Investigating the internal structure of multiple mini interviews-A perspective from Pakistan.

BACKGROUND: Healthcare professionals require many personal attributes in addition to cognitive abilities and psychomotor skills for competent practice. Multiple Mini- Interviews are being employed globally to assess personality attributes of candidates for selection in health professions education at all level of entry; these attributes are namely, communication skills, critical thinking, honesty, responsibility, health advocacy, empathy and sanctity of life. Considering the high stakes involved for students, faculty, institutions and the society, rigorous quality assurance mechanisms similar to those used for student assessment must be employed for student selection, throughout the continuum of medical education. It is a difficult undertaking as these psychological constructs are difficult to define and measure. Though considered to yield reliable and valid scores, studies providing multiple evidences of internal structure especially dimensionality of Multiple Mini-Interviews are sparse giving rise to questions if they are measuring a single or multiple constructs and even if they are measuring what they are purported to be measuring. OBJECTIVE: The main objective is to provide statistical support of the multi-dimensional nature of our Multiple Mini Interviews, hypothesized a-priori, through CFA. Another objective is to provide multiple evidences for the internal structure. Our study highlights the link between content and internal structure evidences of the constructs, thus establishing that our Multiple Mini Interviews measure what they were intended to measure. METHOD: After securing permission from the Institutional review board, an a-priori seven factor-model was hypothesized based on the attributes considered most essential for the graduating student of the institution. After operationally defining the attributes through extensive literature search, scenarios were constructed to assess them. A 5-point rating scale was used to rate each item on the station. A total 259 students participated in the multiple mini interviews over a period of three days. A training workshop had been arranged for the participating faculty. RESULTS: The reliability coefficient using Cronbach's alpha were calculated (range from 0.73 to 0.94), Standard Error of Measurement (ranged from 0.80 to1.64), and item to station-total correlation ranged from 0.43-0.50 to 0.75-0.83. Inter-station correlation was also determined. Confirmatory factor analysis endorsed the results of Exploratory factor analysis in the study revealing a seven model fit with multiple indices of Goodness-of-fit statistics such as Root mean square error of approximation (RMSEA) value 0.05, Standardized root mean square residual (SRMR) value with less than 0.08. All these indices showed that model fit is good. The Confirmatory factor analysis confirmed the multi-dimensional nature of our MMIs and also confirmed that our stations measured the attributes that they were supposed to measure. CONCLUSION: This study adds to the validity evidence of Multiple Mini-Interviews, in selection of candidates, with required personality traits for healthcare profession. It provides the evidence for the multi-dimensional structure of Multiple Mini interviews administered with multiple evidences for its internal structure and demonstrates the independence of different constructs being measured.

Mediastinal Lymphadenopathy As A Predictor Of Worse Outcome In Severe Covid-19 Cases.

BACKGROUND: This cross-sectional study is aimed at evaluating the association of mediastinal lymphadenopathy with COVID-19 prognosis in severe cases. Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital, Pakistan, from June to July 2020. METHODS: One hundred and fifty (150) laboratory-confirmed SARS CoV-2 infected, severe cases in Intensive Care Unit/ High Dependency Unit were included. These cases were divided into two categories, i.e., with and without mediastinal lymphadenopathy on High Resolution Computed Tomography chest. The two categories were compared on the basis of data obtained including age, gender, comorbid, White Blood Cell count, lymphocyte count, median days of hospitalization, need for invasive ventilation, Intensive Care Unit admission, clinical outcome and High-Resolution Computed Tomography chest findings. The data was compiled on a questionnaire and analysed on SPSS 24. RESULTS: Total 155 severe COVID-19 patients were reviewed, out of which 36 (23.2%) had mediastinal lymphadenopathy (category 1) and 119 (76.8%) had no mediastinal lymphadenopathy (category 2). Laboratory findings including median of white blood cells and lymphocyte percentage had no significant change in both categories. Intensive care unit admissions were 12 (33.3%) and 56 (47.1%) in category 1 and 2 respectively. Median days of hospitalization (8 days) and mortality rate (16%) were almost the same in both categories. CONCLUSIONS: Our study concludes that presence of mediastinal lymphadenopathy in severe COVID-19 cases is not associated with worse outcome. However, overall prevalence of mediastinal lymphadenopathy in severe cases is high (23.2%).

A Multicenter Study of Clinical Presentations and Outcomes of Multiple Myeloma in Pakistan: The Real-World Analysis in a Resource-Constrained Country.

This is the first multicenter study from Pakistan exploring the prevalence, clinical presentations and treatment outcomes of Multiple Myeloma patients. This retrospective study involved data collection from hospital record system of four tertiary care referral hospitals of Pakistan including all patients diagnosed as having Multiple Myeloma from January 2014 to December 2018. The demographic details, clinical presentations, laboratory findings, treatment responses, and mortalities were evaluated. The progression-free survival and overall survival were analyzed considering relapse and mortality as the end points, respectively. For the progression-free survival, the Kaplan-Meier survival analysis and the log rank test were used to compare the survival function for chemotherapy followed by autologous stem cell transplant (ASCT) as opposed to chemotherapy alone (non-ASCT). The overall survival analysis was assessed by Kaplan-Meier survival analysis. This study identified 403 Multiple Myeloma patients in five years. The median age at presentation was 55 years. Bortezomib based drug regimens were the most commonly used initial treatments (57.5%). Forty three patients received ASCT. The progression-free survival median for ASCT and non-ASCT patients were 50 months (95% CI, 42-57.9 months) and 26 months (95% CI, 21.5-30.5 months), respectively. The cumulative probability of survival rate at 60 months was 80%. This study identified 403 Multiple Myeloma patients over 5 years in four tertiary care hospitals of Pakistan. It underscores the importance of autologous stem cell transplant in Myeloma patients and advocates improving its facilities in Pakistan.

Community Based Assessment of Behavior and Awareness of Risk Factors of Cystic Echinococcosis in Major Cities of Pakistan: A One Health Perspective.

Background: The parasitic disease, cystic echinococcosis (CE), is a serious health problem in Pakistan. Risk of disease transmission is increased by economic and political instability, poor living conditions, and limited awareness of hygienic practices. The current study aimed to investigate the community perception and awareness regarding the risk factors of CE in Pakistan, from a One Health perspective. Methods: We conducted a community-based survey involving 454 participants in the major cities of Pakistan. Quantitative data based on knowledge, attitude, and practices (KAP), the One Health concept, risk factors, and community perception of CE among the general population of the major cities of Pakistan were collected. The questions included those related to knowledge, attitude, practices, One Health concept, risk factors, and community perception. The Chi-squared test was applied to determine the associations regarding KAPs across socio-demographic parameters. Results: KAPs had no significant associations with sociodemographic aspects such as age, sex, religion, ethnicity, education, marital status, occupation, or financial status of the participants. The findings indicated a lack of awareness about CE among the participants. Respondents were unaware of the risk factors and the One Health concept of CE. However, the community attitude and perception were positive toward the control of CE. Conclusion: Illiteracy, deficient sanitation systems and lack of awareness are the contributing factors to CE in Pakistan. It is necessary to make the community aware regarding CE and its importance. Increasing this awareness represents an important step toward the eradication and control of CE.

Potential risk factors related to academic failure in a medical college: A comparative approach.

OBJECTIVE: To compare risk factors related to medical students' failure based on gender, year of study and living away from home. METHODS: The cross-sectional, non-interventional, comparative study was conducted at a private medical college of Islamabad, Pakistan from 2015 to 2017, and comprised students who had even once scored <50% marks in their professional examinations. Data was collected using a questionnaire that was scored on a five-point Likert scale. Data was analyzed using SPSS 23. RESULTS: Of the 115 students, 62(52%) were day scholars compared to 55(48%) hostellers; 64(56%) were females compared to 51(44%) males; and 50(43%) belonged to the second year. Overall, differences in terms of gender, year of study and living away from home were not significant (p>0.05). CONCLUSIONS: Risk factors for poor academic performance were found to be common among all students.

FLAG vs FLAG-IDA: outcomes in relapsed/refractory acute leukemias.

BACKGROUND: FLAG (fludarabine, cytarabine, granulocyte colony-stimulating factor) and FLAG-IDA (idarubicin added to standard FLAG) are salvage chemotherapy regimens used for relapsed and refractory acute leukemias. The toxicity of the FLAG-IDA courses is generally more severe than for the FLAG courses, with marked neutropenia and thrombocytopenia. This study aims to compare the outcomes of both regimens in terms of morbidity, mortality and remission/transplant. No comparison has been reported so far in Pakistan or the rest of third world countries. METHODOLOGY: This retrospective study was conducted in Hematology and Bone Marrow Transplant unit after approval from Institutional Review Board and Ethics Committee. 76 leukemic patients treated with salvage chemotherapy were included. Our endpoints for patient outcome analysis included disease remission/relapse, HSCT following remission, morbidity, mortality, progression free survival and overall survival. Kaplan Meier curves were made in SPSS for survival analysis. RESULTS: A total of 76 patients were included from 2015 to July 2018. 49 patients were given FLAG, and 27 were given FLAG-IDA. 31.6% in FLAG-IDA achieved complete remission (CR)/complete remission with incomplete counts (CRi). 21% in FLAG-IDA made it to Bone marrow transplant (BMT) (67% of those in CR/CRi). 41.7% in FLAG achieved CR/CRi, and 27.8% in FLAG made it to BMT (67% of those in CR/CRi). Common complications in both regimens were infection, bleeding and other complications e.g., rash, diarrhea, mucositis, etc. A statistically significant difference was found between overall survival of the two regimens, p value 0.033. CONCLUSIONS: FLAG regimen was found superior to FLAG-IDA with better survival and subsequent transplant rate.

The Frequency of Different Risk Factors for Lower Back Pain in a Tertiary Care Hospital.

Background and purpose Lower back pain is an extremely common health problem and causes more global disability than any other condition. Moreover, it causes an enormous economic burden in both developed and developing countries. The aim of this study is to determine the frequency of different risk factors for lower back pain in a tertiary care centre in Islamabad. Methods A cross-sectional study was conducted at Shifa International Hospital's neurosurgery and neurology outpatient department from September 2016 to February 2017. A total of 375 patients with lower back pain were interviewed regarding risk factors. Results Among the 375 patients, the majority were men (51.7%, n = 194). The mean patient age was 42.05 ± 15.35 years (mean ± standard deviation); most of the patients belonged to the 21- to 40-year-old age group (48%, n = 180). The majority (78.4%) had chronic back pain. Lower back pain was found to be predominant in housewives (30.1%, n = 113), followed by those with office jobs (18.1%, n = 68), private jobs (i.e., truck drivers, shopkeepers) (14.7%, n = 55), and healthcare workers (12.3%, n = 46). In terms of work schedule, 51.2% of patients reported working around 41-50 hours per week. The major risk factors identified were lack of exercise (76.3%, n = 286), use of soft foam mattress (52.0%, n = 195), prolonged sitting (50.4%, n = 189), lifting heavy weight (48.5%, n = 182), bending or twisting (41.6%, n = 156), sleep disorder (41.6%, n = 156), anxiety (39.5%, n = 148), hypertension (32.3%, n = 121), and depression (28.8%, n = 108). Conclusions Our study concludes that lower back pain is a multifactorial phenomenon. Age, gender, profession, working hours, comorbid conditions, trauma, lifestyle, and stresses in life all play a role in its causation. Increasing physical activity and modifying lifestyle are suggested to prevent this major health issue.

Treatment for Symptomatic Bacterial Vaginosis: ARandomized Controlled Trial.

OBJECTIVE: To compare the efficacy of multiple doses of vaginal clindamycin with a single oral dose of secnidazole for the treatment of bacterial vaginosis. STUDY DESIGN: Double-blinded randomized controlled trial. PLACE AND DURATION OF STUDY: Shifa Foundation Community Health Center, from March 2012 till February 2015. METHODOLOGY: After obtaining written informed consent, a pelvic examination was performed for the confirmation of symptoms of milky white vaginal discharge on speculum examination, positive Amine test and presence of clue cells on microscopy. Pregnant women, known diabetes or any immunocompromised condition, were excluded. Blinding of the patient, doctor, and the pharmacist was done. Study cohort was then divided into two groups, Group Areceived medicine pack Awhich contained active clindamycin and placebo oral preparation, whereas group B was given pack B which contained active 2-gm secnidazole with placebo vaginal cream. Primary outcome and therapeutic success were defined by correction of two out of three (normal Nugent score, negative Amine test, and no milky white discharge) on day 15. RESULTS: At 15th day of treatment, 96.6% participants in vaginal clindamycin group (Group A), recovered from the bacterial vaginosis; whereas, (group B) 23% patients were cured in oral secnidazole group. CONCLUSION: Multiple doses of vaginal clindamycin are superior to single dose of oral secnidazole for the treatment of bacterial vaginosis.