Association of sleep patterns and water intake with cognitive functions in adults in an urban environment.

Objectives: To explore the behavior patterns of students and working adults regarding the duration and quality of sleep and water intake in an urban environment and to identify the relationship between nighttime sleep extent and water intake with mood and cognitive performance. Methods: This was a descriptive correlational study conducted at Islamic International Medical College, Riphah University at the Pathology department from March to June 2022. A total of 160 participants with age range of 20 to 50 years completed a self-report questionnaire regarding sleep patterns, water intake, and perceptions of mood, concentration, and memory. Analyzed the relationship between sleep duration, water intake, mood, mindfulness/concentration, and memory using Kendall's Tau-b correlation coefficient in SPSS 22. Results: A significant number (28.7%) of participants had a sleep duration of ≤ 6 hours, with 41.3% sleeping after midnight. 82.5% of the participants switch off-screen just before sleeping. 63.7% have a routine water intake of less than 2 L/day. An aberrant statistically significant negative correlation between total sleeping hours and mood (τb = -.313, p = 0.004) was identified, showing a negative effect on mood with a sleeping time of ≥ 9 hours when compared with the other two groups (6-9 hours, τb = - .689, p = 0.001, ≤ 6hours, τb = - .697, p = 0.001). A significant correlation between daily water intake and concentration was found, wherein a decrease in daily water intake showed a negative effect on concentration (τb = .289, p = 0.008). Conclusions: Sleep duration and water intake patterns may affect mood and cognitive performance. Regular sufficient nighttime sleep and adequate hydration may help improve cognitive functioning and mood.

'The best interest of patients, not self-interest': how clinicians understand altruism.

BACKGROUND: Altruism refers to acting in 'the best interest of patients, not self-interest'. With an observed discordance between the concept and practice of altruism, and increasing attention to 'pathologic altruism', the role of altruism is blurred in present day medical care. In this background, the required balance of altruistic attitude which needs to be fostered in medical students needs clarity. This problem may be best addressed by the practicing clinicians. The objectives of this study were to explore clinicians' understanding of altruism in the clinical context and to identify the key concepts of altruism which they felt, must be included in clinical practice. METHODS: It was an exploratory qualitative study to identify clinicians' understanding of altruism and the key practice points for altruism. Online semi-structured interviews were conducted from 18 clinicians through Zoom and transcribed using Otter. Open coding of interview transcripts was done using Atlas ti 8 and grouped by commonalities under sub themes and themes. RESULTS: The main concepts regarding the clinicians' understanding of altruism were prioritizing patients' interest above oneself, favouring patients beyond routine duty and organized team work for practicing altruism. The essential practice areas identified for altruism were finding a balance between altruistic tendency and self/family life, identifying one's individual capacity for altruism, establishing teamwork for developing a workplace altruistic attitude, and facilitating patients beyond routine duty. CONCLUSIONS: Altruism is an important professionalism attribute for clinicians, however prioritizing patients interest requires a balanced approach so that it is effective and sustainable. Workplace altruistic cultures may be better promoted through organized team-based approach rather than individual efforts.

Nonfunctional distractor analysis: An indicator for quality of Multiple choice questions.

OBJECTIVES: To analyze the low to medium distractor efficiency items in a multiple-choice question (MCQ) paper for item writing flaws. METHODS: This qualitative study was conducted at Islamic International Medical College Rawalpindi, in October 2019. Archived item- analysis report from a midyear medium stakes MCQ paper of 2nd year MBBS class, was analyzed to determine the non-functional distractors (NFDs) and distractor efficiency (DE) of items, in a total of 181 MCQs. DE was categorized as low (3-4 NFDs), medium (1-2 NFDs) and high (0 NFD). Subsequently, qualitative document analysis of the MCQ paper whose item analysis report was assessed was conducted to investigate the item flaws in the low to medium DE items. The flaws identified were coded and grouped as, within option flaws, alignment flaws between options and stem/ lead-in and other flaws. RESULTS: Distractor efficiency was high in 69 items (38%), moderate in 75 items (42%) and low in 37 items (20%). The item-writing flaws identified in low to moderate DE items within distractors included, non-homogenous length (1.8%), non-homogenous content (8%) and repeat in distractor (1.7%). Alignment flaws between distractors and stem/ lead-in identified were linguistic cues (10%), logic cues (12.5%) and irrelevant distractors (16%). Flaws unrelated to distractors were low cognitive level items (40%) and unnecessarily complicated stems (11.6%). CONCLUSIONS: Analyzing the low to medium DE items for item writing flaws, provides valuable information about item writing errors which negatively impact the distractor efficiency.