Instituting an undergraduate core clerkship in radiology: initial experiences in Pakistan

Utilization of radiology as an educational resource carries great potential. Accreditation bodies, physicians and medical students deem it important for a well rounded medical curriculum. Unfortunately this resource is yet to be developed and implemented to an optimal extent. We share the experiences from the first radiology core clerkship in Pakistan at the undergraduate level. An overview of clerkship objectives and structure is followed by discussion on lessons learnt during the initial three years of institution. Development of assessable objectives, integration of radiology with other specialties, and supervised andragogical learning tailored for undergraduate students are emphasized

Psychotherapy as a treatment modality for psychiatric disorders: Perceptions of general public of Karachi, Pakistan

<p>Abstract</p> <p>Background</p> <p>Psychiatric disorders affect about 450 million individuals worldwide. A number of treatment modalities such as psychotropic medications, psychotherapy and electroconvulsive therapy can be used to treat these disorders. Attitudes of general public play a pivotal role in effective utilization of mental health services. We explored the perceptions of general public of Karachi, Pakistan regarding psychotherapy.</p> <p>Methods</p> <p>A cross-sectional study was conducted in Karachi, Pakistan during July-August, 2008. A three-step sampling strategy and a structured questionnaire were employed to survey knowledge and perceptions of adult general public about psychotherapy. Descriptive statistics were used for baseline characteristics. Logistic regression models were used to investigate any significant associations between baseline characteristics of the participants and their perceptions.</p> <p>Results</p> <p>The study sample comprised of 985 individuals (536 males; 531 financially independent) with an average age of 36.7 years (SD 13.54 years) and 12.5 years (SD 3.09 years) of education were included. Majority (59.4%; n = 585) claimed to be aware of psychotherapy as a treatment option for psychiatric disorders but 47.5% of these (n = 278/585) failed to identify its correct definition. Concerns voiced by the participants about psychotherapy included stigma (48.7%) and breech in confidentiality (39.5%); 60.7% opined it cost effective and 86.5% favored its use as an adjuvant modality. A preference for psychotherapy as the treatment strategy for psychiatric disorders was demonstrated by 46.6% (n = 459/985). Younger, more educated, financially independent and female participants were more likely to prefer psychotherapy as were those who deemed it cost effective.</p> <p>Conclusion</p> <p>Positive attitudes regarding the acceptability, clinical utility and cost-effectiveness of psychotherapy were observed in a sample representative of general public of Karachi, Pakistan. These findings highlight its potential utility for devising pragmatic mental health strategies in the face of limited resources.</p

Where there is no PET/CT

Technology assessment should touch upon four areas, utility, target population, cost and alternatives. Hybrid Positron Emission Tomography/Computed Tomography (PET/CT) is a promising modality for oncologic imaging. However, reservations about its accessibility and affordability prevail. Magnetic Resonance Imaging (MRI) is an alternative with certain key advantages that can potentially prove equivalent if not better than PET/CT. We have highlighted the value of comparative studies between PET/CT and whole body MRI. Diffusion Weighted sequences may aid in better diagnosis of malignancies on MRI. The \u27Eye of Medicine\u27 should not have a restricted vision even where there is no PET/CT

A paradigm shift in imaging for renal colic - Is it time to say good bye to an old trusted friend?

Objectives: To study the changing pattern in the use of intravenous urogram (IVU) and non-contrast enhanced CT (CTKUB) for evaluation of flank pain at a single centre. Methods: All Patients who underwent either an IVU or CTKUB at a single, tertiary care center from January 2002 to December 2007 were retrospectively identified from the radiology database. Study samples were-divided into two groups: Pediatric (14 years or less) and Adult (greater than 14 years). For each group, overall trends as well as trends across referral setting and gender were explored by plotting line graphs using SPSS version 15. Results: During the study period a total of 11245 uro-radiological examinations were performed using either IVU (43.7%, n=4915) or CTKUB (56.3%, n=6330). A remarkable majority of procedures (95.5%, n=10741) was performed in adult Patients. Overall, the respective proportions of IVU and CTKUB were 87.9% (n=43) and 12.1% (n=61) in the pediatric group whereas 41.6% (n=4472) and 58.4% (n=6269) in adults. Majority in both groups were ambulatory Patients (Pediatrics 83.7%, Adults 76.7%). During 2002-20007, the yearly proportion of CTKUB increased from 27% to 80% in adults and from 3% to 27% in children. Conclusions: There is major shift in the choice of imaging in adults from IVU to CTKUB during years 2002-2007. In pediatric Patients, IVU referrals still comprise the greater proportion of uro-radiological exams

Chart-stimulated Recall as a Learning Tool for Improving Radiology Residents\u27 Reports

RATIONALE AND Objectives: Workplace-based assessments gauge the highest tier of clinical competence. Chart-stimulated recall (CSR) is a workplace-based assessment method that complements chart audit with an interview based on the residents\u27 notes. It allows evaluation of the residents\u27 knowledge and heuristics while providing opportunities for feedback and self-reflection. We evaluated the utility of CSR for improving the radiology residents\u27 reporting skills.MATERIALS AND Methods: Residents in each year of training were randomly assigned to an intervention group (n=12) or a control group (n=13). Five pre-intervention and five post-intervention reports of each resident were independently evaluated by three blinded reviewers using a modified Bristol Radiology Report Assessment Tool. The study intervention comprised a CSR interview tailored to each individual resident\u27s learning needs based on the pre-intervention assessment. The CSR process focused on the clinical relevance of the radiology reports. Student\u27s t test (P\u3c.05) was used to compare pre- and post-intervention scores of each group.Results: A total of 125 pre-intervention and 125 post-intervention reports were evaluated (total 750 assessments). The Cronbach\u27s alpha for the study tool was 0.865. A significant improvement was seen in the cumulative 19-item score (66% versus 73%, P\u3c.001) and the global rating score (59% versus 72%, P\u3c.001) of the intervention group after the CSR. The reports of the control group did not demonstrate any significant improvement.CONCLUSION: CSR is a feasible workplace-based assessment method for improving reporting skills of the radiology residents