From tradition to Simulation: An experience of team training on management of shoulder dystocia.

OBJECTIVE: To determine if simulation-based team training improves the management of shoulder dystocia compared to traditionally taught obstetrical emergencies. METHODS: The prospective mixed-method study was conducted at the Centre for Innovation in Medical Education at the Aga Khan University, Karachi, from June to August 2018, and comprised doctors and nurses having up to five years of labour and delivery experience. The subjects were divided into two equal groups which were further subdivided into four equal teams. Group 1 was taught to manage shoulder dystocia using traditional lectures and hands-on pelvic models, while group 2 was trained in a simulated environment with a simulated scenario of shoulder dystocia. After two weeks, the performance of both teams were assessed and compared. Data was analysed using SPSS 19. A focus group discussion was subsequently conducted on the quality of the simulation experience. RESULTS: Of the 32 subjects, 16(50%) each were doctors and nurses. They were divided into groups having 16(50%) members each, and each group had 4 teams having 4(25%) subjects. The overall mean age of the sample was 31.9±2.8 years (range: 28-38 years). The mean score for performance on technical and communication task of group 2 was 10.25±1.258 compared to 5.7±2.500 in group 1 (p=0.028). Focus group participants agreed that training in a simulated environment was far superior than being traditionally taught. CONCLUSIONS: Simulation-based team training in shoulder dystocia management was associated with better feedback than traditional-style teaching.

WhatsApp an informal learning and communication tool: Perception of medical officers working in low resource setting: A Focus Group Discussion.

OBJECTIVE: To assess if WhatsApp communication improves clinical knowledge and to explore the perception of its use among medical officers at a secondary care facility. METHODS: The mixed method study was conducted at the Department of Obstetrics and Gynaecology, Aga Khan Hospital for Women and Children, Kharadar, Karachi, from May to July,2018, and comprised medical officers working at the secondary care facility. All the officers were added to a WhatsApp group with a consultant. Information regarding patient condition and management were exchanged in the form of messages, images related to patient care along with consultant feedback. A pre-test to assess prior knowledge was done followed by a post-test after three months of WhatsApp communication to see improvement in knowledge. To inquire about participant's WhatsApp experience and perception, a focus group discussion was conducted. SPSS 19 was used for data analysis. RESULTS: There were 10 medical officers in the study. A total of 520 communications were recorded. Of them 352(67.6%) were text messages, 117(22.5%) were images followed by 15(2.88%) web links and 36(6.9%) social messages. The pre-test mean score was 29.8±2.65 while the post-test score was 41.3±2.83 with a mean improvement in knowledge of 11.50±2.46 (p<0.0001). The focus group discussion indicated that the participants felt it was a valuable tool for prompt communication and effective patient care, and enhanced their clinical knowledge. CONCLUSIONS: WhatsApp was perceived as an effective tool for good communication as well as for improving clinical knowledge among medical officers working in low-resource setting.

--------Comparison of Hybrid-Simulation-Based Teaching with Traditional Teaching of Pharmacology.

OBJECTIVE: To compare the outcome of traditional teaching with hybrid simulation-based teaching for undergraduate medical students. Place and Duration of the Study: Department of Pharmacology, Jinnah Medical and Dental College, Karachi, Pakistan, from June to August 2023. STUDY DESIGN: Quasi-experimental study. METHODOLOGY: One hundred students from MBBS 3rd year were included in the study after taking the informed consent. Participants were divided into two cross-over groups and sampling was done randomly. Group A: (even roll numbers, n = 50) was the control group, taught by traditional lecture on positive inotropic medicines. Group B: (with odd roll numbers, n = 50) was the intervention group, taught the same topic by simulation-based teaching through 5 case scenarios. The teaching of this group was reinforced by role plays. Scores of post-test and retention test were compared by applying the Student's t-test. RESULTS: Students taught by traditional lectures i.e., Group A, their post-test mean scores were 30.7 ± 5.6, whereas Group B scored 45.7 ± 3.3, taught by hybrid stimulation (p <0.001). Retention test (MCQs based) was conducted after one month in which Group A obtained a mean score of 18.8 ± 9 with a passing percentage of approximately 30, whereas Group B obtained a score of 41.3 ± 5.6 (p <0.001). CONCLUSION: Hybrid-simulation-based teaching improved the immediate test scores as well as retention. KEY WORDS: Traditional teaching, Hybrid-simulation, MCQs, Retention test, Intervention group.

Effect of ribs in a suddenly expanded flow at sonic Mach number.

This study aims to assess the influence of a rib on the base pressure and the flow development in an abruptly expanded duct at sonic Mach number. Initially, the simulations were done to validate the experimental results, keeping all the parameters the same. Accordingly, a duct-of-area ratio of 6.25 was considered for validation. Five ribs of aspect ratios 3:1, 3:2, and 3:3 were used as a first step, and simulations were performed for the same nozzle pressure ratios. Results indicate that for an area ratio of 6.25, there is a continuous decrease in the base pressure despite the nozzles being highly under-expanded. The lower aspect ratio of the rib tends to reduce the base pressure, whereas a higher aspect ratio effectively increases the base pressure for an area ratio of 6.25. Later simulations considered a single rib instead of five ribs, varying the rib's heights from 1 mm to 5 mm. Results show that the base pressure increases considerably when rib heights are 4 mm and 5 mm. The influence of ribs at two duct diameters (25 mm and 18 mm) is studied to assess the impact of a decrease in the area ratio and, hence, a decrease in the relief available to the flow. Results of duct 18 mm show that passive control becomes very effective when a rib of 3 mm height is located at a 3D position. The differences in the base pressure, velocity, and pressure field for each case are explored. The simulation results indicate that the rib breaks the primary vortex at the base and forms multiple vortices. Turbulent kinetic energy increases in the presence of ribs more than without a rib.

A Step Toward Health Equity for Veterans: Evidence Supports Removing Race From Kidney Function Calculations.

BACKGROUND: The practice of race-based medicine fails to recognize that race cannot be used as a proxy for genetic ancestry and that racial and ethnic categories are complex sociopolitical constructs without biological basis. Clinical algorithms and equations that incorporate race modifiers and are currently considered standard for diagnosis and management of disease are appropriately being scrutinized for lack of biological plausibility and their role in exacerbating health inequities. In this paper, we review the history, evidence, and implications of using a Black race coefficient when calculating estimated glomerular filtration rate (eGFR) in the diagnosis and management of kidney disease. OBSERVATIONS: Currently, the US Department of Veterans Affairs (VA) uses the Modification of Diet in Renal Disease (MDRD) equation for eGFR. This equation includes a Black race coefficient that results in an eGFR that is 21% higher for a Black patient when compared with a patient of any other race. The rationale for the inclusion of this coefficient is based on racist science that incorrectly assumes race as a proxy for genetic ancestry. Multiple studies across diverse Black populations demonstrate that the application of a race coefficient in kidney function estimation equations is inferior when compared with the race-neutral option. Furthermore, the most utilized eGFR equations are biased and imprecise. Because eGFR is the primary diagnostic method for detecting and managing kidney disease, preventing its progression, planning for dialysis, and evaluating for transplantation, it is vital that eGFR be as accurate, precise, and equitable as possible. CONCLUSIONS: The incorporation of a race coefficient in kidney estimation equations lacks biological plausibility and its use exacerbates kidney health disparities. Until a better method to estimate kidney function becomes available, a race-neutral option for current estimation equations should be applied for all patients.

Presenting signs and symptoms of ovarian cancer at a tertiary care hospital.

OBJECTIVE: To identify early warning signs and symptoms of ovarian cancer to create awareness for early diagnosis and management of the disease. METHODS: This study was conducted at the department of Gynaecology and Obstetrics, Liaquat National Hospital, Karachi from 2003 to 2007, having 75 patients. The information collected included age, education, and self perceived state of socio-economic class, presenting clinical signs and symptoms, basic and specific laboratory investigations. The disease was staged from I to IV upon surgical staging and the type of cancer was determined by histopathological examination. RESULTS: Mean age of the patients was 51 +/- 12.3 years. Twenty (52%) patients were uneducated, 17 (22.6%) were below and remaining 19 (25.3%) were above higher secondary level. Most of the patients belonged to the middle socioeconomic class. Abdominal pain (57.3%) was the most common presenting symptom followed by abdominal distension (22.6%), urinary complaints (5.3%), vaginal discharge (2.6%) and postmenopausal bleeding (12%). More than half (56%) of the patients had stage III-IV disease. On histology, papillary serous cystic adenocarcinoma was the most common (54%) type followed by mucinious (22%), endometroid (10.6%), yolk sac (2.6%), dysgerminoma (4%), and adult granulose cell tumour (5.3%). CONCLUSION: There are no specific ovarian carcinoma symptoms either in early or late stages to ensure early diagnosis, but in the age group above 40 years persistent clinical symptoms should always be further investigated.