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Ali A.A.,Services Institute of Medical science
Journal of the College of Physicians and Surgeons Pakistan | Year: 2013

Objective: To assess the adequacy or deficiency of relevant communication skills needed in clinical practice among students of King Edward Medical University and identify the need of developing curriculum for communication skills. Study Design: Sequential mixed method design using survey questionnair and in-depth interviews. Place and Duration of Study: King Edward Medical University, Lahore, from March - September 2010. Methodology: Final year students consented to participate in the survey questionnaire regarding communication skills needed in clinical practice selected on the basis of random stratified sampling technique. The questioned aspects include communication skills, supervised training, breaking bad news, counselling and written communication skills. In the second qualitative phase, volunteers who had passed final year were selected on the basis of non-probability purposive sampling technique for recording in-depth interviews. Qualitative data was analyzed with content analysis after identifying themes and trends from the data. Results: Only 20% students had clarity of communication skills training, 28% believed that their learning was supervised, 20% believed training was structured, 28% were confident about handling difficult situations, 15% could effectively break bad news, and 22% were confident in written communication skills. In the interviews 70% felt that their peers had average skills in handling difficult situations like breaking bad news and counselling, 60% believed that communication skills program was non-existent and 100% agreed that patient turnover is a strength for the institute and structured training would improve their communication skills performance. Conclusion: The communication skills of the studied group were inadequate to address special situations. This presses need for developing a communication skills training program.

Afdhal N.H.,Beth Israel Deaconess Medical Center | Giannini E.G.,University of Genoa | Tayyab G.,Postgraduate Medical Institute | Mohsin A.,Services Institute of Medical science | And 10 more authors.
New England Journal of Medicine | Year: 2012

BACKGROUND: Eltrombopag is an oral thrombopoietin-receptor agonist. This study evaluated the efficacy of eltrombopag for increasing platelet counts and reducing the need for platelet transfusions in patients with thrombocytopenia and chronic liver disease who are undergoing an elective invasive procedure. METHODS: We randomly assigned 292 patients with chronic liver disease of diverse causes and platelet counts of less than 50,000 per cubic millimeter to receive eltrombopag, at a dose of 75 mg daily, or placebo for 14 days before a planned elective invasive procedure that was performed within 5 days after the last dose. The primary end point was the avoidance of a platelet transfusion before, during, and up to 7 days after the procedure. A key secondary end point was the occurrence of bleeding (World Health Organization [WHO] grade 2 or higher) during this period. RESULTS: A platelet transfusion was avoided in 104 of 145 patients who received eltrombopag (72%) and in 28 of 147 who received placebo (19%) (P<0.001). No significant difference between the eltrombopag and placebo groups was observed in bleeding episodes of WHO grade 2 or higher, which were reported in 17% and 23% of patients, respectively. Thrombotic events of the portal venous system were observed in 6 patients who received eltrombopag, as compared with 1 who received placebo, resulting in the early termination of the study. The incidence and severity of other adverse events were similar in the eltrombopag and placebo groups. CONCLUSIONS: Eltrombopag reduced the need for platelet transfusions in patients with chronic liver disease who were undergoing elective invasive procedures, but it was associated with an increased incidence of portal-vein thrombosis, as compared with placebo. (Funded by GlaxoSmithKline; ELEVATE ClinicalTrials.gov number, NCT00678587.) Copyright © 2012 Massachusetts Medical Society.

Khanum Z.,Services Institute of Medical science
Journal of the College of Physicians and Surgeons Pakistan | Year: 2013

Objective: To evaluate the effectiveness of reflective exercises in obstetrics and gynaecology (OB/GY) residents for theimprovement in certain identified skills.Study Design: Experimental study.Place and Duration of Study: Gynaecology Unit III, Services Institute of Medical Sciences / Services Hospital, Lahore,from September 2009 to August 2010.Methodology: Twenty-four residents from all 4 years of residency program were included in the study after their informedconsent. The competencies identified were surgical skills, professionalism, communication skills and critical appraisalskills. The reflective exercises evaluation was done on questionnaire designed for this purpose.Results: The results showed that the residents initially had underdeveloped ability to engage into purposeful reflectiveexercises, which improved with practice and showed encouraging results. Reflective exercises particularly helped inimprovement of surgical skills as opposed to other identified competencies.Conclusion: Regular engagement of postgraduate trainees in reflective exercises in a purposeful manner hasencouraging results in terms of improvement in surgical, communication, critical appraisal skills and has a role in boostingprofessionalism among residents. However, a longitudinal multicentre study can give better insight regarding theeffectiveness of this practice.

Cheema S.A.,Services Institute of Medical science
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2012

The minimum distance between two stimulus points on the skin, which are perceived as distinct points, is defined as two point discrimination (TPD). Among the two types of TPD, i.e., static and dynamic, static two-point discrimination (STPD) is commonly used to determine digital nerve integrity. Local flaps usually do well in maintaining sensibility of the covered area in terms of two-point discrimination in contrast to split thickness skin grafts (STSG). Aim was to determine the frequency of sensory deficit in terms of Two Point Discrimination (TPD) in Split Thickness Skin Grafts (STSG) and local flaps for soft tissue defects of fingers three months postoperatively. Thirty-five patients underwent local flap coverage and other thirty-five had split thickness skin grafting for soft tissue defects of fingers depending upon nature of defect. Patients were followed up at 2, 4, 8 and 12 weeks. TPD, measured at 3 months of follow-up, of 7 mm was considered normal (no sensory deficit) and TPD of 8 mm or more was considered as sensory deficit. The sensory deficit observed at the end of 12th week post operatively was 8.6% in the patients with local flap coverage (3 patients) and 45.7% with STSG (16 patients). Patients with no sensory deficit were 91.4% (32 patients) in the local flap coverage and 54.3% (19 patients) in the STSG at 12th week of follow up. The relative ratio (RR) of sensory deficit in local flaps and STSG was 5 (> 2). Local flaps are better options in terms of TPD preservation as opposed to STSG for soft tissue defects of fingers.

Qureshi H.J.,Services Institute of Medical science
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2010

In postmenopausal women, the two major causes of bone loss are oestrogen deficiency after menopause and age related processes. Bone turnover increases to high levels and oestrogen deficiency may induce calcium loss by indirect effects on extra skeletal calcium homeostasis. Objective of this study was to evaluate calcium status in pre-menopausal and postmenopausal women. This cross sectional study was carried out in 34 premenopausal women and 33 postmenopausal women, in Department of Physiology, Services Institute of Medical Sciences, Lahore. Height and weight of each woman were taken to find out the body mass index (BMI). Serum calcium, parathyroid hormone and calcitonin levels of each subject were determined. Premenopausal women were obese (BMI>30 Kg/m2) while postmenopausal women were overweight (BMI>25 Kg/m2). Serum calcium levels were significantly lower in postmenopausal women than in pre-menopausal women, while serum parathyroid hormone levels were significantly higher in postmenopausal woman. Serum calcitonin level was not significantly different in the two groups. Postmenopausal women are calcium deficient and have increased bone turnover as indicated by increased serum parathyroid hormone levels.

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