Medical students perception about the effectiveness of interactive session in small groups

To find out the perception of undergraduate medical students about the effectiveness of interactive sessions in smallgroups. A descriptive cross sectional study. This study was conducted at Islamic International Medical College Rawalpindi from 10[th] April to 12[th] June 2014. A total of 100 students from 3rd and 4th year MBBS were enlisted on first come first basis out of those who volunteered to participate in the study. They were provided with questionnaire [Table I] to give their opinion about the effectiveness of interactive sessions in small groups as learning tool during undergraduate medical studies. Out of the 100 participants 65% considered interactive small group discussions effective, 16.7% were indecisive, while 18.3% disagreed that interactive small group discussions were very effective at undergraduate level in medical education. In students' opinion sessions kept the students attentive [93%], promoted group interaction skills [95%] and promoted critical thinking [63%]. A majority [76%] thought that there was good retention of the subject discussed in an interactive session. In students'opinion it gave them a good chance to evaluate them [71%].It is concluded that interactive group discussions is an effective method of imparting education to medical students at undergraduate level

Emergency Peripartum Hysterectomy in Pakistan Railway Teaching Hospital Rawalpindi: Eleven Years Review

Emergency Peripartum Hysterectomy [EPH] is a major surgical procedure. There appears to be a rise in the rate of emergency peripartum hysterectomy [EPH] in the developed world. Peripartum hysterectomy is high risk but a life saving operation. It is usually associated with significant maternal and fetal morbidity and mortality. Obstetricians should identify patients at risk and anticipate the complications, as early intervention and proper management results in optimal outcome. To determine the incidence, indications, risk factors, complications and management of EPH over the last eleven years. A descriptive study. All cases of EPH performed in the period between January 2001 and December 2011 were included in the study. Study was conducted at Railway Teaching Hospital, Rawalpindi [in northern Pakistan]. Data of all the cases of EPH cases operated during the study period was collected from the hospital obstetric record. Data of basic demographics, mode of delivery, maternal and fetal outcome along with associated complications was collected and entered into the Statistical Package for Social Sciences version 14.0 [SPSS Inc., Chicago, IL, USA] for further analysis. Indications, pre-op planning, type of operation, emergency decision, blood loss, transfusion, complications, were compared and cross-tabulated. Statistical analysis included: Chi-square and Fisher exact tests, where appropriate, and two-sample t test. Total deliveries were 13560 in 11 years. Twenty Six EPH cases were performed among deliveries, giving an incidence of 1.8 per 1000 deliveries i.e. one in 566 deliveries. The indications were uterine atony [34.61%], ruptured uterus [23.07%] and cervical/vaginal tears [11.53%], placenta praevia [11.53%], invasive placental adhesion [accreta, increta, percreta [11.53%]]. A significant association between previous uterine surgery and abnormal placentation was shown [p=0.02], especially those with previous caesarean [p=0.003]. One maternal and six perinatal mortalities were recorded. Four perinatal deaths were of non-booked patients, handled by traditional birth attendants/private clinics. Out of two perinatal deaths of booked patients, one was pre-term and other was delivered by forceps. Maternal morbidity was prevalent, including twenty three intensive care admissions, three disseminated intravascular coagulopathies, three bladder injuries, three re-explorations, multiple blood, FFPs and platelet transfusions, two pulmonary embolism and one cardio- respiratory failure. Maternal death was of non-booked patient with previous scar, home delivery, uterine rupture and brought to hospital with un-recordable BP and very weak pulse. Incidence of peri-partum hysterectomy is increasing. It is a major operation, and almost always an emergency with significant blood loss. An early decision should be made to save life of the patient and prevent complications. The most important risk factor for peripartum hysterectomy in our patients is hemorrhage, most notably caused by uterine atony, uterine rupture, placenta previa and abnormally adherent placenta

Ideal Mentor- Perceptions of Faculty and Students

Mentoring implies a 2-way relationship between the mentor and the mentee. A successful partnership can lead to the professional development of both individuals. Although the significance of mentoring programs has been realized in the developing countries, its role in the holistic development of our students is still not given its due importance. There are important questions to be answered; who should be a mentor? What are the qualities students look for in an ideal mentor? These gaps in research are especially significant in our part of the world, where robust mentoring systems have yet to be established. To compare the perceptions of our faculty and students regarding the qualities of an ideal mentor as measured by Ideal Mentor Scale [IMS]. Cross-sectional study. At Pakistan Railway Hospital, Rawalpindi, Pakistan during July 2013 to August 2013. Seventy participants [faculty members:26, students:44] participated in the survey using the [Ideal Mentor Scale] [Gail Rose, The University of Iowa, 1999] to identify the relative importance of integrity, guidance and relationship in a potential mentor using a 5-point rating scale. Integrity [average sum of means: 58] was considered to be the most important attribute of an ideal mentor followed by guidance [40] and relationship [35] by all the participants [undergraduate: postgraduate: faculty member]. However, in the scale of relationship the undergraduate students gave higher score than the postgraduates and faculty members [3.8: 3.5: 3.3]. Successful mentoring most importantly requires a mentor who can be emulated as a role model due to his/her principled behavior and integrity

Vicarious learning during Simulations: is it more effective than hands-on training?

This study aimed to investigate whether the type of simulation-based learning [learning by doing versus vicarious learning] and the order in which these activities are carried out [learning by doing ..vicarious learning versus vicarious learning ..learning by doing] have any effect on the acquisition of knowledge on effective doctor-patient communication strategies. A descriptive study. At Obstetrics and Gynecology Department, Islamic International Medical College Trust, Railways Hospital, Rawalpindi from April 2013 to June2013. The sample consisted of 33 undergraduate medical students of 3 batches [25 female, 8 male]. They participated in two separate simulation sessions, each of which was 30 minutes long and was followed by a collaborative peer feedback phase. Vicarious learning led to greater knowledge of doctor-patient communication scores than learning by doing. The order in which vicarious learning was experienced had no influence. The inclusion of an observation script also enabled significantly greater learning in students to whom this script was given compared with students who were not supported in this way, but the presence of a feedback script had no effect. Students appear to learn at least as much, if not more, about doctor-patient communication by observing their peers interact with SPs as they do from interacting with SPs themselves

comparison of oral misoprostol and extra-amniotic foley's catheter with oxytocirx for induction of labour at term

To compare the efficacy and safety of misoprostol with a Foley's catheter and oxytocin for induction of laborator beyond term. Quasi experimental study. This study was carried out in the Department of Obstetrics and Gynaecology, Railway Hospital Rawalpindi from January 2008 December 2008. Hundred patients requiring induction of labor at or beyond term with bishop less than 5 were randomized by lottery method to receive oral misoprostol or a cervical Foley's plus oxytocin. Patients in the misoprostol group [Group A] received 50 microgram misoprostol at6 hourly interval fora maximum of 4 doses or until an adequate contraction pattern developed. Those in the Foley's group [Group B] had a Foley's catheter inserted in the cervix. Whereas oxytocin was administered intravenously by a standard incremental infusion protocol to a maximum dose of 36 milliunits/min. The mean induction delivery interval is 9.8 hours in group A while in Group B the mean induction delivery interval was 17 hours. Although all patients delivered in both groups within 24 hours but the mean induction delivery interval was prolonged in Foley's group as compared to misoprostol group. The neonatal outcome was comparable in both the groups. Oral misoprostol at the dose 50 microgram is better than Foley's group for induction of labor at term

Maternal and fetal outcome of pregnancies with umbilical cord problems

To seek relationship between cord problems [like long cords, short cords, nuchal cord and cord knots] and its effects on fetus as well as mode of delivery. Descriptive [case series] Obs/Gynae wards Railway hospital, Rawalpindi from September 2006 to August 2007. It was a descriptive case series study. Hundred patients with umbilical cord problems, detected at delivery were included.Effects of these cord problems on mode of delivery and fetal outcome were observed. Twenty two percent patients had long cord, 14% had short cords.41% had single nuchal cord, 22% had double loop of cord around the neck, and 4% patients had triple loops of Nuchal cord. It was observed that 4% patients were having true kanots in umbilical cord and and only 26% patients had false knots in umbilical cord. In the patients with cord problems, rate of SVD was more than 70% and LSCS < 20%. These problems did not show significant effects on birth weight and Apgar scores when present alone.But multiple cord problems in a single pregnancy were associated with fetal complications. Long and short umbilical cords, umbilical cord knots and Nuchal cords had no significant effects on mode of delivery and Apgar score in 5 minutes. But multiple umbilical cord problems in same case may pose problems to the fetus and early diagnosis can prevent fetal harm

External cephalic version [ECV] for breech presentation at term -experience at railway hospital

To assess the effectiveness of ECV in singleton breech presentation at term and to determine its effect on maternal, delivery and perinatal outcomes in women to whom the procedure was offered. Aquasi experimental study. The study was carried out in the Department of Obstetrics and Gynaecology, Railway hospital, Rawalpindi, fromAugust2006 to December2008. Eligible women, presenting with uncomplicated breech, between 37-41 weeks gestation, underwent ECV on day care basis. Fifteen minutes before the procedure, injection salbutamol 0.5 mg was administered. Cases with contraindication to ECV or salbutamol injection were excluded from the study. Success rate of ECV [in terms of conversion from breech to cephalic presentation at the completion of procedure confirmed through ultrasound] along with maternal, delivery and perinatal outcomes were assessed. Maternal and fetal demographic characteristics were also recorded as secondary outcome measures. For statistical analysis, SPSS version 10 was used and Chi-square test applied with a p<0.05 taken as significant. Of the 42 ECV procedures, 25 [59.5%] were successful. None of the patient suffered from serious maternal complications. Seven [16.7%] parturients complained of severe palpitations and 4 [9.5%] of marked discomfort during the procedure. Reversible fetal bradycardia was seen in 1 [2.4%] patient. Reversion to a non cephalic presentation occurred in two cases. Vaginal delivery was carried out in 21 patients out of the 25 who successfully underwent external cephalic version while all the patients with failed ECV underwent caesarean delivery. The 5 minute Apgar score was more than 8 in all except one baby. Adverse maternal and fetal outcomes of breech presentation at term are rare and there was no increased risk of complications after external cephalic version. Findings provide important data to quantify the frequency of adverse outcomes that will help facilitate informed decision-making and ensure optimal management of breech presentation

Impact of labour and delivery simulation classes in undergraduate medical learning

To compare the impact on knowledge and learner's satisfaction of adding a labour and delivery simulator-based training module with a self-study session, to the pre-existing theoretical class, in the 5[th] year undergraduate medical curriculum. Descriptive. At Islamic International Medical College, Pakistan Railway Hospital Rawalpindi from September 2007 to December 2008. Ninety four students attending the 5-week Obstetrics and Gynecology rotation were enrolled, and 94 completed the study. After a 45-minute [labour and delivery] theoretical interactive class, students were randomized into two groups: the first [n=53] participated in a 30-minute supervised self-study session, while the second [n=41] attended a 20-30 minute delivery simulator session. Tests consisting of 10 multiple-choice questions were given before the theoretical class [pre-test], after the self-study or simulation session [1[st] post-test] and 12-15 days later [2[nd] post-test]. Paired rank sum test, T test, and z-statistic with continuity correction were employed for statistical analysis, setting significance at p<0.05. Pre-test scores were similar in both groups [p=0.9567], but in the first post-test they were significantly higher in the simulation group [p=0.0017]. In the 2[nd] post-test, however scores were again similar in both groups [p=0.2204]. Satisfaction was significantly higher in the simulation group [p<0.0001]. Adding a simulator-based training session for medical students in management of labour and delivery to the theoretical class led to a higher short-term increase in knowledge and student satisfaction than attending a self-study session. Significant differences in knowledge were no longer demonstrable at 12-15 days

Managing shoulder dystocia: perceptions of accoucheurs regarding their training

To assess the perceptions of labour ward staff at teaching hospitals regarding their theoretical and practical training for the management of shoulder dystocia as well as their opinion for further need of such trainings. Across sectional survey. At Islamic International Medical College, Railway Hospital Rawalpindi and College of Physicians and Surgeons Regional Centre Islamabad, from October to November 2008. The study was carried out by using a six item questionnaire. Four items were related to the respondent's training regarding the management of shoulder dystocia while two wete about their response to frequently performed actions which are known to increase the incidence of complications associated with the management of shoulder dystocia. Among sixty seven healthy personnel's involved in the management of parturient in the labour ward, 86.6% [n=58] were doctors and 1 3.4% [n=9] were midwives. The years of experience managing labouring patients ranged from 1 to 30 years. Although only 1 8% [n=1 2] thought that they did not have any theoretical training in shoulder dystocia and 40% [n=27] thought that they did not have any practical training, almost 72% [n=48] expressed a need for more theoretical and 91% [n=61] wanted more simulated training to manage shoulder dystocia. However, only 7.5% [n=5] of respondents involved in this survey said they would use fundal pressure and 1 0.4% [n=7] would apply strong traction to the fetal neck. In the opinion of labour ward attending physicians, the current level of their training for the management of shoulder dystocia is inadequate and there is a need for organizing regular practical training programs to improve their skills in managing this obstetric emergency

Characteristics of infertile patients with ovulatory dysfunction and their relation to body mass index

Ovulatory dysfunction is a group of disorders with variable clinical presentations occasionally having serious long-term adverse effects. It accounts for 30% of female fertility problems. Evidence suggests an association between an individual's weight and disorders of ovulation. The objective of our study was to describe the clinical and hormonal profile of subfertile women with ovulatory dysfunction in relation to their body mass index [BMI]. This prospective, descriptive study was carried out in Mother and Child Health Centre, PIMS, Islamabad and railway hospital, Rawalpindi from April 2001 to March 2007. One hundred and thirty eight infertile patients with ovulatory dysfunction were included. The clinical data including BMI of each patient was recorded in addition to reports of investigations comprised of cervical smear, pelvic ultrasound and hormonal profile. Primary infertility was found in 61% while secondary in 39% of the patients. The mean age was 29 years and mean duration of infertility was 6 years. Menstrual pattern was normal in 56.5%. BMI was normal in 30.4% while most patients were overweight and obese. Prolonged cycles, history of systemic endocrine disorders, abnormal vaginal -discharge, hirsutism, polycystic ovarian morphology and hormonal abnormalities are more frequent in overweight than infertile patients with ovulatory dysfunction having a normal BMI

OSCE as an assessment tool: perceptions of undergraduate medical students

To describe the perceptions of undergraduate medical students regarding Objective Structured Clinical Examination [OSCE] and its comparison to Multiple Choice Questions [MCQ], essay questions and viva voce. This cross-sectional survey was carried out at Islamic International Medical College Rawalpindi [Pakistan], from 3 December 2008 to 2 January 2009. We used a questionnaire comprising of a total of 12 items, out of which 8 items were regarding the quality of exam [Liken scale], 3 regarding the difficulty, being educative and fairness of OSCE relative to other methods of assessment and last one regarding its acceptability as a method to assess clinical skills for undergraduate medical students. The questionnaire was distributed to students of 4th and 5th year medical students to be filled and returned for assessment of the responses. One twenty seven students completed the questionnaire. The results of the study showed that the exam was stressful for 51% of the respondents. About 81% thought that performance of tasks during OSCE was interesting and educative. OSCE, essay type, MCQ and oral viva examination were perceived easy by 44, 33, 18 and 5% students, educative by 32, 16, 23 and 30% and fair by 43, 13, 32 and 11% respectively. OSCE is well-received and acceptable to undergraduate medical students of Pakistan as a method to assess clinical skills

comparison of placental removal methods on operative blood loss

On an average 1 litre of blood is lost during Caesarean Section. Many variable techniques have been tried to reduce this blood loss. Many study trials have shown the spontaneous delivery of placenta method to be superior over manual method because of reduced intra operative blood loss and reduced incidence of post operative endometritis. The main objective of our study was to compare the risk of blood loss associated with spontaneous and manual removal of the placenta during caesarean section. Quasi Experimental. September 2004 to September 2005, a 13 months study at Islamic International Medical Complex Islamabad. This study was conducted at Department of Obstetrics and Gynaecology, Islamic International Medical Complex, Islamabad from September 2004 to September 2005. All Women undergoing elective or emergency caesarean section were included in the study. Exclusion criteria were pregnancy below 37 weeks, severe maternal anemia, and prolonged rupture of the membranes with fever, placenta praevia, placenta accreta and clotting disorders. Patients were allocated to the two groups randomly. Group A comprised of women in whom the obstetrician waited a maximum of 5 minutes till the placenta delivered spontaneously. In group B the obstetrician manually cleaved out the placenta as soon as the infant was delivered. The primary outcome measures noted were difference in haemoglobin of >2 gm/dl [preoperatively and postoperatively], time interval between delivery of baby and placenta, significant blood loss [>1000 cc], additional use of oxytocics, total operating time and blood transfusions. Data was analysed by SPSS. Statistical tests used for specific comparison were chi 2-test and Student's t-test. One hundred and forty-five patients were allocated to two groups randomly. Seventy-eight patients were allocated to group A and 67 patients allocated to group B. Mean maternal age, birth weight, and total operating time were the same in two groups, but blood loss as measured by a difference in haemoglobin of greater then 2 grams/dl was statistically significant. Significant blood loss [>1000 cc] and time interval between delivery of infant and placenta were also statistically significant between the two groups. Spontaneous delivery of placenta has significant reduction of blood loss as compared to manual removal at caesarean section

Do cardiotocographic changes alone determine fetal outcome?

To compare fetal outcome in fetal distress on CTG with clear liquor versus CTG changes of fetal distress with meconium stained liquor. A cross sectional study. The Department of Obstetrics and Gynecology Islamic International Medical Complex. September2004 to December 2005[16 month]. During the study period 111 patients delivered in which fetal distress was diagnosed clinically and on cardiotocography [CTG]. Vaginal delivery [spontaneous or instrumental] was accomplished in 17 [15%] patients while the rest of 94 [85%] patients underwent emergency caesarean section for fetal distress. Irrespective of the mode of delivery, the patients were divided into two Groups; Group A and Group B. Group A comprised of those patients who had fetal distress on CTG with clear liquor and Group B included those patients who had fetal distress on CTG along with meconium staining of liquor. There were 67 patients in Group A and 44 patients in Group B. Out of the 94 patients who underwent caesarean section, 57 patients were operated for fetal distress on CTG with clear liquor and 37 patients had CTG changes with meconium staining of liquor. CTG changes noted included loss of beat to beat variability, tachycardia, bradycardia and decelerations. Demographic details noted were maternal age, parity, fetal weight and mode of delivery. Main outcome measures noted were CTG, Apgar score at 1 and 5 minutes, baby resuscitation measures and neonatal complications. The main outcome measures were expressedas numbers and percentages. Mean maternal age in Group A and Group B was 26.10 years and 25.57 years respectively Mean gestational age was 38 weeks in Group A and 39 weeks in Group B. Birth weight was 3.2 kg and 3.1 kg in Group A and Group B respectively. Main outcome measures showed more variable and late decelerations, [23% vs 8%] more babies with lower apgar scores [18% vs 6%] and more neonatal complications in Group B. There were two neonatal deaths in Group B. Meconium staining with CTG changes is a more significant sign of fetal distress than CTG changes alone

Sonomammography for evaluation of solid breast masses in young patients

This study was carried out to evaluate the applicability of sonomammography as the primary radiological modality in young patients with breast masses. This study was carried out at Radiology Departments of PNS Shifa Karachi and CMH Rawalpindi from February 2002 to April 2005. Sonomammography of 56 young patients with breast lump was done. Lesions were characterised by using sonographic criteria as benign [n=49], malignant [n=2] and intermediate [n=5] masses. Results of this evaluation were assessed by fine needle aspiration cytology. No false positive result was noted in 49 benign lesions while only one intermediate mass turned out to be malignant. Sensitivity of sonomammography was more for benign 92% than malignant lesions 67%, and its specificity was high for malignant lesions 92.4%. Retrospective scanning was done for intermediate masses. This study proves the efficacy of ultrasound as a method of choice to evaluate breast masses in young patients avoiding the need of biopsy. This study also reflects that benign diseases dominate the disease spectrum in young patients

Determination of gestational age by transverse cerebellar diameter in third trimester of pregnancy

To assess the usefulness of transverse cerebellar diameter [TCD] as an independent parameter for gestational age assessment in third trimester of pregnancy. An observational study. Diagnostic Radiology Department, PNS Shifa, Karachi between April 2002 to July 2004. This study was performed on patients between 26-38 weeks of gestation with normal pregnancy. Grey scale antenatal ultrasonography was done with 3.5 MHz probe to measure fetal transverse cerebellar diameter and was correlated with gestational age in weeks. These cases were followed progressively at different periods of gestation throughout the pregnancy. Collected data was converted into variables which were analyzed by SPSS version 10, descriptive statistics included mean +/- standard deviation which were computed for TCD and other fetal biometry parameters. Transverse cerebellar diameter varied in a linear fashion in third trimester, while transverse cerebellar diameter/abdominal circumference [TCD/AC] ratio remained constant in second half of pregnancy. All the parameters were expressed by regression equations and correlation coefficients were found to be statistically significant [r=0.99 for TCD, r=0.98 for TCD/AC all p<0.0001]. This study signifies that transverse cerebellar diameter and TCD/AC ratio on serial sonography give an accurate idea of gestational age. Cases with intrauterine growth restriction can be diagnosed if local, nomogram can be prepared for different ethnic groups

mortality and morbidity associated with umbilical cord prolapse

A prospective study was carried out on 15 cases of cord prolapse admitted in the study period between January 1995 and December 1995 in Gynae "A" unit at Women and Children Teaching Hospital, Abbottabad, managing 1500 deliveries annually. Survival rates were assessed by APGAR score at 1 and 5 minutes. The incidence of cord prolapse was in 100 in our study group. 8 babies were alive when cord prolapse was diagnosed and all except 1 survived inspite of severe bradycardia. Reason for low mortality rate of hospital diagnosed cases with alive fetuses was a short diagnosis to delivery interval [D.D.I.]