Novel strategy of skill lab training for parenteral injection techniques: a promising opportunity for medical students

Background: To set up an experimental pharmacology skill lab to facilitate training of specific modules for development of core competencies of parenteral drug administration and intravenous drip settings using mannequins for development of skills in administering injections for undergraduate medical students, which will be assessed using Objective Structured Practical Examination.Methods: High quality mannequins were procured from reputed companies in coordination with the biomedical engineering department of the tertiary care teaching institution. Sufficient number of multi-venous access arms, buttock injection model and models for subcutaneous and intradermal injections were obtained to facilitate individual training of 150 students in small groups during practical classes according to the checklist for the procedure. Ethical committee approval was deemed unnecessary for this study as it was a part of curriculum development.Results: Students practiced the technique confidently, without the fear doing it in a patient. This gave them the opportunity to practice in a real human surface texture, which gave them better understanding about the depth and extent of insertion of devices. Moreover, they could easily follow the steps in the check list which enabled them to practice as per protocol.Conclusions: Because of the hands-on training the students receive, we have seen a greater trend toward self-learning and better adherence to the injection technique protocol. Hence mannequin-based learning can be considered as very effective in acquiring procedural skills under the new medical curriculum in India. However, considering the high initial investment and further need of constant maintenance, cost effective mannequins need to be introduced and popularized

A VALIDATED RP-HPLC METHOD FOR SIMULTANEOUS ESTIMATION OF PYRANTEL PAMOATE AND PRAZIQUANTEL IN BULK AND PHARMACEUTICAL DOSAGE FORM

Objective: To develop a simple, accurate and precise reverse-phase high-performance liquid chromatography (RP-HPLC) method and subsequently validate for the simultaneous estimation of praziquantel (PZQ) and pyrantel pamoate (PP) in the pharmaceutical dosage form. Methods: The chromatographic separation was achieved on Phenomenex Luna C18 column (250 mm × 4.6 mm, 5 μm) as stationary phase maintained at an ambient temperature with a mobile phase comprising of water: acetonitrile (20: 80) at a flow rate of 1.0 ml/min and UV detection at 220 nm. Results: The retention time of PZQ and PP was found to be 3.897 min and 1.697 min respectively. The method was validated in terms of specificity, accuracy, precision, linearity and robustness as per ICH guidelines. Linearity was obtained in the concentration range of 20–60 μg/ml for both PZQ and PP with correlation coefficients of 0.987 and 0.998 respectively. The accuracy of the method was determined using a recovery test and found as 98.44 % to 100.35 %. All parameters are found to be within the acceptable limit. Conclusion: The developed RP-HPLC method was simple, rapid, accurate, precise for the simultaneous estimation of PZQ and PP in bulk and tablet dosage form

GlobalFlowNet: Video Stabilization using Deep Distilled Global Motion Estimates

Videos shot by laymen using hand-held cameras contain undesirable shaky motion. Estimating the global motion between successive frames, in a manner not influenced by moving objects, is central to many video stabilization techniques, but poses significant challenges. A large body of work uses 2D affine transformations or homography for the global motion. However, in this work, we introduce a more general representation scheme, which adapts any existing optical flow network to ignore the moving objects and obtain a spatially smooth approximation of the global motion between video frames. We achieve this by a knowledge distillation approach, where we first introduce a low pass filter module into the optical flow network to constrain the predicted optical flow to be spatially smooth. This becomes our student network, named as \textsc{GlobalFlowNet}. Then, using the original optical flow network as the teacher network, we train the student network using a robust loss function. Given a trained \textsc{GlobalFlowNet}, we stabilize videos using a two stage process. In the first stage, we correct the instability in affine parameters using a quadratic programming approach constrained by a user-specified cropping limit to control loss of field of view. In the second stage, we stabilize the video further by smoothing global motion parameters, expressed using a small number of discrete cosine transform coefficients. In extensive experiments on a variety of different videos, our technique outperforms state of the art techniques in terms of subjective quality and different quantitative measures of video stability. The source code is publicly available at \href{https://github.com/GlobalFlowNet/GlobalFlowNet}{https://github.com/GlobalFlowNet/GlobalFlowNet}Comment: Accepted in WACV 202

Organizing a System-Wide Effort on Ventilator Supply Management during COVID-19

We developed a concise definition of ventilators to accurately represent them in all reports across the enterprise, and a ventilator deployment plan

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

A PROSPECTIVE STUDY OF ADVERSE DRUG REACTIONS IN A TERTIARY CARE HOSPITAL IN SOUTH INDIA

Objective: The objective of this study was to determine the prevalence of adverse drug reactions (ADRs) in a tertiary care teaching hospital in South India and to analyze the causality according to the Naranjo scale. Methods: This study was carried out at the SRM Medical College, Chennai, a tertiary care hospital, which is an ADR monitoring center under Pharmacovigilance Programme of India, over a period of 1 year, from September 2017 to August 2018, after approval by the Institutional Ethics Committee. These ADRs were reported by the clinical pharmacy team of our hospital to the department of pharmacology. The relevant data were collected from the patient case notes, treatment charts, laboratory data reports, ADR notification forms, patient interview, and reporter interviews after written informed consent was obtained from each patient. Patients of either sex of all ages who developed ADR within the hospital were included in the study. Patients who developed ADR outside the hospital were excluded from the study. The collected ADRs were subjected to the Naranjo causality assessment scale. Hartwig’s scale was used to assess the severity of the reaction. The causalities and other aspects of the ADRs were analyzed in detail. Results: A total of 80 ADRs were reported during this study period. The ADRs were most frequently reported in the adult age group (75%) with slight female preponderance (60%). Antibiotics contributed to the maximum number of ADRs which accounted for 52.5% of the total, of which beta-lactams were the highest (37.5%) followed by analgesics. Causality assessment of ADRs by the Naranjo scale showed that the maximum reactions could be categorized as probable (85%) followed by the possible category (15%). The most common presentation of ADR was itching (45%) followed by rashes (30%). Three cases of severe adverse reactions were reported, one case each of anaphylaxis to pantoprazole and diclofenac and one case of Steven–Johnson syndrome to cotrimoxazole. Conclusion: ADRs are a common occurrence but are often not recognized. Even if recognized, they are underreported as many physicians are unaware that all ADRs should be reported to ADR monitoring centers. ADRs are an important cause of morbidity and mortality all over the world and are an important public health concern. It inflicts a negative impact on the treatment and exerts a greater economic burden on the patient if it results in prolongation of the duration of hospitalization or other comorbidities. Therefore, the practicing physicians, as well as the nursing staff, should be sensitized of the importance of ADR reporting to their respective pharmacovigilance centers

NANO CARRIER DRUG DELIVERY SYSTEMS FOR THE TREATMENT OF COGNITIVE DYSFUNCTION IN DEPRESSION-AN OVERVIEW ON THE NANO FORMULATIONS TARGETING TO THE BRAIN

To review and discuss the current therapeutic strategies available for the management of cognitive dysfunction in major depressive disorder with special emphasis on novel therapeutics based on nanotechnology like nano carrier delivery systems. The method entailed a review of research articles, review articles, and other internet-sourced materials. Journals, articles, and reports were thoroughly searched for the efficacy and safety of nanotechnology based newer drug delivery approaches for the management of cognitive dysfunction in major depressive disorder. The information obtained during the literature search aided in comprehending the scenario. Several new nanomedicines and nanotechnology based drug delivery systems for improving the efficacy of new and old drugs used for the management of cognitive dysfunction in major depressive disorder were reviewed. There is a dearth of sufficient studies which focus on cognitive domain in depression. Nanomedicines and nanotechnology based drug delivery systems holds tremendous potential in the management of cognitive impairment in depression as well as other neuropsychiatric disorders. It is imperative to conduct advanced studies in this regard for better therapeutic outcomes in the management of such patients

Evaluation of parenteral injection skills of medical undergraduates on mannequins in a tertiary care teaching hospital in South India – A cross-sectional study

Appropriate knowledge and expertise of parenteral injection is vital in the medical field. Hence we impart training on mannequins before the students practice on patients. This study was conducted to evaluate the skill exhibited by the students in parenteral injection skills, namely intravenous, intramuscular, intradermal and subcutaneous injections. The students were assessed for step based on the pre-validated check list created for Objective Structured Practical Examination. In this study, 16 % of the students failed to check the prescription order before starting the procedure. The name and the expiry date of the drug was not checked by 22 % of the students. Hundred percent of the students sterilized their hands. Loading of drug was done properly by 80 % of the students and 88 % of the students checked for air bubbles in the syringe and removed them properly. The site for injection was not sterilized by 26 percent of the students. Tourniquet was not applied by 19 percent of the students and 28 % of the students did not hold the bevel up during insertion for intravenous route. The steps where frequent faltering happened needs to be emphasized for them to perform better in a more efficient manner during the summative assessment as well as for future practice

Strategies for Successful Acclimatization and Hardening of In Vitro Regenerated Plants: Challenges and Innovations in Micropropagation Techniques

The micropropagation technique serves as an effective approach for conserving and propagating numerous plant species. Challenges to its success encompass explant selection, media composition, hormone concentration, microbial contamination, incubation conditions, and photoperiod. Beyond these factors, the veracity of tissue culture hinges on successful acclimatization of in vitro regenerated plants to their natural surroundings. Tissue culture-derived plants exhibit characteristic variations like altered nutrition, reduced cuticular wax, non-functional stomata, etc. During transition to natural conditions, a significant portion of micropropagated plants face survival challenges. Studies propose gradual acclimatization processes for smooth adjustment. Ex vitro rooting is advocated for economic, simple, and enhanced survival outcomes. Hydroponics, photoautotrophic acclimatization, and biotization strategies also improve post-transplantation survival. This study evaluates diverse strategies for achieving successful acclimatization of in vitro regenerated plants