Effectiveness of problem based learning as an instructional tool for acquisition of content knowledge and promotion of critical thinking among medical students

To assess effectiveness of PBL as an instructional tool in clinical years to improve learning of undergraduate students in terms of acquisition of content knowledge, critical thinking and problem solving skills through problem based learning and traditional way of teaching. Quasi-experimental study. Fatima Jinnah Medical College for Women, Lahore, from October 2009 to April 2010. Final year medical students attending Obstetrics and Gynaecology and Surgery rotations were inducted as participants in this study. Two batches of 50 students each attended Gynaecology rotation and two batches attended Surgery rotation, i.e. 100 students in each. Each batch was divided into two groups i.e. A and B of 25 students each. Group-A learnt through traditional teaching, involving bedside teaching and lectures in wards and Group-B learnt relevant clinical knowledge through a modified PBL process. Content knowledge was tested by MCQs testing recall while clinical reasoning and problem were assessed by MCQs testing analysis and critical thinking. Intra-group comparison of mean scores of pre and post-test scores was done using paired sample t-tests while for intergroup comparison of mean scores was done through independent sample t-test. Teaching through traditional method significantly improved content knowledge, [p = 0.001] but did not considerably improve clinical reasoning and problem solving skills [p = 0.093] whereas, content knowledge of students who studied through PBL remained the same [p = 0.202] but there was marked improvement in their clinical reasoning and problem solving skills [p = < 0.001]. PBL is an effective instructional tool to foster critical thinking and problem solving skills among medical students

Obstetrical prognosis after placental abruption

Placental abruption is the premature separation of normally situated placenta after 24 completed weeks of pregnancy and before delivery of a baby. It is self extending process with accumulation of blood clots leading to more separation of placenta. The study was conducted to assess the perinatal mortality, morbidity in relationship to the severity ofplacental abruption and to estimate the magnitude of abruption. It is a descriptive and observational study. The study was conducted in the department of obstetrics and gynaecology, Sir Ganga Ram Hospital, Lahore over a period of one year from May, 2009 to May 2010. A total of 80 patients with the diagnosis ofplacental abruption after 24 completed weeks of gestation were included in this study. Neonates were evaluated at the time of birth and followed upto 46 hours after birth. Among the 80 patients, only 14 were [17.5%] booked, while 66 [82.5%] remained unbooked. A total of 27 [33.75%] patients had pregnancy induced hypertension, 65 [81%] were anaemic. Polyhydramnios and multiple pregnancy were seen in 3 and 4 patients respectively. Majority of patients i.e. 47[58.75%] delivered by abdominal route. Regarding the fetal outcome alive born babies with placental abruption were 41 [51.25%] in which 23 [28.75%] were preterm and 18 [22.5%] were full term. Thirty six [45%] intrauterine dead fetus and in whome 25 [31%] were preterm and 11 [13.75%] were full term, only 3 were still births. Twenty four [30%] neonates required resuscitation, while 20 [25%] neonate were shifted to neonatal intensive care unit. latrogenic prematurity was the underlying cause of most complications. Perinatal morbidity and mortality is significantly high in patients of abruption placentae. Hypertension is a major predisposing factor for placental abruption

Pattern of gynaecological cancer at a tertiary care hospital Lahore-at twelve years study

To determine the relative frequency of gynaecological cancers and also to ascertain the age and parity distribution as well as the stage of disease at presentation. Observational study. Department of Gynaecology and Obstetrics unit II Sir Ganga Ram Hospital/Fatima Jinnah Medical College, Lahore. January1994 to October2005 During the study period of 12 years, there were 13849 admissions in the gynaecology ward, of which 209 women [1.5%] were diagnosed to have gynaecological cancers. The record of these cancer patients was maintained on specially designed proforma and was analyzed for relative frequency, age, parity distribution and stage of disease at presentation. Ovarian cancer was the commonest malignancy [47.84%] followed by cancer of the cervix [32.05%] and of the endometrium [12.91%]. The mean ages for ovarian, cervical and endometrial cancer were 44.52, 51.10 and 57.45 years respectively. 30% of the women with ovarian cancer were between 31-40 years of age. However; about 10% of cases were under 20 years of age. Out of all study subjects, about 45% had a parity of six and above. However; in the group of women with ovarian cancer; 47% cases were Para 1 to 5. At time of initial presentation 66% of ovarian cancer and about 47% of cervical cancer cases were in advanced stage disease [III and IV] while for endometrial carcinoma majority presented at earlier stage. Four patients with ovarian malignancy had family history of ovarian and breast cancer. Ovarian cancer is the commonest malignancy occurring comparatively in younger age group and with advanced stage presentation. Cervical cancer being preventable, is tragically still a major health burden. Although this study has limited epidemiological importance however such data of a teaching hospital can be an incentive for other institutes to carry out similar work, which can help in establishing cancer registry in our country

Comparison of visual inspection of cervix and PAP smear for cervical cancer screening

To evaluate the performance of visual inspection of cervix [VIA] after application of 3% acetic acid in cervical cancer screening in comparison with Pap smear. Design: Comparative study. Place and Duration of Study: This study was conducted at Sir Ganga Ram hospital, Lahore, from January 1996-December 1999. Subjects and Speculum examination was carried out to see the cervix in 501 women. All subjects were screened simultaneously by Pap smear and VIA after application of 3% acetic acid. Positive cases by both screening methods and grossly abnormal cervix even with negative screen were subjected to colposcopy. In case of colposcopic abnormality of atypia or advanced lesions, biopsies were taken. Histology of colposcopically directed biopsy was taken as gold standard to evaluate the performance of the test. Out of 540 subjects, 356 were negative with both screening techniques. One hundred and fifty-six subjects were positive with VIA[28.9%] while Pap smear was positive in seventy-eight subjects [14.4%]. The sensitivity of VIA was 93.9% and of Pap smear was 46.9%. Corresponding specificities were 30.4% and 69.5%. There was no significant difference between the positive predictive value [PPV] of both test [p < 0.05]. The accuracy of VIA was 77.5% compared to 52.8% of Pap smear. The difference was highly significant [p < 0.01]. These results indicate that VIA is more sensitive and has a higher accuracy as compared to Pap smear. It could, therefore, be valuable in detection of precancerous lesions of cervix. Low cost, easy applicability and immediate results make VIA a useful screening test in developing countries like Pakistan as compared to Pap smear

Analysis of tubal pregnancy

This study was carried out to determine the frequency, etiological factors, modes of presentation, accuracy of diagnostic modalities, operative findings and surgical treatment of tubal pregnancies. Design: Observational study. Place and Duration of Study: This study was conducted in gynae unit III, Sir Ganga Ram Hospital, Lahore from January 1995 to December 1996. Subjects and All the patients diagnosed as a case of tubal pregnancy in two years period were included in the study. Detailed history regarding the symptoms and risk factors of tubal pregnancy was taken followed by clinical examination. The diagnostic and treatment modality used and operative findings were also recorded. All the data was recorded on a proforma and finally the results were analysed. Incidence of tubal pregnancy was found out to be 1:305 deliveries. Out of these, 70% of the cases occurred in the age group of 21-30 years and in patients with low parity [in para 0-2] 65% of the patients had high risk factor e.g. previous abdominopelvic surgery PID or history of infertility. Pain was the commonest symptom [90% of cases] followed by vaginal bleeding [80%] adnexal masses [70%] and amenorrhea [65%]. Acute tubal pregnancy was found in 85% of the cases while 15% of cases had chronic tubal pregnancy. Tubal pregnancy in the ampullary region was detected in 65% patients. Previous abdominopelvic surgery, PID, history of infertility and use of intra-uterine contraceptive device are the main etiologic factors. Most of the patients present at a very late stage with ruptured tubal pregnancy followed by salpingostomy in 95% of cases. Only 5% of cases had conservative surgical treatment i.e. salpingostomy. Culdocentesis ultrasonography and laparoscopy were good diagnostic modalities