BackgroundSimulation-based training has emerged as a critical modality in medical education, particularly for areas like point-of-care ultrasound. The effectiveness of the training is heavily influenced by instructional design. Design-based research offers a framework to iteratively develop, implement, and refine educational interventions, particularly in real-world settings, ensuring both practical and theoretical foundation.ObjectiveThis study employed a design-based research approach to develop, evaluate, and implement a blended ultrasound education program for in-service medical professionals, integrating asynchronous e-learning with high-fidelity simulation.MethodsThe study was conducted at a single academic institution and involved 51 practicing healthcare professionals. The course was designed, including needs assessment, iterative curriculum development, and multiple cycles of implementation and evaluation. Online module performance, pre- and post-test assessments, and subgroup analysis of curriculum completers were used to evaluate learning outcomes. Instructional decisions were revised based on observed performance trends. Suitable interventions in the design framework were also planned according to all the feedback and data captured.ResultsParticipants showed a statistically significant improvement in knowledge post-intervention (mean score increase: 10.24%, p = 0.0033). Lung and ocular ultrasound modules showed low variability and high scores, according to module-wise analysis, suggesting good instructional design. Subgroup analysis confirmed the significance of structured progression by showing a correlation between full curriculum engagement and improved performance and consistency. The cardiac ultrasound module showed high variability and lower mean scores, guiding a redesign recommendation for scaffolded instruction.ConclusionThe design-based approach enabled the systematic development of the ultrasound-guided diagnostics course, ensuring alignment between instructional strategies and learner needs. This study highlights the value of evidence-informed design in enhancing clinical competency in ultrasound procedures and offers a scalable simulation-integrated model for future medical education.

Objective:Developing nations with resource limited settings see a higher proportion of presentation at advanced stages of breast cancer compared to developed nations because of poor public awareness and lack of screening guidelines. This study aimed to assess the impact of a video-based teaching module on breast cancer awareness and self-examination among literate women in a developing country. Materials and Methods:This quasi-experimental, community-based, intervention study was conducted among literate women of a metropolitan city in a developing country, to evaluate the impact of a video-based teaching module on breast cancer awareness and self-examination. Female school teachers over 25 years old with virtual platform access were included. Simple random sampling was used to select participant schools. The target sample size was 103 based on a reference study. An educational video and questionnaires were validated through expert and volunteer feedback, followed by baseline and follow-up surveys at 6 weeks and 10 weeks after intervention. The Friedman test for overall change in scores and Wilcoxon signed-rank test were used for pairwise comparison between time points. Results:The survey was completed by 181 participants. Mean (standard deviation) age was 41.79 (9.20) years. Median (interquartile range) cumulative score for the knowledge domain was 18 (14-21), 24 (19-32) and 25 (20-33) at baseline, 6 weeks and 10 weeks respectively with significant differences between each of these time points (p<0.001). There was a significant increase in the number of participants with a median score of 3 at 6 and 10 weeks compared to baseline in the attitude domain after intervention. The proportion of study participants with a score of ≥3 points in the practices domain increased from 22% (40/181) at baseline to 41.2% (74/181) at 6 weeks and 49.1% (89/181) at 10 weeks of educational intervention. Conclusion:A video-based educational intervention may enhance breast cancer knowledge, attitudes, and self-examination practices in educated women with access to electronic media. This may contribute to early breast cancer detection in resource-constrained settings with limited screening options.

Rarely, ectopic thyroid tissue can coexist with an eutopic thyroid. Technetium pertechnetate scan is peculiar for thyroid tissue uptake. However, DOTANOC uptake in mediastinal ectopic thyroid has been rarely reported. We present a unique case of an ectopic mediastinal thyroid mass that did not show any uptake on a pertechnetate scan and showed significantly increased uptake on 68Ga-DOTANOC positron emission tomography-computed tomography with an eutopic cervical thyroid with normal pertechnetate and physiological mild DOTANOC uptake.

Background: Laparo-endoscopic hernia surgery is recommended by various international bodies. However, its uptake by general surgeon is low. We aim to assess the impact of Three Dimensional (3D) endovision system in learning laparoscopic transabdominal preperitoneal (TAPP) repair of groin hernia and transferability of skills acquired from 3D to the Two Dimensional (2D) environment.Methodology: Senior resident doctor with no previous experience in laparoscopic hernia surgery did 20 consecutive cases of TAPP repair using 3D endovision system followed by another five cases of TAPP repair using 2D endovision system. Total operating time, operating time during different phases of hernia surgery, faculty take over time, path length of needle holder, and scissors were recorded. Cumulative sum (CUSUM) and split group analysis were done to assess the learning process. Trainee's operating time was compared with that of experts' from previously published study of the same group. Data were compared between last block of five cases done using 3D system and cases done using 2D system for skill transferability.Results: CUSUM method provided inflection points of total operating time, hernia dissection and mesh placement at 9th case, and peritoneal suturing at 11th case in learning TAPP hernia. After 10th case, trainee's operating time was within the middle 50 percentage of experts operating time. Total operating time in last block of cases done under 3D vision and that of 2D endovision comparable, although peritoneal closure was significantly longer in 2D vision (P = .074, .2, .145, .001).Conclusion: Reduction on operating time appears after ninth case of TAPP hernia repair using the 3D endovision system. The skills acquired under 3D endovision system are transferable to perform the procedure under 2D endovision system, albeit incompletely. Use of 3D technology may facilitate adaptation of TAPP hernia repair by young surgeons.

Post-operative pain following intra peritoneal onlay mesh (IPOM) repair of ventral hernia is commonly attributed to mechanical fixation devices. Fibrin sealant is a novel technique of mesh fixation purported to cause less pain. The aim of this study was to compare postoperative pain in these two methods of mesh fixation. This was a double-blinded, randomized controlled trial. Eighty patients with primary ventral hernia underwent laparoscopic IPOM repair using PROCEED™ mesh, which was fixed with either mechanical fixation device, SECURESTRAP™ (MF group) or fibrin sealant, TISSEEL™ (FS group). Primary end point was postoperative pain at rest and movement on a Visual Analogue Scale (VAS) of 0–10. Operative time, recurrence, seroma and quality of life (QoL) were secondary outcomes. Patients were followed up for one year. There was no significant difference in pain score at 12 h, 24 h, 7 days, 1, 3 and 12 months between the groups, except pain on movement, which was significantly less in the FS group on the seventh day (median VAS 3 vs. 2, p = 0.01). Mean operative time was 8 min longer in the FS group (p = 0.001). Two patients in the FS and none in the MF group had recurrence at one year (p = 0.18). Seroma formation, postoperative QoL and patient satisfaction scores were similar in both groups. Use of fibrin sealant for mesh fixation does not provide significant advantage over mechanical fixation in laparoscopic IPOM repair.

Pulmonary teratomas are extremely rare extragonadal neoplasms. As the clinical features are non-specific, the diagnosis rests on the radiological findings. The characteristic computed tomography (CT) findings of a teratoma in the lung include heterogenous lobulated mass containing soft tissue, fat, fluid, and/or calcification. However, at times these distinctive findings may be absent and the diagnosis is revealed only after surgery. We report a case of intrapulmonary mature teratoma in a patient where the preoperative diagnosis of aspergilloma was considered based on the imaging findings. We discuss some imaging findings that may help differentiate intra-pulmonary teratoma with aspergilloma. We also present a review of all published cases where teratoma mimicked as some other pulmonary lesions.

The aim of this study is to compare outcomes of patients with and without use of systemic post-operative anti-coagulation (SPAC) having undergone end to end medium-sized arterial repair following trauma. A prospective, single-blinded, pilot randomized control trial was conducted at a level 1 trauma center from April 2019 through August 2020. Patients between 14 and 65 years having medium size vessel injury and undergoing end to end arterial repair were included. Patients were randomized into two groups—SPAC and no SPAC. Primary outcome measure was vessel patency measured clinically and/or by Doppler at 48 h and at the time of discharge. Secondary outcome measures included post-operative bleeding, re-exploration, ongoing blood product transfusion, limb salvage, duration of ICU stay, and hospital stay. A total of 32 patients were randomized. There was no difference in vessel patency at 48 h. (93.7% vs. 93.7%, p value 0.572) or at discharge (93.7% vs. 87.5%, p value 0.654). Incidence of post-operative hemorrhage (5 patients vs. 0, p value 0.030), need for additional vascular procedures (37.5% vs. 18.75, p value 0.030), need for further post-operative transfusions (50% vs. 12.5%, p value 0.040), and additional operative procedures (30 vs. 18, p value 0.024) were more in the SPAC group. There was no difference in limb salvage rates (93.7% vs. 87.5%, p value 0.513), rates of fasciotomy (68% vs. 56.3%, p value 0.412), hospital stay (mean 20.12 vs. 16.28 days, p value 0.663), and ICU stay (mean 0.81 vs. 2.7 days, p value 0.358). SPAC does not seem to improve post-operative vessel patency following end to end arterial repair of injured medium-sized vessels. An increase in adverse events following use of SPAC was noted. An adequately powered randomized trial is needed to conclusively bridge the lacunae on the use of anticoagulation in these groups of patients. Trial Registry: ctri.nic.in/clinical trials/login.php, number REF/2019/04/018649 dated 18/04/2019

Pulmonary mucoepidermoid carcinoma (PMEC) is a rare pulmonary neoplasm. Although F-18-FDG PET/CT has been shown to present with increased metabolic activity in PMEC, literature does not report increased somatostatin receptor expression in these tumors. We present the case of a 15-year-old boy where PMEC mimicked a typical carcinoid of the lung on DOTANOC PET/CT by showing significant uptake on( 68)Ga-DOTANOC.

PURPOSE:Non-operative management (NOM) has been validated for blunt liver and splenic injuries. Literature on continuous intra-abdominal pressure (IAP) monitoring as a part of NOM remains to be equivocal. The study aimed to find any correlation between clinical parameters and IAP, and their effect on the NOM of patients with blunt liver and splenic injury. METHOD:A prospective cross-sectional study conducted at a level I trauma center from October 2018 to January 2020 including 174 patients who underwent NOM following blunt liver and splenic injuries. Hemodynamically unstable patients or those on ventilators were excluded, as well as patients who suffered significant head, spinal cord, and/or bladder injuries. The study predominantly included males (83.9%) with a mean age of 32.5 years. IAP was monitored continuously and the relation of IAP with various parameters, interventions, and outcomes were measured. Data were summarized as frequency (percentage) or mean ± SD or median (Q1, Q3) as indicated. χ2 or Fisher's exact test was used for categorical variables, while for continuous variables parametric (independent t-test) or nonparametric tests (Wilcoxon rank sum test) were used as appropriate. Clinical and laboratory correlates of IAP < 12 with p < 0.200 in the univariable logistic regression analysis were included in the multivariable analysis. A p < 0.05 was used to indicate statistical significance. RESULTS:Intra-abdominal hypertension (IAH) was seen in 19.0% of the study population. IAH was strongly associated with a high injury severity score (p < 0.001), and other physiological parameters like respiratory rate (p < 0.001), change in abdominal girth (AG) (p < 0.001), and serum creatinine (p < 0.001). IAH along with the number of solid organs involved, respiratory rate, change in AG, and serum creatinine was associated with the intervention, either operative or non-operative (p = 0.001, p = 0.002, p < 0.001, p < 0.001, p = 0.013, respectively). On multivariable analysis, IAP (p = 0.006) and the mean change of AG (p = 0.004) were significantly associated with the need for intervention. CONCLUSION:As a part of NOM, IAP should be monitored as a continuous vital. However, the decision for any intervention, either operative or non-operative cannot be guided by IAP values alone.

Pulmonary mucormycosis is a rare, life-threatening fungal infection usually seen in immunocompromised patients. Mortality in such patients is high due to underlying immunosuppression and poor general condition of the patients. Invasion of the adjacent structures is known but, to the best of our knowledge, pulmonary mucormycosis presenting with a full thickness chest wall erosion has not been reported. We report such a case with chest wall destruction with superadded bacterial infection. The use of prosthetic materials for chest wall reconstruction was not possible due to the presence of infection. In addition, there were other intra-operative and post-operative challenges which we managed using a multidisciplinary approach. This report highlights the successful outcome of this complex situation using pre-operative optimisation, adequate surgical debridement and effective management of post-operative complications with patience and perseverance.

Abstract Clinical utility of Whole Body Low Dose CT scan for detecting bone metastasis in Breast cancer patients: A cross sectional study Background: Skeletal scintigraphy (Bone scan) is the imaging of choice to detect bone metastasis in locally advanced and metastatic breast cancer patients. Nuclear medicine facilities are however limited in their availability. As an alternative diagnostic modality to bone scan, we studied the diagnostic capability of Whole-Body Low Dose CT (WBLDCT) scan for detection of bone metastasis in these patients. Materials and Method: This cross-sectional study was conducted from November 2021 to May 2023 at a tertiary healthcare center in India with an aim to study the clinical applicability of whole-body low dose computed tomography scan for detecting bone metastasis in patients with breast cancer. Breast cancer patients with primary tumor measuring 5cm or more, pathologically proven axillary lymph node metastasis, Stage III/IV disease, symptoms attributable to metastasis and suspected disease recurrence were included. All patients underwent WBLDCT and Bone scan within a period of about 2 weeks. WBLDCT was done during the same time as conventional dose CT scan was being done as part of metastatic workup. WBLDCT acquisition protocol was set in CT scan machine by modulating the technical parameters like Care dose 4D-automated, Care kV semi, rotation time & noise index. The image analysis was performed by Radiologist and Nuclear medicine experts in a blinded fashion. Data was recorded in MS Excel sheet. Sensitivity, specificity, positive and negative predicative value, and concordance rates were calculated using SPSS software ver 25.0. Agreement amongst WBLDCT and Bone scan was calculated using Inter-rater agreement. p value < 0.05 was taken as significant. Results: 110 patients were enrolled in this study. The mean age of participants was 48.5 years and three fourth had stage III disease at presentation. Estrogen receptor positive disease was seen in 43.64% participants while 30% were triple negative. Her2neu positive disease was seen in 27.27% patients. Bone scan couldn’t be done in 03 patients who deferred treatment (these had no bone metastasis on WBLDCT). Both bone scan and WBLDCT detected bone metastasis in 19 patients. Bone scan picked up additional metastasis in three patients which were missed on WBLDCT. WBLDCT detected bone metastasis additionally in three patients which were not detected on Bone scan. Multiple lesions were most seen in vertebrae in 38.5% and 28.6% on bone scan and WBLDCT respectively. The sensitivity and specificity of WBLDCT for detection of bone metastasis was 86.36% and 96.47% respectively. The concordance rate between Bone scan and WBLDCT scan was 94.39% with an Inter-rater Kappa(k) quotient for agreement of 0.828 (p< 0.0001). Conclusion: WBLDCT scan has comparable diagnostic capability to skeletal scintigraphy in detecting bone metastasis in breast cancer and may be a useful alternative specially in resource limited settings. Table 1: Sensitivity, specificity, positive predictive value and negative predictive value of WBLDCT for detection of metastasis Variables Values Sensitivity (95% CI) 86.36% Specificity (95% CI) 96.47% AUC (95% CI) 0.91 Positive Predictive Value (95% CI) 86.36% Negative Predictive Value (95% CI) 96.47% Diagnostic accuracy 94.39% Inter-rater agreement (kappa) 0.828 Citation Format: Lipton Mitra, Suhani Suhani, Ankur Goyal, Rakesh Kumar, Mohit Joshi, Hemanga Bhattacharjee, Haresh KP, Raju Sharma, Rajinder Parshad. Clinical utility of whole body low dose computed tomography for detecting bone metastasis in breast cancer patients: A cross sectional study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-05-13.

Medical and educational techniques and approaches have evolved globally over the past few decades. The modern approach is more learner-centred, with a focus on the acquisition of skills. The recently implemented competency-based medical education (CBME) for the National Medical Commission (NMC) undergraduate course curriculum is also competency-based rather than an outcome-based traditional curriculum. It is vital to embrace innovative teaching-learning and educational strategies to achieve the aspiration of CBME. This article provides a list of some of the newer tools and their perceived advantages and challenges and serves as a guide for using these methods effectively to meet the objectives of CBME as proposed by the NMC. Virtual teaching, learning from digital resources, objective-structured practical and clinical examination, flipped classroom, case-based learning, serious gaming, simulation-based learning and learning from role-plays and portfolios emerged as novel instructional strategies.

ABSTRACT:Pulmonary mucoepidermoid carcinoma (PMEC) is a rare pulmonary neoplasm. Although 18 F-FDG PET/CT has been shown to present with increased metabolic activity in PMEC, literature does not report increased somatostatin receptor expression in these tumors. We present the case of a 15-year-old boy where PMEC mimicked a typical carcinoid of the lung on DOTANOC PET/CT by showing significant uptake on 68 Ga-DOTANOC.

Three-dimensional high-definition (3D HD) and ultra-high-definition (4 K HD) endovision systems are rapidly adopted in academic setting. However, transferability of laparoscopic skills acquired from these systems to two-dimensional high-definition (2D HD) endovision system is not known. Forty stereo-enabled surgical residents were randomized into two groups. They performed three standardized surgical tasks, Task 1(Peg transfer), Task 2(Precision touch on uneven surface) and Task 3(Surgical knotting on rubber tube) for 15 repetitions using either 3D HD or 4 K HD. Both groups then performed the same tasks using 2D HD for 5 repetitions. Their performances were evaluated for execution time (speed) and error scores (safety). The residents in 3D HD group performed all three tasks significantly faster than residents in 4 K HD group with comparable error scores. The time taken to complete the tasks on 2D HD were comparable between residents trained in 3D HD and 4 K HD in two out of three tasks (p = 0.027, P = 0.115, p = 0.368 in task 1, 2 and 3 respectively). However, in two out of three tasks, residents trained on 3D HD committed significantly more errors than residents trained on 4 K HD (p < 0.0001, p < 0.001 in task 1 and task 2 respectively). Skill acquired on 4 K HD seems transferable to 2D HD environment. Participants trained in 3D HD made more errors while performing the tasks in 2D HD. It may be prudent to offer additional training on 2D HD to residents trained on 3D HD for safer laparoscopic surgical practice.

Background: Workplace violence (WPV) is a significant problem in both developed and developing countries, especially among healthcare workers. It has widespread implications for their overall health and well-being. Objective: The study was conducted to assess the problem of violence among doctors and other healthcare workers in healthcare settings. Material and Methods: A cross-sectional survey was conducted using a validated questionnaire from August 21 to September 18, 2021, based on purposive and snowball-sampling techniques for data collection. Appropriate statistical methods were applied to study the association between sociodemographics and characteristics of violence. Results: A total of 601 responses were analyzed. The results showed that approximately 75% of the participants experienced violence in some form at their workplace. These episodes lead to a significant impact on the physical and mental health of these workers. Around one-third of the participants felt uncomfortable reporting these incidents. Some of the most common risk factors and mitigation strategies were also reported by the participants. Conclusion: The findings of this study can be used by the legislators, administrators, and policymakers to develop strategies that can help in mitigating these episodes of violence for the better functioning of the healthcare system.