Students' perspective of bedside teaching: a qualitative study

Objectives: To determine students' perception of bedside teaching, to find out barriers in its effective implementation and to suggest strategies to make it an effective learning tool

Methods: This study was conducted in Faculty of Medicine, Northern Border University Arar, Kingdom of Saudi Arabia between November 2013 and January 2014. The study design was qualitative inductive thematic analysis using transcripts from audio-recorded focus group discussions. Four focused group discussions with medical students of 4[th] and 5[th] year MBBS were conducted. Each 40 to 50 minutes discussion session was audio taped and transcribed verbatim. Thematic analysis extracted key themes pertaining to objectives of the study

Results: A total 75 students of 4[th] and 5[th] year MBBS took part in the study, 48 were female and 27 of them were male. Students believed that bedside teaching is valuable for learning essential clinical skills. They described many barriers in its effective implementation: uncooperative and less number of patients and faculty attitude. Our students suggested various strategies to address these barriers: promotion of awareness among general public about students' learning and its benefits, free medical treatment for expatriates and building of university hospital

Conclusion: Bedside teaching is an important learning tool. Its utility can be enhanced by orienting local patients' attitude towards importance of students' learning, by providing free medical treatment to expatriates and by including bedside teaching in faculty development programs

Risk factors for diabetic foot ulcer

Diabetic foot is one of the common complications of diabetes mellitus. Many risk factors are involved in its causation. This study was conducted to determine risk factors responsible for foot ulcer in diabetic patients. A total of 196 consecutive patients with diabetic foot were included in the study. Detailed history, clinical findings and investigations were recorded. Lesions were graded according to Wagner's classification, and appropriate medical and/or surgical treatment was carried out. Patients who did not consent to participate in the study, had established gangrene of the foot, or had any medical co-morbidity especially chronic heart failure and chronic renal failure which could influence these risk factors were excluded from the study. Data were collected on a special proforma for analysis. Out of 196 patients 80.1% were male. One hundred and forty-six [74.48%] patients were in the range of 40-70 years. Right foot was more commonly involved [65.3%], 91.3% patients had diabetes of more than 5 years duration. No treatment had been received by 47.4% patients while 41.3% were on oral anti-diabetics; 11.2% patients were on insulin. All patients had type 2 diabetes mellitus. Neuropathy was present in 51% patients, 62.8% had absent or diminished peripheral pulses, 43.4% had poorly controlled diabetes. According to the Wagner classification 30.6% patients had grade 1, 26.5% had grade 2, and 42.9% had grade 3 diabetic foot. Evidence of infection was seen in 85.7% patients; staphylococcus aureus was isolated in 43.4% patients. Osteomyelitis was present in 42.9% patients. Surgical intervention was performed in 85.7% patients. Direct relation was found between the duration of diabetes, sugar control, peripheral neuropathy, peripheral arterial disease, grade of diabetic foot, evidence of osteomyelitis, intervention and the outcome of the disease. Neuropathy, peripheral arterial disease, duration of diseases and underlying osteomylitis are the major risk factors and need to addressed while educating patients

Comparison of closed and open methods of pneumoperitonium in laparoscopic cholecystectomy

Pneumoperitonium is the first step in laparoscopic surgery including cholecystectomy. Two commonly used methods to create pneumoperitonium are closed and open technique. Both have advantages and disadvantages. The current study was designed to compare these two techniques in terms of safety and time required to complete the procedure. This was a randomized controlled prospective study conducted at Department of Surgery, Ayub Hospital Complex Abbottabad, from 1[st] June 2007 to 31[st] May 2008. Randomization was done into two groups randomly using sealed envelopes containing the questionnaire. Seventy envelopes were kept in the cupboard, containing 35 proformas for group A and 35 for group B. An envelope was randomly fetched and opened upon selection of the patient after taking the informed consent. Pneumoperitonium was created by closed technique in group A, and by open technique in group B. Time required for successful pneumoperitonium was calculated in each group. Failure to induce pneumoperitonium was determined for each technique. Time required to close the wounds at completion, total operating time and injuries sustained during induction of pneumoperitonium were compared in both techniques. Out of the total 70 patients included in study, 35 were in group A and 35 in group B. Mean time required for successful pneumo'peritonium was 9.17 minutes in group A and 8.11 minutes in group B. Total operating time ranged from 55 minutes to 130 minutes in group A and from 45 minutes to 110 minutes in group B. Mean of total operating time was 78.34 and 67 minutes in group A and B respectively. Mean time needed to close the wound was 9.88 minutes in group A and 4.97 minutes in group B. Failure of technique was noted in three patients in group A while no failure was experienced in group B. In two cases in group A minor complications during creation of pneumoperitonium were observed while in group B no complication occurred. No patient died in the study. We concluded from this study that open technique of pneumoperitonium was, less time consuming and safer than the closed technique

Carcinoma of prostate in clinically benign enlarged gland

Carcinoma of the prostate is one of the common tumours of old age in men. This cross sectional study was conducted to detect carcinoma of prostate in clinically benign enlarged gland and to evaluate the efficacy of Digital rectal Examination in detection of prostatic cancer in patients presented at Khyber Teaching Hospital, Peshawar from July 1998 to July 1999. Patients presenting with lower urinary tract symptoms over the age of 50 years were evaluated on English version of International Prostate Symptoms Score [IPSS], clinically examined and post-voiding residual urine determined on abdominal sonography. The selection criteria were; Severe IPSS, absence of signs of malignancy on Digital Rectal Examination [DRE] and post-voiding residual urine more than 100 ml. Thus a total 100 patients were selected for further study. Four ml blood was taken to assess Prostate Specific Antigen [PSA] level pre-operatively. All these patients underwent either transvesical prostatectomy or transurethral resection of prostate [TURP] and enucleated prostatic tissues were sent to histopathology. Eighty-five percent patients had PSA level up to 10 [eta]g/ml. PSA level of 15 [15%] patients were above 10n gm/ml out of which 13 [13%] patients were having PSA in range of 11-12 [eta]g/ml and two [2%] had PSA level between 20-25 [eta]g/ml. Histopathology report of 2% patients turned out as adenocarcinoma of the prostate. Out of 100 patients who were having clinically benign DRE findings, 2 turned out as Carcinoma of the prostate histologically

Re-do orchidopexy in a general surgical unit-reliability of clinical diagnosis and the outcome of surgery

Re-do Orchidopexy is not very common, expertise is limited and the results of clinical examination and ultrasonography are not always reliable. This cross-sectional study was based on medical records of patients under-going re-exploration of inguinal region for a missing testicle after previous groin surgery, and no mention of orchidectomy. All patients were thoroughly examined, investigated with ultrasonography and offered re-exploration. Results were graded as Good, Fair and Poor. Out of 11 boys included in the study, 7 [63.63%] had failed orchidopexy. Another 3 [27.27%] were opened for 2nd stage orchidopexy and 1 [9.09%] had iatrogenic ascent of testis after herniotomy. On clinical examination 4 [36.36%] had a palpable testicle at the superficial ring, 2 [18.18%] were in inguinal canal [1 doubtfull], and no testicle could be palpated in 5 [45.45%]. Ultrasonography picked up 2 testicles [18.18%] at the superficial Inguinal ring, 1 [9.09%] in Inguinal canal and 1 [9.09%] testicle in the abdominal cavity. On reexploration, 10 [90.9%] testicles were found and brought down, 7 [63.63%] being considered of reasonable consistency and size. Another 3 [27.27%] were considered soft or small in size, and in 1 [9.09%]], no testicle was found. In 5 patients [45.45%], the testicle was at superficial ring, in 3 [27.27%] in the inguinal canal, and in 2 [18.18%] in the abdominal cavity. Results were considered good in 6 [54.54%], fair in 3 [27.27%]] and poor in 2 [18.18%]. Groin examination after previous inguinal surgery is tricky. Ultrasonography is also not very reliable. Re-exploration via the inguinal approach is adequate and recommended. Thorough exploration is essential before declaring the testicle absent

Abdominal tuberculosis an experience at Ayub teaching hospital Abbottabad

Abdominal tuberculosis is one of the common diseases in our country. This study was performed at Surgical A Unit Ayub Teaching Hospital Abbottabad from August 2006 to December 2007 to asses the clinical presentation of abdominal tuberculosis and its management. All patients presenting to outpatient department with clinical feature suggestive of abdominal tuberculosis were included in the study. They were investigated. On the basis of clinical presentation, patients were divided in two groups. Patients with acute abdomen [peritonitis, intestinal obstruction] were prepared for laparotomy and operated upon. Required surgical procedure performed and tissue diagnosis was obtained. Patients with sub-acute obstruction, chronic pain abdomen and mass abdomen with out peritonism were managed conservatively. These patients were started on anti TB drugs on the basis of clinical and laboratory assessment. Empiric therapeutic trial was conducted for at least for 3 months with standard four drugs regimen. They were sent home on 9 month course of Anti TB drugs and were advised to come for follow up twice a month. On reassessment good clinical response was considered abdominal tuberculosis and anti TB continued with monthly follow up. In case of no response patients were operated. Required surgical intervention performed and tissue was taken to establish diagnosis. Detailed history, family history, examination findings, results of investigations, operative findings of the histologically proven cases of abdominal tuberculosis were recorded on a separate proforma and analyzed. Amongst 76 patients majority were females 52 [68.4%]. Most of the patients were young with mean age of 34 years. Abdominal pain was the most common presentation 73 [96%] followed by fever and anorexia. Tender lower abdomen as found in 53 [70%] patients and mass abdomen was found in 35 [46%]. Family history of TB was present in 20 [26%]. Fifty three [70%] patients underwent laparotomy. Bands and adhesion was the most frequent finding on laparotomy. Abdominal TB is more common in female and abdominal pain fever and nausea are the most common presentations