simplified MCQs interpretation guide for faculty

To devise a guide for faculty to interpret Psychometric Analysis of MCQs followed by its assessment. A cross-sectional study. Shifa College of Medicine, Islamabad, from January to July 2009. A simplified interpretation guide comprising of a visual format and an interpretive summary was designed for faculty members to help them understand the item analysis of the MCQs in an uncomplicated way. A feedback from the faculty was obtained after administration to see the results. Eighty five percent of course coordinators [n=14] agreed that they could understand the MCQ analysis. Eight percent [n=3] faculty strongly, while 82% [n=13] agreed that analysis is helping them to refine the process of MCQ making. Forty five percent [n=7] faculty agreed that analysis of MCQ was helpful in identifying knowledge gaps in students. All the course coordinators agreed that they found the revised format easy to understand. The faculty found the interpretation guide for MCQs user-friendly and helpful

Creating a case activity: an innovative strategy to promote student centered learning

Objective: To innovate a classroom strategy which involves students actively and at the same time not resource intensive

Study design: A Prospective observational single cohort study

Methodology: We designed "CREATING A CASE" activity for our third year students during their respiratory module. Two sessions were arranged for this activity comprising of 42 students each. Students were divided into three groups of 14 and were asked to write a fictitious case detailing the history, physical examination and epidemiology of a patient with community acquired pneumonia using their basic science knowledge from previous years and present their cases to whole class. The facilitator noted salient features from each presentation and subsequently summed up the cases. At the end students completed a survey with 12 statements rated on a Likert scale and answered two open ended questions addressing their perceptions about CACA when compared with other learning strategies

Results: Majority of the students found this activity to be less stressful and helpful in integrating the basic and clinical science knowledge with clarification of concepts

Conclusion: "Creating a Case" activity [CACA] was well received by students. It can be employed successfully for integrating knowledge and promoting small group learning without major logistic requirements

Biochemical pattern of liver function tests in hepatitis E epidemic

To evaluate the biochemical pattern of liver function tests in acute hepatitis E epidemic. Cross sectional descriptive study. Department of Pathology Army Medical College, Rawalpindi from June '09 to Dec '09. A total of 81 patients of acute hepatitis of all age groups, both male and female were included in the study. Patients who reported with symptoms of acute hepatitis and tested positive for hepatitis E IgM antibody were included. Detailed history, clinical examination and serial liver function tests [LFTs] were carried out. Weekly data of LFTs was arranged serially up to 4 weeks. The results were analyzed on SPSS version 17. The patients' age ranged from 17-59 years. Serum Alanine Transaminase [ALT] values were highest in the first 2 weeks reaching 100 times the upper limit of normal [ULN]. Similarly serum total bilirubin [TBil] reached up to 8 times ULN in the 1st week. The increase in serum alkaline phosphatase [ALP] was 2 times ULN and then returned to within the reference range in the 3rd and 4th weeks before other variables. Serum albumin levels remained unchanged. Prothrombin time [PT] was found to be prolonged. Two cases ended up fatally. Rest recovered fully and became symptom free. Hepatitis E is a serious clinical condition. LFTs play an important role in its diagnosis. There is marked derangement of LFTs. Sharp rise in serum ALT up to 100 times ULN is a significant feature and should raise the suspicion of acute Hepatitis E

Percutaneous tracheostomy in critically ill patients: 24 months experience at a tertiary care hospital in United Arab Emirates

We assessed the safety and complications related to percutaneous tracheostomy [PCT] without bronchoscopic guidance in our intensive care unit [ICU]. The prospective data over a period of 24 months were collected for patients who underwent PCT. Major, minor and long-term complications were recorded. The parameters recorded were: age, gender, Glasgow Coma Scale / [GCS] score on the day of tracheostomy, acute physiology and chronic health evaluation II [APACHE] score, and predicted mortality based on score on admission and on the day of procedure, total number of days in the hospital before the final outcome, number of successful decannulations and mortality. The patients were stratified in two groups of survivors and nonsurvivors. A total of 117 patients underwent PCT. Overall mean GCS and APACHE-II scores before PCT were 7 +/- 3 and 16 +/- 5, respectively. The only significant difference was APACHE-II score and the predicted mortality based on APACHE-II score on the day of PCT, which was higher amounts the nonsurvivors [P=0.008 and P=0.006]. All 57 [495] survivors were successfully decannulated with mean post tracheostomy days of 24 +/- 15. The major complication observed was three episodes of major bleeding. Only six patients had an episode of desaturation during the procedure and there were three episodes of accidental puncturing of endotracheal [ET] tube pressure cuff. During subsequent follow-up in hospital, six patients developed stoaml cellulitis. PCT without bronchoscopic guidance can be performed safely by carefully selecting patients and having an experienced team High APACHE score on the day of procedure may lead to poor outcome

Efficacy and safety of total dose infusion of low molecular weight iron dextran in the treatment of iron deficiency anemia during pregnancy

To determine the efficacy and safety of Total Dose Infusion [TDI] of low molecular weight iron dextran for the treatment of iron deficiency anemia compared to oral iron replacement during pregnancy through improvement in hemoglobin [Hb] after intervention. Non-randomized control trial. Section of Gynaecology and Obstetrics, Shifa International Hospital and Shifa Community Health Centre, Islamabad during January 2005 to January 2006. A group of 100 pregnant women with gestational age greater than 12 weeks with confirmed diagnosis of iron deficiency anemia attending the antenatal clinics were enrolled in this study. Total dose iron infusion of low molecular iron dextran was given to these patients after calculating iron deficit, in a monitored in-patient setting. Control comprised of a second group of 50 pregnant females matched for age, parity and baseline hemoglobin, tolerant to oral iron supplementation [ferrous sulphate 200 mg three times a day] attending the antenatal clinics during the same period. Post-treatment hemoglobin levels of study group as well as the oral control group were determined between 3 to 4 weeks. In the intervention group, mean pre-infusion hemoglobin level was 8.57 +/- 0.9 gm/dl [range 5-10.5gm/dl] and mean post-infusion Hb was 11.0 +/- 1.1 [range 8.4-14. 3 gm/dl]. In control group, mean pre-oral intake Hb level was 9.5 +/- 0.9 gm/dl [range 7-1 0.5 gm/dl] and mean post-oral intake Hb was 10.2 +/- 1.2 gm/dl [range 6.4-1 2.8 gm/dl]. Mean increase of Hb in intervention group was 2.43 gm/dl [95% Cl 2.4 - 3.8] and for controls it was 0.7 gm/dl [95% Cl 0.6-2.3]. Flushing and palpitations were observed in 4% of interventional group patients and none in the control group. No significant adverse reactions were observed in either group. We conclude that the total parenteral iron replacement with low molecular weight iron dextran is an effective and safe method for the treatment of iron deficiency anemia in a selected group of pregnant women

Initial experience with an intensive care hyperglycemia protocol in a Saudi Arabian intensive care unit

To study the efficacy of nurse-driven intensive glucose management protocol in an intensive care setting. This cohort study took place at King Abdul-Aziz National Guard Hospital, Al-Hasa, Saudi Arabia from April 2005 through June 2005. We modified a validated nurse-driven glycemic protocol when glucose level was >11.1 mmol/L. Protocol was applied to 103 consecutive patients. Three months after implementing the protocol, we analyzed the glucose control and relevant patient variables. To check the efficacy, glucose values were compared with patients admitted consecutively 2 months prior to the implementation of the protocol. Duration and mean insulin infusion rates were also recorded. A brief nursing survey was also conducted. The median blood glucose upon ICU admission was 8.7 mmol/L [interquartile range 6.9 -12.05]. Our cohort included 45 patients with history of diabetes while the remaining 58 were non-diabetics. Mean blood glucose decreased from 10 +/- 4.4 mmol/L on admission to 8.2 +/- 1.8 mmol/L for the duration of ICU stay. Protocol was effective in both diabetics and non-diabetics. Insulin infusion was employed in 33 patients. Median insulin; infusion rate required throughout the ICU length of stay was 4.3 units/hour. Duration and rate of insulin infusion were not statistically significant between diabetics and non-diabetics. The glucose control was significantly better when compared with the prior practices of glucose control. Our study demonstrates that nurse-driven hyperglycemia protocol were manageable to be used in critically ill patients. Moreover, the protocol is equally effective in both diabetic and non-diabetic patients

Whole lung lavage with intermittent double lung ventilation. A modified technique for managing pulmonary alveolar proteninosis

Whole lung lavage is still the most effective treatment for pulmonary alveolar proteinosis. We report a 21-year-old male diagnosed with pulmonary alveolar proteinosis by open lung biopsy and who underwent whole lung lavage with a modified technique. He showed significant improvement in clinical and functional parameters. The technique of intermittent double lung ventilation during lavage procedure keeps the oxygen saturation in acceptable limits in patients at risk for severe hypoxemia and allows the procedure to be completed in a single setting