Determination of Satisfaction Index as a tool in evaluation of CME Program

Continuing Medical Education is an indispensable part of physician's learning. Welldesigned program based on andragogy principles can enhance learning by motivatingthe learner and providing platform to encourage self directed learning. The presentstudy aimed to explore the impact of program “NAMS-AIIMS Regional Symposiumon Sleep Medicine” in changing the behavior and attitude of participants using“Satisfaction Index” and descriptive analysis of responses as evaluation tools forprogram effectiveness. This descriptive cross sectional study captured the response ofparticipants through a pre-tested and validated questionnaire administered at the end ofsymposium. The result showed almost equal sex distribution (M: F- 27: 34) withmajority being UG students (86%). Reliability of data showed Cronbach's Alpha of0.98 indicating high reliability. Satisfaction index (SI) calculated as per WHOEducational Handbook for Health Personnel showed highest satisfaction for conduciveenvironment of symposium (87.87 %) followed by provision for time to seekclarifications (87.21%), provision of appropriate Learning Resource material (85.90%) and handling of critical comments by organizers (85.57%). Descriptive analysisshowed majority responses as highly positive to our questionnaire with suggestions formore such activity, inclusion of clinical cases and other aspects of practical relevance.Key words : evaluation, program, satisfaction index, Kirkpatrick Model, studentsatisfaction, adult learning, Knowles Theory

Exploring the scope of sleep medicine in current medical teaching and utility of CD Based Learning Resource Material

Background: Only recently health professionals have started recognizing sleep disorders as one of the commonest cause of morbidity. Only in the last 50 years have scientists and physicians attempted a systematic study of the physiology and disorders of sleep. The situation is changing in India too. About a decade ago the sleep medicine started developing but remained in the domain of Pulmonary Medicine. Through various societies, meetings, workshops it has now percolated to physiologists, neurologists, psychiatrists and allied specialists. However, there is still a gap in the awareness about sleep and its disorders among health professionals. Limited information is available regarding sleep education in current medical curriculum in India and globally.Aims: (i) To find out the existence of a course or module on sleep medicine in any of Government medical colleges in India. (ii) To explore feasibility of using Learning Resource Material (LRM) on CDs for Continuing Medical Education.Methods: As an outcome of Sleep Symposium held at National Academy of Medical Sciences (India) conference at AIIMS, Jodhpur, a survey was carried out among 100 Government Medical Colleges in India along with Resource Material consisting of didactic teaching material distributed through Compact Disc (CD) to explore utility of the method.Results: Response rate from medical colleges was 41 %. Ninety five percent of medical colleges denied of having any structured course or module on sleep medicine. Fifty percent felt that such module should be included for both UG and PG while 70 % agreed for PG only. Regarding cost effective delivery methods for the content of such a module, majority responded in favour for an online or DVD based with one of the content experts as a resource person with his physical presence. All respondent were highly satisfied by the content of CD.Conclusion: Sleep education is almost non-existent in most of medical schools in India. Survey elicited average response from academic community. However, sleep education has been perceived by 70 % participants to be included in PG curriculum. The content of PowerPoint presentations was considered highly satisfying and using multi-modal technology for sleep education is regarded to be an effective delivery method by majority. It can be concluded that there is felt but unmet need of a course on sleep medicine in our existing medical curriculum using information technology.Key words: Sleep module, CD based CME, Continuing Education, sleep education

Optimizing the Effectiveness of CME Program: NAMS Experience

purposeful learning require strong basis of principles of adult learning along with a sound knowledge and requisite skills in both psychology as well as technology of medical education. Assessing effectiveness of a CME program is as important as the organization of learning activities and delivery of academic program as these may provide further directions for enhancing the efficacy of the CME delivery system.Objective: (i) The purpose of this study was to investigate the effectiveness of well planned and conducted CME program in terms of enhancing knowledge and competence of the participants. (ii) To explore if the gain in knowledge and competence, if any, can be attributed to the interactive design of the educational process.Methods: The study was conducted during NAMS-AIIMS Regional Symposium on Sleep Medicine at AIIMS, Jodhpur as part of NAMSCON 2013. After explaining the objectives of the study to the participants and assurance of confidentiality, a validated and pre-tested questionnaire consisting of 30 multiple choice, single response questions, was administered to 103 participants. Following intervention consisting of didactic lectures by experts in different aspects of sleep medicine, interactive sessions and problem triggered sessions consisting of clinical data, participants were re-administered post test questions which were, however, different from pre-test but had similar difficulty level.Result: The response rate of participants was 89%. Pre-intervention scores were 11.76 ± 4.4, with only 26 % of participants achieving an arbitrary pass score of 50 %. Comparison of paired score of participants who attempted both pre and post tests (n=59) showed improvement from 12.1 ±4.6 to 18.3 ± 3.8 which was significant (p <0.05). 84.7 % of participants secured above pre decided 50% score. The mean increase in the score was 6.2 with 95% CIs 4.8; 7.5 (P <0.001). Higher gain in knowledge and competencies is attributed to intense interactive involvement of participants during the problem triggered sessions, feedback provided during interaction and system of reward and incentive introduced at time of sessions. The study concludes that well designed educational intervention based on the principles of adult learning brings positive gain in the knowledge and enhances competence of the participants.Key words : Pre-post test, retrospective post-pre test, program evaluation, evaluation of educational intervention

Clinical outcome, viral response and safety profile of chloroquine in COVID-19 patients — initial experience

Introduction: Chloroquine and its analogues are currently being investigated for the treatment and post exposure prophylaxis of COVID-19 due to its antiviral activity and immunomodulatory activity.Material and methods: Confirmed symptomatic cases of COVID-19 were included in the study. Patients were supposed to receive chloroquine (CQ) 500 mg twice daily for 7 days. Due to a change in institutional protocol, initial patients received chloroquine and subsequent patients who did not receive chloroquine served as negative controls. Clinical effectiveness was determined in terms of timing of symptom resolution and conversion rate of reverse transcriptase polymerase chain reaction (RT-PCR) on day 14 and day 15 of admission.Results: Twelve COVID-19 patients formed the treatment arm and 17 patients were included in the control arm. The duration of symptoms among the CQ treated group (6.3 ± 2.7 days) was significantly (p-value = 0.009) lower than that of the control group (8.9 ± 2.2 days). There was no significant difference in the rate of RT-PCR negativity in both groups. 2 patients out of 12 developed diarrhea in the CQ therapy arm.  Conclusion: The duration of symptoms among the treated group (with chloroquine) was significantly lower than that of the control group. RT-PCR conversion was not significantly different between the 2 groups

The global, regional, and national burden of adult lip, oral, and pharyngeal cancer in 204 countries and territories:A systematic analysis for the Global Burden of Disease Study 2019

Importance Lip, oral, and pharyngeal cancers are important contributors to cancer burden worldwide, and a comprehensive evaluation of their burden globally, regionally, and nationally is crucial for effective policy planning.Objective To analyze the total and risk-attributable burden of lip and oral cavity cancer (LOC) and other pharyngeal cancer (OPC) for 204 countries and territories and by Socio-demographic Index (SDI) using 2019 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates.Evidence Review The incidence, mortality, and disability-adjusted life years (DALYs) due to LOC and OPC from 1990 to 2019 were estimated using GBD 2019 methods. The GBD 2019 comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for LOC and OPC attributable to smoking, tobacco, and alcohol consumption in 2019.Findings In 2019, 370 000 (95% uncertainty interval [UI], 338 000-401 000) cases and 199 000 (95% UI, 181 000-217 000) deaths for LOC and 167 000 (95% UI, 153 000-180 000) cases and 114 000 (95% UI, 103 000-126 000) deaths for OPC were estimated to occur globally, contributing 5.5 million (95% UI, 5.0-6.0 million) and 3.2 million (95% UI, 2.9-3.6 million) DALYs, respectively. From 1990 to 2019, low-middle and low SDI regions consistently showed the highest age-standardized mortality rates due to LOC and OPC, while the high SDI strata exhibited age-standardized incidence rates decreasing for LOC and increasing for OPC. Globally in 2019, smoking had the greatest contribution to risk-attributable OPC deaths for both sexes (55.8% [95% UI, 49.2%-62.0%] of all OPC deaths in male individuals and 17.4% [95% UI, 13.8%-21.2%] of all OPC deaths in female individuals). Smoking and alcohol both contributed to substantial LOC deaths globally among male individuals (42.3% [95% UI, 35.2%-48.6%] and 40.2% [95% UI, 33.3%-46.8%] of all risk-attributable cancer deaths, respectively), while chewing tobacco contributed to the greatest attributable LOC deaths among female individuals (27.6% [95% UI, 21.5%-33.8%]), driven by high risk-attributable burden in South and Southeast Asia.Conclusions and Relevance In this systematic analysis, disparities in LOC and OPC burden existed across the SDI spectrum, and a considerable percentage of burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in LOC and OPC burden globally and support cancer control planning efforts

Hearing loss prevalence and years lived with disability, 1990–2019: findings from the Global Burden of Disease Study 2019

Background Hearing loss affects access to spoken language, which can affect cognition and development, and can negatively affect social wellbeing. We present updated estimates from the Global Burden of Disease (GBD) study on the prevalence of hearing loss in 2019, as well as the condition's associated disability. Methods We did systematic reviews of population-representative surveys on hearing loss prevalence from 1990 to 2019. We fitted nested meta-regression models for severity-specific prevalence, accounting for hearing aid coverage, cause, and the presence of tinnitus. We also forecasted the prevalence of hearing loss until 2050. Findings An estimated 1·57 billion (95% uncertainty interval 1·51–1·64) people globally had hearing loss in 2019, accounting for one in five people (20·3% [19·5–21·1]). Of these, 403·3 million (357·3–449·5) people had hearing loss that was moderate or higher in severity after adjusting for hearing aid use, and 430·4 million (381·7–479·6) without adjustment. The largest number of people with moderate-to-complete hearing loss resided in the Western Pacific region (127·1 million people [112·3–142·6]). Of all people with a hearing impairment, 62·1% (60·2–63·9) were older than 50 years. The Healthcare Access and Quality (HAQ) Index explained 65·8% of the variation in national age-standardised rates of years lived with disability, because countries with a low HAQ Index had higher rates of years lived with disability. By 2050, a projected 2·45 billion (2·35–2·56) people will have hearing loss, a 56·1% (47·3–65·2) increase from 2019, despite stable age-standardised prevalence. Interpretation As populations age, the number of people with hearing loss will increase. Interventions such as childhood screening, hearing aids, effective management of otitis media and meningitis, and cochlear implants have the potential to ameliorate this burden. Because the burden of moderate-to-complete hearing loss is concentrated in countries with low health-care quality and access, stronger health-care provision mechanisms are needed to reduce the burden of unaddressed hearing loss in these settings