rare case of Kikuchi-Fujimoto Disease associated with systemic lupus erythematosus

Kikuchi-Fujimoto Disease [KFD], also known as histiocytic necrotizing lymphadenitis, is a self-remitting, immune-mediated rare disorder having unique histopathological characteristics which is commonly seen in young Asian females, but can occur in all ethnicities. There is a strong association between KFD and Systemic Lupus Erythematosus [SLE]. We present a case of a young Pakistani boy who presented with cervical lymphadenopathy, fever, blackish discoloration of finger tips, and Raynaud's phenomenon. His lymph node biopsy was suggestive of KFD. The American Rheumatology Association diagnostic criteria were not met as no other features of SLE were present. His autoimmune workup including Anti-Nuclear Antibodies [ANA] and Anti-Double Stranded DNA [Anti-Ds DNA] antibodies were positive and supported the diagnosis of SLE. He improved clinically with steroid therapy and nifedipine with resolution of symptoms

Patient safety awareness among postgraduate students and nurses in a tertiary health care facility

Objective: To determine the knowledge of patient safety among postgraduate residents [PGR] and nurses in a tertiary care hospital

Methods: This casual comparative study was conducted among the postgraduate residents and nurses working at The Children's Hospital Lahore in the month of July, August 2017. Both PGR and nurses were asked to complete APSQ-IV questionnaire about patient safety on 7 point Likert scale. Data was analyzed using SPSS version 20 and t-test was used to compare the mean score between two groups. The names of the participants were kept confidential

Results: A total of 150 residents and 150 nurses were included. The scores of both postgraduate residents and nurses were similar in all domains having positively worded questions with insignificant difference in mean score [p=0.141]. In the reverse coded questions the nurses showed positive perception with higher mean score as compared to postgraduate residents [p=0.004]. The postgraduate residents in the early years of residency had higher mean score in positively worded question as compared to residents who were in last years of training [p=0.006]

There was no difference in the mean score of nurses as regard to their years of experience [p=0.733]. Medical error disclosure domain was reported lowest by both postgraduate residents and nurses

Conclusion: Both postgraduate residents and nurses showed positive attitude with good knowledge and perception towards patient safety. Lowest rated scores were from error disclosure confidence domain

Analyzing communication skills of pediatric postgraduate residents in clinical encounter by using video recordings

Objective: To analyze communication skills of pediatric postgraduate residents in clinical encounter by using video recordings

Methods: This qualitative exploratory research was conducted through video recording at The Children's Hospital Lahore, Pakistan. Residents who had attended the mandatory communication skills workshop offered by CPSP were included. The video recording of clinical encounter was done by a trained audiovisual person while the resident was interacting with the patient in the clinical encounter. Data was analyzed by thematic analysis

Results: Initially on open coding 36 codes emerged and then through axial and selective coding these were condensed to 17 subthemes. Out of these four main themes emerged: [1] Courteous and polite attitude, [2] Marginal nonverbal communication skills, [3] Power game/Ignoring child participation and [4] Patient as medical object/Instrumental behaviour. All residents treated the patient as a medical object to reach a right diagnosis and ignored them as a human being. There was dominant role of doctors and marginal nonverbal communication skills were displayed by the residents in the form of lack of social touch, and appropriate eye contact due to documenting notes. A brief non-medical interaction for rapport building at the beginning of interaction was missing and there was lack of child involvement

Conclusion: Paediatric postgraduate residents were polite while communicating with parents and child but lacking in good nonverbal communication skills. Communication pattern in our study was mostly one-way showing doctor's instrumental behaviour and ignoring the child participation