Student's perceptions of educational environment across multiple undergraduate medical institutions in Pakistan using DREEM inventory

To objectively assess whether the medical education environment across Pakistan was at an acceptable standard and to determine factors influencing its perception. The cross-sectional study was conducted from August to November 2012 at six undergraduate medical institutions across Pakistan. The Dundee Ready Education Environment Measure [DREEM] inventory having five subscales of perceptions of learning, teachers, atmosphere, academic self-perceptions and social self-perceptions was administered anonymously to all the consenting medical students. Data was analysed using SPSS 17. Of the 3045 questionnaires distributed, 2084[68.4%] were returned duly filled. Of all the respondents, 1311[63%] were females. Overall mean score found positive was 105.0 +/- 25.8 [Max: 200]. Corresponding scores in the subscales were: student's perception of learning 25.1 +/- 7.2 [Max: 48]; social self-perception 15.4 +/- 3.9 [Max: 28]; academic self-perception17.2 +/- 6.5 [Max: 32]; perception of teachers being in need of some re-training 22.5 +/- 7.1 [Max: 44]; and perception of atmosphere as having many issues needing a change 24.8 +/- 7.0 [Max: 48]. Female students and pre-clinical year students perceived environment as more positive than male students [108.6 +/- 23.0 vs. 98.8 +/- 28.9 [p<0.001]] and students belonging to clinical years [108.0 +/- 24.0 vs. 03.3 +/- 26.5 [p<0.001]]. Highest score was found in the domain of student's social self-perceptions and lowest in the domain of student's perception of teachers. Results can be used as a basis for planning and executing remedial measures needed to improve undergraduate medical education environment in Pakistan

Depression in rheumatoid arthritis and its relation to disease activity

To determine the level of depression in Rheumatoid Arthritis and its relationship with severity of Rheumatoid Arthritis. This cross sectional analytical study was conducted from March 2014 to May 2014. Total 102 cases of Rheumatoid Arthritis [RA] diagnosed as per ACR [American College of Rheumatology] 1987 criteria were enrolled from Rheumatology Department, Fatima Memorial Hospital. Severity of Rheumatoid Arthritis was assessed by Health Assessment Questionnaire [HAQ] and disease activity score [DAS - 28] while severity of depression was measured by Beck Depression Inventory [BDI] scale II questionnaire. The relationship between depression and disease activity [severity] of Rheumatoid Arthritis was assessed by calculating correlation coefficient between depression, disease activity score [DAS 28] of Rheumatoid Arthritis and health assessment questionnaire [HAQ]. Out of 102 patients, 77 [75.5%] were females and 25 [24.5%] males. The mean age of patients was 43.5 +/- 11.9 years and the mean duration of disease was 7.8 +/- 5.5 years.71.5% of Rheumatoid Arthritis patients were found to have some degree of depression and this was directly related to the severity of disease. Moderate and severe depression were present in 23 [22.5%] and 19 [18.6%] patients respectively. In this study, almost three-fourths of Rheumatoid Arthritis patients were found to have depression. There was a strong association between Rheumatoid Arthritis disease activity and the level of depression. So it is imperative for clinicians treating Rheumatoid Arthritis patients to screen them for co morbid depression and manage it accordingly

Health ethics education: knowledge, attitudes and practice of healthcare ethics among interns and residents in Pakistan

To assess the knowledge, attitudes, and practices among interns and residents about healthcare ethics in an attempt to assist in development of ethics curriculum in Pakistan. Four hundred respondents comprising of interns, junior and senior postgraduate trainees were recruited from two Public sector teaching institutions in different provinces of Pakistan for this cross sectional study. A self- administered questionnaire was used to collect data. Data was analysed using SPSS-17. More than half of the respondents in all three groups encountered ethical problems on daily basis. These ethical issues were being discussed with the clinical supervisor in only 25% of the instances. Unethical behaviour of seniors towards junior doctors and patients were observed by more than three quarter of the respondents. A very high proportion of respondents [57%] had no knowledge of code of ethics of Pakistan Medical and Dental council. Helsinki declaration was known only to a few individuals. There were difference between interns, junior and senior residents with respect to their views about adherence to patient's wishes, paternalistic attitude of physicians, treatment of children without parental consent, euthanasia, confidentiality and treatment of noncompliant patients. Junior doctors representing different levels of training in Pakistan face ethical dilemmas on a regular basis but their current teaching and training in ethics is insufficient to help them deal with these competently.

Reliability of the ICD-10 international personality disorder examination [Urdu translation]: a preliminary study

To test the reliability and applicability of Urdu translation of the International personality disorder examination [IPDE] in a psychiatric outpatient population in Pakistan. This study was conducted at the outpatient department of Fatima Memorial Hospital Lahore from April 2012 to March 2013. Patients considered to have a personality disorder by a psychiatrist were initially screened by the IPDE screening questionnaire. Those who scored positive on screening were evaluated in a detailed interview using IPDE. Two interviewers conducted the interviews simultaneously, to ensure inter-rater reliability. For translation, permission was taken from World Health Organization. Linguistic equivalence was assessed through back- translation and conceptual equivalence through opinion of mental health experts. The final Urdu draft was obtained after incorporating modifications suggested by experts following a feasibility study. The analysis was carried out using SPSS v.20. Out of 30 enrolled patients, 25[83.3%] were females. The mean age of the sample was 28.5 +/- 6.08 years. Majority of patients had more than one personality disorder. Most prevalent personality disorder was emotionally unstable borderline type with a phi correlation of 0.831, followed by emotionally unstable impulsive type and anankastic personality disorder with phi correlations of 0.930 and 0.867, respectively, for definite cases. Correlation coefficient for dimensional scores between the two raters was 0.392 for paranoid personality disorder, 0.842 for anankastic and around 0.9 for the rest of the personality disorders, each. Urdu translation of IPDE is a reliable tool to screen and diagnose personality disorders in population of Pakistan

Educating tomorrow's doctors: a cross sectional survey of emotional intelligence and empathy in medical students of Lahore

Medical education in Pakistan traditionally emphasizes physician's biomedical knowledge with less emphasis on interpersonal skills and ability to relate to the patients. This study explored the emotional intelligence and empathy of undergraduate medical students and investigated its relationship with various factors to act as baseline for future work in this area. The Schutte Emotional Intelligence scale and Davis' Interpersonal Reactivity Index in addition to socio demographic questionnaire were administered to first year and final year medical undergraduates of two medical Institutions in Lahore, Pakistan. Data was analyzed by using SPSS 17 version. The overall mean scores for medical students both on emotional intelligence and empathy is significantly lower than that found in previous literature, highlighting that medical students do not appear to fare better than average people in EQ. Women showed statistically significant higher scores on Appraisal of emotions, Regulation of emotions, Empathic concern Scale and Personal distress scale. Comparison of EI and IRI of students according to medical college year did not show any statistical significance. Current medical curriculum and training in Pakistan does not appear to increase EI abilities which are building blocks that may allow students and residents to develop competence. Medical educators in Pakistan should look for ways to incorporate emotional intelligence in medical curriculum which will ultimately contribute towards patient centered practice, patient satisfaction as well as effective communication skills

Children's mental health: pattern of referral, distribution of disorders and service use in child psychiatry outpatient setting

To determine the pattern of referrals, socio-demographic factors, frequency of psychiatric diagnosis, and help offered to children presenting in Child Psychiatry Department outpatient clinic of a tertiary care hospital in Lahore. A cross sectional study of children attending child psychiatry outdoor in a tertiary care hospital in Lahore was conducted. Following informed consent from the parent/ legal guardian, 1000 consecutive new referral to the department were assessed by interviewing the parent and the child. A Structured proforma was used for data collection. ICD-10 criteria were used for the diagnosis of psychiatric illness. Record was made of the interventions offered to the child and family.Total sample size was 1000 children with predominant male gender [65%] and mean age of 8.46 [S.D 4.51].More than half [54.5%] of the children in our sample were not enrolled in school and 19% had family history of psychiatric illness. Among the various sources of referral, self-referral was the highest [84.7%] followed by referral from Pediatrics [8.4%]. Psychiatric diagnosis observed were Speech Related Difficulties [including speech delay, articulation problems and specific developmental delays of speech and language [46.5%], Learning Disability [43.3%], Behavior Problems [26.3], Epilepsy [12.6%], Dissociative Disorders [10.1%], Attention Deficit Hyperactivity Disorder [4.5%], Autism [3.2%], Depression[2.4%], Anxiety[1.7%], Psychosis [1%] and Tics [1%]. Co-morbidities were found in 44.7 percent of the children. The various interventions offered included medications, referral to psychologist [for family therapy and individual work], play therapist and speech therapist. Majority of children presenting to the child psychiatry clinic have multiple and complex needs due to high frequency of learning disabilities and co morbidities. The findings illustrate the importance of multidisciplinary approach and to assess the different dimensions of psychopathology in children for future service planning

Brain drain: a harsh reality, international migration of Pakistani medical graduates

To explore final year students and fresh graduates' intentions to train abroad, identify the influencing factors for this decision and understand their attitudes towards conditions in Pakistan and abroad. Following informed consent, respondents were asked to complete a self administered structured questionnaire to collect demographic and educational information, their plans for post graduation training abroad, factors influencing decision to migrate abroad or stay in Pakistan as well as attitudes towards prospects in Pakistan and abroad. Data was entered and analyzed by SPSS 17.0. Among the 275 respondents, 176 [60.4%] intended to go abroad for postgraduate training. Professional excellence [25.5%], easier career settlement [10.2%] and financial prosperity [7.6%] were some of the goals respondents wish to achieve through training abroad while required process of certifications i.e exams and tests [37.5%], expenses [24.4%] and visa problems [21.5%] were identified as barriers for migration abroad. Agreement among various groups [general public, patients, healthcare institutions, academic community] considering doctors trained abroad as more qualified than doctors trained in society and government attitude towards doctors as well as living standards in Pakistan. Positive attitudes were identified towards doctors' status, living standards, and ability to cope with working conditions, political and social circumstances abroad. A significant percentage of medical graduates intend to migrate abroad for post graduate training. Apart from better economic prospects, unhelpful view towards conditions in Pakistan also contribute for increasing trend of migration among physicians from our homeland

Audit of in patient prescriptions in psychiatry ward in a teaching hospital

An audit of inpatient prescriptions in a Psychiatric ward in a teaching hospital was conducted. Audit identified important shortcomings in prescription writing and recording. Intervention resulted in significant improvements in most of these areas. It is concluded that continuous evaluation and feedback by means of regular audits can be used as an effective tool in improving prescriptions writing and thus indirectly patient care in our setup

Unhappy doctors in Pakistan: what are the causes and what can be done?

To determine if the general perception of doctors being unhappy is true as well as to explore the underlying causes for this phenomena. This is a cross sectional study that was conducted over a six months period in two tertiary care hospitals in Lahore. Data was collected by using a structured questionnaire. Demographic information and data assessing perception of overall physicians being unhappy in Pakistan, and their own personal level of satisfaction in life was collected. Possible reasons for unhappiness among doctors from a list of factors was also explored. Finally the respondents were asked about their intentions for near future of remaining/ leaving Pakistan. The data was analyzed by using the statistical package for the social sciences [SPSS version 17]. Six hundred and one [49% males] with the mean age of 28 years [s.d 5.95] participated in a self-reported survey. Majority of the participants [393; 65%] were junior doctors. Fifty nine percent of respondents believe that overall Physicians in Pakistan are unhappy. When asked directly about their own level of unhappiness, respondents gave almost equivocal reply [43% dissatisfied vs 42% satisfied]. Low pay [87%], increase workload [73%], no positive feedback [70%], job insecurity [64%] and poor mutual support [47%] being the most significant causes responsible for this unhappiness. High proportion of doctors [55%] would prefer to be in any other country than Pakistan. This study demonstrated that unhappy doctors are a worldwide phenomenon, Pakistani Doctors being no exception. High proportion of doctors intending to leave Pakistan is a source of concern for the health services. We need to accept the causes and take steps to address the issues identified

Study of anxiety and depression during pregnancy

To find out the prevalence of anxiety and depression symptoms during pregnancy. The sample of one hundred pregnant women was screened while waiting for their prenatal visit in obstetric clinic of FMH [Fatima Memorial Hospital]. They were eligible for the study if they were pregnant and giving consent. Control group [n=100] was taken from non pregnant women matched on age, education, marital status and monthly income. This was cross-sectional study and the convenience sampling [non-probability sampling] technique was used. The study was spread over the period of six months. A brief questionnaire for collecting demographic information was used. DSM-IV criteria for assessing past psychiatric illness were also used by the researcher. HADS [Hospital Anxiety and Depression scale] was used to assess anxiety and depressive symptoms. Of one hundred pregnant women 39% and 18% scored above cut-off on anxiety and depression scale respectively. Among control group the percentage for anxiety and depression was 28% and 12% respectively. Seventeen percent of pregnant women reported receiving psychiatric [pharmacological or psychotherapy] treatment for psychological issues. The T-test results showed significant difference between two groups regarding anxiety and depression. Pregnant women experience more anxiety and depression as compared to their closely matched counterparts and most of them are not being monitored during this time. More work is needed for detection, referral and treatment of anxiety/ depression during pregnancy. Clinical studies for maternal mental health and fetal consequences are also needed

stigmatization of psychiatric illness: what attitudes do medical students and family physicians hold towards people with mental illness?

To examine the attitude and opinions of doctors and medical students towards people with mental illness. It is a cross-sectional survey carried out at Mayo Hospital and Fatima Memorial Hospital Lahore Pakistan, from May-July 2006. An anonymous Questionnaire based on previous research in this area was distributed among Family Physicians attending a CME programme, House Officers in four units of a Teaching Hospital, as well as Medical Students. Four hundred thirty four of 500 questionnaires were returned [86.8%]. Schizophrenia, mania, alcohol and drug addiction produced more negative responses than other disorders and more than 60% respondents considered people with these illnesses as dangerous. For depression, anxiety, alcohol and drug addiction, around half the respondents considered that people were to blame for their problems or that they can pull themselves together. People with dementia and schizophrenia were considered to have the worst long term prognosis. Almost 98% of sample felt that psychological factors play an important role in physical illnesses and 383[88.2%] agreed that management of emotional issues is a medical responsibility. This study showed that there were more stigmatizing views towards people with mental illness in our country's medical professionals than in other countries and even in comparison to general public in developed world. Comparison with other groups in our country would be useful in planning how to reduce the stigmatization of people with mental illness

Do pharmaceutical companies selectively report clinical trial data?

Many studies have shown that there is an association between a positive outcome of clinical trials, economic analyses and systematic reviews, and funding by the manufacturer of the drug of interest. Selective reporting of clinical trial data has been suggested as one of the possible explanations of this so-called funding bias. We conducted a review of the literature to find out if there is any evidence that this selective reporting of clinical trial data occurs. We report the several systematic reviews and cross-sectional surveys, and many case studies of this phenomenon that we found in the medical literature. We searched Medline, Embase and PsycINFO databases for this study besides hand searching BMJ from January 2003 to November 2005. We included systematic reviews, cross-sectional surveys, letters, editorials, comments or news items that referred to actual incidences of withholding, suppression, selective release or selective publication of clinical trial data by pharmaceutical companies