Attitudes of first-year medical students towards the doctor patient relationship.

In recent years, medical schools all over the world have instituted a variety of curricula to teach communication skills, professional values and ethics to medical students. Studies on the student attitudes towards doctor-patient relationships are lacking in Nepal. The present study was carried out to obtain information on the sharing and caring dimensions of the doctor-patient relationship and note any association of the dimensions with the demographic characteristics of the respondents. The study was carried out among first year students of the Manipal College of Medical Sciences, Pokhara, Nepal in August 2003 using the patient-practitioner orientation scale. One hundred and sixty-five students participated. The mean +/- SD total, caring and sharing scores were 3.71 +/- 0.48, 3.51 +/- 0.55 and 3.91 +/- 0.62 respectively. Students whose first degree relative was a doctor had higher sharing score compared to those without doctor relatives. Female students had higher scores. Students had a positive attitude towards the doctor-patient relationship. Our scores were lower than those reported previously. Further studies are required and the results obtained will be helpful in designing a doctor-patient relationship course for Nepal.

Learning styles of preclinical students in a medical college in western Nepal.

OBJECTIVES: Information on the learning styles of medical students are lacking in medical colleges in Nepal. Learning styles may be associated with student understanding and may predict success in examination. The present study was carried out to obtain information on learning styles and preferences for teaching of fourth semester medical students and note the association, if any, between respondents' personal characteristics and preferences for learning styles and types of teaching. The correlation between preferences for learning styles and types of teaching and performance in the second year university examination was also explored. METHODS: The study was carried out during October 2003 at the Manipal College of Medical Sciences, Pokhara, Nepal using the Approaches and Study Skills Inventory (ASSIST) instrument. Information on the respondents' personal characteristics was collected. Respondents had to indicate their degree of agreement with a set of statements using a modified Likert-type scale. The statements were grouped into three main learning styles and two types of teaching. The median scores among different subgroups of respondents were compared using appropriate non-parametric tests (p<0.05). RESULTS: Ninety-two students (92%) participated; fifty-six were male. Thirty-one respondents were Nepalese, 48 were Indians. Majority were educated in English medium schools. The median scores for deep and surface learning styles were 64 and 49 respectively (maximum score=80). The scores for strategic learning was 75.5 (maximum score=100). There was no clear preference for any particular type of teaching. Indian students used more surface apathetic learning strategies compared to others. There was a negative correlation between surface learning and marks obtained in the final examination. CONCLUSIONS: The students mainly used deep and strategic learning styles. Differences in preference for learning styles and types of teaching were noted according the respondents' personal characteristics. This was a preliminary study and further studies are required.

Intensive care unit drug utilization in a teaching hospital in Nepal.

OBJECTIVES: The intensive care unit (ICU) is a setting where a large number of drugs are administered to patients and the costs of hospitalization and drug treatment are high. Information on drug utilization in intensive care units (ICUs) are lacking in western Nepal. The present study was carried out to obtain information on the basic demographic pattern of the respondents, drug utilization during the study period, the antibiotic sensitivity patterns of isolated microorganisms and measure drug consumption in defined daily dose (DDD)/ 100 bed-days. METHODS: A retrospective analysis of patients admitted to the ICU of the Manipal Teaching hospital, Pokhara, Nepal during the time period from 01/02/2002 to 31/05/2002 was carried out. The ICU mortality rate, length of stay greater than 7 days and median length of stay were calculated. RESULTS: A total of 259 individuals were admitted. The ICU mortality rate was 15.4%; median length of stay was 4 days. E.coli, H.influenzae, K.pneumoniae, S.aureus and P.aeruginosa were the common organisms isolated and were found to be resistant to some of the commonly used antibiotics. Mean +/- SD number of drugs and cost of drugs were 5.1 +/- 2.7 and 1958.5 +/- 1267.8 Nepalese rupees (25.1 +/- 16.2 US dollars). Total drug consumption was 356.4 DDD/100 bed-days. Consumption of intravenous fluids was 25.8 litres/100 bed-days. CONCLUSIONS: An antibiotic use policy should be framed. Formation of a multidisciplinary team to oversee drug use and periodically review microbial sensitivity patterns will be helpful. Longitudinal surveillance of ICU drug use should be carried out.

Ginkgo biloba--an appraisal.

Ginkgo biloba has been used in traditional Chinese medicine for about 5000 years. A standardized preparation, EGb 761 has been recently prepared. The pharmacologically active constituents, flavonol glycosides and the terpene lactones are standardized. The terpene lactones comprise of ginkgolides A, B, C and bilobalides. The extract scavenges excess free radicals and pretreatment with EGb 761 reduces damage by free radicals in patients undergoing coronary bypass surgery. The action of platelet activating factor is antagonized and platelet aggregation is reduced. Blood flow is increased. Release of prostacyclines and nitric oxide was shown to be stimulated. Ginkgo biloba has been found to be useful in the treatment of Alzheimers disease and cognitive impairment. EGB 761 has shown beneficial effect in aging and mild cognitive impairment. Bilobalide has been shown to be protective against glutamate-induced excitotoxic neuronal death. Early studies indicate a potential role in age-related macular degeneration and some types of glaucoma. Anticancer action is related to antioxidant, anti-angiogenic and gene regulatory actions. Ginkgo biloba has shown overall improvement in about 65% of patients with cerebral impairment and a similar percentage suffering from peripheral vascular diseases. A recent study suggested that phytoestrogens in Ginkgo biloba may have a role as alternative hormone replacement therapy. Recent trials have not shown a beneficial effect of Ginkgo biloba in tinnitus and acute mountain sickness. Ginkgo biloba increased the bioavailability of diltiazem. The extract has been shown to protect against doxorubicin-induced cardiotoxicity and gentamicin-induced nephrotoxicity in animals. Ginkgo biloba inhibits microsomal enzymes and has a potential for drug interactions. Further studies to establish the efficacy of Ginkgo biloba are required.