Informed consent for surgery: do our current practices conform to the accepted standards?

A qualitative investigation was undertaken to determine and analyse the pattern of existing practices regarding informed consent for surgery at PIMS, Islamabad. Adult postoperative patients who had undergone surgical interventions were randomly selected face-to-face with the help of a team of junior doctors. A questionnaire was employed for data collection and the responses of the patients to the questions regarding various attributes of the consent process were analysed. Overall inadequacy existed in the prevailing practices. There is a need to revisit the consent related practices and make the process more informed and adequate. Instead of taking it as a casual formality, our doctors should regard it as an equally important exercise equivalent to other components of care such as the surgery itself

Postgraduate medical education: residents rating the quality of their training

To determine the residents' rating of the quality of their residency training by measuring their level of satisfaction with the various educational attributes of their training. Cross-sectional survey. Department of Medical Education [DME], Pakistan Institute of Medical Sciences [PIMS], Islamabad, from September to November 2008. Residents who had been pursuing residency training for over a period of one year were included. A comprehensive questionnaire consisting of 14 questions was employed which covered fundamental attributes of the quality of postgraduate training. A five point response scale was used to rate responses to questions. Results for each of the measures of all the included residents were added up, and then an average was calculated and scaled to a score out of 100 to form the Index Score. In this way the residents' level of agreement or disagreement with the questioned statement was measured from 'Strongly disagree' [0%] to 'Strongly agree' [100%]. Out of a total of 150 residents contacted, 109 answered the questionnaire. The response rate was thus 73%. Residents variably rated the various educational attributes of their residency training. Relatively favourably rated areas included regular conduct of case/ topic discussions [75.96%], consultant's supervision during interventional procedures [70.27%] and regularly holding journal clubs [69.54%]. The less favourably rated areas included constructive feedback by supervisor [54.49%], consultant as role model [54.49%] and faculty as the source of learning [50.82%]. Overall, the Index Score was 60.55%. Significant room exists for improvement in the quality of residency training as indicated by the less than desirable ratings of the various educational attributes of the residency programme. Faculty members who constitute the cornerstone of educational process are pivotal to effect the desired improvements

Residents-perceptions of their working conditions during residency training at PIMS

To determine the residents Persephone of their current working considerations by measuring their level of satisfaction with the existing pattern workload, working environment and residential / financial standards. Cross-sectional survey. The Department of Medical education, Pakistan Institute of Medical sciences [PIMS], Islamabad, during Sept. and Oct 2008 Residents of different specialties who had been undergoing residency one year were indicated. A questionnaire was employed which addressed three components of residency program including workload, working enorronment anal financial and residential as pear of training. Supplement question regarding impression of the overall working environment was asked. A five point response scale was used to rate responses to the questions in each of the three components of residency programme. Response rate was 73%. Among the 109 respondents, 74 [68%] were males while 35 [32%] were females. Seventy three [67%] were pursuing FCPS and 36 [27%] were pursuing other degree programmes including MS, MD, MCPS and M.Phil. The age range was 25 to 41 years with a mean of 31.60 +/- 4 years. Working environment was the highest rated area with index score of 67%. Financial and residential aspect of training was the lowest rated area with a score of 37%. Workload's index score was 46.78%. The overall working index score was 26.23%. Residents perceived marked problems with their working conditions as indicated by their unfavourable ratings of the various components of the residency programme. There were problems with workload, duty hours, working environment, income and accommodation. Further research is needed to confirm and improve upon these results

Role of cerebrospinal fluid diversion in posterior fossa tumor surgery

To assess the role of cerebrospinal fluid diversion in posterior fossa tumor surgery. Design: Descriptive study. Place and Duration of Study: This study was conducted at the Department of Neurosurgery, Pakistan Institute of Medical Sciences [PIMS], Islamabad from February 2000 to July 2002 over a period of two and-a-half years. Subjects and Clinical, radiological and operative records of the patients who were operated for posterior fossa tumors were studied. Absolute and relative frequencies of the patients who were managed with external ventricular drainage [EVD] or ventriculoperitoneal shunt [VPS] were determined. Mean age and male to female ratio were also noted. There were 48 patients who were operated for posterior fossa tumors. Mean age was 23 years. Male to female ratio was 1.2:1. VPS was done in 14 patients [29%] pre-operatively, in one patient [2%] per-operatively and in 2 patients [4%] postoperatively. EVD was done in 33 patients out of whom 2 patients were shunted post-operatively. Sixty-five% of the patients remained shunt-free. Although management of hydrocephalus secondary to posterior fossa tumors is controversial, majority of the patients need temporary cerebrospinal fluid diversion

Neurenteric cysts: rare cause of spinal and radicular pain

Neurenteric cyst is a rare condition and usually gets diagnosed only when patients are investigated for neurological deficit. It can present with acute excruciating local pain mimicking spinal tuberculosis. It can also present with insidious low intensity pain mimicking chronic backache due to spondylosis. We report two cases of neurenteric cysts operated in our center over the past ten years. One patient presented with severe neck pain while other with backache and dysesthesia of the left leg. Both of them got diagnosed when they developed quadriparesis and paraparesis respectively. Both of them after excision of the cyst had excellent recovery. These cases are reported here to highlight the presentation of neurenteric cyst with pain. CASE-I: An 8 years old girl was presented with severe neck pain. On her initial presentation she did not have any neurological deficit. Because of the severity of pain, tuberculosis of the spine was suspected and MRI was done which showed well circumscribed hypodense intradural lesion on T-I weighted image at C4-5 level. It was not possible to decide on MRI whether it was lying in an intramedullary or extramedullary location. She was advised surgery but the parents declined. She presented 3 months later with quadriparesis. Cervical laminectomy was performed and an intramedullary cyst was encountered containing yellowish fluid, which was aspirated and complete excision of the cyst was done. Histopathology report showed a cyst wall lined by cuboidal epithelium on collagen fibrils, diagnostic of neurenteric cyst. CASE-II: A 38 years old lady was presented with two weeks history of progressive spastic paraparesis. She had a 2 years history of backache, pain and dysesthesia of the left leg, which was resistant to treatment. She was advised CT myelogram which revealed a well circumscribed intradural hypodense lesion at T7-8 level, more on left side as shown in figure 1. Dorsal laminectomy was done and an intramedullary cyst with extramedullary extension containing xanthochromic fluid encountered, was excised completely. Patient had marked neurological improvement postoperatively, however, dysesthesia persisted for four months after surgery. Histopathology revealed neurenteric cyst

Severe head injury and steroids

Severe head injury been defined as one which results in the patients becoming unable to open his eyes, obey commands or to speak intelligible words for a period of 6 hours or more [1]. The mortality of 50% or more has been recorded in such cases from various canters [2, 3, 4]. In a attempt to improve the prognosis in an otherwise situations a number of therapeutic steps are taken with no experimental or clinical justification. The use of steroids is also one of these desperate attempts on part of the treating clinican the basis of which is ill understood. Before justification for the use of steroids is discussed a brief outline of changes in intracranial pressure and brain oedema is presented as a basis for discussion

Use of prophylactic antibiotics in clean spinal surgery: a prospective randomized double blind study

A prospective randomized double blind study to assess benefits of the use of prophylactic antibiotic in 100 consecutive patients who underwent clean spinal surgery was carried out. Patients were randomly divided among two groups. One group received a single dose preoperative antibiotic only, while the other group received the antibiotic for another five days in addition. There was only one patient who had a stitch abscess which however responded to local treatment. This patient belonged to the group who received postoperative antibiotic for five days. There was no evidence of any other infection in patients of either group. It would seem that a single dose preoperative prophylaxis is all that is required in clean spinal surgery

Shunting in Pakistani infants with gross hydrocephalus: is decision in the surgeon's hand?

A study of 24 children with gross hydrocephalus and very little brain mantle is presented. Ventriculoperitoneal shunts were inserted in all of them without any significant complications postoperatively. In two cases shunts had to be revised. Ventriculoperitoneal shunting is a safe procedure and offers promise of a return to normal life for a child who may appear to have very little brain mantle left