[Structured viva as an assessment tool: Perceptions of undergraduate medical students]

To document the undergraduate medical students' perceptions regarding the structured viva as an assessment tool. Cross sectional. Army Medical College, National University of Sciences and Technology [NUST], Islamabad from April 2013 to April 2014. Data was collected from fourth year students of a public sector medical college. A structured questionnaire was used to evaluate student's perception regarding relevancy of viva questions to syllabus, level of comfort while being assessed and provision of adequate time to answer, bias or harassment by the mentors, freedom to answer in their own learning styles. One hundred seventy one, fourth year students gave consent to participate in this study. Almost all of the students were satisfid after being assessed in oral structed viva room: the results obtaind were: relevancy of questions to course: 169 [98%]; comfortable environment of viva room: 165 [97%]; appropriate time to answer the questions: 162 [94.7%], structured viva: 132 [94.7%]; welcomed upon arrival for viva: 147 [86%]; encouraged by examiner: 144 [84%]; facilitated to answer in their own learning style: 137 [80%]; covered all the topics: 120 [70% 1; demotivated during viva: 11 [6.4%] and bias during viva: 14 [8.1%] There is substantial need of introducing innovations in the conventional exam strategies being practiced in our medical colleges. Introducing structured viva examination, making the exam environment comfortable and adapting an appreciative inquiry approach while assessing students can greatly help them to overcome exam stress

Post graduate students' perception of educational environment at army medical college, rawalpindi: assessment by pheem [post graduate education environment measure]

To assess the post graduate students perception of various aspects of the learning and educational environment at Army Medical College, Rawalpindi. A descriptive study. Army Medical College, Rawalpindi from May 2014-July 2014. The modified Postgraduate Hospital Educational Environment Measure [PHEEM] a scored 34 item questionnaire was administered to evaluate various aspects of the learning environment. Three domains of the learning environment were covered with the help of PHEEM scores: perceptions of autonomy; perceptions of teaching; and perceptions of social support. Total and subscale scores were calculated according to Likert scale. Descriptive statistics were used to calculate mean SD. Analysis of variance [ANOVA] was used to compare scores between different departments. Total 39 postgraduate trainees were included in the study. Average of total score came out to be 107, whereas for perception of teaching it was 45.57 [SD = 5.22, range: 43 - 48], for social support it was 24.76 [SD =3.76, range: 21 - 27] and for perception of autonomy it was 36.84 [SD = 4.09, range: 33 - 39]. The overall and subscale scores were also compared between post graduates of the different departments of the public sector medical colleges. The education climate was rated as more positive than negative determined by overall PHEEM scores. Army Medical College as an institution has a positive education environment

Evaluation of diagnostic accuracy of APRI for prediction of fibrosis in hepatitis C patients

Several non-invasive markers are being used to assess the structural liver damage in patients with chronic hepatitis C [CHC]. We evaluated Aspartate aminotransferase [AST] to platelet ratio index [APRI] in comparison with Metavir scoring for assessing the severity of hepatic fibrosis in the CHC patients in district Rawalpindi. One hundred twenty CHC patients, naive for HCV treatment, underwent liver biopsy in tertiary care hospitals of district Rawalpindi, participated in the study. Liver biopsies were reviewed by Metavir scoring system. Serum AST was analyzed by IFCC method. Platelets were measured on a haematology Analyzer. Patients with mild fibrosis [F0, F1] were differentiated from significant fibrosis [F2, F3, F4] and those with mild/moderate fibrosis [F0, F1, F2] from advanced fibrosis [F3, F4] based on APRI score as compared to liver biopsy. Liver biopsies examination revealed that out of 120 patients 10 [8.3%] had no fibrosis [F0], 46 [38%] portal fibrosis [F1], 34 [28%] septal fibrosis [F2], 21 [18%] bridging fibrosis [F3] and 9 [8%] cirrhosis [F4]. APRI correctly classified 58 [48%] patients of significant fibrosis with AUC=0.82 [95% CI, 0.73-0.88] at cut-off 0.5 and 1.5 with negative predictive value [NPV], Positive predictive value [PPV], sensitivity and specificity of 78%, 72%, 66%, 83% and 58%, 90%, 41% and 90% respectively. Eighty-seven [66%] CHC patients were correctly classified for advanced fibrosis with AUC=0.87[95%CI 0.79-0.94] at cutoffs 0.90 and 1.75 with a 95%NPV at 0.90 and 78% PPV at 1.75. APRI could correctly identify significant fibrosis in 48% and advanced fibrosis in 66% cases with acceptable degree of diagnostic accuracy in CHC patients in our clinical practice

Assessment of lipid dysfunction in patients on maintenance haemodialysis

Dyslipidaemia is a major risk factor of cardiovascular disease in patients on maintenance haemodialysis. Both increased and decreased levels of cholesterol are associated with increased cardiovascular mortality in haemodialysis patients. To assess the lipid dysfunction among patients on maintenance haemodialysis in a nephrology unit at Rawalpindi as compared with healthy individuals. A descriptive comparative study was carried out in a nephrology unit at Rawalpindi, Pakistan. A total of 140 subjects were included consisting of 70 patients on maintenance haemodialysis [MHD] and 70 healthy controls. Body mass index [BMI] was measured according to WHO guidelines. Serum total cholesterol [TC], triglycerides [TG] and high-density lipoprotein cholesterol [HDL-C] were assayed on chemistry analyser. Low-density lipoprotein cholesterol [LDL-C] was calculated by Friedwald equation. MHD patients had significantly lower BMI, mean [SD] 20.07[3.66] as compared with the controls 22.88[3.97] kg/m2 [p < 0.001]. The lipid profile among MHD patients and controls are given as mean [SD]: [a] Total Cholesterol 3.84[1.06] vs 4.65[0.97] [p < 0.001], [b] LDL-C 2.21[0.77] vs 2.93[0.71] [p < 0.001], [c] HDL-C 0.95[0.166] vs 0.97[0.138] [p=NS], [d] Non HDL 2.88[0.95] vs 3.67[0.88] [p < 0.0001], [e] Triglycerides 1.68[1.09] vs 1.69[0.86] [p=NS]. The most common abnormality observed in haemodialysis patients was low HDL-C [81%] followed by increased Non-HDL-C [23%] and increased serum triglycerides [19%]. It is concluded that our patients on maintenance haemodialysis have significantly low BMI, total Cholesterol, LDL-C and Non-HDL-C depicting malnutrition leading to inflammation, accelerated atherosclerosis process and cardiovascular complications