Pakistani Student Nurses' perceptions of their hospital's health professionals' attitudes and suggested ways to improve patient care - An untainted view.

BACKGROUND & OBJECTIVES: Feedback brings a fresh perspective and improvement in any organization. Health professionals (HPs) lose insight of the gaps in medical care. The views of student nurses can help improve systems. The objective of this study was to assess the views of our student nurses and how they perceive the way the doctors and HPs work in our hospital and comment on training, attitudes, care pathways, teamwork, and what needed to be improved. METHODS: A proforma based qualitative study was carried out at the Nurses' Training Centre of PAF Hospital and Fazaia Medical College, Islamabad, from January to March 2020. After approval, a semi-structured proforma with open and closed ended questions was administered, in English and Urdu. The results were analyzed by comparative numbers and percentages for each question and descriptive responses were grouped in recurring themes and analyzed for content and their constructive value. RESULTS: Out of 85 nursing cadets, the proforma could be administered to 61(M=38(62.3%) and F=23(37.7%). Most were FSc with 26% graduates. Majority of the female students' main reason for joining was to serve humanity, unlike most males. According to gender many responses were interestingly different. Majority of females thought male doctors were better (86%). Only 36% said the doctors were sincere in care of patients. Most thought that we needed to improve patient counseling. Most thought the seniors treated them unfairly, but bullying was negligible. They wanted the senior HPs to improve their attitudes and ensure adequate equipment in the wards. They were worried about personal security from patients and relatives. Dedicated mental health services to deal with stress of witnessing every day misery and death was suggested. CONCLUSIONS: Doctors need to improve their counseling skills and should talk more to the patients and their relatives. They should acknowledge the nursing students and improve teamwork. Belittling them in front of others harms their self-efficacy. Simple corrections like punctuality, ownership of their patients and improvement of equipment and systems can improve patient care.

Innovative surgical technique for removal of Light Emitting Diode from segmental bronchus in a child: After the failure of endoscopic retrieval.

A five years boy aspirated Light-emitting diode (LED) of a toy while playing. Initially, he had a cough which later on settled. Chest physician at the local hospital tried to retrieve foreign bodies endoscopically, but he failed. He was referred to our tertiary care hospital. Chest physician and pediatric ear, nose and throat surgeon (ENT) were unable to remove it endoscopically as the (LED) migrated further into posterior basal segmental bronchus with manipulation. We removed this foreign body with our innovative lung parachymal sparing surgical technique without compromising the airway integrity. Post-operative follow up showed full lung expansion. The child was discharged home safely and follow up chest X-ray was unremarkable.

Unusual Presentation of Fibrosarcoma in a Child.

Malignant soft tissue tumours are rare in infants. Specific radiologic features help differentiate benign from malignant musculoskeletal entities. We report a case of malignant soft tissue tumour with initial radiologic evaluation suggesting a benign entity, thus delaying diagnosis. The case was treated as a case of cystic hygroma, suggested by ultrasound and MRI with good initial response to bleomycin injection. Later, symptoms recurred with poor response to repeat therapy which led to review the diagnosis. Angiography, arterial embolisation, surgical excision, and finally histopathology showed that a cystic infantile fibrosarcoma was initially misinterpreted as cystic hygroma. A comprehensive literature review and discussion on infantile fibrosarcoma; and its mimics are provided.

Teaching obstetrics and gynaecology to male undergraduate medical students: student's perception.

BACKGROUND: In Pakistan there is a dearth of male practitioners in obstetrics and gynaecology (ObG) to cater for emergent needs. The Study was done to explore views of male medical students towards ObG as part of curriculum and to identify the problems during clerkship and its impact on selection of ObG as career. METHODS: The study used a 20-item questionnaire-based survey at Shifa College of Medicine from November 2010 to December 2011. Third and fourth year male students (n=124) who completed ObG rotation were the participants. Inquiries were made regarding patient doctor interaction under residents and faculty members, perception of gender- bias during clerkship, inclusion of ObG in curriculum and subsequently as career. Results were analyzed using binary regression analysis. RESULTS: Sixty percent students were satisfied though embarrassed and under pressure during gynaecological examination in consultant supervision. Another 61% said that ObG should be a part of curriculum (p-0.013) and necessary for male students (p-0.008). 62% of the respondents were of the view that faculty has a major role in encouraging the students to take up ObG as career. 84% students replied in negative to adopt it as profession (p 0.002). CONCLUSION: Although basic obstetric curricular objectives are important for medical practitioners, our social set up discourages male students to have concrete clinical interaction. The faculty needs to take a special supportive role to encourage learning and motivation for this specialty.

Enteric duplication in children: clinical presentation and outcome.

INTRODUCTION: Enteric duplication (ED) is an anomaly with varied presentations and possible involvement of the alimentary tract. Once diagnosed, resection of the lesion and the involved part of the gut is usually required. The aim of this study was to evaluate the clinical presentations, diagnostic investigations, management and outcomes of patients with ED. METHODS: This was a descriptive case study conducted at the Department of Paediatric Surgery, Military Hospital, Rawalpindi, Pakistan, from January 2005 to January 2011. The medical records of all patients diagnosed with ED were retrospectively analysed with respect to age, presentation, investigations, site and type of lesion, surgical procedures, histological findings and complications. RESULTS: A total of nine patients were managed during the study period. The patients' ages ranged from three months to five years. Four out of nine EDs were rectal duplications. Three EDs were of the cystic type, five were of the tubular type and one was a complex mixed anomaly. Patients presented with varied symptoms, with the two most common being the presence of an abdominal mass and bleeding per rectum. Diagnosis was mainly achieved based on magnetic resonance imaging and computed tomography, although Meckel's scan provided accurate diagnosis in three of the nine patients. All the cysts were resected without any major complications, and patients were event-free during the five-year follow-up. CONCLUSION: EDs should be kept in mind when examining patients with an abdominal mass and bleeding per rectum. Meckel's scan can provide accurate diagnosis of EDs with bleeding. Prompt diagnosis and management results in satisfactory outcomes.

Conservative management or gamma knife radiosurgery for vestibular schwannoma: tumor growth, symptoms, and quality of life.

BACKGROUND: There are few reports about the course of vestibular schwannoma (VS) patients following gamma knife radiosurgery (GKRS) compared with the course following conservative management (CM). In this study, we present prospectively collected data of 237 patients with unilateral VS extending outside the internal acoustic canal who received either GKRS (113) or CM (124). OBJECTIVE: The aim was to measure the effect of GKRS compared with the natural course on tumor growth rate and hearing loss. Secondary end points were postinclusion additional treatment, quality of life (QoL), and symptom development. METHODS: The patients underwent magnetic resonance imaging scans, clinical examination, and QoL assessment by SF-36 questionnaire. Statistics were performed by using Spearman correlation coefficient, Kaplan-Meier plot, Poisson regression model, mixed linear regression models, and mixed logistic regression models. RESULTS: Mean follow-up time was 55.0 months (26.1 standard deviation, range 10-132). Thirteen patients were lost to follow-up. Serviceable hearing was lost in 54 of 71 (76%) (CM) and 34 of 53 (64%) (GKRS) patients during the study period (not significant, log-rank test). There was a significant reduction in tumor volume over time in the GKRS group. The need for treatment following initial GKRS or CM differed at highly significant levels (log-rank test, P < .001). Symptom and QoL development did not differ significantly between the groups. CONCLUSION: In VS patients, GKRS reduces the tumor growth rate and thereby the incidence rate of new treatment about tenfold. Hearing is lost at similar rates in both groups. Symptoms and QoL seem not to be significantly affected by GKRS.

An unusual case of urinary incontinence in a female child.

We report a case of a 3-year-old female child presenting with continuous urinary incontinence since birth. After relevant investigations, a diagnosis of bilateral single-system ectopic ureters into a vaginalized urogenital sinus was made. We discuss the extreme rarity of the case, importance of an accurate history, along with various treatment options.

Enteric duplication in children: clinical presentation and outcome

<p><b>INTRODUCTION</b>Enteric duplication (ED) is an anomaly with varied presentations and possible involvement of the alimentary tract. Once diagnosed, resection of the lesion and the involved part of the gut is usually required. The aim of this study was to evaluate the clinical presentations, diagnostic investigations, management and outcomes of patients with ED.</p><p><b>METHODS</b>This was a descriptive case study conducted at the Department of Paediatric Surgery, Military Hospital, Rawalpindi, Pakistan, from January 2005 to January 2011. The medical records of all patients diagnosed with ED were retrospectively analysed with respect to age, presentation, investigations, site and type of lesion, surgical procedures, histological findings and complications.</p><p><b>RESULTS</b>A total of nine patients were managed during the study period. The patients' ages ranged from three months to five years. Four out of nine EDs were rectal duplications. Three EDs were of the cystic type, five were of the tubular type and one was a complex mixed anomaly. Patients presented with varied symptoms, with the two most common being the presence of an abdominal mass and bleeding per rectum. Diagnosis was mainly achieved based on magnetic resonance imaging and computed tomography, although Meckel's scan provided accurate diagnosis in three of the nine patients. All the cysts were resected without any major complications, and patients were event-free during the five-year follow-up.</p><p><b>CONCLUSION</b>EDs should be kept in mind when examining patients with an abdominal mass and bleeding per rectum. Meckel's scan can provide accurate diagnosis of EDs with bleeding. Prompt diagnosis and management results in satisfactory outcomes.</p>

Learning from other professions.

In the last few years, medical education has become evidence-based and structured. It has incorporated principles of learning used in professions other than medicine. Safety, simulators and checklists have been learned from aviation industry. Handover protocols are borrowed from oil industry. Legal profession has emphasized the importance of critical thinking. Even the modern war colleges have developed learning strategies like war games and mock scenarios which can be assimilated in our postgraduate medical education. Modern-day medical education is looking for new horizons and innovations. Many professions other than traditional medical education may provide the necessary guidelines for modernisation.