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Medical students master an enormous body of knowledge, but lack systematic problem solving ability and effective clinical decision making. High profile reports have called for reforms in medical education to create a better generation of doctors who can cope with the system based problems they would encounter in an interdisciplinary and collaborative environment and make better reasoned decisions for quality patient care. To achieve this critical thinking is at the very heart of development of new medical knowledge. Critical thinking (CT) can be defined as the ability to identify and analyse problems as well as seek and evaluate relevant information in order to reach an appropriate conclusion. Medical academics and practitioners have raised concerns about the low levels of critical thinking and stress the need for fostering critical thinking among medical practitioners. This article attempts to provide a conceptual analysis of critical thinking with reference to medical education along with measures to foster critical thinking through relevant teaching learning and assessment methods.

Introduction: Literature on implementation leadership program in undergraduate (UG) medical education is lacking in the Asian continent. We aim to describe our experience in sensitizing the 1st year undergraduate medical students (UGMS) toward the principles of leadership in a medical institution. Materials and Methods: Each year, one hundred 1st year UGMS were sensitized towards leadership principles and core domains through interactive sessions, focus group discussions, and short lectures. The students were asked to reflect on the sessions’ activities as well as their follow-up usefulness in their day-to-day activities through a structured questionnaire shared through Google forms. Results: A high proportion (75%) of students reported an improved perception or knowledge toward leadership principles and practices. Leadership attributes such as team building, decision making, confidence building, motivation, and managing crisis were reported to be very useful by 77.8%, 74.1%, 69.1%, 64.2%, and 61.7% of students, respectively. On follow-up, students described this sensitization exercise to be useful in their academic (16/52, 30.76%), organizational (10/52, 19.2%), sports (6/52, 11.53%), short-term research (4/52, 7.7%) activities, and editorial responsibilities (3/52, 5.7%). Conclusion: The leadership sensitization workshop helps students adjust to the medical school’s environment; and this may be incorporated in the UG curriculum to strengthen students’ leadership potential. [ABSTRACT FROM AUTHOR]

Background: Literature on implementation leadership programme in undergraduate medical education is lacking in Asian continent. We aim to describe our experience in sensitizing the first-year undergraduate medical students (UGMS) towards the principles of leadership in a medical institution. Materials and methods: Each year, one hundred first year UGMS were sensitized towards leadership principles and core domains through interactive sessions, focus group discussion, and short lectures. The students were asked to refiect upon the sessions' activities as well as its follow up usefulness in their day-to-day activities through a structured questionnaire shared via Google forms. Results: A high proportion (75%) of students reported an improved perception or knowledge towards leadership principles and practices. Leadership attributes such as team building, decision making, confidence building, motivation, and managing crisis were reported to be very useful by 77.8%, 74.1%, 69.1%, 64.2%, 61.7% of students. On follow up, students described this sensitization exercise to be useful in their academic (16/52, 30.76%), organizational (10/52, 19.2%), sports (6/52, 11.53%), short term research (4/52, 7.7%) activities, and editorial responsibilities (3/52, 5.7%), etc. Conclusion: Leadership sensitization workshop helps students adjust to the to the medical school's environment; and this may be incorporated in UG curriculum to strengthen students' leadership potential. [ABSTRACT FROM AUTHOR]

Background: The contact tracing and subsequent quarantining of health care workers (HCWs) are essential to minimizing the further transmission of SARS-CoV-2 infection and mitigating the shortage of HCWs during the COVID-19 pandemic situation. Objective: This study aimed to assess the yield of contact tracing for COVID-19 cases and the risk stratification of HCWs who are exposed to these cases. Methods: This was an analysis of routine data that were collected for the contact tracing of COVID-19 cases at the All India Institute of Medical Sciences, Bhubaneswar, in Odisha, India. Data from March 19 to August 31, 2020, were considered for this study. COVID-19 cases were admitted patients, outpatients, or HCWs in the hospital. HCWs who were exposed to COVID-19 cases were categorized, per the risk stratification guidelines, as high-risk contacts or low-risk contacts Results: During contact tracing, 3411 HCWs were identified as those who were exposed to 360 COVID-19 cases. Of these 360 cases, 269 (74.7%) were either admitted patients or outpatients, and 91 (25.3%) were HCWs. After the risk stratification of the 3411 HCWs, 890 (26.1%) were categorized as high-risk contacts, and 2521 (73.9%) were categorized as low-risk contacts. The COVID-19 test positivity rates of high-risk contacts and low-risk contacts were 3.8% (34/890) and 1.9% (48/2521), respectively. The average number of high-risk contacts was significantly higher when the COVID-19 case was an admitted patient (number of contacts: mean 6.6) rather than when the COVID-19 case was an HCW (number of contacts: mean 4.0) or outpatient (number of contacts: mean 0.2; P=.009). Similarly, the average number of high-risk contacts was higher when the COVID-19 case was admitted in a non-COVID-19 area (number of contacts: mean 15.8) rather than when such cases were admitted in a COVID-19 area (number of contacts: mean 0.27; P<.001). There was a significant decline in the mean number of high-risk contacts over the study period (P=.003). Conclusions: Contact tracing and risk stratification were effective and helped to reduce the number of HCWs requiring quarantine. There was also a decline in the number of high-risk contacts during the study period. This indicates the role of the implementation of hospital-based, COVID-19--related infection control strategies. The contact tracing and risk stratification approaches that were designed in this study can also be implemented in other health care settings. [ABSTRACT FROM AUTHOR]

Background: There are several reports worldwide on adulteration of herbal medicines (HMs) with allopathic drugs. In India, only a few studies have reported adulteration of HMs with antidiabetics and there are no systematic studies. Aims: To develop a rapid and validated method for detection of allopathic antidiabetic adulterants and to explore the extent of adulteration in HMs sold in South India. Materials and Methods: Standards and solvents were purchased from Sigma-Aldrich. Different brands of antidiabetic HM samples with manufacturing licenses were procured from dispensaries. Spiked drug free psyllium husk as solid and flask seed oil as liquid herbal matrices were used for method development. The spiked matrices with different concentrations were extracted with methanol and subjected to centrifugation. The supernatant was collected and analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Isocratic elution was carried on a C18 column with 0.1% (v/v) formic acid:methanol (3:7, v/v) as a mobile phase. All drugs were monitored for two ion products in positive electrospray ionization mode using multiple reaction monitoring scans. Results: The retention time was 9 min. Limit of detection is 10 Pictograms (pg) for all analytes except for metformin, which was 370 pg. Recoveries of analytes range from 96% to 117%. Forty different brands of antidiabetic HMs were analyzed. Adulterant peaks were not observed in the mass chromatograms of HMs. Conclusions: A single-run method was developed by LC-MS/MS for the detection of proposed antidiabetics in HMs from licensed manufacturing units and online sold HMs across herbal dispensaries in Puducherry union territory, India. None of the HMs was found to be adulterated with proposed allopathic antidiabetic adulterants. [ABSTRACT FROM AUTHOR]

Background. Medication errors have an adverse impact on the healthcare system by increasing patient morbidity and mortality. They are preventable, and educational or technologybased interventions are needed to reduce their prevalence and improve medication safety. We aimed to study the impact of a sensitization programme and a blame-free reporting tool for doctors and nurses on the prevalence and reporting of medication errors in the intensive care units (ICUs) of a tertiary care teaching hospital. Methods. This prospective interventional study was conducted in the ICUs of cardiology, medicine, paediatrics and neonatology. Baseline medication errors were detected by prescription order review and direct observation of administration of medication for 30 days. A sensitization programme was conducted for doctors and nurses in these ICUs, the results were discussed, and a blame-free medication error reporting tool was introduced. Medication charts were modified to remove the transcription process in the cardiology and paediatrics ICUs. The follow-up study was conducted for 30 days in each ICU to monitor the impact of the sensitization programme. Results. The prevalence of medication errors was found to be 334.1/1000 patient observation days. Prescription errors were the most common types of errors at 129.1/1000 patient observation days. The interventions significantly reduced the error rate in all four ICUs. The overall number of prescriptions with errors was reduced from 9.1% (177/1944) to 3.5% (48/1373) and no medication error was reported using the tool. Conclusion. The sensitization programme on medication errors for doctors and nurses may be effective in improving medication safety. The impact was more pronounced in prescription errors. Reporting of medication errors did not improve in this study despite the introduction of a blame-free reporting tool. [ABSTRACT FROM AUTHOR]

Objective: To estimate the frequency and type of prescription errors in patients receiving cancer chemotherapy. Settings and Design: We conducted a cross sectional study at the day care unit of the Regional Cancer Centre (RCC) of a tertiary care hospital in South India. Materials and Methods: All prescriptions written during July to September 2013 for patients attending the out patient department of the RCC to be treated at the day care center were included in this study. The prescriptions were analyzed for omission of standard information, usage of brand names, abbreviations and legibility. The errors were further classified into potentially harmful ones and not harmful based on the likelihood of resulting in harm to the patient. Descriptive analysis was performed to estimate the frequency of prescription errors and expressed as total number of errors and percentage. Results: A total of 4253 prescribing errors were found in 1500 prescriptions (283.5%), of which 47.1% were due to omissions like name, age and diagnosis and 22.5% were due to usage of brand names. Abbreviations of pre medications and anticancer drugs accounted for 29.2% of the errors. Potentially harmful errors that were likely to result in serious consequences to the patient were estimated to be 11.7%. Conclusions: Most of the errors intercepted in our study are due to a high patient load and inattention of the prescribers to omissions in prescription. Redesigning prescription forms and sensitizing prescribers to the importance of writing prescriptions without errors may help in reducing errors to a large extent. [ABSTRACT FROM AUTHOR]

The author reflects on the lowering of medical education standards due to ineffective medical teachers in India. He states that teachers blamed their skills on the low performance of the students during summative examinations. An overview of medical teachers' malpractices are given such as the admission of academically poor students to colleges and the leakage of test questionnaires. He suggests that medical teachers must refuse to com promise standards for the sake of their profession.

Introduction: Dry powder inhalers (DPI) have been in use in the treatment of chronic respiratory diseases for decades. DPIs require proper inhaler technique to ensure appropriate dose delivery to the lungs which in turn provides disease control and hence reduces the economic burden due to frequent acute attacks and hospital visits. Inadequate inhaler technique remains an everlasting problem among patients with chronic respiratory disease. Hence the aim is to assess the inhaler technique in patients using DPI and to determine the factors associated with inhaler technique., Material and Methods: A cross-sectional study was conducted and 385 patients with asthma or chronic obstructive pulmonary disease (COPD) were recruited. Patient-related and disease-related factors were noted. Severity of the disease were assessed using asthma control test/COPD assessment test questionnaire and spirometer. The investigator assessed the inhaler technique of the patient against standard checklist., Results: Nearly 46.2% of the patients performed incorrect inhaler technique. Multivariate analysis showed factors like young age [Odd's ratio (OR) 4.13, CI 1.31-17.8], well controlled disease (OR 2, CI 1.1-3.65), and the patients who learnt the technique from a medical personnel (OR 3.67, CI 1.46-9.24) had better inhaler technique., Conclusion: This study shows that the proper use of inhaler is still an unattained goal and significance of correct use has to be reiterated.