Clinical Profile and Quality of Life of Incident Hemodialysis Patients

Hemodialysis is the most commonly used treatment modality for end stage renal disease. A 6 months observational study was conducted in the Dialysis unit of Kasturba Hospital, Manipal to study the clinical profile, quality of life with the help of KDQoL SF 36 questionnaire and factors affecting quality of life of hemodialysis patients. A total of 45 participants were included who initiated dialysis in the year 2018 and 2019 and were receiving dialysis in our hospital. Out of 45 participant 77.8% were males and 22.2% were females, the mean age was 55.29 (11.29) years. 23 patient-initiated dialysis in the year 2018 22 patients-initiated dialysis in the year 2019. The prevalence of hypertension, diabetes mellitus and cardiovascular diseases in this population were found to be 95.2%, 35.6% and 8.9% respectively. The mean scores of the sub scales were analyzed with the help of scoring manual and descriptive statistics. In the result it was found the hemoglobin, intradialytic weight gain were found to be positively correlated with the Physical component summary (PCS) and Mental component summary (MCS). Effects of kidney disease was found to be very strongly and positively correlated with dialysis vintage. In the result of the study due to its smaller population we cannot determine more factors which were affecting the Quality of life scores.

Midazolam as an adjuvant in supraclavicular brachial plexus block

Background and Aims: Brachial plexus block is a useful alternative to general anaesthesia. Postoperative analgesia is an added advantage. Midazolam, a water soluble benzodiazepine has been used by various routes to prolong analgesia

The present study was undertaken to assess the analgesic efficacy of midazolam with bupivacaine in brachial plexus block

Methods : A prospective, randomized, double blind study was done at Karnataka Institute of Medical Sciences [KIMS], Hubli [India], from 01 March 2008 to 01 March 2009, on 50 adult patients of ASA1 and 2, aged between 18-65 years and scheduled for various upper limb surgeries. Patients were divided into two groups of 25 each. Group B received 30ml of inj. bupivacaine 0.5% +2ml normal saline and group BM received 30ml of inj. bupivacaine 0.5% + inj. midazolam [preservative free] 0.05mg/kg. Patients were observed for sedation, respiratory depression, pulse rate, SBP, DBP, duration of motor block, duration of pain relief and occurrence of any complications

Resutls: Post operative analgesia was significantly longer [805.04 175.75 min] in group BM, as compared to group B [502.24 52.68 min] with p value <0.001. Pain score was significantly low in group BM [mean 1.6], compared togroup B [mean 4.92] at 12 hours postoperatively. Onset of sensory block was 8.36 3.58 min and 8.52 4.18 min in group B and groupBMrespectively with p value >0.05. Hence there was no statistically significant difference. Onset of motor block in group B was 9.96 5.69 min and in group BM 7.92 5.68 min. and p value was >0.05 min. Hence there was not statistically significant difference Mild respiratory depression and sedation occurred intraoperatively in groupBMwhich required no active intervention

Addition of midazolam 50mcg/kg to 30ml of bupivacaine 0.5% for supraclavicular brachial plexus block prolonged sensory blockade and post-operative analgesia without increasing the risk of adverse effects

Implementation and evaluation by formal assessments and term end student feedback of a new methodology of clinical teaching in surgery in small group sessions

The existing clinical teaching in small group sessions is focused on the patient's disease. The main dual limitation is that not only does the clinical skill testing become secondary but there is also a slackening of student involvement as only 1 student is evaluated during the entire session. A new methodology of small group teaching being experimented shifted the focus to testing students' clinical skills with emphasise on team participation by daily evaluation of the entire team. The procedure involved was that the group underwent training sessions where the clinical skills were taught demonstrated and practiced on simulated patients (hear-see-do module). Later the entire small group, as a team, examined the patient and each student was evaluated for 1 of 5 specific tasks--history taking, general examination, systemic examination, discussion and case write-up. Out of 170 students, 69 students (study) and 101 students (control) were randomly chosen and trained according to the new and existing methods respectively. Senior faculty (who were blinded as to which method of teaching the student underwent) evaluated all the students. The marks obtained at 2 examinations were tabulated and compared for tests of significance using t-test. The difference in the marks obtained showed a statistically significant improvement in the study group indicating that the new module was an effective methodology of teaching. The teaching effectiveness was evaluated by student feedback regarding improvement in knowledge, clinical and communication skills and positive attitudes on a 5-point Likert scale. Psychometric analysis was very positively indicative of the success of the module.