COVID-19 booster dose acceptance, hesitancy and concerns among the elderly population: A cross-sectional study.

INTRODUCTION: The COVID-19 pandemic that originated in Wuhan, China in December 2019 results in respiratory and gastrointestinal infections. Elderly patients are at high risk. Preventive measures like avoiding contact with COVID-19 patients and wearing N95 masks can contribute to reducing the risk of infection, but vaccination remains crucial. METHODOLOGY: A cross-sectional survey-based study was conducted among the elderly population (≥ 50 years) in Pakistan. A 16-items questionnaire explored the socio-demographic profile of the participants, including questions about their age, gender, etc. The other sections included questions regarding vaccine registration, vaccine acceptance, and hesitation and fears towards vaccines. The items were developed to collect the data on the basis of the Likert scale. RESULTS: There was a total of 3059 respondents. The majority of the participants (n = 2726, 89.1%) were aged below 70 years, while 10.9% (n = 333) were aged above 70 years. Many participants (47.1%) expressed their concerns about the efficacy of COVID-19 vaccine booster dose. Despite their willingness to vaccinate with the cOVID-19 vaccine, 24.7% female participants expressed concerns related to the safety of the vaccine. Among all the respondents, 23.1% participants had no concerns about the cOVID-19 vaccine booster dose. The study identified a reluctance and lack of confidence in the efficiency of the COVID-19 booster dose. CONCLUSIONS: The alarming situation is rigidity towards vaccination among the elderly population. Necessary measures must be taken by the health department of Pakistan to manage this reluctant behavior and increase confidence on the efficiency of the COVID-19 booster dose.

Basics of faculty-to-faculty mentoring: A process to identify support and challenges.

Faculty mentoring is relatively new in health sciences literature. Faculty mentors are considered to have multiple roles including being a supervisor, teacher, or a coach. Little or no attention to formal mentoring of faculty allows faculty to seek informal mentoring, creating a risk of unexpected outcome. There is dearth of literature with respect to formal mentoring programs from the subcontinent. Although, informal faculty mentoring has been in place but there is no standard faculty mentorship model to be followed at Aga Khan University Medical College (AKU-MC). An observational study was conducted in September 2021 at AKU MC with convenient sampling to share the perceptions of the AKU-MC faculty mentors in a faculty mentorship workshop so that further advanced level faculty development workshops could be planned in this area. Twenty-two faculty mentors participated to share their perspectives on the responsibilities of faculty mentor, faculty mentee and the institution to see faculty grow and to have a sustainable mentorship programme. Challenges faced by the faculty mentors during the process of mentorship were also discussed. Majority of the participants emphasized on the role of the faculty mentor to be supportive, guiding, reflective and formative (respond to the emotional needs, encourage, effective communication, know own limitations, observe, provide feedback). Faculty mentor role modeling, ability to maintain confidentiality, creating and maintaining mentor-mentee relationship, availability of framework of formal mentoring in an academic institution and opportunities within the academic setting to learn mentorship were the main challenges of being a faculty mentor. The process provided valuable training and education to the faculty for the development and strengthening of formal mentoring program. Faculty recommended that institutions should provide the opportunity for development of junior faculty mentors by organizing capacity building activities.

Needs assessment for faculty development in health professions education at a medical university in Karachi, Pakistan.

Faculty Development (FD) embraces all educational activities used by teachers to improve their knowledge and skills for enhancing their academic competencies. This study aimed to identify the areas in Health Professions Education (HPE) in which formal faculty development is required. A needs assessment survey was conducted from among the faculty members at the Aga Khan University (AKU), Karachi, Pakistan, and the French Medical Institute for Mother and Children, Afghanistan. Data was analysed using SPSS 20.0 and reported frequencies and percentages according to various academic tracks. Competency-based curricula (51%), providing effective feedback (51%), developing Objective Structured Clinical Exam (51%), and clinical supervision (48%) were identified as significant areas for faculty development. Faculty in clinician teacher and clinician educator track require advanced training, i.e., Masters and PhD in HPE. The needs assessment facilitated prioritising the areas for FD. This will contribute to enhancing academic practices and inculcating the culture of lifelong learning.

Implementing work place based assessment: The modified direct observation of procedural skills (DOPS) across medical specialties - An experience from a developing country.

OBJECTIVE: To assess the skill level of residents regarding central venous catheterisation insertion, and to assess the reliability of scores in a simulated situation. METHODS: The quasi-experimental study with pre- and post-test design was conducted from February to June 2013 at the Aga Khan University, Karachi, and comprised four workshops attended by residents. The workshops were video-recorded for feedback and self-assessment. At the end of the workshops, knowledge and procedural skills were assessed using a self-generated 38-item, task-specific instrument after ensuring its content validity. Data was analysed using SPSS 19. RESULTS: There were 40 residents in the sample. The self-generated instrument was reliable with Cronbach's alpha value 0.83 and inter-rater coefficient 0.79. There was significant improvement in the skills level post-intervention compared to the baselines mean values (p=0.001). The subjects were satisfied with the workshops, as indicated by a mean score of 8.83±1.367. CONCLUSIONS: The workshops appeared to improve the central venous catheterisation insertion skills of the residents.

Third International Conference on Medical Education and Medical writing, University of Karbala College of Medicine, Karbala, Iraq.

University of Karbala College of Medicine (UKCM), Iraq, conducted a three days' workshop on Medical Education and medical writing. The UKCM is now transforming to conform with the latest trends of modern education. This will help to re-shape the future of medical education and produce capable doctors. This requires a strong faculty, which is sound in teaching, training, learning improvement, research capacity building, and leadership development. The capacity building of faculty at UKCM has been initiated in collaboration with Medics International at a local and government level and includes a series of workshops and online symposia. This educational activity was conducted after a delay of three years due to COVID-19. A three -day refresher course was conducted in the first week of August, 2022. Medical writing is another important feature which has been continuously covered by UKMM since many years with the collaboration of Al-Sadiq International Virtual University (SIVU) and Imamia Medics International (IM).

Evaluation of carbapenem antimicrobial stewardship program at a tertiary care hospital: A prospective interventional study.

This study aimed to determine physicians' acceptance rate of the Antimicrobial Stewardship Program ASP interventions in critically ill patients and to compare the clinical outcomes between accepted and rejected ASP groups. The study included patients on carbapenem therapy who were advised ASP interventions between 18-75 years of age and admitted in ICU/HDU from December 2020 to May 2021 at Liaquat National Hospital Karachi. Based on acceptance by the primary physician, data is divided into two groups. Outcomes were observed based on clinical improvement within seven days, 30-day mortality and readmission rates. Among 134 non-adherent prescriptions, Carbapenem ASP interventions were accepted in 117 (87.3%) patients. The accepted interventions improved clinical outcomes for most patients within seven days, 99 (84.6%). An insignificant association in death between the accepted versus rejected group within 30 days (p=1.000) was observed. On the other hand, a significant association in readmission was seen between both groups within 30 days (p=0.036). This study concluded that carbapenem prescriptions guided by the 'Antimicrobial stewardship program' are widely accepted in Pakistan and have improved clinical outcomes within 30 days of intervention.

Evaluation of Antiinflammatory Activity of Ethanol Extract of Nelumbo nucifera Fruit.

OBJECTIVES: In recent times, the use of natural remedies, which are rich in varieties of vitamins and flavonoids, for treatment of inflammation has increased substantially. These natural remedies are expected to be safe and economical when compared with other conventional allopathic drugs. Thus, existing research investigated the anti-inflammatory effect of Nelumbo nucifera fruit (NNF), in view of estimating its traditional and pharmacologic use against disorders associated with pain and inflammation. MATERIALS AND METHODS: To estimate the antiinflammatory effect of NNF, carrageenan-induced paw edema method was employed with equally distributed (n=7) Wistar male rats (N=35). The paw edema was measured by volume displacement method with plethysmometer. RESULTS: The NNF extract significantly reduced the inflammation of the paw and decreased the edema volume in rats administered carrageenan at all doses from the 3rd to 5th hour when compared to control, whose maximum percent reduction of edema was estimated as 100 mg/kg dose (that is, 73.92% at the 5th hour after administration of carrageenan). CONCLUSION: NNF exhibited a strong antiinflammatory effect, due to its phytochemical constituents, including flavonoids, saponins, and tannins, all of which synergistically exert inhibitory effects on arachidonic acid metabolism, neutrophil degranulation, and enzyme systems that promote cell proliferation and regulation of complement system. However, more preclinical and clinical evaluations are mandatory to validate these findings.

Strengthening the feedback culture in a postgraduate residency program.

Background: Feedback is defined as specific information presented to a learner that facilitates professional development through the process of reflection. Timely provision of constructive feedback to learner is important in optimizing the learning curve. The aim of the current study was to see the effectiveness of various interventions on feedback practices of faculty members. Methods: This is a quasi-experimental study (pre- and postdesign). It was conducted from November 2009 to March 2011 at The Aga Khan University, Pakistan. Faculty development workshops, allotment of specified feedback time, and restructuring of residency feedback forms were done as interventions. Data collection was done pre- and postintervention. Resident's and faculty satisfaction regarding the feedback process were evaluated using a prepiloted questionnaire. Paired t-test was applied to assess the effect of interventions on faculty and resident's satisfaction. Results: The mean satisfaction scores of residents were significantly improved (P < 0.05). Pre- and postintervention faculty satisfaction score also demonstrated significant difference in overall satisfaction level, from 47.88 ± 13.92 to 63.40 ± 8.72 (P < 0.05). Discussion: This study showed improved faculty engagement and satisfaction for the provision of feedback to the trainee resident. Strengthening this, culture requires continuous reinforcement, individualized feedback to the faculty members regarding their feedback practices, and continuing faculty development initiatives.

Ratings of performance in multisource feedback: comparing performance theories of residents and nurses.

BACKGROUND: Multisource feedback (MSF) is increasingly being used to assess trainee performance, with different assessor groups fulfilling a crucial role in utility of assessment data. However, in health professions education, research on assessor behaviors in MSF is limited. When assessing trainee performance in work settings, assessors use multidimensional conceptualizations of what constitutes effective performance, also called personal performance theories, to distinguish between various behaviors and sub competencies., This may not only explain assessor variability in Multi Source Feedback, but also result in differing acceptance (and use) of assessment data for developmental purposes. The purpose of this study was to explore performance theories of various assessor groups (residents and nurses) when assessing performance of residents. METHODS: A constructivist, inductive qualitative research approach and semi-structured interviews following MSF were used to explore performance theories of 14 nurses and 15 residents in the department of internal medicine at Aga Khan University (AKU). Inductive thematic content analysis of interview transcripts was used to identify and compare key dimensions in residents' and nurses' performance theories used in evaluation of resident performance. RESULTS: Seven major themes, reflecting key dimensions of assessors' performance theories, emerged from the qualitative data, namely; communication skills, patient care, accessibility, teamwork skills, responsibility, medical knowledge and professional attitude. There were considerable overlaps, but also meaningful differences in the performance theories of residents and the nurses, especially with respect to accessibility, teamwork and medical knowledge. CONCLUSION: Residents' and nurses' performance theories for assessing resident performance overlap to some extent, yet also show meaningful differences with respect to the performance dimensions they pay attention to or consider most important. In MSF, different assessor groups may therefore hold different performance theories, depending on their role. Our results further our understanding of assessor source effects in MSF. Implications of our findings are related to implementation of MSF, design of rating scales as well as interpretation and use of MSF data for selection and performance improvement.

The effect of proton pump inhibitors on glycaemic control in diabetic patients.

OBJECTIVE: This study aimed to evaluate the effect of proton pump inhibitors on glycaemic control amongst diabetic patients taking anti-diabetic medications. METHODS: This randomised interventional clinical study was conducted in Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. Eighty patients of either sex (aged 30-60 years) with type 2 diabetes mellitus and without any known comorbidities were equally divided into two groups (i.e., n = 40 for each group) and were included in this study. Group A received metformin and glimepiride, while Group B, metformin and glimepiride plus omeprazole. The efficacy of the combination medications was evaluated based on fasting blood sugar (FBS) and glycosylated haemoglobin (HbA1c) levels. Serum creatinine and liver function tests were reviewed to evaluate patients' safety profile at the initial visit and after 12 weeks. RESULTS: After 12 weeks of omeprazole therapy, we observed a more significant improvement in glycaemic control in group B compared to group A based on the patients' FBS (108 ± 2.37 vs. 126 ± 2.9, P = 0.001) and HbA1c levels (7.29 ± 0.07 vs. 7.47 ± 0.04, P = 0.030). CONCLUSION: The addition of a proton pump inhibitor along with anti-diabetic medications was considered effective in achieving better glycaemic control.

Conference Report on First Certificate Course in Health Professions Educationat College of Medicine, University of Kerbala, Iraq.(September 2019).

The current status of medical education in Iraq requires complete transformation to conform to the latest trends of modern education. Presently it is compromised due to the influence of political factors, finances, weakness or fragility of planning and security. It has to be re-shaped for the future of medical education to produce good and efficient medical professionals. It is necessary to reform and revise the curriculum as accreditation in accordance with international medical universities. The initial requirement is faculty development in areas including but not limited to, curriculum development, teaching and learning improvement, research capacity building, and leadership development. The capacity building of faculty at College of Medicine, University of Kerbala (CMUCK) has been initiated in collaboration with Medics International at a local and the government level. Medics International conducted the current Course on Certificate in Health Professions Education (CHPE) programme in September, 2019 to facilitate the faculty to revise their curriculum and improve their current educational practices. Further steps will be taken to develop the faculty for Masters in Medical Education (MME), PhD, and fellowship programmes. To face the on-going challenges in the medical and health care system, continous efforts are required for faculty education. Medics International has volunteered to begin a series of Webinars through its global faculty to reach out to the Iraqi Board followed by engagement of the Arab Board covering 18 countries.

Simulated patient's feedback to improve communication skills of clerkship students.

BACKGROUND: The changing trends of the society and revisions to medical education have changed the way medical students are trained to adroitly care for patients hence, patient centered care has become need of today's society and communication skills are imperative in developing patient physician relationship. Increasingly, simulations are being used to aid medical students to incorporate theoretical knowledge into practice. There are innumerable studies regarding communication skills in terms of reliability, validity and feasibility but no such study has been documented using simulated patient's feedback in improving communication skills in Pakistan. The aim of this study is to explore whether simulated patients' feedback improves the communication skills of undergraduate medical students. METHODS: During a randomized control trail a group of eighty students in the final year clerkship at Al-Nafees Medical College have participated in pre-post Objective Structured Clinical Exam (OSCE) on communication skills. The students were selected through convenience sampling technique. Four Objective Structured Clinical Exam (OSCE) stations based on different scenarios of communication skills were developed. Each station of fifteen minutes duration was assessed by both simulated patients and faculty using a validated tool LCSAS (Liverpool Communication Skills Assessment Scale). The difference between the pre and post-tests of two groups was explored by applying independent t-test. Cronbach's alpha was used to check the reliability of scores and effect size was calculated. RESULTS: Results of this study have showed that there is significant improvement in communication skills after receiving feedback from simulated patients (p value ≤0.05) was observed. An overall Cronbach α = 0.83 on LCSAS reveal a high internal consistency and there was adequate demonstration of effect size(r = 0.8). CONCLUSION: The results on the scores of the students on the Liverpool Communication Skills Assessment Scale confirm that simulated patient's feedback is essential to enhance the communication skills of the medical students. This study offers significant evidence towards successful conduction of a formal communication skills development initiative at Al-Nafees Medical College using simulated patient feedback during teaching and assessments.

Role of Pitavastatin in Prevention of Osteopenic Changes in Ovariectomized Rats.

OBJECTIVE: To determine the effect of pitavastatin, a third generation statin, on development of osteopenia in ovariectomized rats. STUDY DESIGN: Experimental study. PLACE AND DURATION OF STUDY: Department of Pharmacology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Center, Karachi, from January to July 2013. METHODOLOGY: Forty female Sprague Dawley rats were divided into ovariectomized (OVX), Sham OVX and OVX given pitavastatin 0.4 mg/kg/day, 0.8 mg/kg/day, for 8 weeks. Bone density measurements using CT scan and Archimedes’ principle were made on femora and tibiae. Blood samples were analyzed for acid phosphatase (ACP) and alkaline phosphatase (ALP) levels. RESULTS: Ovariectomy-induced osteopenic changes were indicated by significant decrease in bone densities and Hounsfield (HU) index of distal femoral and proximal tibial metaphyses and elevation of ACP and ALP levels. 0.4 mg/kg pitavastatin did not significantly alter the evaluated parameters. 0.8 mg/kg produced a restoration of HU of lower femur and femoral density comparable to Sham. HU of upper tibia and tibial density following 0.8 mg/kg was significantly higher than OVX but was not approximate to Sham. ALP and ACP with 0.8 mg/kg were comparable to Sham. CONCLUSION: Supra-therapeutic dose of pitavastatin was effective in preventing estrogen deficiency-induced decrease in bone density of ovariectomized rates, over an 8-week period.

Challenges of providing timely feedback to residents: Faculty perspectives.

OBJECTIVE: To explore faculty's perceptions of challenges in providing verbal feedback to the Residents and suggest ways to overcome the barriers. METHODS: As part of a larger study on feedback assessment, five focus group discussions were conducted at the Department of Medicine, Aga Khan University Hospital, Karachi, during faculty development workshops held from January to June 2010. Qualitative grounded theory was used to explore faculty perceptions of challenges in providing verbal feedback to the Residents. RESULTS: Of the 54 faculty members, 49(91%) participated. Four themes that emerged were 'time constraint' indicating high patient load; 'faculty related issues' indicating faculty's apprehension about its own evaluation by Residents; 'educational issues' indicating that the importance of feedback was not emphasised; and 'system and logistic issues' indicating that the assessment form used for assessing Residents was ambiguous. CONCLUSIONS: Work load of the faculty and the expectations with respect to patient care responsibilities may have an impact on the quality, timing, content and delivery of the feedback provided to the Residents.

Diabetes and diet in Ramadan.

Ramadan, the month of fasting, is observed by Muslims all over the world. Fasting is obligatory for all healthy adult Muslims which amounts to refraining from eating and drinking from predawn to sunset. The dietary patterns therefore totally change. For people with diabetes, instead of taking 5-6 meals, it is reduced to 2 or 3 meals in 24 hours. Good glycaemic control can be accomplished by people with diabetes, maintaining appropriate diets. It is suggested that during Ramadan similar general dietary guidelines should be followed as those throughout the year. The pre dawn meal should be taken as late as possible, before the start of the fast and should have a high proportion of carbohydrates with fibre. The traditional sugar drinks and foods rich in fat taken at iftar should be avoided. The evening meal or dinner should be consumed as early as possible at iftar and contain whole wheat flour chapattis, vegetables and a meat dish. Salads increase the fiber intake. A glass of milk or fruit at bedtime will maintain normoglycaemia till suhur.

The ringing bells: perspective of Karachiites regarding noise pollution.

OBJECTIVE: To identify the awareness regarding noise pollution and its adverse effects on human health in the people of urban areas of Karachi. STUDY DESIGN: Cross-sectional survey. PLACE AND DURATION OF STUDY: Urban areas of Karachi, from September to October 2012. METHODOLOGY: A survey was conducted with 50 selected subjects of urban areas of Karachi with their informed consent. The questionnaire covered aspects of noise pollution. Descriptive analysis was done with percent responses. RESULTS: All (100%, n=50) subjects admitted to be suffering from noise pollution. The source of noise pollution was vehicles in 64% (n=32). There was 90% (n=45) agreement for laws and regulations regarding noise pollution to be in place. CONCLUSION: Awareness sessions need to be conducted for the public regarding the effects of noise pollution on health with formulation of laws and regulations.

Lessons learnt: pilot of mid rotation feedback.

The Aga Khan University went through an external review of its undergraduate medical education in December 2006 based on the accreditation guidelines by the Liaison Committee for Medical Education (LCME). The external review panel comprised of international and local experts which developed a comprehensive report on its findings with regards to LCME standards of accreditation. In the final report of the external review one of the areas highlighted as not meeting the standards of LCME was documentation of formal mid-rotation feedback of the students by the faculty in AKU clerkships through years 3 to 5. A four hour faculty development workshop was organized by the Department of Medicine in collaboration with the Department for Educational Development to emphasize the role of feedback in improving student's performance, improve faculty's skill in giving effective feedback, and to come up with recommendations for documenting the formative feedback process. A mid-rotation feedback form was designed to facilitate the documentation process. Faculty members who participated in the workshop took a lead in piloting this form and reported the areas that could be further improved upon to facilitate the process of timely and effective feedback.

Use of concept mapping as a facilitative tool to promote learning in pharmacology.

OBJECTIVE: To assess whether students find concept mapping a useful learning methodology to conceptualize and organize topics studied in CNS module of Pharmacology; and to evaluate whether addition of concept mapping assignment could help to improve examination scores. STUDY DESIGN: An analytical study. PLACE AND DURATION OF STUDY: College of Dentistry, Jinnah Medical and Dental College, Karachi, Pakistan, from March to May 2009. METHODOLOGY: A class of 50 BDS students was recruited for the study. Two randomly selected groups of 12 students each, prepared concept maps in topics from CNS pharmacology which were displayed and discussed during tutorial sessions. The other two groups (n = 25) following the traditional teaching methodology, served as controls. Scores from best choice questions and short essay questions were compared between the investigational and control groups using the student's t-test with significance at p < 0.05. Feedback obtained after completion of the study was evaluated as percent response. RESULTS: One-best-choice test of the control group showed a mean grade of 57.1 ± 16.7 vs. test group mean of 58.8 ± 13. For the short essay questions, control group obtained a mean of 52.3 ± 18.8 vs. test group mean grade of 53.8 ± 22.5. Both results were not significantly different (p > 0.05). However, feedback about concept mapping showed that the technique helped the students to conceptualize difficult topics in CNS pharmacology (86.36%). Concept mapping was particularly beneficial in preparing for exams as it provided a quick overview of the entire subject (68.68%). CONCLUSION: Students found concept mapping as a useful pedagogical tool which could potentially be used to acquire meaningful learning in Pharmacology as a supplement to traditional teaching techniques. It was not found beneficial in improving examination grades probably because standard examinations and concept mapping measure different cognitive domains.

Improving the teaching skills of residents as tutors/facilitators and addressing the shortage of faculty facilitators for PBL modules.

BACKGROUND: Residents play an important role in teaching of medical undergraduate students. Despite their importance in teaching undergraduates they are not involved in any formal training in teaching and leadership skills. We aimed to compare the teaching skills of residents with faculty in facilitating small group Problem Based Learning (PBL) sessions. METHODS: This quasi experimental descriptive comparative research involved 5 postgraduate year 4 residents and five senior faculty members. The study was conducted with all phase III (Final year) students rotating in Gastroenterology. The residents and faculty members received brief training of one month in facilitation and core principles of adult education. Different aspects of teaching skills of residents and faculty were evaluated by students on a questionnaire (graded on Likert Scale from 1 to 10) assessing i) Knowledge Base-content Learning (KBL), ii) PBL, iii) Student Centered Learning (SCL) and iv) Group Skills (GS). RESULTS: There were 33 PBL teaching sessions in which 120 evaluation forms were filled; out of these 53% forms were filled for residents and 47% for faculty group. The faculty showed a statistically greater rating in "KBL" (faculty 8.37 Vs resident 7.94; p-value 0.02), "GS" (faculty 8.06 vs. residents 7.68; p-value 0.04). Differences in faculty and resident scores in "the PBL" and "SCL" were not significant. The overall score of faculty facilitators, however, was statistically significant for resident facilitators. (p = .05). CONCLUSION: 1) Residents are an effective supplement to faculty members for PBL; 2) Additional facilitators for PBL sessions can be identified in an institution by involvement of residents in teacher training workshops.