Search

Abstract Background This study was carried out to identify and explore the difference in coping strategies for dealing with stress; adopted by medical residents in surgical and nonsurgical specialties. Methods A mixed methods approach, was chosen for this study. In phase one (quantitative); data were collected by a web-based survey, using a structured questionnaire. This survey was carried out in five major teaching hospitals of Rawalpindi & Muzaffarabad in 2020. Purposive sampling was done and data were analysed using SPSS, recording frequencies and major trends. In phase two (qualitative); six focus group discussions were carried out with 24 participants, using semi-structured questions and prompts. Convenient sampling was done from the cohort of phase 1. These focus group discussions, explored the various coping strategies adopted by medical residents. Later, the data were analysed manually for development of codes, sub-themes and themes. Results Out of 250 (100%) participants, 146 (58%) participants responded to the online survey. Surgical residents had a higher response rate (60%, n = 87) than nonsurgical residents. Moreover, female participation (54%, n = 79) was greater than male participation (46%, n = 67). The Mann-Whitney U test was statistically significant only for seeking medical advice to cope with stress (P = .029). There was no statistically significant difference found between the coping strategies, employed by medical residents. In focus group discussions, female involvement was more (58% n = 14) than their counterparts. Four main themes were developed after data analysis: self-regulation, tailor-made strategies, educational focus and support system. Finally, minor differences were obtained qualitatively; like, socializing is preferred by surgical residents whereas, spiritualism is chosen by nonsurgical residents. Conclusion Quantitatively, no significant differences were found between the coping strategies of medical residents, against work-related stress. However, minor differences were obtained qualitatively due to difference in job demands and level of burnout between these two specialities.

Objective: To assess the effect of using a 3-D atlas on academic performance and compare it with the use of power point presentations during online lectures for gross anatomy of the head. Study Design: Comparative prospective study. Place and Duration of Study: Department of Anatomy, Dental College, Heavy Industries Taxila Education City Institute of Medical Sciences, Taxila Pakistan, from Jun to Jul 2020. Methodology: Forty-nine students from first year BDS were selected through nonprobability convenience sampling. They were assigned to two groups, A and B comprising of 25 and 24 students respectively. Group A was taught gross anatomy of head region via Zoom lectures employing a digital three-dimensional anatomy atlas application (Visual body, 2019). Group B was exposed to only two-dimensional pictures through presentations during their lectures. Ten teaching sessions were conducted with post session MCQ based assessments. One comprehensive assessment was conducted at the completion of the region. Results were compared for both groups. Results: The mean scores for three of the post session assessment tests were higher for group A (15.72 ± 2.03, 15.28 ± 2.79, 16.92 ± 2.13) as compared to that of group B (14.64 ± 3.42, 13.66 ± 3.00, 15.04 ± 3.01) (p

Background: The coronavirus disease 2019 (COVID-19) pandemic has transformed the world’s economy, health and education in a blink of an eye. Almost 1 billion learners have been affected across the globe. This has resulted in a paradigm shift to blended learning. Therefore, it was felt necessary to provide practical guidelines for the development of blended curriculum in medical education. It would help to overcome the challenges faced due to unprecedented transformation of medical education on account of pandemic. Methods: Guidelines based on personal experience of the authors and literature search were developed using the complex adapted blended learning system (CALBS) framework. Seven experts developed these guidelines using the nominal group technique. The consent form and literature for CABLS framework was shared with experts. The experts developed the guidelines independently during phase one of the technique. After a given time, phase 2 started with moderator mediated discussion about the individual guidelines developed by the experts. After discussion and mutual consensus four types of guideline ideas were developed. During the third phase the experts ranked the guideline ideas on a scale of 1 to 5. The guideline idea that ranked highest was selected as a final guideline for developing a blended learning curriculum. Results: The group consensus resulted in developing seven guidelines for a blended course or curriculum in medical education. These guidelines are based on a conceptual framework supplemented by expert’s own personal experience and current evidence from literature. Conclusions: These guidelines would provide a comprehensive and systematic approach to develop a blended learning curriculum in medical education.

Behaviourism is the underpinning learning theory of many teaching and assessment tools utilized to enhance the effectiveness of learning. Feedback, reinforcements, motivation, learning outcomes and objectives are few among many which are implied by the medical teachers while teaching both basic and clinical sciences to the students. The claim of Behaviourism being redundant or dead is not based on realities. Behaviourist approach is and will remain the most powerful theory to be implied in educational processes for gaining successful outcomes. Keywords: Behaviourism, Implications, Medical Education, dead, learning. Continuous...

Abstract The accreditation standards developed by WFME are acknowledged as regulatory mechanism for quality assurance of medical education programs. The scoping review aims to collect all the published and unpublished evidence based on the inclusion criteria, to identify the barriers affecting the implementation of quality curriculum defined by WFME. It summarizes and presents the evidence-based challenges faced by middle and low income countries for accreditation process. The literature was searched using search terms, `challenges of WFME accreditation’, `barriers to accreditation’, `challenges to accreditation in health care system’, `hindrances to WFME accreditation standards’, `barriers to WFME standards’, in PubMed, ERIC, PsycINFO databases and Google scholar (for grey literature) to find the evidence published within last 10 years. This search strategy retrieved 922 publications and only 19 articles fulfill the inclusion criteria. A All those studies, which address the barriers or challenges to implementation of accreditation standards in medical education, were included. The inhibitors to implementation of curriculum in course other than medical education were excluded from the study. The included studies address the barriers to nine areas of WFME standards. The data was charted and QualSyst appraisal tool was used to appraise the quality of studies included in review. The eligibility of selected articles was carried out by using the validated QualSyst checklist to assess the quality of included studies. The scoping review will inform and lay the foundation for more empirical studies on quality improvement in health professions education particularly in low and middle-income countries. Keywords: Challenges of accreditation,

The scoping review study was carried out from January 18, 2019, to February 18, 2019, by following the Arksey and O'Malley method of scoping review. An extensive search in the bibliographic databases, PubMed, ERIC, and Google scholar for the gray literature was done. The search was narrowed by a set of inclusion and exclusion criteria. The studies included in the literature search were sort by the PRISMA flow chart. The selected studies address the use of a positive reinforcement strategy to manage disruptive behavior in the classroom. The positive reinforcement strategies identified were praise (41%), feedback (33%), and other classroom management studies (25%). Skinner's operant learning principle has a classroom implication for increasing the likelihood of the desired behavior. The results of the review can be used to implement evidence-based practice and policy regarding improving the desired behavior in the classroom.

Objective: To explore the impact of drawing on students’ understanding of histology. To determine if students who draw images can score better than those who do not. Study design: Quasi experimental. Place and duration of study: Histology Laboratory, Department of Anatomy, Shifa College of Medicine, Shifa Tameer-e-Millat University, from January 2017 to September 2017. Methods: This histological study was carried out during the Endocrinology and reproduction module (ENR) in January, 2017. There students were divided into two groups, A and B of 50 students assigned by random sampling. During the first half of the module Group A drew the microscopic image of the slide in the practical notebook as a normal practice. Group B was shown images only and the task of drawing the images in the practical note book was excluded. At the end of four weeks MCQ paper of 50 questions of higher order thinking to check their concepts of applied histology was given to students. For the next half of the module the groups were flipped over by a cross-over design and Group A only saw the microscopic image and Group B drew the histological image. A second test of MCQs of higher level of application of knowledge was given at the end of four weeks. Results: Analysis of data showed that there is no statistically significant difference between the mean scores obtained by the drawing group and non-drawing group (p>0.05) in both test I and test II. However there is a statistically significant difference in the mean scores of the same group when they draw the microscopic image and when they do not (p

Background Success of psychosocial interventions in reducing aggressive challenging behaviour is likely to be related not only to mechanistic aspects but also to therapeutic and system factors. The study aims to examine the facilitators and barriers that influence whether psychosocial interventions for aggressive challenging behaviour in adults with intellectual disabilities lead to positive change. We conducted 42 semi-structured interviews with adults with intellectual disabilities who display aggressive challenging behaviour, family/paid carers, and professionals engaged in or delivering a psychosocial intervention across the UK. Data were analysed thematically using a framework approach. Stakeholders considered therapeutic and supportive relationships and personalised care as facilitating factors in addressing aggressive challenging behaviour. The operational structure of community intellectual disability services and conflicting expectations of professionals and carers were the main contextual barriers that impeded the implementation of psychosocial interventions in adults with intellectual disabilities. Findings highlight the valued components that maximise positive change in adults with intellectual disabilities who display aggressive challenging behaviour. Several operational adjustments including referral criteria, roles of professionals and workforce issues need to be addressed in services to maximise the implementation of psychosocial interventions leading to reduction in aggressive challenging behaviour in this population.

Background: Success of psychosocial interventions in reducing aggressive challenging behaviour is likely to be related not only to mechanistic aspects, but also to therapeutic and system factors. The study aims to examine the facilitators and barriers that influence whether psychosocial interventions for aggressive challenging behaviour in adults with intellectual disabilities lead to positive change. Methods: We conducted 42 semi-structured interviews with adults with intellectual disabilities and aggressive challenging behaviour, family/paid carers, and professionals engaged in or delivering a psychosocial intervention across the UK. Data were analysed thematically using a framework approach. Results: Stakeholders considered therapeutic and supportive relationships and personalised care as facilitating factors of psychosocial interventions to address aggressive challenging behaviour. The operational structure of community intellectual disability services and conflicting expectations of professionals and carers were the main contextual barriers that impeded the implementation of psychosocial interventions addressing aggressive challenging behaviour in adults with intellectual disabilities. Conclusions: Findings highlight the valued components that maximise positive change in adults with intellectual disabilities who display aggressive challenging behaviour. Several operational adjustments including referral criteria, roles of professionals and workforce issues need to be addressed in services to maximise the implementation of psychosocial interventions to reduce aggressive challenging behaviour in adults with intellectual disabilities.

Objective: To study the information, supposition and impression of the general population concerning organ donation and transplantation in Pakistan. Study Design: Cross-sectional analytical survey. Place and Duration of Study: Study was conducted at Tertiary Care Hospital, from Jan to Aug 2020. Methodology: We used the web-based questionnaire, devised from relevant studies and National Health Service (NHS) protocols. The questionnaire comprised of 20 multiple-choice questions (MCQs) in addition to demographic profile,distributed among the general population (n=1000) which assessed basic knowledge regarding organ transplantation and willingness for donation. Results: One thousand participants were enrolled in the study. The age range was 24–61, with a mean age of 36.66±9.00 years.933(93.3%) participants believed organ donation should be mandatory, and 600(60%) expressed willingness to donate or accept organ donation. In addition, 933(93.3%) participants believed in arranging awareness campaigns, and 1000(100%) had an opinion of establishing a convenient donor registration system. Conclusion: There are momentous awareness and willingness for organ donation; therefore, befitting tactics can enhance organ donation in Pakistan, and this issue will no longer be considered a haunted one.

Objective: To analyze the effects of uneventful phacoemulsification surgery on choroidal thickness using spectral domain optical coherence tomography. Study Design: Prospective comparative study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Jun 2018 to Jun 2019. Methodology: In this prospective study, 300 eyes of 300 patients undergoing phacoemulsification surgery were included. All patients underwent detailed ophthalmologic examination, including measurement with optical biometry, intraocular pressure and choroid thickness. The choroidal thickness was measured perpendicularly at the fovea using spectral domain optical coherence tomography preoperatively and 1 month postoperatively. Changes in intraocular pressure and choroid thickness after surgery were evaluated. Results: There was a statistically significant increase in the choroid thickness in early postoperative period (p-value

Objective: To evaluate changes in visual acuity and contrast sensitivity in patients with keratoconus after corneal collagen cross-linking. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan, from May 2019 to Apr 2020. Methodology: A total of 48 eyes of 30 patients with progressive keratoconus were included in this study. Baseline uncorrected distance visual acuity, corrected distance visual acuity and contrast sensitivity were recorded, following which transepithelial corneal collagen cross-linking with topical riboflavin and ultraviolet A light was performed. Uncorrected distance visual acuity, corrected distance visual acuity and contrast sensitivity measurements were repeated and recorded 6-months postoperatively. Results: Mean preoperative uncorrected distance visual acuity was 0.56 ± 0.27 logarithm of the minimum angle of resolution which improved to 0.51 ± 0.26 at 6 months after the procedure (p=0.002). Mean corrected distance visual acuity was 0.30 ± 0.19 preoperatively, improving to 0.24 ± 0.18 (p=0.001) at 6 months after corneal collagen cross-linking, thereby depicting a statistically significant improvement. Treated eyes also showed a significant improvement in contrast sensitivity (p=0.001) of 0.05 ± 0.08 logarithmic units of contrast sensitivity, from a mean preoperative contrast sensitivity of 1.72 ± 0.10 to 1.77 ± 0.09 when evaluated 6 months after corneal collagen cross-linking. Conclusion: Corneal collagen cross-linking is a promising advancement in the treatment of keratoconus. It was found effective in significantly improving visual acuity as well as contrast sensitivity, thus enhancing visual outcomes in keratoconus.

Objective: To compare optical biometry and A-scan for calculating intraocular lens power in patients with nuclear cataract at tertiary care eye hospital. Study Design: Cross sectional comparative study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Pak Emirates Military Hospital, Rawalpindi, from Jul to Dec 2018. Methodology: In this study 70 eyes of 70 patients planned for cataract surgery by phacoemulsification underwent both optical biometry with intraocular lens master and ultrasound biometry applanation by A scan after informed consent. Intraocular lens power calculated by these two methods of biometry was compared. Phacoemulsification surgery was performed through a 2.3 mm superior temporal clear corneal incision. All patients underwent in the bag implantation of the same intraocular lens type. Results: The mean age of the patients was 62.89 ± 6.69 years. A significant (p-value65 years. Conclusion: Optical biometry was found efficient and safe method for calculation of intraocular lens power. Optical biometry is noncontact method having very less chance of infection and suitable for most of the eye types.

Objective: To compare I–Gel versus endotracheal tube effects on hemodynamic stability and intraocular pressure in patients undergoing elective ophthalmological surgeries. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Nov 2019 to Oct 2020. Methodology: A total of 108 patients undergoing elective ophthalmological surgeries under general anesthesia from both genders, age range between 18-45 years, American Society of Anesthesiologists status I or II were included. General anesthesia given following standard procedures and monitoring. Heart rate, Systolic & Diastolic blood pressure monitored and intraocular pressure measured in each eye with Reichert ton open at baseline, upon insertion of airway device and 5 minutes after insertion. Results: Total 108 patients enrolled in the study with a mean age of 37.74 ± 6.0 years and age-range of 18-45. Heart rate at Insertion in I-Gel group was 78.14 ± 3.41 beats per minute whereas in intubated group was 97.20 ± 2.84 beats per minute, mean systolic blood pressure at insertion in group A and B was 115.28 ± 5.3 and 130.44 ± 2.81mm of Hg respectively. Intraocular pressure at insertion right eye in group A and B was 12.04 ± 0.48 and 17.98 ± 0.42 mm of Hg respectively. Intraocular pressure at insertion left eye in group A was 12.12 ± 0.45 whereas in group B was 17.95 ± 0.38mm of Hg (p-value=0.001). Conclusion: I–Gel provides better hemodynamic profile and intraocular pressure stability when compared with endotracheal tube.

Objective: To assess frequency of Hepatitis B and C infection in patients undergoing cataract surgery. Study Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Jan 2018 to Jan 2020. Methodology: Pre operatively patients were subjected to detail ocular examination for cataract evaluation. Patient under 20 years of age, complicated cataract, uveitis, retinal detachment, previous history of ocular surgery or neurosurgery, treatment with systemic medication causing ocular side effects were excluded from study. Preoperatively hepatitis B and C screening was performed for all enrolled patients. The findings were recorded on data sheets and analyzed through statistical software system (SPSS) version 20. Results: Out of 4671 patients, 35 (0.74%) were positive for hepatitis B surface antigen (HBsAg) and 146 (3.1%) were positive for hepatitis C antibody (HCVAb). Eight (22.8%) females and 27 (77.17%) males were positive for HBsAg. Fifty seven (39.04%) females and 88 (60.96%) males were found to be HCVAb positive. It clearly shows higher prevalence of hepatitis in males. Twenty three (65%) of patient with hepatitis B virus and 80 (54.8%) of patients with hepatitis C virus had nuclear sclerosis cataract as compared to 51% of non-infected patients. Conclusion: Screening of hepatitis B and C is mandatory in order to prevent health care associated hepatitis infection. There has been a role of inflammation due to hepatitis in development of cataract. Further studies may elaborate it vividly.

Objective: To evaluate the sensitivity and specificity of bedside tests for prediction of difficult airway scheduled for ophthalmological surgeries under general anesthesia. Methods: This prospective study was carried out at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from March 2020 to October 2020. All pediatric and adult patients with American society of anesthesiologist grade I to IV undergoing elective ophthalmological surgeries under general anesthesia were consecutively enrolled. Mallampati grading, sternomental, thyromental distance, and mouth opening used as the predictors tools whereas Cormack and Lehane (CL) classification validated with on table laryngoscopy. Grade I and II were assigned as easy laryngoscopy whereas grade III and IV were declared as difficult intubation. Results: Of 232 patients, difficult intubation was observed in 36 (15.5%). Sensitivity and specificity of thyromental distance was 80.5% and 99.4% respectively. Whereas sensitivity of mouth opening was 66.6% and specificity was 99.4%. In case of sternomental distance, sensitivity and specificity corresponded to 61.6% and 100% respectively. The sensitivity and specificity of Modified Mallampati Grading was 97.2% and 96.4% respectively. The relationship between CL grading and MMC showed that all the patients with CL grade I had Malampati grade I, i.e., 28 (100%), while all patients with CL grade IV had Malampati grade IV, i.e., 7 (100%). Conclusion: Bedside tests prove to be useful parameters for prediction of difficult airway at pre-anesthesia assessment among which Mallampati test is most sensitive and specific, subsequently ensuring availability of difficult intubation equipment, which is a focus of concern in third world countries.

The coronavirus infection 2019 (COVID-19) is a progressing viral pandemic. Adverse impacts related to COVID19 are usually includes sore throat, cough, fever and dyspnea. Anosmia emerged as newer reported symptom however, recognition awaited from the World Health Organization (WHO) and Center for Infection Control and Prevention (CDC). This case series features an instance of isolated abrupt presentation of anosmia as a manifestation of COVID-19 between two young males with parallelism of smoking and modest disease manifestation. Loss of smell is demonstrative of COVID-19 disease and has significant ramifications with regards to healthcare workers working close to infected therefore has increased susceptibility.

Objective: To assess knowledge, opinion and perception of the general population regarding corneal donation and transplantation. Another objective was to investigate desires, fulfilment, battle and results of patient’s experiences of Corneal Transplant Surgeries performed at Tertiary Care Eye Hospital. Study type, settings & duration: A Cross-sectional study conducted at Tertiary Care Eye Hospital over a period of twenty one months from July 2018 till April 2020. Methodology: The format of the questionnaire was based on previously published studies in the field of corneal transplantation. Our study was divided into two parts. The first part was conducted via structured questionnaire distributed among the general population (n =2090) visiting our hospital as patients and attendants which assessed basic knowledge regarding corneal transplantation and willingness for donation. Next step was interviews of operated patients of penetrating keratoplasty (n =30). Results: Total 2090 participants responded to questionnaire in our institution with mean age of sample as 36.66±9.00 years. 1693 (81%) had the opinion that corneal donation will help restoring vision of sufferers whereas 300 (14.3%) considered it unethical. 28 (93.3%) of the patients were in good health and prognosis after surgery whereas 2(6.7%) did not have a good outcome. Vision and quality of life of 29 (96.7%) patients’ improved.30 (100%) supported the idea of corneal donation and transplantation. Conclusion: To conclude a noteworthy population can support corneal donation if the government builds up appropriate channels and facilities to promote corneal donation and eye banks.

PurposeWe wanted to investigate effects of vitamin D3 (25(OH)D3 and 1.25(OH)2D3) on inflammatory cytokine expression in both activated and non-activated Mφ.Materials and methodsMononuclear cells, isolated from healthy donor buffy coats were cultured for a 6-day differentiation-period. Fully differentiated Mφ were pre-treated with either 25(OH)D3 or 1.25(OH)2D3 for (4, 12 or 24 hours) +/-LPS challenge for 4 hours. Gene expression analyses of VDR, Cyp27b1 and pro-inflammatory markers TNF-α, IL-6, NF-κB, MCP-1, was performed using RT-quantitative PCR. TNF-α protein levels from Mφ culture media were analysed by ELISA.ResultsBoth 25(OH)D3 and 1.25(OH)2D3 significantly inhibited TNF-α expression in both LPS-stimulated and unstimulated Mφ. Also, NF-κB, and to a lesser extend IL-6 and MCP-1 were inhibited. LPS up-regulated Cyp27b1 gene expression which was partly reverted by 1.25(OH)2D3.ConclusionThese data show anti-inflammatory effects of vitamin D3 (25(OH)D3 and 1.25(OH)2D3) in human macrophages, and support, that means for targeting high dose vitamin D3 to the immune system may have beneficial clinical effect in inflammatory conditions.