Journal Articles on Category: Health Sciences

Purpose: The purpose of the current study is to explore third- year medical students’ interest in learning about family planning, exposure to family planning (contraception and abortion) and perceived barriers and benefits to family planning education in their obstetrics and gynecology rotation.Method: We conducted four focus groups with 27 third-year medical students near the end of their rotation in obstetrics and gynecology.Results: Students desired education in family planning but perceived limited exposure during their rotation. Most students were aware of abortion but lacked factual information and abortion procedural skills. They felt systemic and faculty-related barriers contributed to limited exposure. Students discussed issues such as lack of time for coverage of contraception and abortion in the curricula and rotation itself. Perceived benefits of clinical instruction in family planning included increased knowledge of contraceptive management and abortion the ability to care for and relate to patients, opportunity for values clarification, and positive changes in attitudes towards family planning.Conclusions: Medical students who desire full education in family planning during their obstetrics and gynecology rotation may face barriers to obtaining that education. Given that many medical students will eventually care for reproductive-age women, greater promotion of opportunities for exposure to family planning within obstetrics and gynecology rotations is warranted.

Issn:10872981

Keywords: Medical student education ; Professionalism ; Family planning ; Contraception ; Abortion

Volume: 13

Pages:

Background: Student views of new curricula can shape training outcomes. This qualitative study elicited student opinions of CAM instruction to examine and distill best strategies.Methods: 49 second, third and fourth year students participated in focus groups using a predefined question route. Interviews were audio taped and transcribed.Results: Students successfully differentiated CAM curricula from other academic content and were supportive of a longitudinal integrated approach. They had positive disposition toward CAM use for themselves but this did not necessarily translate into patient recommendations. They agreed that goals of the CAM curriculum should center on awareness of patient use and evidence and information relevant to clinical practice. They advocated a case-based, hands-on, experiential strategy vs lectures. Students proposed greater institutional commitment to strengthen curricular effectiveness. The majority did not intend to practice CAM modalities but valued skills to assess them. Patient-centeredness was recognized. As training progressed, students exhibited a growing tendency to evaluate CAM efficacy, and therefore value, exclusively according to evidence.Conclusions: In-depth student input allowed examination of the effectiveness of a CAM curriculum,permitting improvement and assessment of program effectiveness.

Issn:10872981

Keywords: Curriculum assessment ; Complementary and Alternative Medicine (CAM) ; focus groups ; medical students ; qualitative

Volume: 13

Pages:

Purpose: The purpose of this study was to determine the impact of professionalism scenarios on the medical school admissions process from applicant and faculty perspectives. Specifically, do completing professionalism scenarios as part of the medical school interview process have an impact on both the interviewee’s and the faculty’s perception of the process and outcome?Method: Ninety-one faculty interviewed 199 applicants from January 2007 through April 2007 at The University of Toledo College of Medicine. All applicants were asked one standard professionalism scenario in each of their two interviews. A total of six scenarios were used for the entire interviewing season in rotation every two months. A survey was administered by an admissions office staff member to both the interviewed applicants as well as faculty who conducted interviews about how these scenarios impacted their interview experience.Results: Asking applicants to respond to professionalism scenarios during the interview was described as having a positive influence on their interview experience. This was also associated with leaving an impression on the applicant about what our institution values in its students and contributed an element of personal reflection about what will be expected of them in the medical profession. Applicants more often reported that asking questions about professionalism was an important aspect of the interview than did faculty. Overall, there was an association between the interviewer’s perception of the applicant’s response and the interviewer’s assessment of professionalism.Conclusions: Professionalism scenarios can be a worthwhile tool for use in the admissions process. The interview process should encourage participation from faculty who value this as an important component in the evaluation of an applicant. Determinants of faculty perception of the role of assessing professionalism in the interview process should be investigated in future research.

Issn:10872981

Keywords:

Volume: 13

Pages:

Acute stroke is the second leading cause of death after heart diseases in the world. Acute ischemic stroke (AIS) accounts for 80% of all strokes. The idea that AIS is an incurable disease has been abolished during the recent years because of thrombolytic treatment. To date, the only proven therapy in acute ischemic stroke to prevent infarction and minimize the degree of permanent brain injury is thrombolytic treatment. But it has some limitations; it has narrow theuropatic index and high risk of serious complications and also well-established stroke centers are needed for this therapy. We present 21 patients with acute ischemic stroke (13 male, 8 female) who were treated with intravenous recombinant tissue plasminogen activator (IV rt-PA) in our department between 19.09.2006 – 30.01.2008. The neurological statuses of the patients were assessed by “The National Institutes of Health Stroke Scale” (NIHSS) before thrombolysis application, at 24 hour, at 1 week and at 3 months. At the first day of the therapy, 75% of patients had excellent global outcomes (minimal or no deficit). The neurological examinations of IV rt-PA patients at 1 month and at 3 months were also excellent. Symptomatic intracranial bleeding was occured in one patient as a result of IV rt-PA threapy. Four patients were died, one patient died because of brain edema without hemorrhage, one patient died because of brain hemorrhage, the others died because of systemic reasons. Despite low number of patients, our experience contributed important information that IV rt-PA treatment is effective and reliable in well-selected patients.

Issn:13001817

Keywords: Acute ischemic stroke ; thrombolytic treatment

Volume: 25

Pages: 75-83

Abstract Background Heart failure is a major and growing public health problem worldwide. The prognosis of Heart Failure (HF) is uniformly poor despite advances in treatment. The aims of the present study were to determine the causes of HF among patients admitted to a Nigerian tertiary medical centre, to determine the prevalence of factors known to be associated with poor prognosis among these patients, and to compare the factors and causes between males and females. Methods The study was cross-sectional in design, carried out on eligible patients who were consecutively admitted with HF, in Aminu Kano Teaching Hospital, Kano, Nigeria. The following established factors associated with poor prognosis of HF were assessed: low Left Ventricular Ejection Fraction (LVEF) of ≤ 40%, anaemia, renal impairment, cardiac rhythm disturbances on the electrocardiogram, prolonged corrected QT interval (QTc), complete Left Bundle Branch Block (LBBB) and advanced age. Results A total of 79 patients were studied over a six-month period. Forty four (55.7%) of these patients were males while the remaining 35 (44.3%) were females. The most prevalent prognostic factor was low LVEF found in a total of 35 patients (44.3%), while the least prevalent was complete LBBB found in two male patients only (2.53%). The commonest cause of heart failure in all patients and males was hypertensive heart disease, found in a total of 45 patients (57.0%), comprising of 33 male (73.3%) and 12 female patients (26.7%) (p = 0.0003). Cardiomyopathies were the commonest causes in females, the predominant type being peripartum cardiomyopathy found in 11 (31.4%) female patients. Acute myocardial infarction has emerged to be an important cause of HF in males (13.6%) with a high in-hospital mortality of 66.7%. Conclusion The most prevalent factor associated with poor prognosis was low LVEF. Hypertensive heart disease and cardiomyopathies were the most common causes of HF in males and females respectively. The findings of the study should guide decision-making regarding management of HF patients.

Issn:14712261

Keywords:

Volume: 8

Pages: 16

Background: To quantify the internal consistency of medical students′ scores. Aim: We assessed the associations between medical students′ scores in physiopathology and clinical courses and compared these scores with their scores in their comprehensive exams. Settings and Design: We collected medical students′ scores in their courses and also in their comprehensive exam in six consecutive years. Materials and Methods: We assessed the associations between students′ scores and their personal characteristics, and the consistency between theoretical and practical courses. Statistical Analysis: We used Pearson correlation coefficient and linear regression. In addition, we computed difficulty and discrimination indices of students′ scores in their courses by comparing these scores with comprehensive clinical exam (CCE). Results: Generally, females and younger students were more successful. CCE were predicted by students′ scores and their characteristics relatively accurate (the adjusted R2 of the model was 0.59). Students′ scores in the pathology and in thesis had the maximum and minimum discrimination indices, while the difficulties of these two courses were in reverse order. The strongest association was observed between theoretical and practical scores in internal medicine while the associations between theoretical and practical scores in the other courses were not strong although all of them were statistically significant. Conclusions: Using this approach to explore the students′ score, might highlight the weak points of the current educational system. For example we found that the students′ score in thesis had the minimum accuracy; although students obtained very high score in this course. Hence, for better comparison of the accuracy students′ scores in colleges around the world, we recommend similar quantitative approach

Issn:00195359

Keywords: Difficulty index ; discrimination index ; Iran ; medical education ; validity

Volume: 62

Pages: 267-274

Issn:09700218

Keywords:

Volume: 33

Pages: 208-208

Abstract Background Short-term medical missions (STMMs) are a well-established means of providing health care to the developing world. Despite over 250 million dollars and thousands of volunteer hours dedicated to STMMs, there is a lack of standardized evaluation to assess patient safety, quality control, and mission impact. The objective of this project is to design and implement an assessment tool that defines objective parameters of quality of care as identified by STMMs. Methods The study was conducted in 3 phases: 1) Base-need analysis to determine factors critical to the quality of STMMs, 2) Design of 5 surveys for mission personnel and patients to enable 360-degree evaluation based on factors from phase 1, and 3) Field testing of the surveys with 5 STMMs. Results An evaluation tool was created assessing 6 major and 30 minor factors identified as important to the quality of STMMs. 5 mission directors, 43 personnel, 10 local hosts, and 55 patients completed the surveys. Of the 6 major measures of quality, missions performed best in Cost (mean score 86%), and Impact (84%). The poorest performance was in Education (64%). Efficiency, Sustainability, and Preparedness showed mean scores of 76%, 77%, and 73%, respectively. Conclusion Our study provides a novel standardized tool for STMM evaluation. Use of the assessment instrument identified areas of strength and weakness of a particular mission, and delineated general trends in performance compared to other STMMs. We anticipate that the use of this tool may improve the quality of care provided by missions, and stimulate solution-sharing and scholarly discussion among missions.

Issn:14726963

Keywords:

Volume: 8

Pages: 121

Abstract Background Emergency Medical Care is an important component of health care system. Unfortunately it is however, ignored in many low income countries. We assessed the availability and quality of facility-based emergency medical care in the government health care system at district level in a low income country – Pakistan. Methods We did a quantitative pilot study of a convenience sample of 22 rural and 20 urban health facilities in 2 districts – Faisalabad and Peshawar – in Pakistan. The study consisted of three separate cross-sectional assessments of selected community leaders, health care providers, and health care facilities. Three data collection instruments were created with input from existing models for facility assessment such as those used by the Joint Commission of Accreditation of Hospitals and the National Center for Health Statistics in USA and the Medical Research Council in Pakistan. Results The majority of respondents 43/44(98%), in community survey were not satisfied with the emergency care provided. Most participants 36/44(82%) mentioned that they will not call an ambulance in health related emergency because it does not function properly in the government system. The expenses on emergency care for the last experience were reported to be less than 5,000 Pakistani Rupees (equivalent to US$ 83) for 19/29(66%) respondents. Most health care providers 43/44(98%) were of the opinion that their facilities were inadequately equipped to treat emergencies. The majority of facilities 31/42(74%) had no budget allocated for emergency care. A review of medications and equipment available showed that many critical supplies needed in an emergency were not found in these facilities. Conclusion Assessment of emergency care should be part of health systems analysis in Pakistan. Multiple deficiencies in emergency care at the district level in Pakistan were noted in our study. Priority should be given to make emergency care responsive to needs in Pakistan. Specific efforts should be directed to equip emergency care at district facilities and to organize an ambulance network.

Issn:1471227X

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Volume: 8

Pages: 8

Issn:00223859

Keywords:

Volume: 54

Pages: 176-179