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   Table of Contents - Current issue
Coverpage
October-December 2020
Volume 7 | Issue 4
Page Nos. 235-288

Online since Thursday, April 8, 2021

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REVIEW ARTICLES  

Triple Cs of self-directed learning: Concept, conduct, and curriculum placement Highly accessed article p. 235
Dinesh Kumar Badyal, Hem Lata, Monika Sharma, Anjali Jain Jain
DOI:10.4103/cjhr.cjhr_13_21  
Self-directed learning (SDL) is one of the teaching-learning methods that can be used in medical education at all levels. The use of SDL in undergraduate (UG) teaching is becoming common due to the implementation of competency-based education in many countries. The new competency-based UG medical curriculum in India includes lifelong learning skills as one of the major components. The SDL method is reported to increase the lifelong learning skills of students. The concept of SDL is based on experiential learning and its conduct needs proper understanding of the concept. The conduct can include two contact sessions and an intersession or gap period of few days. The contact sessions focus on introduction, facilitation, and debriefing. The intersession period is the real learning period for the students. SDL also includes the use of various assessment methods. All SDL sessions are followed by an evaluation of various stakeholders. Advancements in information technology (IT) and the advent of many innovations in teaching can be aptly used in SDL conduct and evaluation. The present coronavirus disease 2019 (COVID-19) pandemic has further provided opportunity to use IT in the new normal post-COVID-19 times. Curriculum placement must be done in alignment with other teaching-learning methods. Training of facilitators, availability of resources, and preplanning help in successful SDL conduct. If implemented appropriately, SDL can be a great method to help students in their postinstitute lives.
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Dermatological manifestations in children and adults with COVID-19 infections Highly accessed article p. 240
Abhilasha Williams, Amrutha Dirisala, Monika Sharma
DOI:10.4103/cjhr.cjhr_7_21  
The cutaneous manifestations of COVID-19 infection are evolving rapidly as new data continue to be published in the literature. Considering that majority of these manifestations resemble other viral exanthemas, a high degree of suspicion and clinical acumen is needed for early identification of COVID-19 infections and its prompt management. The most common manifestations in adults include maculopapular rash, purpura, vesicular rash, urticarial rash, and pseudo-chilblains, while in children, the manifestations include Kawasaki disease-like inflammatory syndrome (pediatric inflammatory multisystem syndrome) and erythema multiforme. This review presents a comprehensive guide to the cutaneous manifestations of COVID-19 infections in adults and children. Also included are the dermatological manifestations observed due to prolonged use of personal protective equipment in healthcare workers.
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Inpatient and home-based rehabilitation regimen after COVID-19 illness p. 248
Ramakant Yadav, Neha Dubey, Sunil Kumar, Vaibhav Kanti, Raj Kumar
DOI:10.4103/cjhr.cjhr_134_20  
The severe acute respiratory coronavirus-2 syndrome infection has spread worldwide and has an abrupt effect on human, economic, and health system. The data are collected from various relevant sources such as PubMed, Infection Prevention Control, World Health Organization novel coronavirus disease (COVID-19) situation update report, Australian and New Zealand Intensive Care Society guidelines, Society of Critical Care Medicine, World Confederation for Physical therapy guidelines, and from other Internet sources. It is observed that about 30% of COVID-19 patients with sepsis needed hospital rehabilitation, while 20% requires a home-based rehabilitation program. Based on the evidence, it is anticipated that severe and critical COVID-19 patients develop postintensive care syndrome, resulting in pulmonary disabilities, dyspnea on exertion, physical deconditioning, cognitive impairment, and mental health disturbances. Most of these symptoms may also occur in patients recovered from symptoms, or who were not admitted to intensive care unit, or in older adults with chronic health conditions, or who have been deconditioned due to mobility disability, social isolation, etc. Such patients need access to effective pulmonary therapy, functional rehabilitation, and stress management in the hospital- and home-based settings to regain their previous independence level. The evidence suggests that viruses could even survive in the oropharyngeal cavity and stool for up to 15 days after COVID-19 infection has been declared cured. The physiotherapist must take proper safety measures before managing patients at home; a virtual care therapy is therefore highly recommended. Due to the increasing demands of hospital beds, the patients may need to be discharged earlier than expected. Rehabilitation act as adjuvant therapy in preparing patients for discharges, reducing the experience of disability, and ensuring the quality of treatment among recovered/discharged COVID-19 patients in hospital- or home-based settings.
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ORIGINAL ARTICLES Top

Efficacy of industrial-grade infrared noncontact temperature recording device for fever screening during coronavirus pandemic p. 256
Kaminder Bir Kaur, Anuj Singhal, Arun Kumar Yadav, Vishal Mangal, Rohit Jain, Satish Kumar
DOI:10.4103/cjhr.cjhr_50_20  
Background: The World Health Organization declared COVID-19 “a pandemic” on March 11, 2020. An essential preventive and screening strategy adopted was temperature screening at various public places such as airports and hospitals with devices like handheld, noncontact infrared thermometers. Before this pandemic, the industrial thermometers have never been used in health-care settings. The study was conducted to compare temperature readings of these industrial-grade infrared noncontact handheld thermometers with a digital thermometer. Materials and Methods: Three Testo® industrial-grade infrared noncontact thermometer (IGNCT) and Dr. Trust digital thermometer were used on 117 individuals for recording temperature. The average of three readings was taken for each instrument by a single investigator. Results: Out of 117 individuals, 14 (11.9%) were febrile. The Pearson correlation values between the digital thermometers varied from 0.3 to 0.42. The reliability, as measured by the intraclass correlation, was poor (0.16-“0.4). The area under the curve for IGNCT devices varied from 76% to 84%. Conclusion: Industrial-grade infrared noncontact temperature (IGNCT) recording devices with its no-touch technique to measure temperature while maintaining distance may be useful in a pandemic situation. However, the higher the area under the curve, the better it is. In a large cohort, 20% will be misclassified, and in absolute terms, they may be translated into large numbers. Hence, there is a case for better devices having an area under the curve of nearly 100% for the screening of population. The role of IGNCT devices for the screening of individuals to identify cases of febrile illness is limited owing to its poor reliability and unacceptable area under the curve for screening large populations.
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Handling of face masks by health-care workers during the coronavirus pandemic scare: An eye-opener p. 261
Vishal Mangal, Anuj Singhal, Arun Kumar Yadav, Kaminder Bir Kaur, Rohit Jain
DOI:10.4103/cjhr.cjhr_55_20  
Background: The first case of coronavirus disease 2019 (COVID-19) was reported on January 30, 2020, in India, and it was declared to be a pandemic on March 11, 2020, by the World Health Organization. The use of face masks by the general population and the health-care workers (HCWs) is the most important preventive strategy. Materials and Methods: The study aimed to know the knowledge, attitude, and practices of usage and disposal of face masks among HCWs during the COVID-19 pandemic. Data were collected using a peer-reviewed, prevalidated questionnaire. The quantitative variables were described in mean and standard deviation and qualitative variables by number and percentages. P < 0.05 was considered statistically significant. Results: Nearly 71.43% of the participants were wearing a triple-layered surgical face mask. Almost 48.74% of HCWs were provided with the mask from the place of work. Surprisingly, 56.30% of the HCWs were not changing the mask daily and not following the proper disposal system; moreover, 35.8% of doctors and 64.2% of paramedics were taking the masks back to their homes in their pockets. Conclusions: Personal protection equipment started getting scarcely available and was a control item during the hour of this pandemic. This unawareness requires immediate attention, as it poses a high risk for transmission of COVID-19 among Health care service providers.
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Faculty survey about online teaching during early lockdown period of COVID-19 pandemic in a medical college in central India p. 265
Anil Kapoor, Anju Kapoor, Kailash Charokar, Anil Mishra, Manjunath V Motagi, Sahebrao K Sadawarte
DOI:10.4103/cjhr.cjhr_115_20  
Background: COVID-19 pandemic has led to disruption of onsite teaching of medical students, necessitating faculty to start online teaching at a short notice. This faculty survey was conducted with an aim to identify their perceptions, preparations, and participation in online teaching-learning activities during early lockdown period in our medical college. Materials and Methods: A Google form for online survey using a peer-reviewed 27 item questionnaire was designed and the link was shared with all faculty from Dean's office through WhatsApp group and E-mail. Data gathered were analyzed quantitatively and qualitatively to identify the perceptions, challenges faced, and need for corrective actions. Results: Out of 136 faculty, 108 (79.4%) responded. Majority (93; 88.89%) had put efforts to develop their skills for online teaching after lockdown was imposed. Eighty faculty (74.07%) had taken online classes using online platforms, mainly WhatsApp (77.5%), Zoom (56.25%), and Google classroom (25%). Flexibility and convenience for students and teachers were perceived as most common advantages while missing eye contacts and in-depth discussions were perceived as the most common disadvantages. Teaching and assessing cognitive skills was perceived as most feasible and psychomotor skills as least feasible using online platform. Need for faculty training for online-teaching methodology was strongly expressed; a faculty development program for the same was designed and conducted. Conclusions: Majority of the faculty had put efforts to develop skills for online teaching and started taking online classes, mainly on WhatsApp and Zoom. They strongly perceived need for faculty-development for online teaching methodology; teaching and assessment of cognitive skills was perceived as most feasible as compared to other skills.
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Paradigm shift in health-care seeking behavior: A report from central Kerala, India, during COVID-19 pandemic p. 271
Kezia Kuruvilla, Praveenlal Kuttichira, Pulikkottil Raphael Varghese, Elamthuruthy Vilson Vinu, Indu K Gopi
DOI:10.4103/cjhr.cjhr_132_20  
Context: Coronavirus is a novel public health problem, which has influenced the mindset of people and restricted the community mobility. These changes influence the health-care seeking behavior of people. Aim: This study analyzes the changing trend in patients coming for hospital based non-COVID care in the context of COVID-19. Settings and Design: This is a retrospective study based on hospital records of patients attending a tertiary care center, attached to a private medical college. Materials and Methods: Age, gender, and department wise daily registrations of patients from January 1 to June 30 of 2 consecutive years, 2019 and 2020 were considered, with new and review cases noted separately. Statistical Analysis Used: Data analyzed using Excel 2007. Results: The number of patients seeking hospital-based care during the year 2020 decreased by 31.01% compared to 2019 (P < 0.001). Maximum patient fall was noticed in the month of April. Patient decline was highest in the age group ≤14 (37.22%) and least in the senior citizen group (29.26%). The outpatient departments showed higher fall percentage (31.52%) compared to emergency services (26.65%), with highest fall in pediatrics (40.76%) and minimum in surgical allied super specialty (20.04%). Conclusions: A fall in patients occurred during COVID-19 and the associated restrictions implemented to contain the virus, which might be the result of an altered approach to morbidity and health care. This will disrupt the health care services to the vulnerable groups with complex health needs, influencing their health outcome in the long run.
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Knowledge and perception regarding coronavirus disease-19 among the nurses in Kebbi State North-west Nigeria p. 276
Kehinde Fasasi Monsudi, Abayomi O Ayodapo, OO Deji-Dada, AA Bioku, Fahd M Moshood
DOI:10.4103/cjhr.cjhr_79_20  
Background: The world is presently faced with a coronavirus disease-19 (COVID-19) pandemic which has overwhelmed countries health systems and has had an enormous toll on human lives. Health-care workers of all levels are primarily involved in taking care of patients with COVID-19, and this has posed serious occupational health risk to this important workforce. Aim: The aim of this study is to assess the knowledge and perception regarding COVID-19 among the nurses in Kebbi State. Materials and Methods: This was a hospital-based, descriptive, cross-sectional study conducted among the nurses working in the only tertiary hospital in Kebbi State using self-administered questionnaires. Information obtained from the participants includes sociodemographic characteristics, knowledge, and perception on COVID-19. The data were analyzed using the Statistical Package for the Social Sciences software version 21. Results: Of the 170 nurses that were given the questionnaires, 161 returned it. There were 61 (37.9%) males. The mean age of the participants was 36.1 years (standard deviation = 9.3), and the age range was between 20 years and 57 years. Majority of the respondents were in the age group of 31-“40 years (41.6%), married 128 (79.5%), Hausa 84 (55.2%), Muslim 103 (64%), registered nurse/registered Midwives 111 (88.9%), and 97 (60.2%) have been practicing nursing profession between 1 year and 10 years. Slightly more than half (51.6%) of the respondents have poor knowledge of COVID. While majority 98% have the high level of perception on COVID-19. Conclusion: Nurses in our hospital have poor knowledge of COVID-19 but good perception of the disease. Internet/social media remains the sources of information on the disease. The importance of creating more awareness of the disease among the health workers is underscored.
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SHORT COMMUNICATION Top

Children in COVID 19: Giggles to quietude p. 282
Shobhit Kumar Prasad, Vipin Nain, Avni Gupta, Aparna Goyal
DOI:10.4103/cjhr.cjhr_56_20  
Children make up about one-third of the Indian population. Due to large size and special needs, it is extremely important to consider this demographic group in the planning for COVID-19. Here we identify the risk factors with possible psychological impact and emphasize in brief on the different strategies which need for effective implementation to ensure their well -“ being.
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MINI REVIEW Top

Ensuring safety of employees during COVID 19 pandemic in workplace settings p. 284
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/cjhr.cjhr_27_20  
The coronavirus disease 2019 pandemic has influenced all the domains of human's life. Owing to the novel nature of the infection, with no potential drug or vaccine available till date for the management or prevention of the infection, it is extremely important to ensure that all the stakeholders work together. An extensive search of all materials related to the topic was carried out in the PubMed search engine and World Health Organization website and a total of 3 articles were selected based upon the suitability with the current review objectives. Keywords used in the search include COVID-19, and workplace. There is an immense need to implement appropriate strategies to prevent the spread of the infection both in the workplace and in the community. A series of measures such as early case detection, isolation of cases, contact tracing, and appropriate treatment has to be taken to ensure effective containment of the infection. To conclude, it is the need of the hour to improve the outbreak readiness and emergency response in workplace is an important component of the containment of the infection. However, this will essentially require support from all the stakeholders and the employers have to take the center stage..
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LETTER TO EDITOR Top

Distance learning and community of inquiry: How webinars for postgraduates are different from undergraduate online teaching sessionsx? p. 287
M Shuriya Prabha, V Dinesh Kumar
DOI:10.4103/cjhr.cjhr_89_20  
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