Making difficult decisions with older patients on medical wards.

Decision making with older people can be difficult because of medical complexity, uncertainty (about prognosis, treatment effectiveness and priorities), difficulties brought by cognitive and communication impairment and the multiple family and other stakeholders who may need to be involved. The usual approach, based on balancing benefits and burdens of a treatment, and then deciding on the basis of autonomy (or best interests for someone lacking mental capacity), within the constraints of resources and equity, remains valid, but is often inadequate. In addition, approaches relying on optimal communication and relationship building and professional virtues are important. Older people vary in their medical status, views and preferences more than younger people and these variations must be sought and accommodated, using a shared decision-making approach. This includes adapting to the increasing numbers of people from different cultures.

Faculty awareness and interest about bioethics in a private medical college of Islamabad, Pakistan.

This study sought to evaluate the awareness of bioethics among faculty at Shifa College of Medicine, Islamabad, Pakistan, and to assess their interest in becoming part of a bioethics discussion group and enhancing their knowledge of this subject. 122 faculty members from the medical college, hospital and school of nursing filled out a questionnaire on ethics. 53% were aware of bioethics as a specialty. 85% showed an interest in educating themselves further in the subject and 61% were interested in becoming part of a bioethics discussion group. Only 50 out of 122 faculty members knew what an ethical dilemma was and only 38 were able to describe one in detail. The awareness level of bioethics as a specialty increased with seniority. However the enthusiasm to join a bioethics discussion group was greater among those at a junior level.

Revising an objective structured clinical examination in a resource-limited Pakistani Medical School.

INTRODUCTION: The objective structured clinical examination (OSCE) has not been used extensively in undergraduate medical education in resource-constrained locations, including Pakistan. The Shifa College of Medicine (SCM) in Islamabad modified an end-of-clerkship OSCE assessment in internal medicine for final year medical students from a previous static, pattern-recognition format to an interactive, clinical reasoning and skill-based format. METHODS: We modified the OSCE to be more dynamic and effective by creating a customized clinical skills laboratory, using standardized patients, developing competency checklists for OSCE stations, and stimulating more active participation from faculty members. Students were surveyed at the end of their medicine clerkship about the OSCE's organization, content, perceived utility and validity and its stressfulness. Faculty involved in the modified format also reported their perceptions in an open-ended survey. RESULTS: The modified format was generally received positively by students and faculty. Twenty-eight percent of students found the OSCE to be stressful, which is a lower proportion than reported in the literature in other settings. Students suggested that OSCEs should be given more frequently and come with clearer instructions, and they indicated a need for better training in counseling skills. Responses from faculty were generally positive even though the modified format was regarded as more labor-intensive and time-consuming. CONCLUSION: The OSCE, in its true sense, can be created and successfully implemented to assess the clinical skills of medical students in a resource-limited setting in the developing world.

Frequency of the metabolic syndrome in adult type 2 diabetics presenting to Pakistan Institute of Medical Sciences.

OBJECTIVE: To determine the frequency of metabolic syndrome in both genders, in a limited adult type 2 diabetic population presenting to Pakistan Institute of Medical Sciences, Islamabad. METHODS: This was a cross sectional study conducted in a tertiary care teaching hospital. During the six months of study period, 106 adult type 2 diabetics were examined and evaluated for the presence of metabolic syndrome according to the ATP-III criteria. Asian standards for the waist circumference were used. RESULTS: Out of 106 patients, 91 (85.8%) had metabolic syndrome of whom 95% were females. Abdominal obesity was present in 91% females and 86% males. Low HDL levels were present in all females and 83% males. Seventy eight percent females and 63% males had elevated levels of triglycerides. Hypertension was present in 68% and 73% females and males respectively. CONCLUSION: This study showed a very high prevalence of the metabolic syndrome in type2 diabetic population. Females were more affected than males in all respects.

Empysematous gastritis--a case report with literature review.

Emphysematous gastritis is a condition characterized by gas within the wall of the stomach and associated, systemic toxicity. We are reporting to our knowledge the first case of emphysematous gastritis in a 76 year old female from Islamabad, Pakistan. She was admitted with five day history of upper abdominal discomfort and vomiting. Diagnosis of emphysematous gastritis was made on CT scan. She was treated successfully with conservative management including IV antibiotics and few sessions of dialysis, and was discharged home within two weeks.