Evaluation of FamMed essentials: a blended-learning program for capacity building of general practitioners in Pakistan.

BACKGROUND: To provide access to primary care and universal health coverage, Pakistan requires 60,000 trained family physicians by 2030. At present, most primary care is provided by general practitioners (GPs) who do not have any post-graduate training. Empowering GPs through competency-based programs, that strengthen their knowledge and skills, may be a cost-effective strategy for improving healthcare quality. We describe the development and evaluation of FamMed Essentials, a modular, blended-learning program to improve clinical knowledge and skills of GPs. METHODS: This is a mixed method study. We used the CIPP (content, input, process and product) framework for course development and evaluation. We describe the steps used in content development, strategies for teaching and assessments, and evaluation of strengths and weaknesses of the program. In depth focus group discussions were conducted to gather insight on participants' and faculty's perceptions regarding the program's effectiveness. RESULTS: Of the 137 participants who have completed the program, 72% were women and 49% had been practicing for more than five years. We saw a significant improvement in knowledge across all modules (p = < 0.001) and perceived confidence in clinical skills (p = < 0.001). An objective assessment showed participants' competence in patient management. Participants reported a high level of satisfaction (4.4 ± 0.83 on a 5-point Likert Scale). Focus group discussions revealed a positive impact on clinical practice. Flexibility and use of different teaching and learning strategies were additional strengths. In addition, participants reported an interest in further training. Power outages were highlighted as a major challenge. CONCLUSION: In resource-constrained health systems, a modular, blended-learning, competency-based program is helpful to upgrade GPs knowledge without impacting their busy schedules. Accreditation of such programs and provision of a career trajectory for the trained GPs are pivotal to expansion of such initiatives.

A review of top cardiology and cardiovascular medicine journal guidelines regarding the use of generative artificial intelligence tools in scientific writing.

BACKGROUND: Generative Artificial Intelligence (AI) tools have experienced rapid development over the last decade and are gaining increasing popularity as assistive models in academic writing. However, the ability of AI to generate reliable and accurate research articles is a topic of debate. Major scientific journals have issued policies regarding the contribution of AI tools in scientific writing. METHODS: We conducted a review of the author and peer reviewer guidelines of the top 25 Cardiology and Cardiovascular Medicine journals as per the 2023 SCImago rankings. Data were obtained though reviewing journal websites and directly emailing the editorial office. Descriptive data regarding journal characteristics were coded on SPSS. Subgroup analyses of the journal guidelines were conducted based on the publishing company policies. RESULTS: Our analysis revealed that all scientific journals in our study permitted the documented use of AI in scientific writing with certain limitations as per ICMJE recommendations. We found that AI tools cannot be included in the authorship or be used for image generation, and that all authors are required to assume full responsibility of their submitted and published work. The use of generative AI tools in the peer review process is strictly prohibited. CONCLUSION: Guidelines regarding the use of generative AI in scientific writing are standardized, detailed, and unanimously followed by all journals in our study according to the recommendations set forth by international forums. It is imperative to ensure that these policies are carefully followed and updated to maintain scientific integrity.

Pharmacoeconomic Analysis of Fixed-Dose Combinations of Proton Pump Inhibitors Available in India.

Introduction The global proton pump inhibitors (PPIs) market was valued at US$ 2.9 billion in 2020 and is expected to exhibit a compound aggregated growth rate of 4.30% during the forecast period (2020-2027), as they are regularly prescribed for many gastrointestinal disorders, and the treatment usually lasts for a longer period. PPIs are usually combined with antiemetics and prokinetic drugs. The price of PPIs for the same combination varies a lot, which can lead to a lot of financial burden on the patients. Objective To evaluate the cost ratio and percentage cost variation of commonly used PPIs in various combinations. Methodology The cost of different brands of commonly used PPIs in combination with other drugs was analyzed in our study. A total of 21 different combinations (10 capsules/tablets for oral use) were tabulated by referring to the "Monthly Index of Medical Specialities" October-December 2021, and 1mg online pharmacy. The cost ratio and percentage cost variation for various brands of a particular strength and dosage form were calculated and compared. Cost ratio > 2 and cost variation > 100% were considered significant. Results The results show a huge variation (1788.88%) in costs of different brands with the highest being rabeprazole 20 mg and domperidone 10 mg (cost ratio: 18.88, percentage cost variation: 1788.88%) in oral formulation, followed by pantoprazole 40 mg and itopride 150 mg. The minimum cost ratio (1.35) and percentage cost variation (1.35%) is for pantoprazole 40 mg and levosulpiride 75 mg. Logistic regression analysis between the number of brands and percentage cost variation gives an R2 value of 0.0923. Conclusion There is a wide variation in the prices of PPIs available in the market, which can inadvertently increase the financial burden of therapy on patients. Physicians need to be made aware of these price differences so that they can choose the best available alternative for patients, which can help in increasing compliance with the prescribed drugs.

A Critical Review of the Drug Promotional Literature Published in Scientific Medical Journals and Available at Outpatient Departments: A Cross-Sectional Observational Study.

Background A vital method used by pharmaceutical companies to make physicians aware of new drugs and increase the prescription and sale of the same is through drug promotion literature (DPL) published in scientific journals and distributed in outpatient departments (OPDs). It is important that drug promotion is done ethically to avoid the spread of false information for which guidelines are available at the international level by the World Health Organization (WHO) and at the national level by the Organisation of Pharmaceutical Producers of India (OPPI). In this study, we aim to review the DPLs used for promotion by market authorization holders (pharmaceutical business entities) in scientific healthcare journals and OPDs for their compliance with the "Ethical criteria for medicinal drug promotion" of the WHO and OPPI Code of Ethics Practice. In addition, we compare the ethical standard of the DPL available in scientific journals and OPDs with respect to existing norms and guidelines. Methodology A cross-sectional, observational study was conducted at a tertiary care teaching institute in Navi Mumbai, India. DPLs were collected from journals available at the institute library nearby published from January-June 2022 and from the outpatient departments of our hospital and other clinics nearby during the same time duration. Analysis was done according to the criteria given in WHO and OPPI guidelines. Each point in the criteria was scored as 1 or 0 based on whether the DPL was compliant or not respectively. DPLs were graded into 3 categories based on percentage compliance: Grade A (>70%), Grade B (35-70%), and Grade C (<35%). Results A total of 370 DPLs were collected, of which 191 (51.6%) were collected from scientific journals and 179 (48.4%) from OPDs. DPLs collected from journals showed that only 7.85% belonged to Grade A (WHO guidelines). According to the OPPI guidelines, 57.59% of the same DPLs belonged to Grade A. DPLs from OPDs showed similar results by both guidelines with >90% belonging to Grade B. Approximately less than 5% of the DPLs belonged to Grade C from both scientific journals and OPDs. Conclusions None of the DPLs were found to be entirely compliant with either of the guidelines. Most of the DPLs from both sources belong to Grade B, with information about adjuvants, adverse drug reactions, contraindications, drug interaction, and references to scientific literature missing from them. DPLs belonging to Grade C even had information about active ingredients missing from them which can lead to serious harm due to the wrong prescription of drugs.

Renal Function in Hypertensive Patients Receiving Cilnidipine and L-Type Calcium Channel Blockers: A Meta-Analysis of Randomized Controlled and Retrospective Studies.

Nearly 65%-95% of chronic kidney disease (CKD) patients have hypertension. Calcium-channel blockers are the first-line drugs for the treatment of hypertension, including hypertension with diabetes. This study aims to estimate the effect of an L-type calcium channel blocker (CCB), cilnidipine, on the renal function of hypertensive patients. Randomized control trials were selected from PubMed, Embase, Google Scholar, China National Knowledge Infrastructure (CNKI), Science Direct, Elton B. Stephens Company (EBSCO), Springer, Ovid, Cochrane Library, Medline, VIP, and Wanfang databases (from the date of databases' establishment till January 2022). Data were independently evaluated following the Cochrane risk-of-bias tool. The changes in serum creatinine (SCr), urinary protein excretion (UPE), urinary protein/creatinine ratio (UPCR), and estimated glomerular filtration rate (eGFR) before and after treatment, in percentages, were extracted for the meta-analysis. The mean difference (MD) and a CI of 95% were determined using RevMan 5.3 software. A total of 11 studies were analyzed. The standardized mean difference (SMD) between cilnidipine and L-type CCBs was -0.022, suggesting a reduced SCr with cilnidipine. For UPCR, the SMD value is 1.28. Although cilnidipine reduced UPCR in all four studies, the L-type CCBs reported a slight increase in UPCR. For eGFR, the SMD value was found to be 0.693. Cilnidipine had a more favorable effect on eGFR when compared to the L-type CCBs. While cilnidipine had similar effects on SCr to that of L-type CCBs, cilnidipine showed greater improvement in UPCR, UPE, and eGFR values.

The outcomes of a mobile just-in-time-learning intervention for teaching bioethics in Pakistan.

INTRODUCTION: The study aimed to test the effectiveness and the feasibility of a mobile just-in-time-learning (m-JiTL) approach for teaching bioethics at a university in Pakistan. Over four months, a mobile app (EthAKUL) was used to enhance ethical reasoning among practising nurses, trainee physicians, and medical and nursing students utilising the m-JiTL approach. Participants used EthAKUL to access bioethics modules and participate in asynchronous discussions. METHODS: A mixed methods design was adopted. Pre- and post-knowledge tests were used to assess changes in participants' knowledge of bioethics concepts, while pre- and post-surveys were used to assess changes in participants' attitudes towards m-learning. After the intervention, focus group discussions with the participants were held. Analysis of the discussion posts and meeting notes was conducted. RESULTS: The learners had a favourable attitude toward using mobile devices for learning purposes at the start of the intervention, and the score remained positive afterwards. Bioethics knowledge test scores improved at the end of the intervention, with medical students experiencing the greatest improvement. However, because of the high drop-out rate and lack of participation after the initial phase, it is unclear whether the increase in score or positive attitude is the result of the intervention, making it difficult to draw firm conclusions about the intervention's success. CONCLUSIONS: EthAKUL is the first of its kind app for teaching bioethics, and the study has offered important insights into adopting new pedagogies and technologies for bioethics teaching. It has also identified issues with the design of the app and m-JiTL pedagogy that must be addressed before curriculum-wide adoption.

Reusable sanitary napkins-time to revisit.

BACKGROUND: To assess knowledge, attitude and practices (KAP) of women regarding menstrual hygiene and to evaluate the use of reusable sanitary napkins as an alternative to disposable sanitary napkins. METHODS: A community-based cross-sectional study was done in two phases. In the first phase, 50 married women attending Gynecology OPD were asked to use reusable sanitary napkins for 2 months. A pre- and post-usage vaginal swab testing was done to rule out genital infection. This study was extended in the second phase to another 534 women after confirming that reusable sanitary napkins do not cause genital infection and are acceptable. KAP analysis regarding menstrual hygiene was done for all women. RESULTS: In phase 1 of the study, the microbiological evaluation revealed no pathological organisms on vaginal swab culture after 2 months of usage. KAP analysis of 584 women revealed that only 26% women had awareness about menstruation before attaining menarche; in 51.88%, the primary source of information was their mother; 76.54% women in the study used disposable sanitary pads of which 15% were disposing of them unhygienically; 80.49% women found the reusable napkins comfortable and easy to use and 83.6% women confirmed recommending these napkins to others. CONCLUSION: Reusable sanitary pads are an effective, environment friendly, and cost-effective alternative to disposable napkins.

Fostering teaching-learning through workplace based assessment in postgraduate chemical pathology residency program using virtual learning environment.

BACKGROUND: The principle of workplace based assessment (WBA) is to assess trainees at work with feedback integrated into the program simultaneously. A student driven WBA model was introduced and perception evaluation of this teaching method was done subsequently by taking feedback from the faculty as well as the postgraduate trainees (PGs) of a residency program. METHODS: Descriptive multimethod study was conducted. A WBA program was designed for PGs in Chemical Pathology on Moodle and forms utilized were case-based discussion (CBD), direct observation of practical skills (DOPS) and evaluation of clinical events (ECE). Consented assessors and PGs were trained on WBA through a workshop. Pretest and posttest to assess PGs knowledge before and after WBA were conducted. Every time a WBA form was filled, perception of PGs and assessors towards WBA, time taken to conduct single WBA and feedback were recorded. Faculty and PGs qualitative feedback on perception of WBA was taken via interviews. WBA tools data and qualitative feedback were used to evaluate the acceptability and feasibility of the new tools. RESULTS: Six eligible PGs and seventeen assessors participated in this study. A total of 79 CBDs (assessors n = 7 and PGs n = 6), 12 ECEs (assessors n = 6 and PGs n = 5), and 20 DOPS (assessors n = 6 and PGs n = 6) were documented. PGs average pretest score was 55.6%, which was improved to 96.4% in posttest; p value< 0.05. Scores of annual assessment before and after implementation of WBA also showed significant improvement, p value 0.039, Overall mean time taken to evaluate PG's was 12.6 ± 9.9 min and feedback time 9.2 ± 7.4 min. Mean WBA process satisfaction of assessors and PGs on Likert scale of 1 to 10 was 8 ± 1 and 8.3 ± 0.8 respectively. CONCLUSION: Both assessors and fellows were satisfied with introduction and implementation of WBA. It gave the fellows opportunity to interact with assessors more often and learn from their rich experience. Gain in knowledge of PGs was identified from the statistically significant improvement in PGs' assessment scores after WBA implementation.

Perceptions of technology-enhanced learning in undergraduate medical education at a private medical college in Karachi, Pakistan.

OBJECTIVE: To identify perceptions of key stakeholders in a private medical college for the adoption of technology enhanced learning at the undergraduate level. METHODS: The mixed-method study was conducted at the Aga Khan University Medical College in Karachi from May 2014 to May 2015. Data was collected from students, faculty and academic programme leaders through questionnaires, focus group discussions (FGDs) and semi-structured interviews. SPSS 19 was used for quantitative data analysis. Qualitative data was analysed by generating codes and themes from the FGDs and interview transcripts. RESULTS: There was a consensus among the stakeholders regarding the need to incorporate technology-enhanced learning at the undergraduate level to supplement the curriculum, but not as a replacement for face-to-face class sessions. Students and faculty members have access to technology on campus. Students are appropriately digitally literate and use information and communication technology extensively for studies and other communication needs. All faculty members use PowerPoint and videos, and some use other tools, like simulations. The key challenges to technology-enhanced learning use identified included faculty members' skills to incorporate it in teaching, limited opportunities and time to learn the use of technology, poor faculty incentives for teaching innovation, and lack of availability of technical support and appropriate technologies. CONCLUSIONS: Successful adoption of technology-enhanced learning requires changes in the curriculum and pedagogical approaches, preparedness and willingness of the stakeholders, and academic leaders' vision and support to embrace new teaching and learning approaches.

Obstetrical risks in the older primigravida.

OBJECTIVE: To compare the complications, delivery mode and fetal outcome between elderly primigravidae and young primigravidae. DESIGN: A comparative study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynaecology, POFs Hospital, Wah Cantt, from January 2001 to December 2002. SUBJECTS AND METHODS: One hundred and fifty six elderly primigravidae were compared with a matched pair group of younger primigravidae regarding antenatal, intrapartum and postpartum complications. Perinatal mortality was also compared. Specially designed proforma was used to record the information. Data analysis was performed using SPSS package for windows version 10.0. Results were compared using Chi-square test by keeping the p-value of <0.05 as significant. RESULTS: Amongst the complications during pregnancy, pregnancy induced hypertension was commonest complication in elderly primigravidas (24.35% vs. 6.41%, p-value < 0.05). Diabetes, malpresentation and premature labour were also more frequent in elderly group (p-value < 0.05). More (30.76%) of elderly group were delivered by caesarean section as compared to 16.02% in young group (p-value < 0.05). Congenital malformations of the fetus were common in elderly group (5.12% vs. 1.28%). Cases of essential hypertension (12.82% vs. 1.92%), fibroid uterus (9.61% vs 2.56%) and ovarian cyst (7.69% vs. 1.92%) were frequent in elderly group patients. Perinatal mortality was relatively high in elderly groups and compared to young patients and 17 babies in elderly group were still born as compared to 10 babies in young group. CONCLUSION: Advanced maternal age has been associated with an increased risk of various complications like hypertension, diabetes, and intrauterine growth retardation and congenital malformations. Timely and accurately diagnosis of complications and their treatment leads to favorable outcome. The higher rate of caesarean section in older primigravidas is due mainly to higher rate of obstetrical complications.