Effect of a Formative Objective Structured Clinical Examination on the Clinical Performance of Undergraduate Medical Students in a Summative Examination: A Randomized Controlled Trial

Objective: To study the effect of formative Objective structured clinical examination(OSCE) on the undergraduate medical students’ performance in a subsequent summative-OSCE assessment. Methods: In a randomized single-blind trial, 130 fifth year medicalstudents at Raparin hospital, Erbil were assigned to intervention (n=61) and control group(n=69). Formative-OSCE was performed for the intervention group in pediatric module withfeedback on their performance versus standard pediatric module for the control group.Students’ clinical performance was assessed by a summative-OSCE. Multiple regressionwas used to predict the summative-OSCE score depending on the participation in formative-OSCE along with the other factors. Results: Eleven students were excluded because ofearly drop-out, leaving 119 students for analysis. The summative-OSCE mean score (out ofa total score of 100) in intervention group 64.6 (10.91) was significantly lower as comparedto the control group 69.2 (10.45). Conclusion: Single formative-OSCE does not necessarilylead to better performance in subsequent summative-OSCE.

Major determinants of maternal near- miss and mortality at the maternity teaching hospital, Erbil city, Iraq

Objectives: To find out the major determinants of maternal near-miss [NM] and maternal deaths [MDs] in Erbil city, Iraq, by comparative analysis of maternal NMs and MDs

Methods: We conducted a hospital-based cross-sectional study in the Maternity Teaching Hospital in Erbil city from 1 June to 31 December 2013. All MDs and NMs that occurred in the hospital during the study period were included in the study. Systematic identification of all eligible women was done. This identification included a baseline assessment of the severe pregnancy-related complications using the World Health Organization NM criteria

Results: Severe preeclampsia and postpartum hemorrhage [PPH] constituted the highest proportions of complications in women with potentially life-threatening conditions [PLTCs] [30.5% and 30.0%, respectively]. The highest mortality indexes were those for ruptured uterus [16.7] and severe complications of placenta previa [14.2]. Factors that were significantly associated with MD[compared to NM] were hepatic dysfunction [p = 0.046], multiple/unspecified disorders [p = 0.003], arrival as an emergency condition by ambulance [p = 0.015], and history of previous cesarean section [p = 0.013]

Conclusions: Severe preeclampsia and PPH are the main complications that lead to PLTCs. Factors found to be associated with MDs are hepatic dysfunction, multiple/unspecified disorders, arrival as an emergency condition by ambulance, and history of a previous cesarean section

Inpatients' satisfaction toward nursing services in the medical and surgical wards of Rizgary Teaching Hospital, Erbil, Iraq

Background and objective: Patients' satisfaction toward nursing care is an important indicator of the quality of nursing services. This study aimed to assess patients' satisfaction with nursing services provided in Rizgary Teaching Hospital and to find out the factors that are associated with levels of satisfaction

Methods: A cross-sectional study was conducted in Rizgary Teaching Hospital in Erbil city, starting from January 17th, 2014 to March 11th, 2015. A convenience sampling method was used to recruit 200 patients [100 males and 100 females] from medical and surgical wards. Patients aged >/=15 years, who were admitted to medical and surgical wards for >/=48 hours were included. A structured questionnaire designed by researchers was completed through direct interview. Chi-square test of association [or Fisher's exact test] was us compare proportions. A P value of

Results: The study showed that 40.5% of patients were highly satisfied with the nursing services, only 20.9% of those with secondary education or higher were highly satisfied [P = 0.005], and 80% of those with high income were highly satisfied [P = 0.001]. There was no significant association between patients' satisfaction and patients' age, marital status, occupation, residence, the length of stay, and type of ward. A relatively poor rate of satisfaction [20.5%] was observed regarding the information provided by nurses before the medical care or drug administration

Conclusions: Less educated patients were more satisfied with nursing services. The majority of patients were unsatisfied with the information provided by nurses before medical care or drug administration

Assessment of primary schools' environment in Erbil city

Healthy school environment is one of the main determinants of students' health in order to maximize the benefit from the educational programs. This study was aimed to assess the primary school environment in Erbil city. A cross-sectional study was conducted in 50 primary schools in Erbil city out of 242 schools through the academic year 2010-2011. Data were collected using a questionnaire constructed by the researchers which included general information, area around the school, school environment, class-room and school canteen. Most of the primary schools were located near the main street, nearly all [98%] the streets leading to the schools were paved. In contrast, thirty one [62%] schools had been exposed to a pollution source, mainly noise [54.84%] and garbage [45.16%] pollution. The majority of the schools had standard school fencing, school yard, and garbage container, and only 8 [16%] of them had available/standard school ground. The study showed that nearly half of the schools had appropriate classrooms, lighting, and majority of them had adequate desks, appropriate blackboards and clean classrooms, while ventilation and age appropriate desks were partially available. The amount of chlorine in water was not tested. There is lack of materials in the first aid kits. Canteens were available, but not standard and the working staff did not have the health certificate. School environment in Erbil city is not optimum

Effect of thrombolytic therapy on the incidence of early left ventricular infarct expansion in acute anterior myocardial infarction

To determine the incidence of early left ventricular infarct expansion within five days after first anterior ST-segment elevation myocardial infarction and the effect of early thrombolytic therapy on the incidence of early infarct expansion compared with late thrombolytic therapy. In a prospective study of 101 patients [75males and 26 females], with the first attack of acute anterior myocardial infarction, their ages ranged from 40-80 years [mean age: 61.07 +/- 10.78] who had been admitted to the Coronary Care Unit of Hawler Teaching Hospital for the period from July 2007 through to September 2009. Those who received alteplase 3-12 hours were labelled as group-II [52 patients]. The incidence of early left ventricular infarct expansion was diagnosed by 2D-echocardiography and was found to be 17.8%. Group I patients had a lower incidence of early left ventricular infarct expansion [8.16%] compared with group-II [26.92%; p=0.014]. Patients with early left ventricular infarct expansion had a higher frequency rate of left ventricular systolic dysfunction [94.44%] compared to patients without early left ventricular infarct expansion [8.43%; p<0.001]. There was a significant difference in the incidence of in-hospital mortality between the patients who developed early left ventricular infarct expansion [11.1%] compared with patients without early left ventricular infarct expansion [1.2%; p=0.025]. Early reperfusion therapy in acute anterior myocardial infarction can decrease the incidence of early left ventricular infarct expansion, preserve left ventricular systolic function and decrease in-hospital mortality