and improve quality care during pandemic.

Use of new learning methods in the training of internal doctors

The article provides a form of performing a fragment of scientific work by interns, which motivates a young doctor to study modern methods of diagnosis and treatment in various sections of otolaryngology. It provides for the study of an important modern issue in the specialty, attending online conferences on the selected topic and a thorough study of international literature over the past 3 years. Control over the implementation is carried out by all employees of the department through a presentation of the scientific work and defense of these by an intern doctor.

THE PSYCHOLOGICAL IMPACT OF COVID-19 ON FRONTLINE HEALTHCARE WORKERS IN MOROCCO

Introduction: On March 11th 2020, the World Health Organization declared the infection of the virus severe acute respiratory syndrome coronavirus 2 or SARS-COV-2 a pandemic. The virus, which was first discovered in China in Wuhan province in December 2019, has affected more than 100 million people and more than two million deaths in more than 200 countries.Along with other epidemics and pandemics, the existence of this virus has led to psychiatric disorders in people in or without direct contact with the disease, especially frontline healthcare workers. Objective: To assess the impact of the virus on medical personnel working in Morocco, in particular stress, depression and sleep disorders. Methodology: To explore this topic, we used an anonymity questionnaire based on, in addition to individual status and conditions, scales assessing stress, depression and sleep.The questionnaire was sent via social networks to health personnel working in Morocco in the various hospitals and departments treating patients infected with this virus.The CES-D (Center of Epidemiological Studies - Depression) scales for depression, the PSS-10 (Cohens Perceived Stress Scale) for perceived stress and ISI (C. Morins Insomnia Severity Index) for disorders of sleep, were chosen given their frequent use in a number of studies on the same topic. Results: After sorting our responsesrigorously, we were able to collect 376 responses, of which 53.5% were women, with an average age of 28.45 years, 23.9% were nurses, 14.4% general practitioners, 19, 7% of internal doctors 37.2% of residents or specialists and 4.8% occupied other functions such as medical transport. 66% of our candidates were at the level of the different university hospital centers of Morocco.Our candidates respectively occupied 39.1% 28.2% 29% and 25.8% triage positions, observation of suspected cases, the COVID sector and resuscitation.Regarding our results, it was observed that 71% of our participants presented moderate stress, 44.9% had a risk of developing depression and 53.7 had insomnia of varying severity.The female sex, the lack of medical, surgical and psychiatric history influence the occurrence of the three abnormalities studied, it should also be noted that these last three maintain a relationship of influences between them. Conclusion: The exploration of stress, depression and insomnia revealed an impact of the state of health on the daily life of front-line health workers in Morocco.

Rabies And Treatment Following Dog Bites: Knowledge Among Adults Residing In A Semi-Urban Medical Officer Of Health Area In Sri Lanka

Introduction: Rabies is a zoonotic disease that is endemic in Sri Lanka and the main vector of human rabies is the dog. The county invests a huge portion of its annual health budget to prevent this deadly disease. The treatment following dog bite has an important place in the prevention of human rabies, which consists of the provision of first aid and Post Exposure Therapy (PET). The objective of the study was to describe knowledge on human rabies and treatment following dog bites (TFDB) and their associated factors among persons aged 20-59 years in a semiurban Medical Officer of Health area in Sri Lanka Method- A community-based cross-sectional study was carried out among a random sample of 340 participants, aged 20-59 years in a semi-urban Medical Officer of Health area, Sri Lanka by using probability proportionate to the population size cluster sampling technique. Data were collected by using a pre-tested interviewer-administered questionnaire by two trained pre intern doctors and analyzed using SPSS 22 software. Results- Response rate was 94.7% (322/340). The mean age was 38.1 years (SD=11.2 years).Of the participants, 94% were Sinhalese (n=303): 87% Buddhists (n=280); 74.2% married (n=239); 64.6% employed (n=208); 82% lived in own house (n=264) with a median income of Rs. 38,000.00 (IQR=Rs. 38,000/=). Only 11.5% (n=37) were dog owners. Overall knowledge on rabies was good in 64.9%, (n=209): 70.8% (n=228) knew the route of entry of virus but < 45% knew cat & bat are also reservoirs. The factors associated with good knowledge on rabies were Sinhala (OR=3.4, 95% CI- 1.3 -8.9,p=0.01); having higher level of education (OR=18.7, 95% CI- 9.7 -35.8 ,p<0.001), being employed (OR=2.3, 95% CI- 1.4 -3.6 p<0.001), having a higher income level (OR=4.8, 95% CI- 2.9 -7.9, p<0.001);owning dog (OR=2.7, 95% CI- 1.6 -4.4, p<0.001). Overall knowledge on treatment following dog bite was good in 61.2 %,(n=197):89.6%,(n=288) on first aid but < 30% knew the importance of noticing offending dog’s health, observability, and what to do if a dog is suspected to have rabies. The factors associated with knowledge on the treatment following dog bite were: ever-married(OR=1.7, 95% CI- 1.1 -3.2, p=0.02); having a higher level of education (OR=13.3, 95% CI- 7.5-23.5, p<0.001); having a higher level of monthly income (OR=3.0, 95% CI-1.9 -4.8, p<0.001); being employed (OR=2.2, 95% CI- 1.4 -3.5, p<0.001); owning a dog (OR=27.7, 95% CI-3.7 -205.0, p<0.001). Conclusions and Recommendations: The majority of the study participants had good overall knowledge of rabies and treatment following a dog bite. In general, knowledge on non-canine reservoirs of rabies and treatment following dog bites on specific events were deficient. There is a need to give holistic knowledge with regard to rabies as well as treatment following a dog bite to the general public. Keywords—rabies, treatment following dog bites, knowledge, Sri Lanka

Evaluation of a combination protocol of CT-first triage and active telemedicine methods by a selected team tackling COVID-19: An experimental research study

BackgroundMany health care workers around the world tackled with COVID-19, however sadly, the infection of many medical care workers were reported. To reduce the risk of infection, we launched selected team (Team COVID) of non-specialists and brought in active telemedicine method and computed tomography (CT)-first protocol. We describe our actual practice and the health status of medical doctors dealing with COVID-19 patients. MethodsBetween April 17, 2020 and May 24, 2020, 10 doctors worked with COVID-19 patients as part of Team COVID. The Team COVID doctors used a CT-first triage protocol for outpatients and telemedicine for inpatients and outpatients. We evaluated paired serum-specific antibodies for SARS-CoV-2 at the initial and end of the study duration and PCR results for SARS-CoV-2 at the end of the study duration. Furthermore, 36-item short-form of the Medical Outcome Study Questionnaire (SF-36) at the beginning and end of the study period were evaluated. ResultsTen doctors worked as Team COVID: seven internal medicine doctors and three surgeons. During the study period, Team COVID treated 165 individuals in the outpatient clinic and isolated hospitalized patients for 315 person-days. There were no positive results of serum-specific antibody testing and PCR testing for SARS-CoV-2 in Team COVID doctors. Furthermore, the SF-36 showed no deterioration in physical and mental QOL status. No in-hospital infection occurred during the study period. ConclusionsThe Team COVID fulfilled the treatment using the active telemedicine and CT-first triage protocol without in hospital infection and excess stress. The combination strategy seems acceptable for both the protection and stress relief among the medical staff.

Knowledge, Awareness, and Attitude Towards Dementia Amongst Medical Undergraduate Students

Background:Current undergraduate medical academic curriculum does not emphasize on evaluation and management of dementia. The knowledge and attitude of medical students towards patients with dementia in India has not been ascertained previously.Objective:We aimed to assess the knowledge and attitude of final year medical students about dementia and Alzheimer's disease. We also aimed to assess if a dedicated sensitization cum teaching session by a group of interns doctors guided by a neurologist could help improve students’ knowledge and awareness towards dementia or not.Methods and Materials:82 consenting final year medical students answered questionnaires of Alzheimer Disease Knowledge Scale (ADKS) and Dementia Attitude Scale (DAS) at a baseline level. A sensitization cum teaching session by intern doctors was conducted to enhance students’ knowledge about dementia. A post sensitization reassessment of students was done to assess impact of the session.Results:The ADKS score was 57% at baseline which was increased to 71% post sensitization program. The mean DAS score was 3.2 at baseline which was reported to be 3.4 after sensitization program. Students reported significant improvement in their knowledge level but did not show the same improvement in their attitude and comfort level in caring for dementia after the sensitization program. Students were still not comfortable dealing with patients with dementia.Conclusion:Medical students lack significant knowledge and training about dementia. Patient contact and practical training for basic assessment and care of dementia needs to be incorporated in the current academic curriculum. Dedicated sensitization sessions on dementia care can help improve the gap. Practical exposure to management of patients with dementia would be required to enhance the comfort level and attitude of students towards dementia.

The Impact of Body Mass Index Values on the Quality of Cardiopulmonary Resuscitation: a Manikin Study

Objective: The purpose of this study is to assess the impact of body mass index (BMI) on the quality of cardiopulmonary resuscitation (CPR) by using a manikin. Methods: 50 people composed of research assistants, intern doctors, emergency medical technicians and nurses who had previous cardiopulmonary resuscitation experience performed CPR on Laerdal Skillmeter Resusci-Anne® with SimPad manikin during the study. BMI data of participants were recorded and then the participanst were categorised as BMI &amp;lt;21 and BMI &amp;gt;21. Compression data obtained from the summary section of SimPAD QCPR were compared with the participants BMI values. Results: 18 (36%) out of 50 participants were male, while 32 (64%) were female. 16 (32%) out of 50 participants were in the slim group, while 34 (68%) were in the normal group. Mean age of participants was calculated as 26.8±4.2, and mean BMI as 22.56±3.32. Mean compression depth in the slim group was significantly lower in comparison to the normal group (slim51.94±4.64, normal 55.79±4.35, p=0.006). Compression ratiowith sufficient depth in the slim group was statistically lower than the normal group (slim 66.19±25.79, normal 87.29±19.36, p=0.002). A statistically significant positive correlation was found in the lineer regression analysis conducted between mean compression depth and BMI (r2:0.179, p=0.002). Moreover, a significant positive correlation was observed in the pearson correlation analysis of mean compression depth and BMI (r: 0.423, p= 0.002). Conclusion: As a result, it was found out that low BMI values are associated with low mean compression depth.

Teaching clinical ethics to intern doctors by integrated seminar and online discussions

Objectives: We report our experience of an educational project conducted with the objectives of inculcating the knowledge and encouraging the application of the principles of clinical ethics among intern doctors. Materials and Methods: An interdepartmental, integrated, interactive seminar was conducted by the departments of psychiatry, pharmacology, surgery, and medicine for various aspects of clinical ethics. A pre-post 20-item test of multiple-choice questions (MCQs) was conducted with the seminar. It was followed by 45 days of online discussion on clinical ethics among the participants of the seminar. Content analysis of the online discussion was done. Feedback was taken after the seminar and online discussion. Results: Fifty intern doctors participated in the seminar and 34 in the online discussion. The MCQs’ score significantly increased from 10.7 to 16.8 out of 20. There were 35 posts and 66 comments about clinical ethics made on the online forum. The feedback revealed that the interns wanted more departments to be involved in the seminar and practical knowledge was gained from the online discussion. It also suggested that this combination of seminar followed by online discussion encouraged them to apply the principles in their clinical rotations. Conclusion: Integrated teaching and online discussion were effective in sensitizing the intern doctors, enhancing their knowledge, and encouraging the application of the principles of clinical ethics.

What were the changes during the COVID-19 pandemic era concerning occupational risks among health care workers?

BackgroundAccidental exposure to percutaneous needle stick and sharp injuries (NSSIs) and blood and other body fluids is the unintended contact with risky medical instruments or patient secretions during a medical intervention. During the COVID-19 pandemic, the significance of occupational injuries in healthcare professionals was revealed once again. To assess the occupational injuries, we compared rates, distribution and type of exposure to blood and body fluids and NSSIs of health care workers for 2019 (pre-pandemic era) and 2020 (pandemic era) years, respectively. Material and methodsOur study included data collected by the ‘Hospital Infection Control Committee’ for the years 2019–2020. Data collected using the active surveillance method were analyzed retrospectively. ResultsDuring 2019 (pre-pandemic period) and 2020 (pandemic period), 112 (27.65%0) and 82 (21.4%0) NSSIs reported, respectively. Of the exposed HCWs in 2019 (pre-pandemic period), 16.8%0 (14) were doctor, 53.6%0 (60) were nurse and 47.4%0 (14) were intern doctors. In the 2020 (pandemic period), NSSIs were observed most frequently in nurses and cleaning staff, 50.24%0 and 33.64%0, respectively. Concerning the total percentage of exposure to blood and other body fluids, a slight increase was revealed from 1.48%0 to 2.62%0 in 2019 and 2020, respectively. A significant decrease in exposure rate was reported among the doctors between the pre-pandemic and pandemic era; 3.6%0 and 1.19%0 at 2019 and 2020, respectively. A significant increase in exposure rate was reported among the nurses between pre-pandemic and pandemic era; 0.8%0 and 6.89%0, respectively. ConclusionIn conclusion, the exposure to NSSIs during the pandemic period decreased; however, there was no severe difference at pre-pandemic and pandemic periods concerning exposure to blood and body fluids. Well-designed training and awareness programs can be effective in preventing exposure to NSSIs and blood and other body fluids and exposure to respiratory acquired viruses.

An evaluation of knowledge, attitude and perception about adverse drug reactions and pharmacovigilance among intern doctors in a medical college teaching hospital of Sangli

Background: Underreporting of various adverse drug reactions (ADRs) by consultants is a common incurable problem. National pharmacovigilance program is one of the ongoing programs to monitor the adverse drug reactions &amp; reporting at the earliest to the nearby AMCs. As medical interns are budding doctors, the focus of this study was to evaluate the knowledge, attitude and perception about ADRs and pharmacovigilance in them.Methods: A cross section questionnaire-based study was conducted after approval by our institutional ethics committee pretested and validated questions consisting of 20 questions (knowledge, attitude, perception) were administrated to medical interns. The filled questionnaires were collected and analysed.Results: In our study, medical interns have fair enough idea about ADR and pharmacovigilance. In knowledge domain they were aware of term ADRs (100%), pharmacovigilance (72.6%). In attitude domain majority of interns (80.6%) known availability of ADR forms, compulsory of pharmacovigilance unit (90.3%). In perception domain very poor response from interns, not even a single intern had reported any ADR filled form and they don’t know meaning of re-challenge and de-challenge, very few interns (9.7%) know how to manage the ADRs in emergency conditions.Conclusions: Under reporting problem can be improved by doing more teaching activities at undergraduate level and intern’s level including various workshops, CMEs, problem-based teaching of adverse reactions in their curriculum. These exercises will improve their reporting frequency and sensitize the interns from the undergraduate days itself in their upcoming clinical practice in community.

Дистанційне навчання за циклом "Невідкладні стани" очима лікаря-інтерна лікувального профілю та стоматолога

The purpose of the study. We analyzed the advantages and disadvantages of distance training of interns of various specialties for the licensed integrated exam "Krok-3" by studying the opinions of the subjects of training. Materials and methods. More than 200 anonymous questionnaires of first-year interns in various specialties were analyzed. The survey was conducted on a five-point system. If the respondent had not wanted to answer any item of the questionnaire, in the corresponding column he put a mark "0". A comparative analysis of the results of testing the interns in the areas of "General Medicine" and "Dentistry" has been carried out. Distance learning means such an organization of the educational process in which the main attention is paid to the independent training of an intern doctor. Our previous studies have shown that most interns can master large volumes of educational material. Therefore, according to the subject of the cycle, we have developed a number of microlectures in the form of voiced multimedia presentations for self-preparation of interns for classes, which were approved by the CMC of the Academy. At the end of each section, there is a considerable list of questions for self-control and a selection of test tasks on the topic. For self-preparation, we also offer clinical lectures texts copies of the department staff, published in professional scientific publications. Results and discussion. According to the results of an anonymous survey, 58.8% of respondents in the medical profile consider the "Emergencies" on-line cycle very significant for the preparation to a licensed exam, 35.3% - important, and only 5.1% - not paramount. Among interns-dentists, only 26.3% of the respondents recognized our classes as very important for passing “Krok-3”, and 47.4% - not very serious, and 26.3% did not at all perceive the expediency of this cycle. It can be explained by the fact that the thematic plan of classes of somatic pathology, which our department conducts for interns-dentists, is a very small share of the special dental program. Only 26.5% of medical interns and 21.1% of dentists recognized the stimulating effect of “Krok-3” for mastering knowledge of emergency care, 44.1% and 15.8% of respondents consider it quite important, respectively, and 32.4% of medical interns and 63.1% of dentists do not consider it appropriate at all, they say, the exam itself does not contribute to the improvement of medical qualifications. Conclusion. Conducted on-line cycle "Emergencies" was generally quite highly appreciated by subjects of training in many qualitative components. Interns of the dental profile showed significantly less interest in the performed cycle due to its limited somatic pathology. The problem of the unfair attitude of interns to the means of control at our department has been completely solved in full-time education, but in the case of distance education, it requires an urgent search for ways to overcome it. The transition to distance learning during an epidemic is a forced, but the only possible measure that will preserve the health and life of the subjects of learning. This type of training requires careful study, optimization and adaptation to modern conditions

FREQUENCY OF GUILLIAN-BARRE SYNDROME AND ITS VARIANTS AT MILITARY HOSPITAL RAWALPINDI

Objective: To assess the frequency, variants, clinical profile and outcome of patients admitted with the diagnosis of GuillianBarre Syndrome at neurology unit of a tertiary care teaching hospital of Pakistan.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Neurology department, Pak Emirates Military Hospital Rawalpindi, from Jan to Dec 2018.&#x0D; Methodology: This study was conducted on 42 patients of Guillian-Barre Syndrome admitted in hospital. Demographic profile included age, gender, and the symptoms with which the patient presented. Medical and neurological complications were also documented among the target population. Outcomes included recovery, shifting to intensive care unit and death.&#x0D; Results: Out of 42 patients included in the final analysis 25 were male and 17 were female. Most of the patients presented with lower limb weakness followed by numbness. Acute inflammatory demyelinating polyneuropathy was the commonest while cranial nerve variant was least reported. Motor deficit were the commonest complication faced by the patients followed by respiratory involvement. Out of 42 patients, 34 (80.9%) recovered, 4 (9.5%) were shifted to the intensive care unit and 4 (9.5%) died.&#x0D; Conclusion: This study gives an insight into the pattern of a fairly common neurological illness which if diagnosed and managed in time has a good outcome in our set up. Management of critically ill Guillian-Barre Syndrome patients involves a multidisciplinary team with a need of intensive care unit during the course of management. Variety of types and presentations should be part of training of neurology doctors as well as internal medicine doctors.

Highlights and comments on EHRA/HRS/APHRS/LAHRS expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome.

Patients with heart disease, or at high risk of developing a cardiac condition, usually undergo risk assessment by primary care physicians, internal medicine doctors, or cardiologists. There are several methods that can be used for this risk assessment, and their applicability differs with respect to availability, complexity, and usefulness in different geographic populations. This document focuses on some of the many relevant clinical topics recently presented in the “Expert Consensus on Risk Assessment in Cardiac Arrhythmias: Use the Right Tool for the Right Outcome,” which include statements based on the best available evidence. In this review, we want to highlight and make some pertinent comments on some of the most relevant points of this Consensus.