ABSTRACT
Background: The first medical college in Iraq was established in 1927, adopting a subject-based curriculum. Aims: To provide a description of undergraduate medical education curricula in Iraq and how they developed since 1927. Methods: We identified Iraqi medical schools and curricula from local and global directories. Curricular data were compared to 3 educational benchmarks (Dale's effectiveness of teaching methods, SPICES, Miller's pyramid). We searched for studies describing curricula and modernization. Results: There are 34 medical colleges in Iraq (32 with identified curricula) with a wide scope of visions and aims adopting 3 types of curriculum: subject-based (SBC) 20 (63%), integrated (IC) 10 (31%) and problem-based learning (PBLC) 2 (6%). The majority of updates were SBC to IC, with only 1 moving from SBC to PBLC. The predominant type of curriculum at the start of instruction is SBC or IC. Although PBLC and IC provide opportunities for inquiry-driven competencies in the first 3 years only, none provide such opportunities in the clinical phase (last 3 years). Conclusions: Curricular reform needs to focus on modernizing the learning process/outcomes rather than reorganization of the teaching only. A new approach is needed to provide opportunities for competence and experience to prepare doctors to deal with challenges. One such approach would be the adoption of an outcomes-based curriculum model based on domains of competence with clearly defined outcomes/competencies achievable the time of graduation. All curricula should lead to the achievement of the same outcomes.
Subject(s)
Education, Medical, Undergraduate , Schools, Medical , Curriculum , Education, Medical, Undergraduate/methods , Humans , Iraq , Problem-Based LearningABSTRACT
Abstract Introduction Historically, concerns about complications following parathyroid surgery, such as airway compromise, bleeding and hypocalcemia, have precluded its consideration as a short-stay surgical procedure. Recent advancements in perioperative care have resulted in several publications demonstrating that parathyroidectomy can be safely performed as a short-stay procedure. Objectives The aim of the present study was to describe the process of implementing a short-stay protocol focusing on preoperative patient education and postoperative calcium management for those undergoing surgery for primary hyperparathyroidism (PHP). Method A retrospective audit of consecutive parathyroidectomies performed for PHP over the period between 2010 and 2013 was performed. A short-stay protocol (SSP) was introduced focusing on postoperative calcium management. Results were reaudited over the period between 2013 and 2015. Results Consecutive parathyroidectomies in 76 patients were included in the study. A total of 42 patients underwent parathyroidectomy prior to the introduction of the protocol. A total of 26.2% of these patients were symptomatic from hypercalcemia. A total of 40 out of 42 (95.2%) patients had a biochemical cure. A total of 36 out of 42 (85.7%) cases were due to parathyroid adenomas. A total of 34 patients underwent surgery following the introduction of the protocol. A total of 13 out of 34 (38.2%) of the patients had symptomatic hypercalcemia. A total of 33 out of 34 (97.1%) had a biochemical cure. A total of 32 out of 34 (94.1%) cases were due to parathyroid adenomas. The length of stay decreased from a median of 3 days (range 2-9 days; mean 3.32) preprotocol to a median of 2 days (range 2-3 days; mean 2.16) postprotocol (p< 0.0001) with no difference in the 30-day unplanned readmission rate (4.8 versus 2.9%; p= 0.999). Conclusions The postoperative length of stay after parathyroidectomy for PHP can be safely reduced through patient education and by rationalizing postoperative calcium management without adversely affecting outcomes.
ABSTRACT
Introduction Historically, concerns about complications following parathyroid surgery, such as airway compromise, bleeding and hypocalcemia, have precluded its consideration as a short-stay surgical procedure. Recent advancements in perioperative care have resulted in several publications demonstrating that parathyroidectomy can be safely performed as a short-stay procedure. Objectives The aim of the present study was to describe the process of implementing a short-stay protocol focusing on preoperative patient education and postoperative calcium management for those undergoing surgery for primary hyperparathyroidism (PHP). Method A retrospective audit of consecutive parathyroidectomies performed for PHP over the period between 2010 and 2013 was performed. A short-stay protocol (SSP) was introduced focusing on postoperative calcium management. Results were reaudited over the period between 2013 and 2015. Results Consecutive parathyroidectomies in 76 patients were included in the study. A total of 42 patients underwent parathyroidectomy prior to the introduction of the protocol. A total of 26.2% of these patients were symptomatic from hypercalcemia. A total of 40 out of 42 (95.2%) patients had a biochemical cure. A total of 36 out of 42 (85.7%) cases were due to parathyroid adenomas. A total of 34 patients underwent surgery following the introduction of the protocol. A total of 13 out of 34 (38.2%) of the patients had symptomatic hypercalcemia. A total of 33 out of 34 (97.1%) had a biochemical cure. A total of 32 out of 34 (94.1%) cases were due to parathyroid adenomas. The length of stay decreased from a median of 3 days (range 2-9 days; mean 3.32) preprotocol to a median of 2 days (range 2-3 days; mean 2.16) postprotocol ( p < 0.0001) with no difference in the 30-day unplanned readmission rate (4.8 versus 2.9%; p = 0.999). Conclusions The postoperative length of stay after parathyroidectomy for PHP can be safely reduced through patient education and by rationalizing postoperative calcium management without adversely affecting outcomes.
ABSTRACT
INTRODUCTION: A pilomatrixoma is a benign appendage tumour related to hair cells matrix. Most of the literature review about pilomatrixoma is in the form of case reports with fewer cohort studies. The objective of this cohort is to study the variable demographic characteristics, presentation and histopathology of this condition among a larger group of patients. MATERIALS AND METHODS: We conducted a retrospective study of patients who had excision of pilomatrixoma between February 1998 and August 2011 in a District General Hospital in UK. RESULTS: The study included 67 patients with histopathologically diagnosed pilomatrixoma. The mean age was 32 years. Male to Female ratio was 35:32. The average diameter of the lesion at presentation was 13 mm (range: 2-30 mm). 66 of 67 (98.5%) patients presented with solitary lesion, while 1 patient (1.5%) had two lesions. CONCLUSION: Pilomatrixoma is not an uncommon benign lesion. It is more common in the maxillofacial area.
