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Rationale: This study presents the first comprehensive analysis and mapping of scientific research on point‐of‐care testing (POCT) in infectious diseases, filling a gap in understanding the evolving landscape of this field. The identification of research themes and global contributions offers valuable insights. Aims and Objectives: This manuscript aims to analyse and map scientific research on POCT in the context of infectious diseases. Methods: The study employed a comprehensive search strategy using terms related to POCT and infectious diseases. The search was conducted on the Scopus database, refining results based on inclusion and exclusion criteria. The dataset of 1719 research articles was then subjected to descriptive analysis and mapping using VOSviewer. Results: The research findings indicate an exponential growth in POCT‐related publications, with 46.8% published post the COVID‐19 pandemic. Plos One journal led in publication frequency, and Biosensors and Bioelectronics received the highest citations per article. North America and Western Europe dominated contributions, with notable participation from China, South Africa, and India. The research landscape revealed the following research themes: detection technologies, human immunodeficiency virus (HIV)/sexually transmitted infection (STI) diagnosis, antibiotic optimisation, and schistosomiasis. Clinical trials focused on antibiotic prescribing, HIV, STIs, and specific infections. The findings suggest a shifting landscape towards POCT, emphasising the need for future planning and investment in healthcare systems. The research identifies areas for future exploration, such as the impact of POCT on antibiotic prescribing and its role in combating infectious diseases in low‐ and middle‐income countries. Conclusion: Implementation of POCT has the potential to revolutionise infectious disease management, improve patient outcomes, and reduce the global burden of diseases. Better public awareness, healthcare team management, and planning for POCT at entry points are crucial for societal benefit. Results demonstrated the evolving role of POCT in infectious disease management and prevention. [ABSTRACT FROM AUTHOR]

Background: Hypothyroidism is a chronic disease, affecting almost all body functions, associated with deficiency in the thyroid hormones T4 and T3. Though different clinical practice guidelines available, but lots of inconsistency still exists in treatment practices by different physicians across different specialties. This study was conducted with an aim to document and report current clinical practices for managing hypothyroidism. Materials &Methods: A cross-sectional survey was conducted in 30 practicing doctors including family physicians/ general practitioners /primary care physicians, endocrinologists and doctors of other specialties practicing in and around Kolkata, West Bengal, India. Pre-designed validated questionnaire was used after necessary modification in view of pilot study to evaluate the clinical practice patterns for managing hypothyroidism in this study. Results: About 36.67% of participating doctors were practicing gradual restoration of euthyroidism, whereas 26.67% were of the opinion to prescribe an empiric dose and there after adjusting the dose to achieve target thyroid hormone levels and 36.67% agreed that they would start with a calculated full-replacement dose from the beginning. About 54% would increase in increments of 25 microgram during gradual restoration of euthyroidism. Approx. 90% would use a brand name of L-T4. 45% would recheck thyroid hormone levels 6 weeks after starting therapy and 56% would obtain laboratory studies at 3-month intervals. In patient planning pregnancy, the preferred TSH target was 1.0 to 1.4 mU/L (40%) while 60% would continue the current dose of LT4 during pregnancy. In subclinical hypothyroidism, positive TPO antibodies and symptoms of hypothyroidism constitute the main determinants for initiating treatment. Conclusion: The survey revealed both alignment and focal deviation from recent Clinical practice guidelines. [ABSTRACT FROM AUTHOR]

The study is an attempt to find out vital areas related to doctors' attitude towards generic medicines limiting its mass use. Attitude of medical practitioners, one factor amongst several, was chosen to evaluate doctors' behaviour towards generic medicines. Most of the countries in the world, rich or poor, are taking more interest in generic medicines due to rising healthcare costs. In India, out of pocket expenses towards healthcare costs are one of the highest in the world besides affordability issue due to its demographics. Generic medicines offer as an alternative to expensive medicines. Government is promoting use of generic medicines; doctors are being advised to write prescription in generic names; however, there are several challenges in its mass use. The study is of national importance as it addresses the issue of low generic prescriptions despite unaffordable access to expensive branded medicines. A questionnaire constructed descriptive, cross-sectional study was conducted in North India in 2020 amongst 228 medical practitioners at primary, secondary and tertiary healthcare centres. Spearman's rank correlation computed to assess the association between attitude and prescription of generic medicines was found to be positively correlated between the two variables indicating a significant moderate association between them. Attitude of doctors towards generic medicines has been found to be playing a significant role in influencing doctors in prescribing generic medicines which explains limited use of generic drugs. [ABSTRACT FROM AUTHOR]

We systematically reviewed empirical studies of psychotherapy with Indian clients. We defined psychotherapy as an intervention aimed at treating mental disorders using "talk," which, in a professional medical setting, along with the therapeutic relationship, acquires medicinal value. Besides manual searches in three leading Indian psychiatry journals, we conducted digital searches in PubMed, Google Scholar, and Scopus databases. We found that the commonly practiced evidence-based psychotherapy in India follows the cognitive-behavioral model. Our findings suggest several replication studies which claimed to have used the well-established western models of cognitive behavioural paradigm but have mostly focused on basic behavioural techniques in their protocol. A few innovations were observed, and several essential errors were noted. Innovations include contextual modifications to address the difficulties and challenges faced in service delivery, while errors include deviations from protocol without adequate rationale. [ABSTRACT FROM AUTHOR]

Background: Domestic violence is a deeply entrenched issue in Indian society, with global implications, especially for women's physical and mental health. Healthcare providers play important role in early identification and support of the victims. Medical interns, the future generation of Health care professionals, often acting as primary caregivers are uniquely positioned and expected to recognize and assist victims. This study aims to evaluate their knowledge, attitudes, practices, and readiness to manage domestic violence and its associating factors. Methods: This cross-sectional study was conducted among 157 medical interns at a Medical college and hospital in West Bengal, India, from December 2022 to February 2023. Simple random sampling was done. Data were collected using a semi-structured questionnaire, Medical Intern Readiness to manage domestic violence scale (MIREDS), validated after adoption from Physician Readiness to manage Intimate partner violence scale (PREMIS). Ethical approval was obtained, and participants gave informed written consent for inclusion. Satisfactory threshold was determined to be more than 50 percent. Data analysis was performed using MS Excel and SPSS software, including descriptive and inferential statistics, with a significance level of p less than 0.05, along with logistic regression analysis. Results: Only 45.2% of medical interns demonstrated satisfactory knowledge, 54.8% had a satisfactory attitude. Most interns (91.7%) exhibited poor practice in dealing with domestic violence cases, only 31.2% considered themselves ready to manage domestic violence cases. Interns who attend more patients was found to have better attitude. Positive associations were found between knowledge, attitude, and readiness to manage domestic violence cases among doctors. Conclusion: A substantial proportion of medical interns demonstrated inadequate knowledge, negative attitudes, and poor practice and inadequate readiness to manage domestic violence. Comprehensive training and education with cultural sensitivity training along with more practical exposures are in need to address this issue properly. [ABSTRACT FROM AUTHOR]

Introduction: Pediatric dentists play a role in the prevention of the communicable diseases such as COVID-19 and in the identification and referral of those children. There are concerns about the identification, referral, diagnosis, and treatment of oral manifestations of COVID-19 in children. Aim: To assess the knowledge, attitude, and practice (KAP) among pediatric dentists regarding oral manifestations of COVID-19 in children. Materials and Methods: This questionnaire-based cross-sectional survey included 255 registered pediatric dentists at Indian Society of Pedodontics and Preventive Dentistry. They were E-mailed an E-questionnaire with the help of Google Forms portal including informed consent and 16 formulated questions assessing the KAP among pediatric dentists regarding oral manifestations of COVID-19 in children. Incomplete forms were not accepted. The response was awaited for a period of 3 months. The collected data were subjected to descriptive and Chi-square analysis. Results: Sixty-three percent of the population had knowledge about all the oral manifestations of COVID-19 seen in children. Sixty percent were unsure about scheduling the next dental appointment for such patients. 48.3% of pediatric dentists could not prescribe medications for oral manifestations of COVID-19. Conclusion: Pediatric dentist could identify and diagnose the oral manifestations of COVID-19 and its associated complications however were unsure of treatment modalities as there is limited evidence for definitive treatment regarding the same. Clinical protocols concerning treatment for oral manifestations due to COVID-19 should be well established and practiced. [ABSTRACT FROM AUTHOR]

Alcohol use disorders (AUDs) are prevalent in intensive care units (ICUs). Alcohol abuse and/or dependence, leading to alcohol withdrawal syndrome (AWS), is as high as 10% or more. There seem to be wide variations in management strategies used to manage these patients, prompting an evaluation of the knowledge gap as well as finding the barriers. Noting lack of such literature in the Indian setting, a survey is undertaken to evaluate practice patterns surrounding the identification and management of alcohol dependence/abuse and AWS in the Indian critical care scenario. The main respondents of the survey are independent practitioners with anesthesia as their base specialty and overwhelmingly practice in multidisciplinary ICUs. They estimated AUD prevalence to be under 10%. The reason most expressed for lack of AUD documentation is fear of insurance rejection. Very few used risk assessment tool in evaluation of AUDs and AWS. Awareness of ICD 10/DSM-V components of AWS diagnosis was negligible. Chlordiazepoxide and lorazepam were used either in a fixed- or symptom-based therapy. Compared to available literature, haloperidol use is excessive, while barbiturates rarely. The wide variation is seen with the dose and frequency of thiamine in AWS without neurological complications. The impact on mortality and morbidity is poorly understood. In conclusion, the survey reported a lower prevalence compared to international literature. Insurance rejection is one of the main factors in limiting adequate history taking or documenting AUDs. Alcohol withdrawal syndrome risk assessment, monitoring, and management is variable and suboptimal. Variability in all aspects of AUDs is attributable to the knowledge gap. Further studies are needed to bridge the research gap. [ABSTRACT FROM AUTHOR]

Background: India has a high burden of stroke, but there are limited data available on the characteristics of patients presenting with stroke in India. Aims: We aimed to document the clinical characteristics, practice patterns, and outcomes of patients presenting with acute stroke to Indian hospitals. Methods: A prospective registry study of patients admitted with acute clinical stroke was conducted in 62 centers across different regions in India between 2009 and 2013. Results: Of the 10,329 patients included in the prescribed registry, 71.4% had ischemic stroke, 25.2% had intracerebral hemorrhage (ICH), and 3.4% had an undetermined stroke subtype. Mean age was 60 years (SD = 14) with 19.9% younger than 50 years; 65% were male. A severe stroke at admission (modified-Rankin score 4–5) was seen in 62%, with 38.4% of patients having severe disability at discharge or dying during hospitalization. Cumulative mortality was 25% at 6 months. Neuroimaging was completed in 98%, 76% received physiotherapy, 17% speech and language therapy (SLT), 7.6% occupational therapy (OT), with variability among sites; 3.7% of ischemic stroke patients received thrombolysis. Receipt of physiotherapy (odds ratio (OR) = 0.41, 95% confidence interval (CI): 0.33–0.52) and SLT (OR = 0.45, 95% CI: 0.32–0.65) was associated with lower mortality, while a history of atrial fibrillation (OR = 2.22, 95% CI: 1.37–3.58) and ICH (OR = 2.00, 95% CI: 1.66–2.40) were associated with higher mortality. Conclusion: In the INSPIRE (In Hospital Prospective Stroke Registry) study, one-in-five patients with acute stroke was under 50 years of age, and one-quarter of stroke was ICH. There was a low provision of thrombolysis and poor access to multidisciplinary rehabilitation highlighting how improvements are needed to reduce morbidity and mortality from stroke in India. [ABSTRACT FROM AUTHOR]

Purpose: In the study, we investigated whether speech-language pathologists (SLPs) in India use practice and feedback conditions of motor learning principles (MLPs), including biofeedback, in dysphagia therapy in adults using a problem--solution approach. Method: Based on a literature review and clinical experience, we developed and validated a hypothetical case involving an adult with dysphagia (representing the problem) and a purpose-built 22-item questionnaire (representing the solution). We distributed the questionnaire electronically by sending an e-mail to 2,069 SLPs and also published a flyer on the dysphagia special interest group of India. Results: A total of 107 SLPs anonymously submitted their responses. In practice conditions, most of the SLPs reported following massed over distributed, small over large, blocked over random, whole over part, variable over constant, and internal over external practice strategies. In feedback conditions, most of the participants reported using knowledge of results over performance, high over low, immediate over delayed, and self over therapist feedback strategies. Lastly, more than two thirds of SLPs did not use biofeedback devices for dysphagia therapy. Conclusion: The findings from our study indicate that SLPs in India do not adhere uniformly to the recommended practices of MLPs for dysphagia therapy in adults. [ABSTRACT FROM AUTHOR]

Alcohol Use Disorder (AUD) is a chronic disease characterized by excessive drinking, increased craving, development of tolerance and withdrawal symptoms toward alcohol. Anti-craving drugs, psychotherapy, and supportive therapy (vitamin supplements) play a major role in managing AUD and preventing relapse. This study focuses on the prescribing pattern of anti-craving drugs among AUD patients. A prospective observational study was conducted for 6 months in the Department of Psychiatry of a multispeciality hospital in south India with a sample size of 169 AUD patients. Anti-craving drugs of each patient were analyzed. Males were majorly diagnosed with AUD. Approximately equal distribution of newly diagnosed cases and existing cases were seen. Most of the inpatients were treated with anti-craving drugs like benzodiazepines, ondansetron, baclofen, or topiramate, while outpatients were treated with benzodiazepines, ondansetron, or baclofen along with psychotherapy and supportive therapy. Craving was the common factor for relapse. Patients were initially treated with the benzodiazepines in tapering or continued dose, along with ondansetron, baclofen, or topiramate. Psychotherapy and supportive therapy were given to all the patients and most of them were discharged with benzodiazepines, ondansetron, or baclofen. Several factors played a significant role in the starting of alcohol and relapse. [ABSTRACT FROM AUTHOR]

Introduction A crash cart is the trolley for storing lifesaving equipment and drugs in a hospital. During an emergency situation, nurses are left with confusion and hurry in getting the emergency medication and equipment. Typically, the crash cart system remains locked until a code blue triage is initiated by the hospital. This lack of exposure leads to poor competency and confident in performing essential tasks during a code blue. A well-organized crash cart system can save a lot of time and confusion during an emergency, which in turn can save a life. Aim The aim of this study was to identify the knowledge and practice of internship students on emergency crash cart system and to find the correlation between knowledge and practices of nursing internship students on maintenance of emergency crash cart system. Materials and Methods A descriptive correlative research study was conducted among 93 nursing internship students tertiary care hospital, Mangaluru, Karnataka, India. The samples were selected by using purposive sampling techniques. Demographic proforma, structured knowledge questionnaire on knowledge regarding emergency crash cart system with 32 items was used to determine the level of knowledge and observation practice checklist with 24 items was used to assess the practice of internship students on maintenances of emergency crash cart system. Descriptive and inferential statistics was used to analyze the collected data. Results Majority (89; 95.7%) of the internship students are in the age group of 20 to 25 years and most (59; 63.4%) of internship students are working in wards. Of that 79 (84.9%) internship students have average knowledge with mean 18.1, median 19, and standard deviation (SD) 3.2. Majority 90 (96.7%) of the internship students have satisfactory practice on emergency crash carts with mean 22.9, median 23, and SD 1. 11. There is a moderate positive linear relationship between knowledge and practice scores of the internship students on the emergency crash cart system (r = 0.38, df =92, p = 0.05). Conclusions The study concludes nursing internship students have average knowledge about emergency crash cart system. And the practice of internship students on maintenance of crash cart was satisfactory. The study thus implies the need for frequent reinforcement and training programs, which may help the internship students to improve knowledge on emergency crash cart systems. There should be clear instructions about the arrangement and use of a crash cart in each and every unit. [ABSTRACT FROM AUTHOR]

Introduction: Social and economic position, environment, access to healthcare, ethos, and worldview are all important determinants of people's health-seeking behavior. Tribal communities in India oscillate between their emic rationale for the cause and treatment of health concerns on the one hand and affordable modern methods on the other. The present article is based on a study conducted among the Junag tribe of Odisha to understand their acceptance and preference for traditional or modern healthcare systems and the reasons for these choices. Material and Methods: Purposive sampling, a pre-structured schedule, an observation approach, case studies, and interviews with community members have been used to gather the primary data used in the study. Result: The study identified a diverse pattern of health-seeking behavior. From the four villages, 70% of respondents combined into cluster-1 preferred the traditional healthcare system, mostly for geographical and cultural reasons, as opposed to 95% of respondents from the villages in cluster-2, who preferred modern healthcare services because they were more easily accessible and involved modern healthcare providers. Conclusion: In this research work, it has been found that the Juang tribe is in a transitional phase and uses a hybrid approach to health seeking. Moreover, it has also been discovered that important variables including cultural attitudes and the affordability of contemporary healthcare services have influenced people's decisions toward healthcare systems. [ABSTRACT FROM AUTHOR]

Background and object: The burden of neurological disorders in India is expected to increase due to the rapid demographic and epidemiological transition, with irrational drug use, which is also a global concern. Thus, drug utilization evaluation is designed to ensure appropriate medicine use within the healthcare settings. The aim of the study was to assess the rate and pattern of drug utilization in the management of neurological disorders. Materials and methods: A hospital-based cross-sectional drug utilization evaluation study on neurological drugs was carried out at the Department of Neurology over a span of six months. All legible prescriptions consisting neurological medications irrespective of patient's gender, aged ≥ 18 years were included for the study. The World Health Organization (WHO) core drug use indicators were used to assess the drug prescribing and utilization patterns. Results: A total of 310 prescriptions were reviewed, where male predominance was found to be 56.45%. Out of 310 prescriptions, drugs belonging to 26 neurological classes were prescribed for the management of various neurological disorders. The majority of patients were diagnosed with epilepsy and the most prescribed drugs per patient were phenytoin (14.8%) and valproic acid (6.45%). By following the WHO core drug prescribing indicators, 65.47% of drugs prescribed from the India National List of Essential Medicines, 2022, followed by 29.83% of drugs prescribed in generic name and 10.86% of prescriptions including injections. Conclusion: The study findings showed that the prescribing pattern in the Department of Neurology was in accordance with the WHO core prescribing indicators. But, the extent of polypharmacy prescriptions was very high. Therefore, interventions are very necessary to promote rational drug prescribing patterns and thus clinical pharmacists can contribute to assess and review the drug utilization pattern to optimize the drug therapy and improvement in patient safety. [ABSTRACT FROM AUTHOR]

Background: Antibiotic misuse is a global threat. In recent years, inadequate awareness and inappropriate adherence to antibiotic prescription have been coupled with frequent self-medication practices. Aims: The study aims to assess awareness, perception and practices followed by nurses on antibiotics use at a tertiary care hospital in North India. Materials and Methods: This online survey was completed by 232 nurses working at a tertiary care teaching hospital in North India from September to October 2020. A pre-validated questionnaire of awareness, perception and practices was used to collect information. Appropriate descriptive and inferential statistics are used to generate the results. Results: The mean age of nurses was 27.84 (±3.06) years, and 60% were male. The majority of the nurses (80.17%) had a graduate degree in nursing, with a professional experience of 6.25 (±5.30) years. More than two-third (87.5%) of nurses are familiar with the word antibiotics resistance. Surprisingly, 47.4% of nurses used antibiotics more than two times without a prescription in the current year. Interestingly, 95.26% of nurses know antibiotics are effective against bacteria and are disease specific (93.79%). Further, 96.55% of nurses said that unnecessary antibiotic use might lead to resistance, and 68.10% agreed to take antibiotics after a doctor's prescription. Conclusions: Self-medication practices were high amongst nurses. Organising more in-service education, intense orientation programmes and instruction-based training needs to intensify nurses on the appropriate use of antibiotics and to set up an antimicrobial stewardship programme at the institute. [ABSTRACT FROM AUTHOR]

Introduction: Clinical practice guidelines (CPG) exist for the management of non‐specific low back pain (LBP). The objective of this study is to evaluate if Indian physiotherapists' follow CPGs when treating patients with acute LBP. Methods: A cross‐sectional survey using an online questionnaire was used to collect demographic information, views, and opinion about acute LBP and CPGs, and management strategies of a clinical vignette presenting a patient with acute LBP. Results: Responses from 328 physiotherapists were included in this study. Eighty‐one percent of respondents indicated familiarity with CPGs for LBP and 75.3% (n = 328) respondents indicated that their intervention choices aligned with guidelines to at least some extent. Participants with post‐graduate and doctoral degrees were more accustomed to CPGs than those with bachelor's degrees (p < 0.01). There were significant differences in clinical practice (p < 0.01) between therapists who expressed familiarity with guidelines and those who were not, as well as those with and without post‐graduate and doctoral degrees. Conclusion: In general, the study showed adherence to guidelines; however, there were areas that did not align with established evidence, especially referral for radiology and use of electrical modalities. [ABSTRACT FROM AUTHOR]

The objective of the present study was to evaluate the Drug utilisation pattern in patients of diabetic nephropathy (stage 1–4) in a tertiary care hospital in South-Asia. A cross-sectional observational study was conducted in the nephrology out-patient-department of a tertiary care hospital in South-Asia. WHO core prescribing, dispensing, and patient care indicators were evaluated, and adverse drug reactions (ADRs) encountered by the patients were analysed for causality, severity, preventability, and outcome. The most commonly prescribed antidiabetics in diabetic nephropathy patients were insulin (17.42%), followed by metformin (4.66%). Current drugs of choice SGLT-2 inhibitors were prescribed in a lesser frequency than expected. Loop diuretics and calcium channel blockers (CCBs) were the preferred antihypertensives. The use of ACE inhibitors (1.26%) and ARBs (3.45%) for hypertension was restricted to Stage 1 and 2 nephropathy. The patients were on 6.47 drugs on average. 30.70% of drugs were prescribed by generic names, 59.07% of the drugs were prescribed from the national essential drugs list and 34.03% of the prescribed drugs were supplied by the hospital. CTCAE grade 1 (68.60%) and grade 2 (22.09%) ADR severity was the highest. Prescribing patterns in patients of diabetic nephropathy were adapted from relevant medical evidence, affordability and availability of the drugs. Generic prescribing, availability of drugs and ADR preventability in the hospital have a broad scope for improvement. [ABSTRACT FROM AUTHOR]

Background: It is crucial for anaesthesiologists to know the hazards of biomedical waste [BMW] and its management from the initial generation to segregation and storage at site followed by disinfection and its final disposal. The present cross-sectional study was conducted to assess the levels of Knowledge, Attitudes, and Practices with respect to biomedical waste management (BMWM) amongst students and consultants in anaesthesiology working in government, corporate, private hospitals and own setups. Method: The study tool consisting of a questionnaire of 21 questions divided into 6, 7 and 9 questions on Knowledge, Attitudes and Practices respectively was distributed to 300 participents. Amongst them total respondents were 275 and 17 incompletely filled questionaires were excluded from the study. Thus, the analyses represents the answers of 258 respondents that represent consultants and post graduate students of anaesthesiology. Results: Majority (>50%) had PG degree (MD/DNB), working as consultants (>80%) with >10 years' experience. Amongst them 44% were working in Govt. set-up, 23% in Private, 22% in Corporate and 11% in own setup. Overall, knowledge, attitude and practice score amongst participants was 48.31%, 43.57% and 62.32% respectively. For knowledge, significantly higher (49.16%) with correct responses was observed for consultants working in Govt. setting. For attitude, significantly lower percentage with correct responses was observed for consultants working in Private (25.73%) and Own setting (13.69%). For practices, highest (64.97%) correct responses was observed for participents working in Corporate setup and >50% students follow safe BMWM practices. Overall combined KAP score of participants regarding BMWM was 50.89%, amongst which participants in Govt Setup performed better with highest number of correct responses. Conclusion: Overall knowledge was poor; attitude was unsatisfactory but practices towards BMW amongst anaesthesiologists was satisfactory. Thus, there is need to organise lectures/CME/training sessions in hospitals to bring more awareness on BMWM which will help in competent disposal of biomedical waste. [ABSTRACT FROM AUTHOR]

Introduction: The World Health Organization (WHO) recommends quality-based “AWaRe classification of antibiotics” for the monitoring of antimicrobial consumption. It classifies commonly used antimicrobials into five main categories: Access, Watch, Reserve, Not-recommended (NR), and Others. At least 60% of total consumption should be from the Access category and <10% should be from the Reserve category to minimize the further development of resistance. However, we do not know how these recommendations compare with current trends in antimicrobial consumption in India. Hence, a study was planned to statistically evaluate the AWaRe classification-based trend of antimicrobial consumption over 5 years. Materials and Methods: A retrospective study was conducted to retrieve the antimicrobial consumption data of SMS Hospital, Jaipur, from January 2017 to December 2021 as per AWaRe classification. Regression and statistical process control analysis was carried out separately for all five categories of antimicrobials on MATLAB 2016a (9.0.0.341360). Results: Regression analysis revealed that the consumption of Access, NR, and Others significantly decreased while that of Watch and Reserve increased between 2017 and 2021. Statistical process control analysis showed that the use of Access, Watch, and Others was within prescribed statistical limits but that of Reserve and NR was higher than statistical thresholds at times. Conclusion: The increased consumption of Watch and Reserve antimicrobials combined with surpassing of upper control limit by Reserve and NR antimicrobials at certain times raises concern. Hence, there is an acute need to take measures to generate awareness about the incorporation of the WHO recommendations in practice to support the antimicrobial stewardship program. [ABSTRACT FROM AUTHOR]

Introduction: Antibiotic use during endourological procedures is often discordant from the reported guidelines, despite the potential risks of antibiotic resistance, adverse effects, and health-care costs. A nationwide audit was conducted, with the support of the Urological Society of India, to ascertain the current antibiotic prescription practices for the endourological procedures and the reasons associated with them. Methods: A multi-institutional, national-level, cross-sectional audit analyzing elective endourological procedures was performed. The data regarding the disease profile; risk factors for infectious complications; urine culture; pre-, per-, and post-operative antibiotic use; additional antibiotic use; and patient demographics were collected in a standardized pro forma. Reasons for prescribing antibiotics divergent from the guideline recommendations were also noted. Any infectious complication that necessitated the antibiotic use was also noted prospectively up to 1 month. All the data were entered into a single centralized and customized online portal on a real-time basis. Results: One thousand five hundred and thirty-eight cases were recruited from 20 hospitals. A single-dose prophylaxis was prescribed in only 319 (20.7%) of the cases, and the majority received a multi-day prophylaxis. A combination of two or more antibiotics was prescribed as the prophylaxis in 51% of the cases. One thousand three hundred and fifty-six (88.2%) cases were continued on a long-duration prophylaxis after the discharge, with 1191 (77.4%) receiving it for > 3 days. One thousand one hundred and sixty (75.4%) cases received a guideline-discordant prophylaxis solely on the basis of the surgeon's or institution's protocol, rather than any specific case based need. Ninety eight (6.4%) cases developed postoperative urinary tract infection. Conclusions: Multi-dose, combination and post-discharge antibiotic prophylaxis for endourological surgeries is highly prevalent in India. This audit highlights the huge potential to reduce such guideline-discordant overuse of antibiotics during the endourological procedures. [ABSTRACT FROM AUTHOR]

Introduction: The key objective of this research was to describe the prescription rate of various antibiotics for dental problems in India and to study the relevance of the prescriptions by analysing antibiotic types associated with different dental diagnoses, using a large-scale nationally representative dataset. Methods: We used a 12-month period (May 2015 to April 2016) medical audit dataset from IQVIA (formerly IMS Health). We coded the dental diagnosis provided in the medical audit data to the International Statistical Classification of Diseases and Related Health Problems (ICD-11) and the prescribed antibiotics for the diagnosis to the Anatomic Therapeutic Chemical (ATC) -2020 classification of the World Health Organization. The primary outcome measure was the medicine prescription rate per 1,000 persons per year (PRPY1000). Results: Our main findings were—403 prescriptions per 1,000 persons per year in the year 2015 -2016 for all dental ailments. Across all ATC level 1 classification, 'Diseases of hard tissues' made up the majority of the prescriptions. 'Beta-lactam', 'Penicillin,' and 'Cephalosporins' were the most commonly prescribed antibiotics for dental diagnoses followed by 'Macrolides' and 'Quinolones'. 'Dental caries', 'Discoloration of tooth', and 'Toothache' were the most common reasons for 'Beta-Lactams' and 'Penicillin' prescriptions. Conclusion: To conclude our study reports first ever country (India) level estimates of antibiotic prescription by antibiotic classes, age groups, and ICD-11 classification for dental ailments. [ABSTRACT FROM AUTHOR]

The article focuses on the Indian Psychiatric Society (IPS) Clinical Practice Guidelines (CPGs) for psychiatric emergencies and brain stimulation techniques. The first set of topics covers psychiatric emergencies, providing guidance on how psychiatrists can manage patients with aggression and violence, suicidal behavior, and breaking bad news with topics covering brain stimulation techniques, including electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).

The objective of the present study was to find out the current practices in evaluating and managing vestibular disorders across the country by Audiologists in India. An e-survey was performed. A total of 31 questions were prepared for the survey. The survey questionnaire was circulated among 400 Audiologists. Out of 400 participants, 248 participants responded to the survey. Out of 248 participants, 111 participants reported performing vestibular testing. Most of the professionals worked in a corporate setup. Total patients with vestibular disorders reported to these setups ranged from 1-2 per month to 100–120 patients/month. Regarding the clinical tests, most participants reported performing the Romberg test, Fukuda stepping test, tests for cerebellar functioning and HINTS/HINTS plus in their setup for vestibular assessment and management. Regarding the barriers to vestibular assessment and management, most participants indicated that the lack of necessary training and experience to conduct vestibular assessment and management procedures was significant. There is a lot of variability in assessment and management procedures among the professionals. There is a need to make uniform protocol across the country, and the vestibular assessment and management should be included as a separate course in their curriculum. [ABSTRACT FROM AUTHOR]

Background: Trauma is the leading cause of death in India resulting in a significant public health burden. Indian Society of Critical Care Medicine (ISCCM) has established a trauma network committee to understand current practices and identify the gaps and challenges in trauma management in Indian settings. Material and methods: An online survey-based, cross-sectional, descriptive study was conducted with high-priority research questions based on hospital profile, resource availability, and trauma management protocols. Results: Data from 483 centers were analyzed. A significant difference was observed in infrastructure, resource utilization, and management protocols in different types of hospitals and between small and big size hospitals across different tier cities in India (p < 0.05). The advanced trauma life support (ATLS)-trained emergency room (ER) physician had a significant impact on infrastructure organization and trauma management protocols (p < 0.05). On multivariate analysis, the highest impact of ATLS-trained ER physicians was on the use of extended focused assessment with sonography in trauma (eFAST) (2.909 times), followed by hospital trauma code (2.778 times), dedicated trauma team (1.952 times), and following trauma scores (1.651 times). Conclusion: We found that majority of the centers are well equipped with optimal infrastructure, ATLS-trained physician, and management protocols. Still many aspects of trauma management need to be prioritized. There should be proactive involvement at an organizational level to manage trauma patients with a multidisciplinary approach. This survey gives us a deep insight into the current scenario of trauma care and can guide to strengthen across the country. [ABSTRACT FROM AUTHOR]

Introduction: The etiology of hypertension in post renal transplant patients is multifold and effective control of blood pressure (BP) contributes towards proper graft functioning and reduces risk of cardiovascular diseases. This prospective observational study was undertaken to evaluate the prevalence of antihypertensive drug use, the prescribing pattern and trends of blood pressure control in a cohort of post renal transplant patients from eastern India. Materials and Methods: Patients who had undergone renal transplant in this public hospital were enrolled as per eligibility criteria. All enrolled patients were on antihypertensive from at least 3months prior to transplant and were followed upto one year post-transplant. Antihypertensive drug (AHD) and immunosuppressant intake, BP recordings and occurrence of major adverse cardiac events (MACE), if any were noted at each visit. Results: 56 patients were enrolled with a mean age of 33.04 ± 9.96 years, 87.5% were male. 75% were hypertensive at discharge (2-3 weeks post-transplant). Percentage of patients on AHD at 3, 6, 9 and 12 months post-transplant were 83.9%, 82.1%, 75% and 71.4% respectively. Amlodipine was the most common prescribed AHD. Target BP control (≤130/80 mm of Hg) was achieved in 62.5% patients at 1year post-transplant. There were no major adverse cardiac events (MACE) during the study period. Conclusion: In our study comprising of a relatively young cohort of transplant patients from India, hypertension control was well achieved in majority of the subjects and no MACE were noted. Amlodipine was the most commonly used AHD either as monotherapy or in combination with beta-blocker. Long term follow up of this cohort shall provide further insights into the trends of such control. [ABSTRACT FROM AUTHOR]

Introduction: There are a few studies on the psychotropic prescription pattern in Eastern India, particularly in West Bengal, with limited statistics and focus, as well as there is no study conducted in health facilities particularly catering to the labor class population. To improve the mental health-care delivery in laborers and their dependents through policy-making, information is required regarding psychotropic prescription patterns in laborers suffering from mental disorders. Materials and Methods: A hospital-based, cross-sectional study was conducted for 6 months. A total of 3000 patients were randomly selected from those who consented to utilize their information for study purposes. DSM-5 was used for psychiatric diagnosis. Descriptive statistic was used to describe drug use pattern. The World Health Organization-drug use indicators were used for analyzing prescriptions. Results: Among 3000 participants, 1114 (37.1%) and 537 (17.9%) were suffering from somatic symptom disorder and generalized anxiety disorder, respectively. Antidepressants and benzodiazepines (BZDs) with Z-drugs together form the major bulk of prescriptions. Amitriptyline, olanzapine, and alprazolam were the most commonly prescribed antidepressants, antipsychotics, and BZDs, respectively. Conclusion: Neurotic and anxiety disorders are major psychiatric morbidity among the labor class population. Antidepressants like amitriptyline and BZDs like alprazolam can meet the majority of mental health needs of laborers. Therefore, policy and provision are required for an adequate availability of these drugs in catering centers. [ABSTRACT FROM AUTHOR]

Background Despite its mostly viral etiology, antibiotics are frequently used to treat acute respiratory infections (ARIs) in children. India is one of the largest global consumers of antibiotics and has one of the highest rates of resistance to antimicrobial treatments. However, the epidemiology of antibiotic treatment among young children in India is poorly understood. Methods Using nationally representative household survey data from the Indian National Family Health Surveys (NFHS) conducted between 2015 and 2016 and 2019 and 2021, we estimated the prevalence of antibiotic use among 17472 children under the age of three who reported ARI symptoms within two weeks before their mothers were interviewed. To assess the factors associated with antibiotic use for the treatment of ARI symptoms, we used multivariable logistic regression models that included sociodemographic, child-related, household, and health care related characteristics, with results reported on the prevalence difference (PD) scale. Results We estimated that 18.7% (95% CI=17.8-19.6) of under-three-year-old (U3) children who exhibited ARI symptoms in the two weeks prior to the survey were given antibiotics as a treatment. The highest prevalence was observed in the southern and northern geographic zones of India. Furthermore, multivariable regression models indicated that children with greater access to health services were more likely to receive antibiotics for ARI treatment, regardless of the type of health care facility (public, private or pharmacy/unregulated). Additionally, the prevalence of antibiotic consumption was higher among children from families with religious affiliations other than Muslim and Hindu backgrounds (i.e. Christian, Sikh, Buddhist/neo-Buddhist, Jain, Jewish, Parsi/, no religion and other) (PD=11.7 (95% CI=6.3-16.7)) compared to Hindu families and among mothers with a secondary or higher education (PD=5.8 (95% CI=1.7-9.9)) compared to mothers lacking formal education. Conclusions Our findings provide an important baseline for monitoring the use of antibiotics for the treatment of acute respiratory infections, and for designing interventions to mitigate potential misuse among young children in India. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to address the issue of antibiotic prescription processes in an Indian Intensive care unit (ICUs). Materials and methods:: In a prospective longitudinal study, all adult patients admitted in the ICU for 24 hours or above between 01 June 2020 and 31 July 2021 were screened for any new antibiotic prescription throughout their ICU stay. All new antibiotic prescriptions were assessed for baseline variables at prescription, any modifications during the course, and the outcome of antibiotic prescription. Results: A total of 1014 patients fulfilled entry criteria; 59.2 and 7.2% of days they were on a therapeutic or prophylactic antibiotic(s). Patients, who were prescribed therapeutic antibiotic(s), had worse ICU outcomes. A total of 49.5% of patients (502 of 1,014) received a total of 552 new antibiotic prescriptions during their ICU stay. About 92.13% of these prescriptions were empirical and blood or other specimens were sent for culture in 78.81 and 60.04% of instances. A total of 31.7% of episodes were microbiologically proven and were more likely to be prescribed by an ICU consultant. A total of 169 modifications were done in 142 prescription episodes; 73 of them after sensitivity results. Thus, the overall rate of de-escalation was 13.95%. Apart from the negative culture result (36.05%), an important reason for a relatively low rate of de-escalation was the absence of sampling (12.32%). Longer ICU stay before antibiotic prescription, underlying chronic liver disease (CLD), worse organ dysfunction, and septic shock were independently associated with unfavorable treatment outcomes. No such independent association was observed between antibiotic appropriateness and patient outcome. Conclusion: Future antibiotic stewardship strategies should address issues of high empirical prescription and poor microbiological sampling hindering the de-escalation process. [ABSTRACT FROM AUTHOR]

* Context.--The histopathology reporting practice in rural areas is largely variable. To ensure the adequacy of histopathology reports (HPRs), the College of American Pathologists (CAP) has developed cancer reporting checklists. Objective.--To assess the adequacy of resection specimen HPRs received from outside centers for a second opinion. Further, the adequacy of breast resection HPRs from these centers was compared with that of our center. Additionally, the reports representing endometrial carcinoma were assessed for impact on the treatment decision. Design.--This was a retrospective study conducted from June 2015 to December 2019. HPRs from outside centers and our institute were analyzed for mandatory reporting elements as per CAP 2013 checklists. Results.--A total of 730 HPRs (558 outside HPRs and 172 in-house breast HPRs) were reviewed for completeness. The outside HPRs were complete in 42 of 558 cases (7.5%). Only 11 of 143 reports (7.7%) from the academic centers were complete. Seventeen of 249 outside breast HPRs (6.8%) were complete, whereas predominant (n = 123 of 172; 71.5%) in-house breast HPRs were adequate. Most outside endometrial carcinoma reports (60.8%; n = 28 of 46) were inadequate with potential impact on the adjuvant treatment, whereas 10 of 46 reports (21.7%) were inadequate and had an actual impact on the adjuvant treatment decision. Conclusions.--Minimal data set reporting using checklists is not yet widely operational in most rural laboratories. We call for continuous education and sensitization of the practicing pathologists, oncopathology education of the trainees, and regulatory standards for signing out an oncopathology report. [ABSTRACT FROM AUTHOR]

The study was conducted to assess patterns of prescribed drug therapy and clinical predictors of need for therapy escalation in outpatients with diabetes mellitus (DM). This was a prospective cohort study, conducted at an apex tertiary care teaching hospital in central India for a period of 18 months. The demographic, clinical, and treatment details on the baseline and follow up visits were collected from the patients' prescription charts. Glycemic control, adherence, pill burdens along with pattern of antidiabetic therapy escalation, and deescalations were analyzed. A total of 1,711 prescriptions of 925 patients of diabetes with a mean age of 53.81 ± 10.42 years and duration of disease of 9.15 ± 6.3 years were analyzed. Approximately half of the patients (n=450) came for ≥1 follow up visits. Hypertension (59.35%) was the most common comorbidity followed by dyslipidemia and hypothyroidism. The mean total daily drugs and pills per prescription were 4.03 ± 1.71 and 4.17 ± 1.38, respectively. Metformin (30.42%) followed by sulphonylureas (SUs) (21.39%) constituted majority of the AHA's and dual and triple drug therapy regimens were most commonly prescribed. There were improvements in HbA1c, fasting/postprandial/random blood sugar (FBS/PPBS/RBS) as well as adherence to medication, diet, and exercise in the follow up visits. Among patients with follow ups, therapy escalations were found in 31.11% patients, among whom dose was increased in 12.44% and drug was added in 17.28%. Apart from Hb1Ac, FBS, and PPBS levels (p<0.001), characteristics such as age, BMI, duration of diagnosed diabetes, presence of hypertension and dyslipidemia, and daily pill burdens were found to be significantly higher in the therapy escalation group (p<0.05). Inadequate medication adherence increased the relative risk (RR) of therapy escalation by almost two times. Disease and therapy patterns are reflective of diabetes care as expected at a tertiary care center. Higher BMI, age, pill burden, duration of diabetes, presence of comorbidities, and poor medication adherence may be the predictors of therapy escalation independent of glycemic control and such patients should be more closely monitored. [ABSTRACT FROM AUTHOR]

Background: Although guidelines from multiple scientific studies decide the general trend in ACLR practice, there is often a variation between scientific guidelines and actual practice. Methods: A 17-member committee comprised of sports surgeons with experience of a minimum of 10 years of arthroscopy surgery finalized a survey questionnaire consisting of concepts in ACL tear management and perioperative trends, intraoperative and post-operative practices regarding single-bundle anatomic ACLR. The survey questionnaire was mailed to 584 registered sports surgeons in six states of south India. A single, non-modifiable response was collected from each member and analyzed. Results: 324 responses were received out of 584 members. A strong consensus was present regarding Hamstring tendons preference for ACLR, graft diameter ≥ 7.5 mm, viewing femoral footprint through the anterolateral portal, drilling femoral tunnel from anteromedial portal guided by ridges and remnants of femoral footprint using a freehand technique, suspensory devices to fix the graft in femur and interference screw in the tibia and post-operative bracing. A broad consensus was achieved in using a brace to minimize symptoms of instability of an ACL tear and antibiotic soaking of graft. There was no consensus regarding the timing of ACLR, preferred graft in athletes, pre-tensioning, extra-articular procedure, and return to sports. There was disagreement over hybrid tibial fixation and suture tapes to augment graft. Conclusion: Diverse practices continue to prevail in the management of ACL injuries. However, some of the consensuses reached in this survey match global practices. Contrasting or inconclusive practices should be explored for potential future research. [ABSTRACT FROM AUTHOR]

Depression is a prevalent mental health condition treated with antidepressants and other psychotropic medications. This study aimed to assess the utilization pattern of antidepressants among patients visiting the outpatient clinic of the psychiatry department of a tertiary care hospital. The study included the patients who visited the study site and fulfilled the mental and behavioral diagnostic criteria for depression. The demographic and clinical details, including drugs prescribed, were documented in a study-specific data collection form. The ratio of Prescribed Daily Dose to Defined Daily Dose (PDD: DDD) was calculated to assess the adequacy of antidepressant utilization. Data total of 154 patients were collected. A total of 22 psychotropic drugs were used among the study patients as mono (n = 70), dual (n = 69), triple (n = 10), or quadruple therapy (n = 1). Escitalopram was the most often prescribed antidepressant out of the nine antidepressants alone and in combination and was used in slightly high doses (PDD: DDD ratio 1.6). Sertraline, paroxetine, and desvenlafaxine, were used in adequate doses (PDD: DDD between 1 and 1.1), and fluoxetine, duloxetine, amitriptyline, imipramine, and mirtazapine, were used in inadequate doses (PDD: DDD <0.5). Our study findings reveal the need for continuous assessment of antidepressants medications usage in a hospital set up. [ABSTRACT FROM AUTHOR]

Background: The management of frozen shoulder (FS) differs depending on experience level and variation between scientific guidelines and actual practice. Purpose: To determine the current trends and practices in the management of FS among shoulder specialists and compare them with senior shoulder specialists. Study Design: Consensus statement. Methods: A team of 15 senior shoulder specialists (faculty group) prepared a questionnaire comprising 26 questions regarding the definition, terminology, clinical signs, investigations, management, and prognosis of FS. The questionnaire was mailed to all the registered shoulder specialists of Shoulder and Elbow Society, India (SESI) (specialist group; n = 230), as well as to the faculty group (n = 15). The responses of the 2 groups were compared, and levels of consensus were determined: strong (>75%), broad (60%-74.9%), inconclusive (40%-59.9%), or disagreement (<40%). Result: Overall, 142 of the 230 participants in the specialist group and all 15 participants in the faculty group responded to the survey. Both groups strongly agreed that plain radiographs are required to rule out a secondary cause of FS, routine magnetic resonance imaging is not indicated to confirm FS, nonsteroidal anti-inflammatory drugs should be administered at bedtime, steroid injection (triamcinolone or methylprednisolone) is the next best option if analgesics fail to provide pain relief, passive physical therapy should be avoided in the freezing phase, <10% of patients would require any surgical intervention, and patients with diabetes and thyroid dysfunction tend to fare poorly. There was broad agreement that routine thyroid dysfunction screening is unnecessary for women, a single 40-mg steroid injection via intra-articular route is preferred, and arthroscopic capsular release (ACR) results in a better outcome than manipulation under anesthesia (MUA). Agreement was inconclusive regarding the use of combined random blood sugar (RBS) and glycosylated hemoglobin versus lone RBS to screen for diabetes in patients with FS, preference of ACR versus MUA to treat resistant FS, and the timing of surgical intervention. There was disagreement over the most appropriate term for FS, the preferred physical therapy modality for pain relief, the most important movement restriction for early diagnosis of FS, and complications seen after MUA. Conclusion: This survey summarized the trend in prevalent practices regarding FS among the shoulder specialists and senior shoulder surgeons of SESI. [ABSTRACT FROM AUTHOR]

Background: The outcomes in critical illness depend on disease severity, practice protocols, workload, and access to care. This study investigates the factors affecting outcomes in mechanically ventilated coronavirus disease-2019 acute respiratory distress syndrome (COVID-19 ARDS) patients admitted in a tertiary teaching hospital intensive care unit (ICU) in Central India with reference to different time periods in pandemic. This is one of the largest series of mechanically ventilated COVID-19 ARDS patients, globally. Methods: This retrospective cohort study classified the entire data into four time periods (Period 1: April 2020 to June 2020; Period 2: July 2020 to September 2020; Period 3: October 2020 to December 2020; and Period 4: January 2021 to April 2021). We performed a multivariable-adjusted analysis to evaluate predictors of mortality, adjusted for baseline-severity, sequential organ failure assessment (SOFA score) and time period. We applied mixed-effect binomial logistic regression to model fixed-effect variables with incremental complexity. Results: Among the 56 survivors (19.4%) out of 288 mechanically ventilated patients, there was an up-gradient of survival proportion (0, 18.2, 17.4, and 28.6%) in four time periods. Symptom-intubation interval (OR 1.16; 95% CI 1.03-1.31) and driving pressures (DPs) (OR 1.17; 95% CI 1.07-1.28) were significant predictors of mortality in the model having minimal AIC and BIC values. Patients aged above 60 years also had a larger effect, but statistically insignificant effect favoring mortality (OR 1.99; 95% CI 0.92-4.27). The most complex but less parsimonious model (with higher AIC/BIC) indicated the protective odds of high steroid on mortality (OR 0.59; 95% CI 0.59-0.82). Conclusion: The outcomes in mechanically ventilated COVID-19 ARDS patients are heterogeneous across time windows and may be affected by the complex interaction of baseline risk and critical care parameters. [ABSTRACT FROM AUTHOR]

Gestational diabetes (GDM) is a common complication of pregnancy. To decrease GDM-related morbidity and mortality, appropriate perinatal care, counselling of the mother and family, and individualised nursing interventions play a major role. The objective of this study was to assess the knowledge of nurses and midwives working in maternity wards regarding screening and management of GDM. A total of 96 nurses working in the maternity settings of public and private hospitals in India were approached using non-probability purposive sampling. Overall, 15% of the participants had good knowledge regarding GDM, 70% had average knowledge and 15% had poor knowledge. It was also concluded that 59% of the nurses had poor knowledge regarding diagnosis of GDM, while 63% and 52% had poor knowledge regarding medical nutrition therapy and complications and management of GDM, respectively. It is concluded that nurses and midwives, as the frontline healthcare providers, require training or refresher courses to increase their knowledge and skills in dealing with mothers with GDM. [ABSTRACT FROM AUTHOR]

Background  A questionnaire-based survey was conducted to determine the preanesthetic evaluation (PAE) practices among the members of the Indian Society of Neuroanesthesiology and Critical Care (ISNACC). The survey aimed to assess the current clinical practice of PAE and optimization of neurosurgical patients in India. Methods  An online questionnaire was designed by the working group of ISNACC and circulated among its active members. Response to individual questions was considered significant if 50% or more respondents concurred. The survey questions to which less than 50% of respondents concurred were identified as inconclusive results. Results  Out of 438 active ISNACC members, 218 responded. Responses were obtained from various parts of the country. The majority of participants were practicing neuroanesthesiology. Questions asked were regarding clinical assessment, preoperative optimization, prognostication, and airway management in neurosurgery. More than 50% of practitioners acceded to most of the questions; however, the percentage of responses varied across different questions (50–100%). The questions related to preoperative duplex scanning in chronically immobilized patients, preoperative cognitive testing, and risk stratification during neurosurgical procedures received an inconclusive response (< 50%). Conclusion  The survey highlights the variable PAE practices perused by ISNACC members across the country. A guideline for uniform PAE practices may help to enhance research and improve perioperative care. [ABSTRACT FROM AUTHOR]

What is Known and Objective: Antibiograms gives an overview of the cumulative susceptibility of formal antibiotics to bacterial isolates, which reflects the portion of each bacterium susceptible to a given antibiotic formulation by using antimicrobial susceptibility testing. The objective of this study is to gather and analyse data from drug utilization evaluation (DUE) studies and antimicrobial susceptibility tests in order to create an antibiogram toolkit that will help clinicians to select appropriate antimicrobial agents for initial empirical antibiotic therapy at point of care settings and avoid irrational use of antibiotics. Methods: A prospective interventional study was conducted at tertiary care hospital, biological samples of infectious patients were collected from various wards as per Clinical & Laboratory Standards Institute CLSI M39‐A4 guidelines. Antimicrobial susceptibility results were analysed using WHONET software. Antibiotic stewardship committee was formed and involved in monitoring the usage of antibiotics, measuring outcomes, collecting feedback and finding the scope for improving the application of antibiogram toolkit in the hospital. Antibiotic usage tracking method was followed to know the level of adherence to the prescribing guidelines by the health care professionals. Results and Discussion: A total of 157 samples were obtained from various wards of the hospital. In that, Escherichia coli, Staphylococcus aureus and Klebsiella Pneumoniae were isolated in significant numbers. Antibacterial susceptibility results were collected, an initial antibiogram was developed for 18 antibacterial agents with respect to 3 gram‐positive (+) and 1 gram‐negative (−) organisms. 90% of prescribers mentioned that the antibiogram was useful, and 76% of them adhered to the guidelines. 26% were not adhered due to the patient‐related factors. What is New and Conclusion: In our study, we have used qualitative and quantitative evaluation of drug utilization (DUE) reports to understand the existing prescribing pattern of antibiotics and setting target organisms and antibacterials to develop the hospital antibiogram. Combining DUE studies and antibiogram development was helpful in implementing effective antibiotic policies for the hospital. Further, this study pattern will be continued on a yearly basis and focused on developing cumulative antibiograms to understand the changes in resistance pattern of antimicrobials and utilization of antibiotics in the hospital. [ABSTRACT FROM AUTHOR]

Context: Over the years, telepsychiatry services have expanded in many institutes. The Telemedicine Practice Guidelines and Telepsychiatry Operational Guidelines (TPOG) released in 2020 have been received by the fraternity with a mixture of apprehension, relief, and dissatisfaction on the list of drugs provided in Lists O, A, B, and C. Many psychiatrists have raised the issues of having a consensus in the formulation of List A. Aims: To draw consensus on the medications that can be listed in Lists O, A, B, and C in TPOG-2020. Settings and Design: This was an online survey with ethics approval by the Indian Psychiatric Society Ethics Review Board. All psychiatrists, who are members of the Indian Psychiatric Society and whose E-mail address was available with the society, were sent the survey link by E-mail. Methodology: Opinions and suggestions on Lists O, A, B, and C of TPOG-2020 and reasons for the suggestions were collected. Statistical Analysis Used: Frequency, percentages, mean, and standard deviation were calculated. T-test and Chi-square tests were used to see the influence of demographics on the concurrence of the lists. Results: Responses from 340 responders were analyzed. Majority of the responders agreed that List O (277, 85.5%), List B (263, 82.4%), and List C (223, 69%) are apt except for List A (162, 50.3%). Conclusions: This online survey showed that majority of the responders agreed to the lists except for List A. The approach taken to include the medications in List A, which was to include the essential drugs, has various benefits. However, the lists are not final, and the results of this survey may become an impetus to modify the list in the next edition of TPOG. [ABSTRACT FROM AUTHOR]

To gain insights on the diverse practice patterns and treatment pathways for prostate cancer (PC) in India, the Urological Cancer Foundation convened the first Indian survey to discuss all aspects of PC, with the objective of guiding clinicians on optimizing management in PC. A modified Delphi method was used, wherein a multidisciplinary panel of oncologists treating PC across India developed a questionnaire related to screening, diagnosis and management of early, locally advanced and metastatic PC and participated in a web–based survey (WBS) (n = 62). An expert committee meeting (CM) (n = 48, subset from WBS) reviewed the ambiguous questions for better comprehension and reanalyzed the evidence to establish a revote for specific questions. The threshold for strong agreement and agreement was ≥90% and ≥75% agreement, respectively. Sixty-two questions were answered in the WBS; in the CM 31 questions were revoted and 4 questions were added. The panelists selected answers based on their best opinion and closest to their practice strategy, not considering financial constraints and access challenges. Of the 66 questions, strong agreement was reached for 17 questions and agreement was achieved for 22 questions. There were heterogeneous responses for 27 questions indicative of variegated management approaches. This is one of the first Indian survey, documenting the diverse clinical practice patterns in the management of PC in India. It aims to provide guidance in the face of technological advances, resource constraints and sparse high-level evidence.. [ABSTRACT FROM AUTHOR]

Objective. To assess the knowledge, practice, attitude, and preparedness of dental professionals in prescribing nicotine replacement therapy (NRT). Methodology. A prevalidated voluntary web-based questionnaire was generated as a link through Google Drive and was sent to 117 dental professionals in North India using Whatsapp, Messenger, and Instagram social media platforms. A total of 94 responses were received and out of which 76 responses were analyzed (18 forms were excluded due to incomplete or duplicate responses). Frequency analysis was done using SPSS software version 21. Result. The participation rate was found to be 80.3%. More than half of the study population were familiar with the term NRT (77.6%) and its uses (67.1%), but approximately less than half of the total study subjects knew the duration (32.9%), cost (27.6%), dosage (25%), and contraindications (36.8%) of the NRT. Approximately 56.6% of the study participants showed a positive attitude towards helping patients to quit smoking through tobacco cessation counseling. Nearly one-fourth of the study population, i.e., 27.6%, were confident in explaining the negative impacts of tobacco, while 22.4% knew about the tobacco cessation protocol. Among the participants, only 27.6% reported that they practice NRT and out of which approximately less than 20% of the study participants were prescribing correct dose of NRT. Conclusion. Though study subjects had an ample knowledge regarding NRT use in tobacco cessation, it does not reflect their current attitude and preparedness. Thus, there is a need for continuing education to further train dental professionals for prescribing NRT. [ABSTRACT FROM AUTHOR]

This article explores the self-positioning of Indian social workers who work with female survivors of domestic violence (DV). We know from previous research about the experiences of persons who have encountered DV, but more studies on the point of view of the professionals is needed. Relying on positioning theory and discursive analysis as a framework, we analyzed interviews (N = 18) concerning the practices, emotions, and attitudes of social workers. Positioning theory enables scholars to approach the situation of encountering a survivor as a social event, which consists of the meaning-making activities of social workers. Professionals self-position themselves as one or a combination of the following: (a) a challenger of gendered oppression, (b) an advocator of women's rights, (c) a facilitator of women's empowerment, and/or (d) a self-reflector of personal emotions and attitudes. The findings suggest that the event of DV intervention is a discursive and contextually situated moral practice in which the distribution of rights and duties to say and do things is of particular interest. The act of self-positioning is constructed in relation to sociocultural settings. Social workers may take several positions during the meetings with survivors. Positions build our understanding of how social workers in violence-specific units make sense of DV, illustrating how the act of self-positioning may also define to the position of the survivor. Social workers experienced boundaries, and possibilities in responding to DV were explored. The study reveals that barriers should be addressed at a wider level by funders and policy makers to enhance the continuity of work and the implementation of women rights legislation in India. [ABSTRACT FROM AUTHOR]

Background: Addressing stillbirth is a difficult task and becomes more challenging with a huge burden and skewed doctorpatient ratio. There is a lack of data regarding the knowledge about the bereavement care practices following pregnancy loss and practices being followed by the health-care providers in the Indian context. The objective of this study is to describe the experience, views, and practices of health-care professionals while managing women with stillbirths. Design: Internet-based Monkey Survey. Methodology: An on-line self completion questionnaire was shared with various health care providers via emails and whats app groups. Results: A total of 281 responses of health-care providers were analyzed, and the majority of them were obstetricians. Almost 90% had managed women with stillbirth, but just a third (38.1%) had provided bereavement care. The majority of them felt the lack of a uniform and comprehensive training model for providing bereavement care to such women. Out of 281 participants, 258 (91.8%) believed that health-care providers should have a bereavement care training and support system, whereas only 23 (8.2%) rejected this idea. Conclusion: There is no defined protocol or standards for providing bereavement care to women following stillbirth. Most health-care professionals feel an urgent need for professional training to bridge the gap between the expectations of patients and the care provided. [ABSTRACT FROM AUTHOR]

Introduction: Despite remarkable improvement in Wilms' tumor (WT) survival in Western world, sub-optimal outcome in resource-constrained settings is influenced by late presentation, larger size, and poor access to treatment. This prompted us to study the outcome at a tertiary care center and to identify the global and local practice gaps. Materials and Methods: A retrospective, observational study of WT was conducted from October 2009 to September 2019 at a tertiary care setting. Following the National Wilms' Tumor Study Group protocol, an upfront nephrectomy (unilateral resectable tumors) and preoperative chemotherapy (large/unresectable Stage I–III) were followed. The records were reviewed for demographics, stage, preoperative chemotherapy, predictive factors, and outcome. Survival curves were plotted by the Kaplan–Meier method, and analysis was performed using the SPSS software version 16. Results: One hundred and fifty-six children were included, median age was 4.1 years, with a male predominance. The most common stages of the presentation were II (40.4%) and III (34.6%). An upfront surgery was done in 27.6%, while remaining received preoperative chemotherapy. The median follow-up was 22 months, and the events included relapse in 46 (29.48%) and death in 54 (34.61%). The mean survival time was 45.7 (95% confidence interval [CI], 41.08–50.30). The 2-year overall survival was 65.38% (95% CI, 59–73), and the 2-year event-free survival was 36% (95% CI, 32–41). On comparison of the impact of preoperative chemotherapy, the survival estimates in Stages I–III and relapse rate were statistically similar, tumor size reduced significantly, and tumor spill was significantly lower (P < 0.05). Conclusion: WT is associated with late presentation, sub-optimal survival, and higher relapse in our setting associated with practice gaps related to the management including practice violations. [ABSTRACT FROM AUTHOR]

Introduction:Ventilator associated pneumonia is one of the most frequent hospital acquired infections occurring in intubated patients within 48 hours of endotrachial intubation[1][2]. Because VAP is associated with higher mortality, morbidity and costs[3], there is a need to keep a check on skills and knowledge upgrading among the healthcare professions and especially nursing personnel on regular intervals, as they are the prime care givers to the patients in intensive care units. Several healthcare agencies have developed evidence based guidelines to prevent nosocomial infections in healthcare settings and with which various healthcare facilities had formulated certain care bundles to fend off VAP. [4][5][6]. Methodology: In this study the knowledge & practice of nursing personnel on prevention of Ventilator Associated Pneumonia were assessed using a structured knowledge questionnaire &structured observational checklist. Data from three selected tertiary care hospitals of Delhi & NCR region were analyzed &interpreted using descriptive & inferential statistics at 0.05 level of significance. Results: Majority of the nurses were found to have adequate knowledge (54%) and practice (74%) scores. However there was no positive co-relation found for knowledge and practice of the nurses in preventing VAP, although factors as qualification, experience of nurses &any special training on prevention of VAP were found to have association with knowledge & practice of nurses. Conclusion: Knowledge and practice of nurses needs to be explored so as to deliver quality care to patients on ventilator. [ABSTRACT FROM AUTHOR]

Introduction: Recently, the Zika virus (ZIKV) has become a major concern across the world. ZIKV can primarily spread through the bite of infected Aedes aegypti mosquitoes. Till now, ZIKV is considered an incurable infectious disease. As Zika is an emerging disease of an international concern with the ongoing speculation about a potential outbreak in India in the future, the present study was conducted with an aim to assess knowledge, attitude, and practices regarding ZIKV among nursing students. Materials and Methods: This hospital-based cross-sectional study was conducted among 240 nursing students during 2019, and data were collected using a pretested, predesigned, standardized, and self-administered questionnaire. The ethical approval was obtained from the Institutional Ethical committee before the conduct of the study. All tests were performed at 5% level of significance. Results: The present study has included 240 nursing students (228 female students and 12 male students). The most common source of information related to ZIKV was social media among 75.6% of the students and 46.7% of the participants has low knowledge regarding ZIKV. Surprisingly, about one-tenth of the participants (14.2%) made an attempt to gain more knowledge about ZIKV, and nearly one-fifth of the participants were not using any method at all (17.1%) to prevent mosquito bites. Conclusion: This study showed inadequate knowledge among nursing students which will be future health care providers about ZIKV infection. The awareness about ZIKV infection should be ensured and maintained among health care providers to face any possible emergence in the region. [ABSTRACT FROM AUTHOR]

Introduction: Psychosocial factors are significant drivers of inappropriate antibiotic prescription leading to antibiotic resistance. We ascertained the psychosocial predictors of outpatient antibiotic prescribing (OAP) behavior among early-career clinicians in India. Materials and Methods: We enrolled 200 early-career clinicians, including 100 medical interns and 100 junior residents (postgraduate student doctors) in six clinical departments, and collected data using a self-administered questionnaire. Response options were coded on five-item Likert scales. Results: Antimicrobial resistance was viewed as a significant public health problem by most (95%) participants. Presumptive antibiotic prescribing was reported by 84% of participants, although the participant attitude indicated a slight disinclination against the presumptive use of antibiotics (mean = 2.8, standard deviation = 0.72). The majority (52.5%) of the participant's perceived social pressure frequently influenced their decision to prescribe antibiotics to the outpatients. Furthermore, the maximum social pressure was perceived as driven by patient expectation for antibiotics and the existing antibiotic prescribing behavior of their peers and colleagues. The perception of increased social pressure stipulating antibiotic prescribing negatively correlated with the participant's intention to reduce antibiotic use in outpatients (r= -0.124, P < 0.001). Social pressure was reported to be higher when treating adult patients reporting diarrheal symptoms and children having cough. Conclusions: OAP practices among early-career clinicians working in the government health sector in India are mediated by considerable social pressure despite behavioral intention for reducing antibiotic use. [ABSTRACT FROM AUTHOR]

Introduction: Extracorporeal membrane oxygenation (ECMO) is increasingly used in managing patients with severe acute respiratory distress syndrome (ARDS). The aim of the study is to describe the practice of ECMO and evaluate the outcomes in patients with severe ARDS in Indian intensive care units (ICUs). Methods: Data of 39 patients with severe ARDS managed with ECMO in two tertiary centers between 2012 and 2018 were retrospectively studied. Results: The mean age of the patient was 44.6 ± 13.5 years and 51% were female. Primary ARDS due to viral pneumonia was the common indication for ECMO. Mean APACHE II and Murray scores were 32.3 ± 7.8 and 3.64 ± 0.21, respectively. Prone ventilation and/or inhaled nitric oxide were used in 69.3% of the patients prior to ECMO therapy. Among 39 patients, 38 patients were managed with venovenous ECMO and 1 patient was managed with venoarterial ECMO. Average ECMO duration was 9.4 ± 6.9 days. Among the 17 (43.5%) patients successfully weaned off ECMO, 15 (38.5%) survived to discharge home. The average ICU and hospital length of stay were 18.9 ± 15.5 and 20.6 ± 16.6 days, respectively. While, sepsis was the common complication noted in 19 (49%) patients, bleeding and thrombotic complications were also noted in six and two patients, respectively. Conclusion: In conclusion, ECMO support was used as rescue therapy in severe ARDS with a survival rate of 39%. Sepsis was the common complication of ECMO followed by bleeding and thrombosis. [ABSTRACT FROM AUTHOR]

Background: We aimed to study organizational aspects, case mix, and practices in Indian intensive care units (ICUs) from 2018 to 2019, following the Indian Intensive Care Case Mix and Practice Patterns Study (INDICAPS) of 2010--2011. Methods: An observational, 4-day point prevalence study was performed between 2018 and 2019. ICU, patient characteristics, and interventions were recorded for 24 hours, and ICU outcomes till 30 days after the study day. Adherence to selected compliance measures was determined. Data were analyzed for 4,669 adult patients from 132 ICUs. Results: On the study day, mean age, acute physiology and chronic health evaluation (APACHE II), and sequential organ failure assessment (SOFA) scores were 56.9 ± 17.41 years, 16.7 ± 9.8, and 4.4 ± 3.6, respectively. Moreover, 24% and 22.2% of patients received mechanical ventilation (MV) and vasopressors or inotropes (VIs), respectively. On the study days, 1,195 patients (25.6%) were infected and 1,368 patients (29.3%) had sepsis during their ICU stay. ICU mortality was 1,092 out of 4,669 (23.4%), including 737 deaths and 355 terminal discharges (TDs) from ICU. Compliance for process measures related to MV ranged between 62.7 and 85.3%, 11.2 and 47.4% for monitoring delirium, sedation, and analgesia, and 7.7 and 25.3% for inappropriate transfusion of blood products. Only 34.8% of ICUs routinely used capnography. Large hospitals with ≥500 beds, closed ICUs, the APACHE II and SOFA scores, medical admissions, the presence of cancer or cirrhosis of the liver, the presence of infection on the study day, and the need for MV or VIs were independent predictors of mortality. Conclusions: Hospital size and closed ICUs are independently associated with worse outcomes. The proportion of TDs remains high. There is a scope for improvements in processes of care. [ABSTRACT FROM AUTHOR]

Background: This study presents a real-world scenario for prescription pattern, efficacy, and safety data on the current clinical use of intravenous fosfomycin in critically ill patients in Indian settings. Patients and methods: This was a retrospective cohort study conducted for a period of 10 months among critically ill patients admitted to hospital's critical care unit. The primary objective of the study was to analyze the prescription pattern of intravenous fosfomycin, and the secondary objective was to evaluate the safety profile and patient outcomes. Results: A total of 309 patients were enrolled, and they were diagnosed with bacteremia (45.3%), pneumonia (15.85%), septic shock (14.24%), and urinary tract infections (UTI) (13.91%). The average dose of fosfomycin given was 11.7 ± 4.06 gm/day. The average duration of the therapy was 4.85 ± 3.59 days with a median duration of 4 days. Fosfomycin was given at 8 hourly dosing frequency to maximum (45.6%) cases. Hypokalemia was the most observed adverse event. The overall survival was seen in 55% of patients. Conclusion: Our data suggest that UTI, infection caused by Escherichia coli, and a daily dose of >12 g were associated with better clinical outcomes. The overall survival of critically ill patients receiving fosfomycin was 55%. [ABSTRACT FROM AUTHOR]

Background: Anesthesia leads to impairments in central and peripheral thermoregulatory responses. Inadvertent perioperative hypothermia is hence a common perioperative complication, and is associated with coagulopathy, increased surgical site infection, delayed drug metabolism, prolonged recovery, and shivering. However, surveys across the world have shown poor compliance to perioperative temperature management guidelines. Therefore, we evaluated the prevalent practices and attitudes to perioperative temperature management in the Asia–Pacific region, and determined the individual and institutional factors that lead to noncompliance. Methods: A 40-question anonymous online questionnaire was distributed to anesthesiologists and anesthesia trainees in six countries in the Asia–Pacific (Singapore, Malaysia, Philippines, Thailand, India and South Korea). Participants were polled about their current practices in patient warming and temperature measurement across the preoperative, intraoperative and postoperative periods. Questions were also asked regarding various individual and environmental barriers to compliance. Results: In total, 1154 valid survey responses were obtained and analyzed. 279 (24.2%) of respondents prewarm, 508 (44.0%) perform intraoperative active warming, and 486 (42.1%) perform postoperative active warming in the majority of patients. Additionally, 531 (46.0%) measure temperature preoperatively, 767 (67.5%) measure temperature intraoperatively during general anesthesia, and 953 (82.6%) measure temperature postoperatively in the majority of patients. The availability of active warming devices in the operating room (p < 0.001, OR 10.040), absence of financial restriction (p < 0.001, OR 2.817), presence of hospital training courses (p = 0.011, OR 1.428), and presence of a hospital SOP (p < 0.001, OR 1.926) were significantly associated with compliance to intraoperative active warming. Conclusions: Compliance to international perioperative temperature management guidelines in Asia–Pacific remains poor, especially in small hospitals. Barriers to compliance were limited temperature management equipment, lack of locally-relevant standard operating procedures and training. This may inform international guideline committees on the needs of developing countries, or spur local anesthesiology societies to publish their own national guidelines. [ABSTRACT FROM AUTHOR]