Bedside manners: do we care?

Teaching bedside manner might prove to be one of the most challenging tasks in medical education as it is not easy to structure or formalise such training. Besides, the rigorous training process for acquiring clinical and technical skills often overshadows the humanistic aspect of medical care. The aim of this study was to assess the perception of final year medical students as well as the faculty regarding the teaching and practice of bedside manner including a brief evaluation of students' bedside manner. A cross-sectional study was conducted involving final year medical students from five medical colleges [n=193] and faculty from a single institution [n=29]. Sample was selected using systematic random or convenient sampling techniques. Data was collected using self administered, anonymous, structured questionnaire. Data were analysed using SPSS-17. While evaluating students' bedside manner, 85% of the students reported they always take consent while interacting with a patient whereas, only 17% of the faculty members agreed with this. Only 3% of the faculty members reported that students take care of privacy of patients and none of them thought that students reassure a patient during an encounter whereas the percentages among students were 76% and 48%, respectively. Though students thought they need to improve, majority [56%] of them was confident of their bedside manner. On the other hand, 83% of the faculty members rated students' bedside manner from fair to poor. A large proportion [69%] of the faculty members were not satisfied with the quality of teaching regarding bedside manner, reporting lack of focus on this particular aspect of medical care as the most important cause. Majority of the students [87%] believed doctors have a better bedside manner in private as compared to public hospitals. Students have an inflated evaluation of their bedside manner but majority felt a need to improve. A sharp contrast exists between students' and faculty's opinion regarding the practice of bedside manner by students. An outright lack of focus on bedside manner was reported as the most important cause for inadequate emphasis on teaching this particular aspect of medical care

Evaluation of procumbent and storage of medicine at rural health centers in district Chiniot

Objective: to assess the process of procurement and storage of medicines at rural health centers [RH Cs] in District Chiniot

Material and Methods: a cross-sectional study was conducted. All 5 RHCs in the District were included in the study and in charge of the RH Cs were interviewed on a prescribed questionnaire to assess the procurement of medicines. The condition of stores was assessed by a separate structured check list

Results: eighty percent of the officers in charge were Senior Medical Officers, 40% had post-graduation qualification and majority had 15-20 years' experience. 20% had less than 1 year experience in purchase. Forty percent had Pull and Push both drug procurement systems and 100% calculated their demand on the basis of average monthly consumption, buffer stock and review period basis. All procured major chunk of medicine through District Medical Store but purchase from local market and petty purchases were also made to meet the demand of the patients. Tender was called, and the rate contract was done by District Health Authority and all in charges submitted their demands and supply orders. Majority [80%] of them accepted the drug having more than 75% shelf life. Eighty percent had more than 1 drug store at their health facility and only 40% had got the store white washed annually. 100% maintained their stock by following FIFO and FEFO methods. Despite only 40% received budget in time, 80% utilized the budget 100% and only 60% faced some sort of audit paras. Custodian of RH Cs were dispensers at 100% RHCs. 60% in charges had got logistics management training for less than 2 weeks whereas none of the store keeper had got any such training. None of the store had adequate space i.e. 250 sq. ft. 20% stores had leaking roofs. 60% stores had pellets, shelves and racks. Space between stacks and wall was not present in any of these stores. In majority 80% stores the cartons were placed on the floor instead of on the racks. To maintain the cold chain and storage temperature of controlled items, functional refrigerator was present in 80% stores, whereas deep freezer was present in only 20% stores. Tripping and power supply failure is very important issue especially in rural areas. Generators were present in 40% RH Cs out of which 20% was not functional. Cleanliness was satisfactory in 100% stores. None of the store was white washed. Exhaust fans were not present in any of these stores. Direct sunlight was not coming into 80% stores. Cross ventilation was ensured in only 60% stores and 80% stores had separate cool place for temperature controlled items. At 100% RH Cs stock registers were maintained but stock was physically present as per record at only 20% RH Cs. Physical verification of stock by in charge, DOH or EDOH was conducted at 80% RHCs during the year. Major issues / constraints at RHCs were: delay in budget provision and rate contract, insufficient store space and difficulty in unloading the stock

Conclusion: these results indicate that although the in charges had successfully completed the process of procurement, yet there is need for logistics management training. As the store space is insufficient at all RHCs, there is need to build new medicine stores according to the international standards at all RHCs. Timely provision of efficient drugs at RHCs will decrease the morbidity and mortality in the rural commun1ty and will help reduce the poverty

Bullying among primary School children

Objective: to study different forms of bullying and its effects on primary school children

Material and Methods: this cross sectional study was conducted in three primary schools in Mozang and Samanabad areas of Lahore. Data was collected by interviewing each student using a structured questionnaire. SPSS 17.0 was used for data entry and analysis

Result: a total of 414 primary school children participated in the study. Seventy four percent of the students reported having being bullied in one form or the other. Frequency of bullying was higher among males than females. The major types of bullying were, teasing [37.5%], hitting [42, 7%], and calling names [34.9%]

Conclusion: bullying is an ever rising phenomenon in our society. It is a significant mental and social health problem in primary school children in Pakistan. It affects students' right to learn in safe and secure environment

Mobile phone usage among female college students

Objective: to assess the prevalence and patterns of mobile phone use among female college Students

Material and Methods: the colleges were selected by convenient sampling and grades were selected randomly. The study population was 332 female students. The data was collected using questionnaire. The research was carried out by the doctors of community medicine department of Fatima Jinnah Medical College Lahore

Results: three colleges having total of 332 female students were surveyed for this research purpose. A significant proportion of this study group [85.5%] was found to be using mobile phones. Monthly mobile phone expenditure of 31.3% students was 100-200 rupees. 38% students were sending less than 20 messages per day. Over 39.8% students used their mobiles for less than an hour per day. So far as features of the mobile phone and their use were concerned, text messaging was the most frequently used feature [63.6%]. 10.2% of the students were in the habit of using mobile phones during their classes whereas only 13.9% students contacted their parents through mobile more than once per day

Conclusion: the above research depicted extensive use of mobile phone among female college students. Majority of the students were not using mobile phone during the class .The students used mobile to chat with their friends through messaging and their expenditure and time spent on phone was reasonable. Few of the girls were using mobile to contact their parents

Prevalence of polycystic ovarian disease [PCOD] among female medical students

Objective: to estimate the prevalence of PCOD among female medical students

Material and Methods: across sectional study of 1st and 2nd year medical college students was undertaken to estimate the prevalence of PCOD. Data was collected through a self-administered questionnaire based on the clinical tool developed by Pedersen Sue et al. Obesity, longer and/or abnormal menstrual cycles, hair on upper lip, chin, breast, chest, back, belly, arms, and thighs, dark hair and acne were associated with the diagnosis of PCOD. Data was analyzed using SPSS and descriptive statistics were calculated. Chi-square or Fisher exact test were used to determine statistical significance at a=0.05

Results: a total of 391 students from 1st [75%] and 2nd [25%] year participated in the survey, The majority of the students were aged between 18-20 years [96%], originated from Punjab [79.1%], had less than 50,000 Rupees per month family income [57%] and lived in the hostel [60%]. Although the majority reported having normal menses [79.7%] with an average length of 25-34 days [56.7%], a significant minority reported one of the diagnostic criteria of PCOD especially fewer than 8 menstrual cycles per year [18.5%], acne [40%] and a coarse body hair pattern [41.8 %]. This pattern included coarse hair on the upper lip [20.8%], chin [13.1 %], breast [10.5%], chest [6.7%], back [2.3%], belly [13.8%], arms [10.5%] and thighs [11.8%]. A noteworthy portion also reported other signs and symptoms including being rated as overweight [25.4%], experiencing milky discharge from nipples [5.4%], suffering from anxiety or depression [67.9%] and thinning scalp hair [54.9%]. Historical indicators included a positive personal history of ovarian cysts [7.4%] and a family history of diabetes [39%] and ovarian cysts [12.1 %]

Conclusion: according to the clinical diagnostic criteria, 7.7% of female medical students in the sample population have PCOD validating the claim that PCOD is a common and under diagnosed endocrinopathy and highlighting the need for increased awareness, knowledge and appropriate treatment

Problems faced by lady health workers [LHWs] in Punjab province

Objective: to assess the problems faced by Lady Health Workers in Punjab province

Material and Methods: this cross-sectional study was conducted in 9 union councils of Punjab province. All 111 Lady Health Workers working in these nine union councils were included in the study and were interviewed on a structured questionnaire

Results: ninety two percent of the LHWs faced problems while providing services. Ninety five percent had salary related problems, seventy four percent had problems with supplies, and thirty two percent faced problems in community services, 44.1 % had difficulties with health facility liaison, 56.7% faced problems due to workload, 44.1 % had problems in traveling, 8.8% in supervision, 20.6% in monitoring, 9.8% in reporting, 29.4% in feedback, 36.3% in security; 14.7% faced problems due to harassment, 18.6% due to training deficiency and 32.4 % faced other problems

Conclusion: efforts must be focused to strengthen the program and increase the LHWs capacity as efficient health care workers by involvement of LHWs' own views and addressing the problems faced by them

audit of Acute Pain Service in Central, Saudi Arbia

A retrospective analysis of acute pain service [APS] was performed to look at the epidural and patient-controlled analgesia [PCA] with respect to their indications, duration and quality of pain control, dosage regimen and common side effects. This study was conducted in the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia. All APS monitoring forms, from the year 1994 to 2003 were collected. Every tenth PCA and epidural form was then randomly taken out and reviewed. From each sample form information concerning operation, analgesic modality [epidural or PCA], its duration, side effects and non-steroidal anti-inflammatory drug [NSAID] use was collected. Postoperative pain and sedation were monitored as 0=none, 1=mild, 2=moderate and 3=severe. For the first 24 hour of APS period, information was also gathered concerning duration of each pain score, highest pain score, sedation score and lowest respiratory rate. Informations of PCA [incremental dose, lock-out interval, back ground infusion, number of hours PCA not activated and total morphine consumed] and epidural infusion [concentration of mixture of local anesthetic with opioid and its volume consumed during first 24 hours] were also collected. A total of 10002 patients aged 16-74 years received APS; one third of them receiving epidural and two thirds receiving PCA. Eighty-five% of patients received APS after cesarean section and 7.8% received APS after abdominal hysterectomy. Acute pain service served 77% of total APS patients for 24-48 hours. The average duration of APS was 44.2 hours. For the first 24 hours, PCA and epidural was compared for severity and duration of pain. A pain score of zero was found for a longer period [average 19.6 hours] with epidural whilst; a pain score of 1 and 2 was observed for a longer period [average 11.4 and 4.0] with PCA. The mean highest pain score was 0.7 for epidural and 1.7 for PCA. Patients having no postoperative pain included 35.7% of the epidural analgesia group and 0.5% of the PCA group. The highest sedation score of one was found more often in the epidural group and a score of 2 was found more often in the PCA group. No case was documented where the respiratory rate was <12/minute. Most [51%] PCA patients were prescribed an incremental dose of 1.5mg of morphine with a lock-out interval of 10 minutes. Basal morphine infusion was used in 96% of PCA patients. Patient-controlled analgesia was not activated for the mean period of 13.2 hours in the first 24 hours postoperative period. Average total amount of morphine consumed by patients was 76.8 mg during the average total duration of 42.9 hours of PCA. Amongst patients who received epidural analgesia, 93.6% received the mixture of fentanyl [4 microgram/ml] and Bupivacaine [0.03%]. On average, 194 mls of epidural infusion was used in the first 24 postoperative hours. Overall, 35% of patients received NSAIDs along with APS and 12.6% of patients developed complications during APS. Complications were recorded in 25.6% of epidural patients and 4.4% of PCA patients. The most common complication was pruritis. In the past decade, APS has provided a safe and efficient service to over 10 thousand postoperative obstetric and gynecology patients. Epidural analgesia as compared to PCA provided superior analgesia but caused more frequent minor side effects. More resources are required to provide good quality APS to all eligible postoperative patients for the desirable period