Medtronic (India)

Procedural errors during 12-lead electrocardiography (ECG)particularly from incorrect electrode placement—can distort waveforms and contribute to diagnostic error. We evaluated a virtual-reality (VR) ECG training module that delivers standardized, feedback-rich practice and objective scoring. In a single-arm pre-post pilot at a medical college skills lab, second-year MBBS students <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$(\mathrm{N} = 30)$</tex> completed one guided VR session followed by an evaluation run. The primary outcome was total procedural error score in Evaluation Mode; secondary outcomes covered five domains (patient communication, preparation, lead placement, verification/patient safety, documentation). The platform scored swap errors (e.g., RA↔LA, V1↔V2) and positional misplacements exceeding a predefined geometric tolerance around anatomical targets (e.g., V1/V2 at the fourth intercostal space, V4 at fifth intercostal space mid-clavicular, V6 at mid-axillary). Analyses used Wilcoxon signed-rank tests with rank-based effect sizes <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$r=Z / \sqrt{N}$</tex>; domain inferences-controlled multiplicity (Bonferroni, <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$\boldsymbol{\alpha}_{\text{adj }}=\mathbf{0. 0 1}$</tex>). Total errors fell from <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$51.33 \pm 23.04$</tex> pre-VR to <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$18.08 \pm 18.68$</tex> post-VR <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$(Z=-4.36, \mathrm{p}&lt; 0.001, \mathrm{r}=0.80$</tex>), a 64.8% reduction. Domain improvements remained significant after adjustment for lead placement, preparation, and communication <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$(r=0.68-0.71)$</tex>; verification/patient safety and documentation did not. No sessions were terminated; no adverse events were recorded. A baseline comparison showed no difference in pre-training errors by prior VR exposure (Mann-Whitney <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$Z=-1.48$</tex>, <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$p= 0.139$</tex>). Findings suggest that a brief VR session can substantially reduce ECG procedural errors, particularly for tolerance-based lead placement. Future randomized, blended-learning studies with bedside transfer (OSCE), retention, usability, simulator-sickness metrics, and cost-per-learner analyses are warranted.

ABSTRACT Objectives Obstructive sleep apnea (OSA) is a sleep-related breathing disorder characterized by recurrent episodes of nocturnal breathing cessation resulting from upper airway collapse. Given the absence of a comprehensive review of the cost-effectiveness of OSA treatments, we undertook an extensive systematic review and meta-analysis to calculate the pooled incremental net benefit (INBp). Methods A systematic search of PubMed, Embase, Scopus, and Tufts cost-effectiveness analysis registry was conducted. INBp with 95% confidence intervals (CI) was estimated using a random-effects model, and heterogeneity was assessed through the Cochrane-Q test and I2 statistic. Study quality was evaluated using the modified ECOBIAS Checklist, and GRADE framework was applied to assess the certainty of outcomes. Results Thirty-four studies were included in the systematic review, fifteen qualifying for meta-analysis. CPAP was cost-effective compared to other treatments, with a INBp of $13,024 (95%CI $6,813 to $19,236), and substantial heterogeneity (I2 = 97.48%). Compared to no treatment and oral appliances (OAs), CPAP showed cost-effective INB values of $30,834 ($21,325 to $40,343) and $2,708 ($645 to $4,771) respectively. Conclusion CPAP is cost effective compared to all treatments collectively, as well as specifically to OAs and no treatment though with low certainty.

Premature-ventricular-complexes (template/fixation beat) guided left bundle branch pacing (LBBP) was recently described as a novel method of successful lead deployment by rapid rotations. We aimed at analyzing the incidence of a unique morphology template beat, which we labelled as 'M-beat' in patients undergoing PVC-guided LBBP, its ability to predict selective LBB-capture and clinical significance. Overall 210 out of 217 attempted-patients (96.7%) underwent successful LBBP. Template beat was noted in 90.4% patients (n = 190) and M-beat in 32.8%(n = 69). Non-selective to selective capture transition demonstrated in 55.2%(n = 116). The QRS duration of the M-beat was 129.3 ± 13.1ms. Patients were divided into two groups: Group-I with M-beat (n = 69;32.8%) and Group-II without M-beat (n = 141; 67.2%). The mean fluoroscopy-time was significantly less in group-I as compared to group-II (13.1 ± 11.1 vs 16.8 ± 12.04 minutes; p-0.03). Patients in group-II required more attempts as compared to group-I for successful lead deployment (2.8 ± 1.09 vs 2.2 ± 1.04; p - 0.01). Six patients showed loss of R-wave in lead-V1 and 2 showed rise in LBB capture threshold by >1V during follow-up in group-II. M-beat had a specificity of 96.77% and sensitivity of 58.62% (positive-predictive-value-98.55%) to predict selective-LBB capture. Myocardial excitability would not modify the occurrence of M-beat as opposed to capture transition response since it could be demonstrated without pacing protocols. When confirmation of LBB-capture itself would be difficult in patients with baseline LBBB-morphology, M-beat with 42.8% incidence predicted selective capture with 96.7% specificity and 66.04% sensitivity(positive-predictive-value-97.22%). M-beat is a marker of transient-selective LBB-capture, independent of the local myocardial excitability with high specificity and positive predictive value irrespective of the baseline QRS morphology.

Untreated hearing loss is recognized as a growing global health priority because of its prevalence and harmful effects on health and well-being. Until recently, little progress had been made in expanding hearing care beyond traditional clinic-based models to incorporate public health approaches that increase accessibility to and affordability of hearing care. As demonstrated in numerous countries and for many health conditions, sharing health-care tasks with community health workers (CHWs) offers advantages as a complementary approach to expand health-service delivery and improve public health. This paper explores the possibilities of task shifting to provide hearing care across the life course by reviewing several ongoing projects in a variety of settings – Bangladesh, India, South Africa and the United States of America. The selected programmes train CHWs to provide a range of hearing-care services, from childhood hearing screening to management of age-related hearing loss. We discuss lessons learnt from these examples to inform best practices for task shifting within community-delivered hearing care. Preliminary evidence supports the feasibility, acceptability and effectiveness of hearing care delivered by CHWs in these varied settings. To make further progress, community-delivered hearing care must build on established models of CHWs and ensure adequate training and supervision, delineation of the scope of practice, supportive local and national legislation, incorporation of appropriate technology and analysis of programme costs and cost–effectiveness. In view of the growing evidence, community-delivered hearing care may now be a way forward to improve hearing health equity.

Aim:To assess whether the socioeconomic and stereotypical barriers for the adoption of advanced diabetes technologies can be overcome in the underprivileged children and their families in India, predominantly from the rural areas, by providing insulin pump therapy (CSII) to deserving patients.Materials and Methods:All patients were selected from the type 1 diabetes mellitus (T1DM) database of the Kovai Medical Center and Hospital, Coimbatore. Sixteen people with type 1 diabetes (PWD) were chosen due to poor control or an urgent situation like pregnancy or renal failure. Demographic data along with variables such as age, sex, time of diagnosis of T1DM, duration of CSII therapy, total daily insulin dose, hypoglycaemias, hospitalisations, glycosylated haemoglobin pre- and post-pump were collected. The glycosylated haemoglobin values were collected at 3, 6 and 12 months, post-CSII hypoglycaemia was defined as self-reported hypoglycaemia by the patient.Results:During 12 month follow-up, all 16 PWD were using the insulin pump with significant reductions in HbA1c from 11.4% at baseline to 8.0% (P < 0.001) and 7.6% at the end of 3 and 6 months, respectively.Discussion:Our results indicate that the CSII therapy without prejudice can lead to significant reductions in glycaemic control, hospitalisations and quality of life. This pilot work will help us lobby government policy makers to ensure policy changes that help the underprivileged with T1DM in India.