The National medical journal of India最新文献

{"title":"Mid-level healthcare providers: Making a fresh case for modern Indian healthcare.","authors":"Soham Bhaduri","doi":"10.25259/NMJI_694_2023","DOIUrl":"10.25259/NMJI_694_2023","url":null,"abstract":"<p><p>To compensate for physician shortage, many countries around the world have introduced a cadre of mid-level healthcare providers (MLHPs) into their health systems to shoulder many of the conventional responsibilities of a physician. Besides backing their clinical competence and service quality, evidence and experience on MLHPs also supports their lower turnover and higher rural retention rates. In India, mainstreaming of MLHPs has time and again been met with resistance from organized medicine. We explore a fresh case for MLHPs in India in view of some recent developments and the probable future contours that Indian healthcare is likely to assume. Aided by global precedents, we broaden the rationale for mainstreaming MLHPs, address some common misunderstandings, and describe the conducive emergent legal and policy landscape. We also explain how a possible reorganization of Indian healthcare, highly likely under expanded publicly financed health insurance and value-based healthcare regimes, can warrant greater health workforce differentiation and an expanded role of MLHPs in mainstream healthcare delivery. We also touch upon important political economy considerations, including the need for navigating organized medical opposition, involving medical stakeholders in the MLHP mainstreaming process, autonomous regulation of MLHP professions, streamlining MLHP competencies, and inclusive health financing systems.</p>","PeriodicalId":519891,"journal":{"name":"The National medical journal of India","volume":"37 4","pages":"215-218"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning medical sociology through an innovative 'Elective study module' integrating humanities with medicine for undergraduate students of a medical college in Bengaluru, India.","authors":"Nisha Gomes, Vidya Harikumar, James Joseph, Aparna Mohapatra, Amal Rai, Siddharth Senthil, Namitha Varughese, Prem Mony","doi":"10.25259/NMJI_893_2023","DOIUrl":"10.25259/NMJI_893_2023","url":null,"abstract":"<p><p>Background The newly introduced 'Elective programme', a voluntary special study module in the final phase of the undergraduate medical curriculum, offers scope for new immersive, self-directed learning opportunities. We describe a programme of study for learning 'medical sociology' through the innovative use of humanities in medicine. Methods Our elective module, called 'Community Health and Rock Music' (CHaRM), was a 2-week programme, merging the curricular subject of community health with 'rock music' as an exposure to the 'counter-culture' outside of the medical world. The half-day sessions consisted of: (i) watching/listening to a rock song-video without reading its lyrics; (ii) listening to the same song again but with lyrics; (iii) undertaking an emotionally stimulating activity (watching a movie, making a site-visit, etc.); and (iv) debriefing, to identify/discuss the underlying social determinants of health and their relevance in the grooming of a socially aware medical student. Formative assessment was intended to gauge levels of expression of the affective domain (attitude/emotions). Results Seven of 143 students volunteered for this programme. Key learnings were a clear appreciation of the societal determinants of health (such as deprivation/discrimination/social structures); multi-level causation of diseases; social issues not addressed in traditional medical curriculum; personal growth; teamwork; and the role of empathy in medical practice. Additional learning was the exposure to the 'counter-culture of arts'. All 7 student assessments 'met expectation', with 4 of them 'exceeding expectation'. Conclusion An 'elective programme' combining humanities with medicine is potentially an innovative, student-centric and replicable model of learning that impacts the affective domain critical for doctors-in-training.</p>","PeriodicalId":519891,"journal":{"name":"The National medical journal of India","volume":"37 4","pages":"205-208"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uraemic frost: Sweating urea out.","authors":"Arun Karat, Usha Samuel, Biju Gopinath","doi":"10.25259/NMJI_324_2023","DOIUrl":"10.25259/NMJI_324_2023","url":null,"abstract":"","PeriodicalId":519891,"journal":{"name":"The National medical journal of India","volume":"37 4","pages":"232"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Macklin effect: Spontaneous pneumomediastinum caused by marijuana.","authors":"Bárbara Segura-Méndez, Álvaro Fuentes-Martín, José Soro-García","doi":"10.25259/NMJI_95_2023","DOIUrl":"10.25259/NMJI_95_2023","url":null,"abstract":"","PeriodicalId":519891,"journal":{"name":"The National medical journal of India","volume":"37 4","pages":"231"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exchange transfusion as a therapeutic modality for aniline dye-induced methaemoglobinaemia.","authors":"Nidhi Gupta, Sonali Dhagia, Arjun Kelaiya, Ruksar Sama, Kiran Padhy","doi":"10.25259/NMJI_406_21","DOIUrl":"10.25259/NMJI_406_21","url":null,"abstract":"<p><p>Methaemoglobinaemia and a Heinz-body haemolytic anaemia are uncommon but potentially treatable complications of aniline poisoning. Management of aniline poisoning is mainly removing the source of aniline exposure and management of methaemoglobinaemia. Management of methaemoglobinaemia is guided by blood methaemoglobin levels and patient symptoms. Blood methaemoglobin level <30% requires only supplemental oxygen while for methaemoglobin level >30%, intravenous methylene blue is the mainstay of treatment. All patients treated with methylene blue should be observed for delayed haemolysis, acute renal failure and cardiac complications. In patients with contraindication to methylene blue, exchange transfusion can be used while haemodialysis is reserved for complicated cases. We successfully managed 6 patients of methaemoglobinaemia due to aniline poisoning by methylene blue. Two of these patients who developed Heinz-body haemolytic anaemia with acute renal failure as a complication also required exchange transfusion.</p>","PeriodicalId":519891,"journal":{"name":"The National medical journal of India","volume":"37 4","pages":"195-199"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detached Schwalbe line in Axenfeld-Rieger syndrome.","authors":"Manju Pillai, Chinmayee Pabolu, Sameer Chaudhary","doi":"10.25259/NMJI_382_2023","DOIUrl":"10.25259/NMJI_382_2023","url":null,"abstract":"","PeriodicalId":519891,"journal":{"name":"The National medical journal of India","volume":"37 4","pages":"230"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a novel method for teaching drawing of histology diagrams to first year MBBS students.","authors":"Srividya Sreenivasan, Manisha Sandeep Nakhate","doi":"10.25259/NMJI_852_2022","DOIUrl":"10.25259/NMJI_852_2022","url":null,"abstract":"<p><p>Background The challenge faced by an undergraduate medical student to draw factually correct histology diagrams needs to be addressed by the use of innovative teaching strategies. We introduced a new method to teach drawing of histology diagrams and compared its outcome with two preexisting methods. We obtained feedback from the students and faculty. Methods We introduced an innovation (method 3): A validated hand-drawn pencil sketch of a histology diagram was provided to the students. Students drew on the pencil sketch with haematoxylin and eosin (H&E) pencils and coloured it. They then drew the same diagram afresh. Three diagrams of systemic histology were chosen and the evaluation criteria shared with students. The students drew all three diagrams once, each by a different method. The scores of method 3 were compared with the other two methods, copying from standard atlas (method 1) and from hand-drawn colour chart made by teacher (method 2). Feedback was sought from students and faculty by means of a google form. Results A total of 112 students (of 167 who volunteered) completed the study. The mean (SD) score obtained by method 3 (4.83 [0.298]) was higher than the mean score by method 1 (3.91 [0.95]) and method 2 (4.82 [0.27]). There was a statistically significant difference between method 3 and method 1 (p<0.01), and method 2 and method 1 (p<0.01). However, the difference in scores between methods 3 and 2 was not statistically significant (p>0.05). Conclusion We found method 3 (the innovation) to be better than one of the pre-existing methods (method 1) but not better than method 2. The quality of diagrams produced by methods 2 and 3 were better than those by method 1, and equally so. The ease of drawing and time taken to draw were the best for method 2. Hence, overall, method 2 may be adjudged the best method.</p>","PeriodicalId":519891,"journal":{"name":"The National medical journal of India","volume":"37 4","pages":"209-214"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence-powered Healthcare for India: Promises, opportunities and challenges.","authors":"Ashish Makani, Anurag Agrawal, Anjali Agrawal","doi":"10.25259/NMJI_1193_2024","DOIUrl":"10.25259/NMJI_1193_2024","url":null,"abstract":"","PeriodicalId":519891,"journal":{"name":"The National medical journal of India","volume":"37 4","pages":"177-180"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autologous stem cell transplantation can potentially reverse dialysis dependence in patients with myeloma: Report of two cases and practical considerations.","authors":"Suvir Singh, Rintu Sharma, Jagdeep Singh, Kunal Jain, Rajesh Kumar, Vikram Narang","doi":"10.25259/NMJI_268_2023","DOIUrl":"https://doi.org/10.25259/NMJI_268_2023","url":null,"abstract":"<p><p>Background Autologous stem cell transplantation (ASCT) is potentially beneficial for patients with myeloma-related renal impairment but is associated with high rates of complications in dialysis-dependent patients and requires specific precautions. Methods Patients diagnosed with myeloma and concomitant dialysis-dependent renal dysfunction were admitted for ASCT after achieving at least partial response with bortezomib-based induction therapy. For both patients, mobilization consisted of granulocyte colony stimulating factor for 5 days and CD34 directed Plerixafor on Day 1. Melphalan was administered at a dose of 140 mg/m2 and a pre-emptive session of haemodialysis was planned 24 hours after melphalan. Peripheral blood stem cell infusion was done after 24 hours. A central venous sample for blood gas analysis was obtained daily and ad hoc dialysis was planned at the earliest sign of metabolic acidosis (pH <7.35, HCO3 <15 or K >6 mEq/L). Results Two patients with biopsy proven cast nephropathy and dialysis dependence (twice a week) were taken for ASCT with the above protocol. No variation from usual stem cell yield or engraftment kinetics was noted. Patient 1 (M, 49 years) achieved very good partial response post-transplant and has been dialysis free for 18 months post-ASCT. Patient 2 (M, 48 years) achieved negative immunofixation post-ASCT and was dialysis free for 9 months post-transplant, following which he requires one session of dialysis every 3-4 weeks for onset of uraemic symptoms. Conclusions ASCT in dialysis-dependent patients is associated with a higher risk of drug toxicity, infections and transplant-related mortality. Use of reduced dose melphalan, pre-emptive dialysis after 24 hours and monitoring for acidosis and symptoms of uraemia to identify acidosis at an early stage allows safe administration of high dose chemotherapy. A major proportion of patients can potentially achieve reduction or freedom from dialysis support post-transplant.</p>","PeriodicalId":519891,"journal":{"name":"The National medical journal of India","volume":"37 3","pages":"138-140"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Haemodiafiltration or haemodialysis in kidney failure.","authors":"Gopesh K Modi, Sumit Kumar","doi":"10.25259/NMJI_212_2024","DOIUrl":"https://doi.org/10.25259/NMJI_212_2024","url":null,"abstract":"","PeriodicalId":519891,"journal":{"name":"The National medical journal of India","volume":"37 3","pages":"143-144"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}