Quality of Trauma Surgery Podcasts in Credibility, Content, and Design.

Importance: There has been an emerging trend of podcast use in medical education over the past decade. With the increasing number of podcasts and learners' interest in trauma surgery, it is vital to validate the quality of these podcasts. Objective: To determine the quantity and quality of podcast episodes on trauma surgery. Design, Setting, and Participants: This cross-sectional study identified trauma surgery podcasts published globally on the Google, Apple, and Spotify platforms as of May 31, 2023. An initial screening excluded podcasts not fulfilling the inclusion criteria (published as of May 31, 2023, and covering clinical knowledge or mentorship on general trauma surgery). A 10-item checklist developed from a modified Delphi consensus method was created to assess the podcasts' credibility, content, and design as indicators of quality. Data extracted from each podcast episode included the duration, setting, host and guest credentials, and fulfillment of quality indicators. Data were analyzed on August 13, 2023. Main Outcomes and Measures: The quality of each podcast was assessed using the 10-question checklist. A score of at least 80% in credibility (4 of 5 points), 75% in content (3 of 4 points), and 100% in design (1 of 1 point) was required to classify a podcast episode as having good quality. Results: The initial search identified 204 podcasts on trauma surgery, of which 55 podcasts met the inclusion criteria. All 55 podcasts were published after 2014, with the majority hosted by males (85% [61 of 72 hosts]), based in the US (91% [50 of 55 podcasts]), and focused on clinical knowledge (80% [44 of 55 podcasts]). Podcast hosts and guests predominantly held a Doctor of Medicine degree (83% [113 of 136]), with 72% [46 of 64] of guests identifying as practicing trauma surgeons. While all 55 podcasts had excellent quality in terms of content and design, 20% (11 of 55) of podcasts were rated poorly on credibility. Credibility was further reduced for 60% (33 of 55) of podcasts because of nondisclosure of conflicts of interest. Conclusions and Relevance: In this cross-sectional study of trauma surgery podcasts, most had good-quality content and design, but there was a lack of explicit conflict of interest disclosure. Content producers need to disclose their conflicts of interest appropriately to ensure credibility and improve the quality of their podcasts.

Teacher Injustice and Classroom Citizenship Behavior of Pakistani Nursing Students: A Moderated Mediation Model.

People sometimes limit themselves to doing what is explicitly expected of them and purposely avoid engaging in socially desirable behaviors. Against this background, this study tested a moderated-mediation model based on Conservation of Resources theory and equity theory in academic context through a mixed-methods approach. More specifically, it examined the role of equity sensitivity in influencing the indirect effect of teacher injustice (TI) on classroom citizenship behavior (CCB) through burnout. Results achieved through a four-wave data collected from Pakistani nursing students partially supported the model. They demonstrated that while burnout serves as a mediator in the TI-CCB relationship, the mediation effect is independent of the level of equity sensitivity. A follow-up focus group was also conducted whose findings gave additional details regarding the psychosocial processes underlying the effect of TI on targeted students' attitudes and behaviors. Overall, the study offers theory- and evidence-based insights into the CCB withdrawal process, and provides guidance to education management practice and research.

Comparison of Upper Limb Translocated Femoral Vein and Prosthetic Arteriovenous Bridge Grafts.

Introduction Native veins are an ideal option for dialysis in a patient with chronic kidney disease (CKD) as compared to a prosthetic graft. Femoral vein (FV) translocation to the upper arm is also an alternative to a prosthetic graft as reported in the literature when all options of using the native veins of the arms are exhausted. Thus, we aimed to compare the patency of the upper limb translocated FV arteriovenous fistula (AVF) with a prosthetic arteriovenous bridge graft (AVBG). Methods It is a retrospective cohort study that was conducted in the Department of Vascular Surgery, Aga Khan University Hospital. It included adult patients who underwent either upper arm translocation of FV or prosthetic AVBG using the consecutive purposive sampling technique. There were a total of 10 patients who underwent FV translocation AVF and 20 patients who had AVBG in the upper arms. Results A total of 30 patients were included in the study. Of these 30 patients, 10 underwent FV translocation AVF and the remaining 20 had AVBG. There was a significant difference in the mean operating time of the two surgeries. The mean operating time in FV translocation was 223 (± 41.5) minutes and in those with AVBG, the mean operating time was 100 (±26.5) (p= <0.001). There was no significant difference in the total length of hospital stay in both procedures performed. The primary patency rate for FV translocation was 90% and 95% in AVBG (p=1.00). Ten percent of FV translocation had a primary failure rate compared with that of AVBG, which was 5% (p=1.00). The mean follow-up period was 61 weeks in the FV translocation group and 64 weeks in the AVG group. Conclusion There was no significant difference in both groups in terms of patency, length of hospital stay, and fewer complications were observed in the FV translocation group as compared with the AVBG group.

Teaching and practising rectal examination in Pakistan.

BACKGROUND: Digital rectal examination (DRE) is an integral part of physical examination. The teaching and practising of DRE should start early in medical school for mastering the skills to perform DRE by the time of graduation. In recent years it has been observed that medical students are reluctant to learn and practise DRE because of a perception of the reduced importance of DRE as compared with other modalities of investigation. We evaluated the knowledge and attitude of medical students and interns towards the teaching and practising of DRE. METHODS: We conducted a cross-sectional survey of four medical institutions in Karachi, Pakistan. RESULTS: Of the 398 participants included in the study, almost half were medical students. Almost all (98%) of the participants appreciated the importance of DRE. Only half of the participants reported having been formally taught about DRE before reaching the final year of medical school. Only 16 per cent reported the use of manikins as an aide to demonstrate and practise DRE. The median number of times respondents had performed DRE was one. Patients' refusal to grant consent was the most common reason given for not performing DRE. Students are reluctant to learn and practise DRE because of a perception of its reduced importance CONCLUSION: Teaching sessions on DRE using manikins are suggested to begin early in medical school. It is also suggested that a minimum number of DREs should be performed under supervision before the completion of the internship.

Outcome and Cost Effectiveness of Ultrasonographically Guided Surgical Clip Placement for Tumor Localization in Patients undergoing Neo-adjuvant Chemotherapy for Breast Cancer.

BACKGROUND: To determine the outcome and cost saving by placing ultrasound guided surgical clips for tumor localization in patients undergoing neo-adjuvant chemotherapy for breast cancer. MATERIALS AND METHODS: This retrospective cross sectional analytical study was conducted at the Department of Diagnostic Radiology, Aga Khan University Hospital, Karachi, Pakistan from January to December 2014. A sample of 25 women fulfilling our selection criteria was taken. All patients came to our department for ultrasound guided core biopsy of suspicious breast lesions and clip placement in the index lesion prior to neo-adjuvant chemotherapy. All the selected patients had biopsy proven breast cancer. RESULTS: The mean age was 45 ± 11.6 years. There were no complications seen after clip placement in terms of clip migration or hemorrhage. The cost of commercially available markers was approximately PKR 9,000 (US$ 90) and that of the surgical clip was PKR 900 (US$ 9). The cost of surgical clips in 25 patients was PKR 22,500 (US$ 225), when compared to the commercially available markers which may have incurred a cost of PKR 225,000 (US$ 2,250). The total cost saving for 25 patients was PKR 202,500 (US$ 2, 025), making it PKR 8100 (US$ 81) per patient. CONCLUSIONS: The results of our study show that ultrasound guided surgical clip placement in index lesions prior to neo-adjuvant therapy is a safe and cost effective method to identify tumor bed and response to treatment for further management.