Medical errors; causes, consequences, emotional response and resulting behavioral change

Objective: To determine the causes of medical errors, the emotional and behavioral response of pediatric medicine residents to their medical errors and to determine their behavior change affecting their future training

Methods: One hundred thirty postgraduate residents were included in the study. Residents were asked to complete questionnaire about their errors and responses to their errors in three domains: emotional response, learning behavior and disclosure of the error. The names of the participants were kept confidential. Data was analyzed using SPSS version 20

Results: A total of 130 residents were included. Majority 128[98.5%] of these described some form of error. Serious errors that occurred were 24[19%], 63[48%] minor, 24[19%] near misses, 2[2%] never encountered an error and 17[12%] did not mention type of error but mentioned causes and consequences. Only 73[57%] residents disclosed medical errors to their senior physician but disclosure to patient's family was negligible 15[11%]. Fatigue due to long duty hours 85[65%], inadequate experience 66[52%], inadequate supervision 58[48%] and complex case 58[45%] were common causes of medical errors. Negative emotions were common and were significantly associated with lack of knowledge [p=0.001], missing warning signs [p=<0.001], not seeking advice [p=0.003] and procedural complications [p=0.001]. Medical errors had significant impact on resident's behavior; 119[93%] residents became more careful, increased advice seeking from seniors 109[86%] and 109[86%] started paying more attention to details. Intrinsic causes of errors were significantly associated with increased information seeking behavior and vigilance [p=0.003] and [p=0.01] respectively

Conclusion: Medical errors committed by residents have inadequate disclosure to senior physicians and result in negative emotions but there was positive change in their behavior, which resulted in improvement in their future training and patient care

Are dental access centers, the potential locations for primary prevention of oral cancer

The objectives of the study was to determine the proportion of patients attending dental access centers that are at risk of developing oral cancer because of lifestyle habits. Data were collected prospectively about the smoking and smokeless tobacco habits of patients attending a dental access centre at Karachi Medical and Dental College and Abbasi Shaheed Hospital in Karachi. It was a cross-sectional questionnaire survey. Results showed that more than 50% of patients attending the dental access centre were smokers, with almost 30% of the patients in high or very high tobacco use groups. The majority of attendees were under 45 years of age. It was concluded that significant numbers of patients attending the dental access centre have lifestyle habits that make them vulnerable to oral cancer. Dental access centres could usefully provide opportunistic health messages to patients about risk factors in the development of oral cancer and could create smoking cessation programmes

Morphological Spectrum of Diseases in Patients Presenting with Enlarged Cervical lymph Nodes, Diagnosed on FNAC

Purpose of the study was to know the relative frequencies of different morphological disease patterns in patients of cervical lymphadenopathy by FNAC. A descriptive cross sectional study. Surgery and Pathology department of Pakistan Railway teaching Hospital Rawalpindi from January 2005 to October 2011. Results of fine needle aspiration cytology of patients with enlarged cervical lymphnodes was recorded. Total number of patients was 150. The male to female ratio was 1.3:1 [86 males and 64 females]. The maximum patients were in 11-20 years [40%], followed by 21-30 years [20%]. The youngest patient was 4 Years and the oldest was 67 years. The FNAC showed chronic granulomatous inflammation suggestive of tuberculosis [43%] as the commonest pathology, followed by reactive hyperplasia [39%], nonspecific lymphadenitis [9%], lymphoma, [5%], and metastatic carcinoma [4%]. All patients with enlarged cervical lymph nodes should be thoroughly investigated. FNAC is a reliable diagnostic tool in evaluation of lymphadenopathy. Chronic granulomatous inflammation suggesting tuberculosisis one of the major causes of enlarged cervical lymphnodes in our country

Early Community and Hospital Contact of Undergraduate Medical Students; Innovating the MBBS Curriculum through DCH [Doctor, Community and Hospital] Module

Transition from traditional to integrated curriculum has been very slow in Pakistan. However in the last few years there has been tremendous increase in the number of medical schools. Early clinical and community exposure is one of the key factors in generating interest of medical students in learning the clinical aspect of the basic sciences. For this purpose [DCH module] was incorporated in the first 3 years of the medical curriculum at Islamic International Medical College. To develop and implement DCH module for early clinical exposure of MBBS students. To determine teachers' and students' perceptions of about its influence on the overall learning of medicine. Action Research. Islamic International Medical College from Jan 2011 to Jan 2014. Initially Wise man approach was used to develop the module. However modifications were brought into the module applying the United Nations approach of designing a curriculum. The module has been incorporated in the curriculum, aligning it with the last 2 years of intensive clerkship of a five year MBBS program. Significant improvement has been observed by the faculty, in students' approach about dealing with the clinical context of the basic sciences. It has also resulted in better communication skills and their reasoning approach in PBL sessions. Early clinical exposure enhances the interest and understanding of medical students of the basic sciences. It lays the foundation of the students towards a professional and clinical approach in dealing with patients, which is in addition to better integration of basic sciences with clinical sciences

simple and convenient method for the simultaneous in vitro study of metformin and glimepiride tablets

A simple and convenient method was developed for the simultaneous determination of metformin HCl and glimepiride in tablet dosage form of different pharmaceuticals companies. This method was validated and proved to be applicable for assay determination in intermediate and finished staged. More over a single medium dissolution of metformin HCl and glimepiride was established and the media was evaluated for comparative studies for different formulations. Reverse phase HPLC equipped with UV detector was used for the determination of metformin HCl and glimepiride. A mixture of acetonitrile and ammonium acetate buffer 0.05M pH 3.0 was used as mobile phase at flow rate of 1.0 ml/min. Promocil C18 5 micro 100 A° 4.6 x 100 mm C18 silica column was used and detection was carried out at 270 nm. Method was found to be linear over the range of 4 ppm to 16 ppm for glimepiride and 170 ppm to 680 ppm for metformin HCl. Regression co-efficient were found to be 0.9949 and 0.9864 for glimepiride and metformin HCl respectively. Dissolution was performed in 500 ml 0.2% sodium lauryl sulfate at 37°C for 45 min using paddle apparatus. Dissolution of glimepiride was found to be 98.60% and 101.08% in Orinase Met1 tablet and Amaryl M tablet respectively whereas metformin was found 99.41% and 98.59% in Orinase Met 1 tablet and Amaryl M tablet. RSD for all the dissolutions was less than 2.0% after completion

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

Does PBL Make Medical Students Life long learners?

our medical school has switched from traditional to integrated modular spiral outcome based curriculum. Problem based learning has been introduced as one of the main teaching/learning strategies. One of the major benefits of PBL mentioned in the literature is to make student a lifelong learner. However it is not easy to assess that PBL imparts this basic feature of adult learning in students. PBL is used as learning strategy in the first 02 years of medical curriculum, so that the lifelong learning capability can be assessed in the last three years of medical school. To determine the role of PBL in developing lifelong learning ability among medical students. A quantitative cross sectional co-relational study. The study was conducted in Islamic International Medical College in April 2012. Three hundred students from 3rd to final year MBBS were distributed Revised Jefferson scale of Physician Lifelong learning [JeffSPLL] at the start of the lecture. The questionnaire was collected at the end of the lecture. Data was collected from JeffSPLL inventory. This was entered into SPSS 18. Both non parametric and parametric analysis were done. Non parametric analysis included mean, median and mode of ages and gender of the participants. Parametric analysis was based on Pearson Co relation analysis to find a relationship between the PBL and developing the capability of Lifelong learning. Lifelong learning is multidimensional idea. Factors associated with lifelong learning include need recognition, undertaking research, self-motivation, practical abilities and personal motivations. The discussion will be based on the relationship between the development of lifelong learning skill and the process of Problem based learning. The process of PBL makes the students lifelong learners

Our Lectures: What do the Students Think?

The objective of the study was to reveal the perceptions and experience of our students regarding the lectures taken in our medical school. It was a cross-sectional descriptive study. This study was conducted among second year MBBS students of Islamic International Medical College. A questionnaire was developed, validated by piloting among faculty members and then was distributed to the students of MBBS year 2 from June to July 2013. The response rate was 100%. Questions were grouped under various headings and categorization was done [i.e., Excellent, Very Good, Good, Fair and poor] according to responses. Lecture as an instructional strategy and the presentation of lectures was regarded as [Good] by 39% and 42% of students respectively.36% of students commented the Multimedia preparation of lectures as [very good]. Only 23% of students have mostly gone through the learning outcomes of a lecture before coming to attend it. Most of the students regarded lectures as a good instructional strategy. Students were also satisfied with the Multimedia presentations and delivery of lectures

Assessing the Long Case in Undergraduate Medical Students: Development of Structured, Feasible, Valid and Reliable Tool.

To develop structured, feasible, valid and reliable tool in assessing long case in undergraduate medical student. Qualitative Action Research. IIMCT, Aug, 2012 to Oct 2013. An action research approach was used. Problems of un-structured examination in long case were identified. Delphi technique with the senior faculty was used to identify the components of the assessment tool. Final draft of the tool was sent to medical educationists for their input. A structured tool [SLICE] for examining the holistic approach of student towards managing a patient was developed and was found to be reliable [Cronbach alpha 0.87] and valid. SLICE is a feasible, valid and reliable tool to assess long case in undergraduate medical students in our setup

Identifying Learning Styles Among Medical Students: Does Our Assessment Favors Certain Learning Style?

Learning Style is usually identified as an individual's pattern for acquiring information. This study was used to identify the learning style of Medical students and comparing the individual Learning Styles with the Result of Annual Summative Assessment to ascertain any link. Objectives of the study were two-fold: First, to identify the learning style of Medical Students for their sake and for the sake of faculty so that adequate planning in the curriculum could be done. The second aim was to search whether our Curriculum is oriented towards a particular learning style in students through comparison of learning styles with Annual Assessment Result. It was a Cross-Sectional Descriptive Study. The study was conducted among students of 3 year MBBS, Islamic International Hospital. The 80-item Honey and Mumford Learning Style Questionnaire was distributed to a class of 100 students .The result was compiled on MS Excel and compared with the results of Summative Assessment of the students. In our study, Majority of the students were Reflectors [35.5%] [n=32], followed by Reflector-Pragmatists [13.3%] [n=12]. Theorists [12.2%], Pragmatists [11%], Reflector/Theorists [8.8%] and Activists [6.6%] 34% of the students [n=31] had a combination learning style. One student had all four learning styles. Comparison of Assessment result with the result of the Questionnaire was done: on an Average Reflectors have scored higher [73%] as compared to Pragmatists [72%], Theorists [71.5%] and Activists [66%]. Although no gross difference, the Assessment result on an average, was a bit higher for reflectors. This study also shows that most of the students learn more effectively from lectures, project works and independent study

Frequency of echocardiographic complications of dilated cardiomyopathy at a tertiary care hospital

Background: Dilated cardiomyopathy can lead to a variety of complications recognisable on clinical, echocardiographic, electrocardiographic and radiographic assessment. Among this, transthoracic echocardiography has the dual advantage of being helpful in making the diagnosis of dilated cardiomyopathy as well as an effective tool in early recognition of certain complications for timely management to improve the quality of life of these patients. Methods: This descriptive [case series] study was undertaken at Departments of Medicine, Cardiology, Paediatrics and Obs/Gyn, Ayub Teaching Hospital, Abbottabad from July to December, 2008. Fifty patients of dilated cardiomyopathy without age and gender discrimination were selected by convenience sampling. Those with hypertrophic and restrictive cardiomyopathies, valvular and congenital heart disease, hypertension and ischemic heart disease were excluded. Results: Mean age was 47.12 +/- 17.9 year with male predominance [males=34, females=16]. Mean ejection fraction was 30.6 +/- 6.9%. Complications revealed on echocardiography were intracardiac thrombi [5, 10%], spontaneous echo contrast [5, 10%], pericardial effusion [6, 12%], mitral regurgitation [46, 92%], tricuspid [25, 50%], aortic [5, 10%], pulmonary [2, 4%] multi-valvular regurgitation [28, 56%], and left atrial dilatation [36, 72%]. Conclusion: LV systolic dysfunction, cardiac thrombi, spontaneous echo contrast, mitral and tricuspid regurgitation and left atrial enlargement are important complications of dilated cardiomyopathy. Echocardiography is important tool towards identification of these complications. Keywords: cardiomyopathy, dilated, cardiomyopathy, complications, cardiomyopathy, congestive, echocardiography

Respiratory distress with urinary ascites; a rare presentation of urinary bladder injury after caesarian section

Respiratory distress with Urinary ascites is a rare diagnosis usually associated with intra-peritoneal bladder perforation. We present a case of a 35 year old female who had her 3[rd] C- section and presented 08 days later with respiratory distress and massive urinary ascites .We have discussed why the diagnosis was missed initially and then how was it made, and then eventually its management. In summary, we show that a combination ascitic biochemistry and CT Urography are essential to make a diagnosis of urinary ascites and to know the site of urinary tract injury

Frequency of sensory neuropathy in foot of asymptomatic type2 diabetic patients using semmes-weinstein monofilament

To detect neuropathy in diabetics who are clinically asymptomatic, using SW monofilament and to correlate the frequency of detected neuropathy with the duration of diabetes. Known patients of type 2 diabetes that do not have symptoms of peripheral neuropathy were included. Height, weight and duration of diabetes were measured and BMI calculated. SW monofilament was pressed perpendicular to the test site with enough pressure to bend it for one second. Comparison of frequency of SW monofilament test among gender was done by x2 test. Bivariate correlation of SW monofilament test result with duration of diabetes was done by Kendall's test. A total of 700 patients including 324 males and 376 females were examined. Asymptomatic neuropathy was detected in 14.4% of patients. The mean age of males was significantly more [50.4 +/- 9.0 vs 46.7 +/- 8.4 yrs; P < 0.0001] but BMI was lower than females [24.4 +/- 2.8 vs 26.2 +/- 4.2; P < 0.0001]. No correlation of asymptomatic neuropathy with duration of diabetes was detected [P = 0.995]. Asymptomatic neuropathy is prevalent in our diabetic population and it does not correlate with the duration of diabetes. Diabetics should be actively screened for asymptomatic neuropathy by SW monofilament

Pulmonary cryptosporidiosis in a bone marrow transplant recepient

Cryptosporidium, a protozoan parasite of Phylum Apicomplexa, causes acute short term intestinal infection in immunocompetent individuals. However, in immunocompromised patients, it causes prolonged and life threatening watery diarrhea, rarely with extra-intestinal involvement. We present a case of Cryptosporidium parvum with pulmonary involvement who was managed with azithromycin and co-trimoxazole combination. This is the second reported case in the world in HIV negative patient undergoing bone marrow transplantation

JAK2 mutation and myeloproliferative disorders in Pakis

To study the haematological features and JAK2 mutation in Pakistani patients of myeloproliferative disorders. Descriptive cross sectional. Department of Heamatology, Armed Forces Institute of Pathology, Rawalpindi from Jan 2004 to Jan 2007. Forty seven consecutive patients of myeloproliferative disorders [MPD] diagnosed by the conventional haematological criteria were included in the study. The patients on treatment were excluded. Age, sex, splenic enlargement, blood complete counts and bone marrow examination findings were recorded. All patients were screened for G-T Point mutation [V617F] in the JAK2 gene on chromosome 9 by an allele specific PCR Out of the 47 MPD patients, 17 [36%] had polycythaemia rubra vera [PRV], 7 [15%] had essential thrombocythaemia [ET] and 18 [38%] had idiopathic myelofibrosis [MF]. JAK2 positive was seen in 37/47 [79%] patients including 17/17 [100%] in PRV, 4/7 [57%] in ET and 13/18 [72%] in IMF. MPDs are an important group of haematology disorders in Pakistan. Vast majority of these disorders [79%] showed mutation in the JAK2 gene. JAK2 mutation analysis is especially useful in the diagnosis of polycythaemia vera where it was found in 100% of the cases

Pattern of valvular lesions in rhematic heart disease and its complications in nwfp-a prospective echocardiographic study of 226 cases

To study the pattern of valvular lesions in rheumatic heart disease and assess its complications echocardiographically. Design: This is on observational prospective echocardiographic study of 226 cases of rheumatic heart disease studied between August and November 1996. Setting: A diagnostic Cardiology Centre in private sector, in Peshawar, NWFP, Pakistan. Findings: Two hundred and twenty six cases of rheumatic heart disease from all over North West Frontier Province, were studied echocardiographically. Simultaneous mitral and aortic valve lesions were seen in 45% cases. Isolated mitral or aortic valve involvement was uncommon. Regurgitant valvular lesion were twice as common as the stenotic lesions. Operated rheumatic heart disease were 3.98% of total cases. Conclusions: Rheumatic heart disease with multiple valvular lesions is a common medical problem. Echocardiography plays a vital role in the evaluation of these patients

Falciparum malaria pregnancy diagnosed on marrow examination

A case report of a pregnant patient with febrile illness is presented. After repeated negative peripheral smear reports, falciparum malaria was diagnosed on examination of the bone marrow. Empirical antimalarial therapy for resistant falciparum malaria may be justified in such cases where other diagnostic possibilities have been excluded