Intrauterine Foley catheter for 48 versus 24 hours for cervical ripening: A randomized controlled trial.

OBJECTIVE: To compare the safety of keeping an intrauterine Foley catheter for 48 hours versus 24 hours for cervical ripening. METHODS: A randomized controlled trial was conducted at the De Soysa Hospital for Women, Sri Lanka from April 1 to December 31, 2014 (trial registration: SLCTR/2014/006). Low-risk women with a Bishop score ≤5 at 40 weeks + 5 days of gestation were allocated to either 24-hour (n=107; Group A) or 48-hour (n=94; Group B) groups. Proportions developing spontaneous onset of labor (SOL), neonatal status, pre- and post-procedure C-reactive protein (CRP), cervical smears, and placental histology in those who experienced SOL were compared. RESULTS: In Group A, 35 (32.7%) experienced SOL, against 54 (57.4%) in Group B (P<0.001, odds ratio 2.78, 95% confidence interval 1.56-4.93). There was no difference in mean length of active labor (7.48 vs 7.69 hours), cesarean delivery (16% vs 14%), bacterial vaginosis rates in post-induction cervical smear (10.3% vs 6.7%), mean CRP increase (4.08 vs 3.91 IU), evidence of chorioamnionitis (5.7% vs 11.1%), mean 1 and 5-minute Apgars, number of neonates with pyrexia (8.4 vs 8.5%), and admission to the Special Care Baby Unit (15% vs 12.8%). CONCLUSION: Group B experienced a statistically significant increase in SOL, without increasing infectious and neonatal morbidity.

The students' voice: Strengths and weaknesses of an undergraduate medical curriculum in a developing country, a qualitative study.

BACKGROUND: In medical education, feedback from students' is essential in course evaluation and development. Students at Faculty of Medicine, University of Colombo, Sri Lanka complete a five year medical curriculum comprising of five different streams. We aimed to evaluate the five year medical curriculum at the Faculty of Medicine, University of Colombo, Sri Lanka. METHODS: A qualitative research was conducted among recent graduates of the faculty. Students' opinions on strengths and weaknesses of the curriculum were collected via questionnaires, which were analysed and classified into common themes. A focus group discussion (FGD) based on these themes was conducted among two student groups, each comprising of a facilitator, two observers and nine students selected as a representative sample from questionnaire respondents. FGDs were conducted using a semi-structured set of open-ended questions to guide participants and maintain consistency between groups. The FGD evaluated the reasons behind students' perceptions, attitudes, emotions and perceived solution. Verbal and non-verbal responses were transcribed and analysed. RESULTS: Questionnaire response rate was 82% (153/186). Students highlighted 68 and 135 different responses on strengths and weaknesses respectively. After analysis of both questionnaire and FGD results the following themes emerged: a well organized module system, increased frequency of assessments, a good variety in clinical appointments, lack of specific objectives and assessments at clinical appointments, community and behavioural sciences streams beneficial but too much time allocation, lengthy duration of course, inadequate knowledge provided on pharmacology and pathology. CONCLUSION: We demonstrate how a brief qualitative method could be efficiently used to evaluate a curriculum spanning a considerable length of time. This method provided an insight into the students' attitudes and perceptions of the present faculty curriculum. Qualitative feedback from students highlighted certain key areas that need attention and also possible solutions as perceived by the students'.