Pakistan Journal of Medical Sciences最新文献

Gamification involves using gaming elements in education to capture learners' attention and motivate participation, offering innovative solutions to traditional teaching challenges. In various fields gamification enhances learning by fostering competition, collaboration and peer learning. In the realm of medical education, innovation is key to foster knowledge acquisition, critical thinking and skill development. Family physicians, dealing with comprehensive care, emphasize preventive measures like family planning and contraception. Effective contraceptive education is crucial not only for providing patient-centered reproductive healthcare but also to address the unique needs and preferences of a diverse patient population. To make learning more engaging we incorporated the board game "Snakes and Ladders" into a didactic session for family medicine trainees. Divided into teams, they solved case-based questions linked to game progression. Feedback indicated the session was more engaging and enjoyable compared to traditional lectures and they wish to see similar teaching methods in future academic sessions.

Objective: Although Vitamin-D (VD) deficiency in pregnancy continues to be an important public health problem, the effects of VD on fetal outcomes are not clear. VD can show its effects at the feto-maternal junction via nuclear factor-kB (NF-kB). This study was planned to determine the effect of changes in serum VD levels on amniotic fluid NF-kB levels.

Methods: Participants were selected among patients who applied to Samsun Medikalpark Hospital Gynecology and Obstetrics outpatient clinic between November 1, 2022 and November 1, 2023. Sixty patients whose serum VD measurements were performed at 24 weeks of gestation were included in the study. The pregnant women were divided into two equal groups according to their serum VD levels (n=30). The patients in Group-1 consisted of 30 patients with a VD level less than 20 ng/ml (VD deficienct group) and Group-2 consisted of 30 patients with a VD level higher than 20 ng/ml (VD sufficienct group). NF-kB levels were measured by ELISA in amniotic fluid samples taken during cesarean section from patients in both groups.

Results: The amniotic fluid NF-kB concentration of the VD sufficient group was found to be significantly lower than the VD deficient group. The amniotic fluid NF-kB levels of the VD deficient group were approximately two times higher than the VD sufficient group (6.36±2.12 ng/mL vs. 3.95±1.49 ng/mL, p< 0.01). After adjusting for gestational age, fetal birth weight, and parity, significant associations were found between VD and amniotic fluid NF-kB. The mean gestational ages at the time of cesarean section were similar in both groups.

Conclusion: Although VD insufficiency causes early inflammatory changes in fetal membranes by increasing amniotic fluid NF-kB levels, it does not lead to preterm delivery.

Objective: To find out the risk factors for respiratory distress syndrome in late preterm infants.

Methods: This was a retrospective study. A total of 1605 premature infants born in Maternity & Child Care Center of Qinhuangdao from January 2020 to June 2023 were selected as the research subjects. They were divided into RDS group and non RDS group based on the presence or absence of respiratory distress syndrome(RDS). The clinical pathological characteristics of the two groups of patients were compared. Logistic regression analysis was used to analyze the risk factors for respiratory distress syndrome in late stage premature infants.

Results: The results of univariate analysis showed that there was no statistically significant difference in neonatal weight, placental abnormalities, gestational hypertension, and maternal age between the RDS group and the non RDS group(P>0.05). There were significant differences in gender, whether premature rupture of membranes, whether cesarean section, and diabetes during pregnancy(P<0.05). The binary logistic regression analysis showed that gender(male), cesarean section(yes) and diabetes in pregnancy(yes) were all risk factors for RDS in preterm infants (P<0.05). Premature rupture of membranes is a protective factor for RDS in premature infants (P<0.05). Gender (male), cesarean section(yes), and diabetes in pregnancy(yes) were all risk factors for poor prognosis of RDS children(P<0.05). Premature rupture of membranes (PROM) is a protective factor for poor prognosis in premature infants (P<0.05).

Conclusion: Male sex, cesarean section, and diabetes in pregnancy may be the risk factors for RDS and poor prognosis of premature infants.

Objective: To assess the maternal mortality ratio (MMR), causes, trends and delays in care over a period of twelve years at institutional level.

Methods: This cross-sectional study was conducted over a 12 years period (2011-2022) at Services Hospital, Lahore, Pakistan. Maternal mortality ratio was calculated as number of maternal deaths per 100,000 live births. The study period was divided in two equal halves i.e. 2011-2016 and 2017-2022. Causes, trends in maternal mortality and delays were analyzed and compared between the two study periods. SPSS-23 was used for data analysis.

Results: There were 222 maternal deaths and 47,853 live births during the study period. The cumulative MMR was 463.92/100,000 live births with a decreasing trend over 12 years. Postpartum hemorrhage and cardiac disease in pregnancy were leading cause of death in 44(31.65%) and 31(22.3%) of patients in 2011-2016, while hypertensive disorders in 18(21.69%) patients and sepsis in 15(18.0%) patients were significantly responsible for maternal mortality in 2017-2022 (p=0.00). Analysis of 12 years data showed first delay i.e. delay in seeking care was the commonest seen in 92(41.44%) patients, followed by second delay in 29(13.06%) and third delay in 27(12.16%) patients. Postpartum period and first delay were significantly associated with maternal mortality (p=0.05 and <0.001).

Conclusion: Reduction in maternal mortality is a great challenge for developing countries like Pakistan. Although maternal mortality has declined over period of twelve years in our study, targeted interventions at community level are needed to address the delay in seeking care and improve maternal outcomes.

Background & objective: The COVID-19 pandemic exposed significant mental health challenges among healthcare workers, particularly nurses, who are key frontline responders and are the largest segment of the global health workforce. Given the ongoing threat of Mpox and potential new COVID-19 variants, understanding these challenges is vital. This review estimates the prevalence of anxiety and depression among nurses during the early phase of the pandemic to inform future pandemic responses.

Methods: A systematic review was conducted to identify studies published from January 1st to November 9, 2020. The quality of the included studies was assessed using the JBI Critical Appraisal Checklist. This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A meta-analysis was performed using a random-effects model to estimate the pooled prevalence of anxiety and depression.

Findings: Twenty-seven studies, involving 39,386 nurses from ten countries, were included in the meta-analysis. The pooled prevalence of anxiety across 24 studies was 38.54% (95% CI: 33.99, 43.10) (I² = 97.89%). The pooled prevalence of depression in 22 studies was found to be 35.52% (95% CI: 26.61, 44.43) (I² = 99.72%).

Interpretation: The pooled prevalence of anxiety and depression in nurses caring for patients with COVID-19 during the early phase of the pandemic was higher than that in other healthcare workers. With the ongoing Mpox outbreak and the potential for future pandemics, these findings necessitate timely screening and robust mental health strategies to support nurses and enhance healthcare resilience.

Objective: To investigate the efficacy and adverse reactions of caffeine citrate in the treatment of primary apnea of prematurity(AOP) and its effect on the long-term development of preterm infants.

Methods: This was a retrospective study. One hundred and forty six infants with AOP treated in the Neonatal Department of Second People's Hospital of Changzhou Affiliated to Nanjing Medical University between December 2019 and December 2023 were divided into the low-dose group (5mg/kg) and the high-dose group (10 mg/kg) according to the maintenance doses of caffeine, with 73 patients each group. Efficacy, complications, adverse reactions, total hospitalization cost and long-term development of the two groups of patients were retrospectively compared.

Results: Short-term efficacy: No statistically significant differences in the number of apnea events, assisted ventilation duration, oxygen inhalation duration, and weaning success rate were observed between the two groups (P<0.05). The incidences of bronchopulmonary dysplasia (BPD) (P=0.012) and periventricular leukomalacia (PVL) (P=0.005) in the high-dose group were decreased compared with those in the low-dose group, with statistically significant differences. Long-term efficacy: the motor and mental development scores at 12 months of age in the high-dose group were increased compared with those in the low-dose group (P<0.05); and cost-effect analysis: there was no significant difference in the total hospitalization cost between the two group (P>0.05).

Conclusion: High maintenance dose of citrate caffeine in the treatment of AOP significantly reduces the number of apnea events, oxygen inhalation duration, the incidence of BPD and PVL, and positively affects the long-term neurological and motor development, without a significant increase in the hospitalization cost.

Objective: To examine the status of early clinical exposure (ECE) programs in Korean medical schools and to determine the educational needs for ECE in undergraduate medical education.

Methods: In this cross-sectional study, 30 medical education experts and 65 professors from 30 medical schools across Korea were surveyed about the status of ECE programs in medical schools and the educational needs for ECE. This survey was conducted between January and March 2024 using Google Forms, and the collected data were analyzed using frequency analysis.

Results: Out of the 30 participating medical schools, 70% had implemented ECE programs. In most schools, ECE programs were required courses and offered from the first year of pre-medical phase to the second year of medical phase. Among 95 respondents, 88.4% recognized the necessity of ECE programs. Most respondents considered "understanding the role of a doctor" an essential objective (70 out of 95, 73.7%) and outcome (73 out of 95, 76.8%) of ECE programs. Most respondents considered "observation/field trips" and "reflection journal" as essential teaching methods (69 out of 95, 72.6%) and assessment methods (68 out of 95, 71.6%) in ECE programs, respectively. Furthermore, most respondents (68 out of 95, 71.6%) considered the "lack of educational support personnel" a concern in implementing ECE programs in medical schools.

Conclusions: This study sheds light on the status of ECE programs in Korean medical schools. Additionally, its results regarding the educational needs for ECE have implications for the future implementation of ECE programs in Korean medical schools.

Objective: To explore the efficacy of refined management based on the quality control (QC) mode in maintaining pediatric endoscope equipment.

Methods: Eighty sets of pediatric endoscopes that were sent to the endoscopy room for cleaning, disinfection, and storage at Hebei Children's Hospital from January 2022 to October 2023 were enrolled. Based on the maintenance method, endoscopes were divided into study group (refined management plus QC mode, n=40) and control group (conventional QC mode, n=40) using a random number table method. The rate of dirt presence, detection rate of pathogenic bacteria, adenosine triphosphate (ATP) positivity rate, cleanliness qualification rate, adverse event occurrence rate, endoscopy-related processing time, and endoscopic usage were analyzed.

Results: The presence rate of dirt, detection rate of pathogenic bacteria, and ATP positivity rate in the study group were significantly lower than in the control group. The cleaning qualification rate, safety storage rate, and disinfection record qualification rate were significantly higher than those of the control group (P<0.05). The incidence of adverse events in the study group was lower than in the control group (P<0.05). The study group had significantly shorter endoscopic recovery time, packaging review time, sterilization distribution time, and clinical acceptance confirmation time than the control group (P<0.05). Satisfaction with endoscope use was significantly higher in the study group than in the control group (P<0.05).

Conclusions: Refined management based on the QC mode can significantly improve the cleaning quality of pediatric endoscopes. This management mode can shorten processing time, reduce the occurrence of adverse events, and achieve high satisfaction with endoscope use.

Objective: To evaluate medical students' experiences with mentors along with strengths and limitations of the first formal mentorship program at Medical School.

Methods: This cross sectional study was conducted at Services Institute of Medical Sciences, a public sector medical college in Lahore. The mentoring program was planned and implemented for first time from January 2022 to November 2022 for MBBS students. Mentors were faculty members who received training prior to the program. Mentorship session of two hours every month was included in timetable. After the successful completion of one year of the program, the feedback questionnaire was filled by mentees about their perceptions about mentors and mentorship program and analyzed.

Results: A total of 362 students gave feedback. The findings highlight that 327/362 (90.3%) of students had positive experiences with their mentors, particularly in areas of mentor accessibility, confidence building, learning ethical behavior, how to study smart, professionalism, psychological support and communication skills. There were five key strengths identified by student responses including personal development and support 141(40%), better communication and interaction 131(35%), time and relationships management skills 22(6%) and professional guidance 10(3%). Around 107(29%) of the students did not perceive any weaknesses in the mentorship program. Half of the respondents expressed concerns about the lack of assurance regarding confidentiality. Around (15.1%) reported hesitancy in communicating within group settings and suggested individual distraction free sessions.

Conclusion: Formal mentorship program is beneficial in personal and professional development of students. A comprehensive framework that ensures confidentiality should be considered to enhance its effectiveness.

Objective: This study aimed to analyze the efficacy of an emotion and stress management program based on empowerment theory on family caregivers of stroke survivors.

Methods: This retrospective study was conducted at Linping Campus, The Second Affiliated Hospital, Zhejiang University School of Medicine, and included 130 family caregivers of stroke survivors from October 2022 to May 2024. The caregivers were given emotion and stress management program based on empowerment theory (Empowerment group, n=65) or given traditional management program (Traditional group, n=65). Caregiver burden inventory (CBI), self-rating depression scale (SDS), self-rating anxiety scale (SAS), and the Chinese version of the Perceived Stress Scale (CPSS) were used for analysis.

Results: After intervention, CBI, SDS, SAS, and CPSS in both groups decreased significantly compared to before intervention and were significantly lower in the Empowerment group compared to the Traditional group (P<0.05).

Conclusions: Compared with traditional management, emotional and stress management plans based on empowerment theory can reduce caregiving burden, alleviate negative emotions, and improve perceived stress in family caregivers of stroke survivors.