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The incidence and magnitude of depression are rarely assessed during preanaesthetic evaluation. The shared physiological mechanisms of depression and anaesthetic drugs are likely to alter the pharmacodynamics of propofol. Therefore, the study aimed to evaluate the burden of presurgical depression and its effect on propofol consumption during anaesthesia. This prospective, observational, cross-sectional, analytical study included adult patients (> 18 years) undergoing surgery. During the preoperative period, depressive symptoms were evaluated by the psychiatrist on 9-point Patient Health Questionnaire-9 (PHQ-9). The propofol requirements were recorded during anaesthesia and compared with those for patients without depression. One hundred and seventy-four patients (87 patients each with and without cancer) underwent presurgical evaluation. The prevalence of depression (>4 Patient Health Questionnaire-9) and moderate to severe depression (>9 PHQ-9) among patients with cancer was 58.6% and 35.6%, respectively. The prevalence of depression (>4 PHQ-9) and moderate to severe depression (>9 PHQ-9) among patients without cancer was 18.4% and 3.4%, respectively. In the cancer group, propofol requirement was significantly lower (114.7 ± 22.9mg vs. 126.4 ± 24.3mg; p = 0.025) in patients with depression than that in those without depression. In conclusion, the burden of depression during the preanaesthetic period among patients with cancer is substantial, and depression reduces propofol requirement during surgery.

Background There is limited Indian data on the epidemiology of hospital-based restraint practices and the knowledge and attitude of caregivers toward restraint. Therefore, this study aimed to report the frequency and pattern of restraints in a general hospital psychiatry setting and assess the knowledge and attitude about restraint practices among caregivers of patients.Methods We calculated the frequency of restraints (physical and chemical) over one year. The knowledge and attitude toward restraint were assessed in 75 caregivers each of patients from inpatient and outpatient settings, using a questionnaire designed by the authors and pretested in a pilot study.Results The frequency of any form of restraint was 19%. The frequency of chemical and physical restraints was 19% and 0.5%, respectively. Less than 20% of caregivers in both groups reported that restraint was either stigmatizing (5.33% inpatient caregivers vs. 12% outpatient caregivers), cruel (8% inpatient caregivers vs. 15.33% outpatient caregivers), or a measure of punishment (9% inpatient caregivers vs. 16% outpatient caregivers). No significant difference was found between knowledge and attitude about restraint between caregivers of outpatients and inpatients, except for a significantly greater number of caregivers of outpatients reporting that the restraint practices in the hospital were similar to those adopted by faith healers or religious/spiritual centers.Conclusion The frequency of either physical or chemical restraint was less compared to the existing international and Indian data. In addition, most caregivers of patients of both outpatients and inpatients did not report a negative attitude toward restraints.

Background: Mental disability is a common condition but is considered as an invisible disability. The disability certificate in psychiatry remains underexplored. Some reasons are issues of confidentiality, stigma, lack of awareness in the public, and the hesitancy in the mental health professionals. We aim to provide a brief profile of patients with mental illness issued disability certificates from a psychiatric unit over a five-year period (2013–2017).Methods: Our retrospective study is based on the data available from the copies of the issued disability certificates from a psychiatric unit that functions in a multispecialty tertiary care teaching government hospital in Southern India. Patients undergoing treatment in psychiatry apply for a disability certificate to the medical superintendent of the hospital. Each applicant undergoes a detailed workup to ascertain the diagnosis, and the mental disability is assessed using Indian Disability Evaluation and Assessment Scale (IDEAS). Those with intellectual developmental disorder (IDD) are assessed by a clinical psychologist for quantifying intelligence quotient, based on which the disability certificate is issued. Data were extracted and analyzed using SPSS. Descriptive statistics were used.Results: Over five years, 258 disability certificates were issued. A total of 218 were for mental illness and 40 were for IDD. Schizophrenia was the commonest primary diagnosis. There was no gender predominance, nor the influence of gender on different domains of IDEAS except on work domain dysfunction due to mental illness. The validity period was not mentioned in 81% of the issued certificates for mental illness.Conclusions: This descriptive study found a lower number of certificates issued from the psychiatric unit. Schizophrenia remains the main psychiatric diagnosis for which a disability certificate was issued. We did not assess the utilization pattern of the issued certificates.

Background Anxiety disorders are commonly associated with a higher risk of fatal cardiovascular diseases (CVD). Anxiety disorders lead to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, thus weakening the key neuronal components of the autonomic nervous system (ANS) that are involved in cardiovascular functions, leading to increased cardiovascular risk.Purpose Impaired ANS activity, as reduced parasympathetic tone is strongly associated with an increased risk of CVD in anxiety disorders. Slow pranayama influences the ANS by activating the parasympathetic tone and deactivating the sympathetic tone in healthy volunteers and various diseased conditions. Therefore, we aimed to study the effects of slow pranayama and savasana on cardiac autonomic function tests in anxiety disorder patients.Methods Anxiety disorder patients (N = 140) of either sex between the age group 18 and 40 years attending the psychiatry outpatient department (OPD) in JIPMER were recruited for the study and were randomly assigned into the pranayama group and control group. The Pranayama group practised slow pranayama and savasana for 8 weeks along with routine psychiatric care, while the control group continued with routine psychiatric care only. Outcome measures were heart rate variability (HRV), baroreflex sensitivity (BRS), 30:15 ratio during lying to standing, E: I ratio during deep breathing, and ∇DBP during isometric handgrip, which were assessed before and after the intervention period.Results After 8 weeks in the Pranayama group, the HRV parameters showed significant improvement towards the parasympathetic domain. Also, there was a significant increase in parasympathetic reactivity with a decrease in sympathetic reactivity and significant improvement in BRS.Conclusion Slow pranayama and savasana practice in anxiety disorder patients as an adjunct to routine psychiatric care effectively improves cardiac autonomic function with a shift towards parasympathetic predominance, with significant improvements in cardiovascular parameters. Slow pranayamas with savasana may be incorporated into the routine care of these patients to enhance their cardiovascular health.

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Background:There is need for a common and uniform nomenclature for suicide and related behaviors. Many nomenclatures exist to address the same. Aims:Study proposes to assess the inter-rater reliability of Silverman et al. nomenclature on suicide and suicidal behaviors. Method:The present study was conducted at the crisis intervention clinic of a tertiary care centre. Case records of patients referred to the centre were evaluated by two trained psychiatrists and were rated according to the Silverman’s nomenclature in the domains of suicide related ideation, suicide related communication and suicide related behavior. Inter-rater reliability was measured using kappa coefficient. The relationship of suicide intent item of a structured scale with suicide related ideation, communication and behavior were explored. Results:Inter-rater reliability of the two evaluators using the Silverman’s nomenclature on 198 case records was in the moderate range for suicidal related ideation and behavior domains (kappa of 0.476 and 0.502 respectively), but low for communication domain (kappa value of 0.016). The stated intent item of the Pierce Suicide Intent Scale correlated highly with suicide related ideation and behavior as assessed using the Silverman et al. nomenclature (Kendall tau = 0.723 and 0.747 respectively). Conclusions:Based upon the same case record material, evaluators rate suicide related ideations and behaviors with moderate degree of concordance. However, the concordance is poor for suicide related communication.

In this paper the architectures and usability issues of web-based software tools are discussed. For the development of automobile lighting components, various designers, developers and manufacturing personnel are involved, each group needing different software tools. On the one hand, traditional part designers use powerful, 3D CAD systems that usually run on UNIX machines. On the other hand, product engineers, optical engineers and marketing personnel have limited access to such CAD systems. In this Smartlite project, several software tools were thus developed and then tested using two different user interfaces (UIs); the first was based on a commercial CAD system and the second was based on a web browser. The specific focus of this study is a user-based comparison between the new web-based UIs, and the UIs on commercial CAD systems. The usability data have been collected from the users and showed that the web-based UIs provided comparable functionality with the CAD-based UIs in terms of performance and usefulness. For the criteria of accessibility, the web-based tools out-performed the CAD-based tools. As well as the comparison of software tools for different user groups, different communication architectures of the web-based modules were tested and discussed.

Conventional computer-aided design (CAD) packages have drastically reduced the workload of the human designer and shortened the product design cycle. However, the degree of effort and volume of information required to use these tools limit their use to the later stages of design. Intelligent computer-aided design (ICAD) systems have sought to provide a more complete design tool to assist the designer in all phases of design. ICAD systems incorporate conventional CAD elements as well as knowledge engineering constructs. The level of integration between different components of an ICAD system determines its usefulness. Most commercial intelligent CAD packages are tied to a specific set of CAD tools, restricting their application domains. This dependence on specific software tools can be reduced by using general purpose modules to interface with available CAD packages. This paper discusses a method of introducing knowledge engineering technology to help develop an advanced intelligent product design system by integrating ICAD's Concept Modeller with SDRC's l-DEAS package for engineering product design. This integration is necessary because neither the Concept Modeller nor the I-DEAS package provides any unified design environment where users can access both symbolic and numerical design tools as needed to carry out design synthesis and analysis activities. Interfacing engineering design and knowledge processing together is not an easy task. The task is further complicated since it needs to be done only by those who have enough knowledge of both technologies, and also because it may result in reorganization of the traditional design process altogether. The proposed intelligent product design system uses artificial intelligence techniques to take care of human experts knowledge and it advocates the use of several commercial software packages that come from a variety of sources (and are proven to be robust) to perform design synthesis in a cost-efficient and timely manner. The technique described here is relatively easy to implement and is well suited to industrial needs.

Establishing an "intelligent link" between conventional CAD systems and different analytical tools like finite element analysis packages is a significant concern in design automation. This paper proposes the use of knowledge engineering for the unification process and outlines the dimensions of an overall framework for an integrated CAD/FEM system A prototype system for structural design of aircraft wings has been implemented in this integrated environment.