What impressions do medical students of the University of Benin have about anaesthesia and anaesthesiologists?

A survey on the impressions 500 level medical students of the University of Benin have about anaesthesia and anaesthesiologists was carried out from May to August 1999. The survey showed the mean age of the students to be 25.3 years and a male to female ratio of 3:1. The study also showed that 170 (82.5%) of the students were unaware of the scope of anaesthesia before the posting. After the posting, this figure decreased to 58 (34.5%) (chi2 = 11.7, p < 0.05, df = 2). Approximately same number of females (71.1%) and males (72.3%) had low awareness (unaware and limited awareness) about the scope of anaesthesia. However, more males (16.9%) were fully aware about anaesthesia and anaesthesiologists than female students (9.4%). Similarly, 76 (54.3%) of the students knew that anaethesiologists were doctors before the posting. This figure improved to 109 (85.2%) after the posting and was statistically significant. Interest in the specialty was exhibited by only 2 (2%) of the students before the posting and 21 (25%) of them became interested during and 4 (5%), after the posting in anaesthesia. The impressions had by those uninterested in anaesthesia include the unchallenging, non-lucrative and stereotyped nature of the specialty. It also included the dependency of the specialty on other specialties and that it attracted dull, lazy doctors whose job was unrecognized. This study's findings suggest the need for better exposure of medical students to anaesthesia to increase awareness and for the specialty to grow. Keywords: medical students, awareness, anaesthesia, anaesthesiologists.     

In search of pigbel: gone or just forgotten in the highlands of Papua New Guinea?

Throughout the 1960s and 1970s, pigbel (enteritis necroticans) was the most common cause of death in children over the age of 1 year in hospitals in the highlands of Papua New Guinea (PNG). There has been recent widespread perception that after the successful vaccination program in the 1980s the disease virtually disappeared. A new vaccine is now available, but disease burden information is conflicting: despite almost no pigbel being reported from major hospitals there have been many reports of the disease from outlying health centres. This study aimed to provide information on the disease burden of pigbel in PNG, so that appropriate vaccine policy decisions could be made. We conducted a 12-month prospective study of all cases of acute abdomen in children presenting to 38 health facilities, 29 health centres and 9 hospitals in the highlands. Children were eligible for inclusion if they were aged 1-12 years and had abdominal pain of less than 2 weeks' duration. A standardized case definition of pigbel was used to distinguish cases of acute abdominal pain very likely to be due to pigbel from cases very likely to be accounted for by other diagnoses (such as gastroenteritis, typhoid, dysentery, intussusception, urinary tract infection and others). A total of 119 cases of acute abdomen were reported from 17 of the 38 health facilities involved. Of these 119 cases 11 met the criteria for pigbel and a further 8 were probable cases. There were 4 deaths among the 119 children with acute abdomen: 2 from definite pigbel, 1 from probable pigbel and the other due to complications of measles. In 2002 pigbel was the cause of between 9% and 16% of presentations with acute abdominal pain in children in the PNG highlands. The overall disease burden of pigbel was relatively small (19 definite or probable cases and 3 deaths in 12 months). However, there was substantial geographical clustering of cases: more than 50% of the definite cases occurred in children living within three electorates on the Western Highlands-Enga provincial border, no more than 40 km from each other. This study will be useful in planning pigbel vaccine policy and future surveillance.     

What do Malawi Polytechnic first year students know and do about HIV and AIDS?

Background

The Polytechnic introduced a “WHY WAIT?” course to equip first year students with skills to help reduce transmission of Human Immune-deficiency Virus (HIV). Training is conducted during the first week of arrival at college. The study aimed to explore existing knowledge, beliefs and attitudes in order to tailor the training programme to students'' needs.

Methods

This was a cross sectional study. During first day of arrival, first year students available on campus were given a structured self-administered questionnaire which was filled and submitted before the course. Out of 320 questionnaires distributed, 295 were returned representing 92% response rate.

Results

Ten percent (30) had more than one girlfriend or boyfriend. Ninety-seven percent (286) indicated that condoms are not 100% effective towards prevention of HIV while 72% (169) reported that they had never had sexual intercourse before. Of 66 students who had had sexual intercourse before, 30% indicated that they used condoms always during sexual intercourse, 40% used it occasionally while 30% never used condoms. Thirty-two percent (94) reported having an HIV test before and 19% (56) would feel uncomfortable to share a room with an HIV infected person.

Conclusion

The Polytechnic first year students have varying knowledge and practices about HIV and AIDS. There is need to intensify “WHY WAIT?” course to first years during first week at College to help equip them with necessary knowledge and skills to protect themselves against HIV and AIDS.     

What do medical students experience as moral problems during their obstetric and gynaecology clerkship?

This article reports on moral problems that were raised by medical students as the basis for an ethical case-conference in an obstetrics and gynaecology clerkship. After introducing the issue of teaching clinical ethics, the method of our case-conference is explained. Next, the variety of topics and related moral problems are presented. The article continues with a discussion of three distinct and challenging aspects that characterise obstetrics and gynaecology as a domain for teaching clinical ethics. The conclusion puts forward three significant points our review raises.     

Does integrated management of childhood illness (IMCI) make a difference to the assessment of sick children in Papua New Guinea?

Two provinces, one of which had introduced the Integrated Management of Childhood Illness (IMCI) policy to some degree and one in which there was no IMCI program, were selected to compare health workers' assessment of children attending provincial hospitals, district hospitals and health centres. 23 health workers were observed during 373 child assessments to determine their ability to detect the symptoms and signs detailed in the IMCI 10-step checklist. Health workers in the province that had introduced IMCI performed significantly better than their counterparts in 11 of the 24 criteria studied. These criteria included asking about 'too sick symptoms' (p < 0.001 for asking about vomiting and feeding and p < 0.012 for asking about convulsions), counting respiratory rate and checking for chest indrawing in children presenting with cough (p < 0.001), checking skin elasticity in children presenting with diarrhoea (p < 0.02), checking for neck stiffness in those presenting with fever (p < 0.001), checking for pallor (p < 0.001) and accurately plotting the child's weight on the weight graph (p < 0.001). Children in this province were more likely to be fully vaccinated (OR 1.96 [1.25-3.08]) than those in the province in which no attempt had been made to introduce IMCI. The facilities were ranked by the proportion of children correctly assessed. The best facility was the health centre which had been a pilot site for the introduction of IMCI in the province several years before the study. The results of the study, which clearly demonstrate that IMCI does make a difference, are in accordance with data from many parts of the resource-poor world and strongly support the Department of Health's decision to implement IMCI in the country. Every effort should be made to ensure that all provinces introduce the program and support its continuation as part of the Strategic Package for Child Survival.     

What is the prevalence of rheumatic disorders in general medical inpatients?

It has been suggested that rheumatological disorders are underdiagnosed in patients with medical problems and that this might be rectified by incorporating a standard brief screening examination as part of the routine assessment of all patients admitted to hospital with medical conditions. Therefore the GALS screening examination was used to assess the prevalence of rheumatic disease in 100 patients admitted with acute medical problems and in a further 100 in the rehabilitative phase of their disease. The nature of locomotor dysfunction in all patients with a positive result was defined by an independent review and then sensitivity and specificity of the screening test was calculated for rheumatic disease in both populations.
The median age of the two populations were 63 and 78 years respectively, with more females in the rehabilitation group. The overall prevalence of a positive screening test was 53% in the acute and 94% in the chronic disease groups, although the false positive rate in the rehabilitation patients was 30% due to factors other than rheumatic disorders limiting locomotor function (mainly orthopaedic and neurological conditions). The diagnosis of a rheumatological disorder was made de novo in a significant minority (10%) of patients and was usually amenable to treatment. The commonest rheumatic disorder was osteoarthritis which accounted for 55% of all rheumatic disease, followed by inflammatory joint disease (16%), and osteoporosis (12%). In addition to osteoporosis, Paget''s disease of bone and polymyalgia rheumatica were found more frequently in those patients undergoing rehabilitation than in those admitted with an acute medical problem. A number of clinically important associations between medical and rheumatic disorders were found, such as stroke disease with shoulder capsulitis and heart failure with gout.
The sensitivity of the GALS screening test was extremely high (92% and 100%), while its specificity fell in the rehabilitation group from 83% to 17%. None the less, it is felt that this study indicates that the routine use of this test should be considered as part of the assessment of all hospitalised patients with medical problems, whether acute or chronic.


     

What do you think of us? Evaluating patient knowledge of and satisfaction with a psychiatric outpatient service

Aim  

This study aimed to measure patient satisfaction with the care they were receiving; examine patients’ knowledge of the psychiatric services in general; and identify variables associated with satisfaction.     

What do I do when bone hits the ground?

While performing a distal first metatarsal bunion correction, care is always taken to stabilize the capital fragment during relocation and until fixation is completed. The underlying concern is that one false move could cause the capital fragment to end up on the floor. There are articles relating what surgeons have done when this has happened, but there is no evidence-based literature relating to guidelines or policy for decontaminating dropped bone. This case study relates what happened to me after saying, "Can you pick that up for me please?"     

Regulation of treatment of infants at the edge of viability in Italy: the role of the medical profession?

In the last few years there has been intense debate in Italy on administration of life-prolonging treatment to premature babies at the edge of viability. In 2006, a group of experts based in Florence drafted recommendations known as Carta di Firenze (CdF) for responsible use of intensive care for premature infants between 22 and 25 weeks of gestational age (GA). The CdF was later endorsed by several medicoprofessional associations, but was followed by recommendations by the Ministry of Health mandating resuscitation for all premature babies regardless of GA and parental consent. Recent statements from medicoprofessional bodies seem to show that the 'always resuscitate rule' is not supported by many Italian doctors. We argue that ethically sensitive issues in medicine should be regulated with, and not against, the medical profession and its representative bodies.     

Community screening for diabetes in the National Capital District,Papua New Guinea: is betelnut chewing a risk factor for diabetes?

This cross-sectional study was conducted intermittently in the National Capital District of Papua New Guinea from 1995 to 1999. Fasting capillary blood glucose (FCBG) was used as the screening test for diabetes. Blood glucose level was measured using the standard pocket-size reflectometer. A total of 769 individuals were screened. There were 385 males and 384 females ranging in age from 12 to 76 years. High FCBG (hFCBG) (> or = 7.0 mmol/l) was found in 13% of those examined and was associated with older age (p = 0.001), high body mass index (p = 0.027), coastal region of origin (p = 0.012) and betelnut chewing (p < 0.001). The prevalence of hFCBG in those of highland origin was 9% compared to 16% among the coastal people. Among the Seventh Day Adventists, the prevalence of hFCBG was 10%. The overall prevalence of hFCBG was the same in males and females but in those aged 35 years or more the prevalence was higher in females. Multivariate analysis (logistic regression) showed that hFCBG was significantly associated with betelnut chewing (p = 0.005) and age (p = 0.028); the body mass index (p = 0.061) and region of origin (p = 0.056) associations approached statistical significance. Sex and smoking were not statistically significant factors. In conclusion, diabetes is common in the 'healthy' population of Port Moresby and rates in highlanders living there were surprisingly high. In this study, betelnut chewing was independently associated with diabetes, and may therefore be a risk factor for diabetes mellitus.     

How are our medical students using the computer and internet? A study from a medical college of north India

Background:

In today''s world, use of Internet has become indispensable. Medical students have much to gain from the Internet technology that has revolutionized the medical field. There is a very rapid change in the way communication technology is being handled and our medical students should also be ready to embrace it. Very few studies have been done on this topic in India. The aim was to find out the knowledge, practice, and barriers of Internet use among the medical undergraduates of Subharti Medical College, Meerut.

Materials and Methods:

A cross-sectional study was conducted among the MBBS students belonging to the first, second, third, and fourth years of their course during August to October 2009. A pretested questionnaire was used collecting information on their Internet usage patterns, knowledge about information technology, and barriers to using it. Data were entered in Microsoft Excel and appropriate statistical tests were applied for analysis.

Results:

The proportion of respondents having a laptop were more in cohort of students belonging to the admission year 2009 (65.8%) followed by 2008 (54.7%), 2007 (53.0%), and 2006 (38.0%), i.e., a gradual increase in newer cohorts. About half (57.4%) of the students had some sort of formal training in computer and Internet use. Knowledge about Internet was more among the junior cohorts compared to the senior cohorts (P<0.0001). Only about one-fifths of the respondents used Internet for searching literature for projects from medical journals on the Internet. Majority of the respondents accessed Internet for less than 3 hours per week. About one-tenth (8.0%) of the students felt that Internet is totally useless in medical field. The major barrier (54.4% of the respondents) to using Internet was lack of time.

Conclusions:

Further research should focus on designing and implementing computer and Internet training for medical students.