Understanding Undergraduate Students\u27 Perceptions of International Teaching Assistants

The purpose of this mixed method study was to better understand undergraduate students\u27 perceptions of international teaching assistants (ITAs) at a major research institution. For the purpose of this inquiry data were collected from surveying a sample of 436 of undergraduate students from different colleges and at different class levels. Survey data were analyzed both qualitatively and quantitatively. Through the qualitative analysis of the open-ended survey data, undergraduate students\u27 perceptions were derived from their responses, which resulted in themes both established in previous research (e.g., language), and original ideas (e.g., learning to understand ITAs language). Qualitative analysis of the survey data revealed that undergraduate students\u27 perceptions of ITAs were varied and complex. For example, one perception identified was the connection of language to pedagogic difficulties, while another perception focused on the interactive construct of communication. Further, the quantitative analysis revealed a statistically significant relationship between these two relational perceptions and undergraduate students who reported having experienced problems with ITAs in their classes. More specifically, students who indicated that they did not have problematic experience with ITAs were not very likely to articulate perceptions that were relational, whereas more students that did report having a problem in courses taught by ITAs articulated perceptions that involved an interaction (e.g., communication and language as a barrier interfering with pedagogic performance of ITAs). The findings from this study thus provide a critical understanding of undergraduate students\u27 perceptions from their perspectives. In addition, the finding that language-pedagogy and communication were connected by undergraduate students who had encountered problems with ITAs, suggests that instead of ITA education programs addressing the challenges of accommodating the needs of individual departments and/or colleges in a university (Jia & Bergerson, 2008), ITA education would benefit more from focusing on language in relation to pedagogy

Haemodynamic response to induction, laryngoscopy and tracheal intubation in diabetic and non-diabetic patients

OBJECTIVE: Presence of autonomic neuropathy in diabetic patients can alter the haemodynamic response to induction and tracheal intubation. This trial was conducted to compare this response in 30 non-diabetic (control group) and 30 diabetic patients including both insulin and non-insulin dependent. METHODS: A prospective, age matched case controlled study was conducted at the Aga Khan University Hospital, for one year. After pre-medication with tablet midazolam 7.5 mgs orally, patients received pethidine 0.8 mg kg(-1), thiopentone sodium 4 to 5 mg kg(-1) for induction and vecuronium 0.1 mg kg(-1) to facilitate tracheal intubation. Following manual ventilation with isoflurane 0.8% in oxygen 33% and nitrous oxide 66%, laryngoscopy and tracheal intubation was performed. Blood pressure (systolic, diastolic and mean) and heart rate responses were measured for 10 minutes. RESULTS: The systolic arterial pressure dropped by 9% after induction and rose by 16% after intubation in nondiabetics compared to 12% drop after induction and a rise of 10% after intubation in diabetics. No difference was seen in diastolic blood pressure which increased by 27% in ND compared to 22% in DB groups. The heart rate rose by 27% in non-diabetics compared to 17% in diabetics after intubation. CONCLUSION: The systolic, diastolic and mean blood pressure response was similar in the two groups. A greater fall in SAP was observed post intubation in the DB group. A significant difference was observed in the heart rate response which was less in the diabetic group

Pediatric critical incidents reported over 15 years at a tertiary care teaching hospital of a developing country

Background and Aims: The role of critical incident (CI) reporting is well established in improving patient safety but only a limited number of available reports relate to pediatric incidents. Our aim was to analyze the reported CIs specific to pediatric patients in our database and to reevaluate the value of this program in addressing issues in pediatric anesthesia practice. Material and Methods: Incidents related to pediatric population from neonatal period till the age of 12 years were selected. A review of all CI records collected between January 1998 and December 2012, in the Department of Anaesthesiology of Aga Khan University hospital was done. This was retrospective form review. The Department has a structured CI form in use since 1998 which is intermittently evaluated and modified if needed.Results: A total of 451 pediatric CIs were included. Thirty‑four percent of the incidents were reported in infants. Ninety‑six percent of the reported incidents took place during elective surgery and 4% during emergency surgery. Equipment‑related events (n = 114), respiratory events (n = 112), and drug events (n = 110) were equally distributed (25.6%, 25.3%, and 24.7%). Human factors accounted for 74% of reports followed by, equipment failure (10%) and patient factors (8%). Only 5% of the incidents were system errors. Failure to check (equipment/drugs/doses) was the most common cause for human factors. Poor outcome was seen in 7% of cases.Conclusion: Medication and equipment are the clinical areas that need to be looked at more closely. We also recommend quality improvement projects in both these areas as well as training of residents and staff in managing airway‑related problems in pediatric patients

An analysis of perioperative adverse neurological events associated with anesthetic management at a Tertiary Care Center of a developing country

Background and Aims: Existing literature on neurological complications related to anesthesia is reported from affluent countries but the trends may vary in less affluent countries.MATERIAL AND Methods: The objective was to find the associated factors contributing to neurological adverse events occurring within 48 h of anesthesia and surgery. The existing departmental morbidity and mortality database was reviewed from 1992 to 2012 for major adverse neurological events. A standardized methodology was used in reviewing and classifying the data. All adverse events were predefined and categorized before filling the form into the following headers; meningitis, cord/plexus/peripheral nerve injury, stroke, paraparesis/paraplegia/quadriparesis/or quadriplegia, new onset postoperative seizures, postoperative vocal cord injury, and a miscellaneous group.Results: During this period, 195,031 patients underwent anesthesia and twenty-nine patients had major neurological morbidity within 48 h (1:6700). There were three cases of meningitis/meningism, eight cases of cord, plexus or peripheral nerve injury, seven of stroke, four had new onset seizures, one had quadriparesis, five had vocal cord, and one had cranial nerve palsy. Forty-one percent cases received regional anesthesia alone or in combination with the general. In six cases, anesthesia was considered solely responsible. Human error contributed to 93% of these events.CONCLUSION: This data has helped in identifying areas of concern and can serve as a reference for further audits in the region

Skill Shortage versus Subject Choice, Case of Pakistan

Higher Education is believed to be a very important determinant of economic growth. The growth can be optimized with a suitable combination of skills in various subjects. A mismatch between required combination of skills and available combination of skills carries heavy costs for developing economies since import of skill from foreign is much more in expensive for such economies. We compare skill shortage in Pakistan with the subjects choice of students recently enrolled in institutes of higher learning. We found that there is a mismatch between skill shortage and the enrollment trend. We propose that the Government should regulate recruitment of students into various subjects in order to create greater harmony between national needs and students enrollment.Subject Choice, Skill Shortage, National Needs

Arterial to end-tidal carbon dioxide difference in neurosurgical patients undergoing craniotomy: a review of practice

Objective: To see if PETCO2 reflects PaCO2 with acceptable accuracy.Methods: In this audit the.anaesthetic chart of fifty consecutive patients, age 12 years and above undergoing craniotomy for intracranial pathology, were reviewed.Results: The difference between end tidal carbon dioxide (ETCO2) value corresponding to the time of taking the arterial sample and the PaCO2 was calculated. The mean end tidal CO2 was 29.3 +/- 2.8 and the mean PaCO2 was 32.63 +/- 4.5. The mean difference between the two values was calculated as 4.09 +/- 3.0. The regression coefficient was 0.496, which showed a moderate association. A wide variability was observed in the results.CONCLUSION: Based on our results we recommend that arterial samples should be taken to determine PaCO2 in neurosurgical patients where maintenance of cerebral blood flow is crucial e.g. cerebral aneurysm surger

The role of prophylactic intra-aortic balloon pump counterpulsation (IABP) in emergency non-cardiac surgery

Patients with recent myocardial infarction (MI), congestive heart failure, severe angina, or uncorrected multivessel coronary artery disease are at increased risk of cardiac complications after urgent major non-cardiac surgery. Although invasive haemodynamic monitoring and preoperative optimization of cardiac status may lead to some reduction in the rate of perioperative cardiac events, the mortality from such events still remains high. The use of an intra-aortic balloon pump (IABP) may play a role in such patients by improving the function of the injured heart. We report our experience with the use of perioperative IABP in a patient with unstable angina and recent MI who underwent urgent cholecystectomy. There were no perioperative cardiac events while the IABP was in place. The anaesthetic concerns, intraoperative and postoperative monitoring and care and usefulness of IABP will be discussed

Airway management in a patient with bullous pemphigoid

Airway management in patients with pemphigoid lesions has anaesthetic implications. We report a case of a 23 years old female with bullous pemphigoid who presented with laryngeal stenosis and critical airway narrowing. The airway was initially managed with jet ventilation. Anaesthesia was maintained with propofol infusion and ventilation was performed by introducing a size 10 French gauge suction catheter through the stenotic laryngeal orifice. Thirty minutes into anaesthesia, she developed subcutaneous emphysema and decreased air entry on right side of the chest but remained hemodynamically stable. The airway was further managed by tracheostomy. This case report highlights complications that can occur during the anaesthetic management of such cases

Airway management and hemodynamic response to laryngoscopy and intubation in supine and left lateral positions.

Introduction: Intubation in the lateral position is desirable in several conditions. We compared the technical ease and hemodynamic response to laryngoscopy and intubation in the lateral (group L) and supine (group S) positions in 120 Patients with normal airway in a prospective randomized controlled study. Methods: This was a randomized, controlled observational study. All intubations were performed by a single investigator experienced in lateral intubation. Ventilation score with bag and mask ventilation, laryngoscopy duration and attempts, application of external pressure and Cormac & Lehane grade were measured. Blood pressure and heart rate were observed before and after induction of anesthesia, after laryngoscopy/intubation and then at one minute interval for 6 minutes. Results: 90% of Patients in group S were ventilated by a single operator compared to 17% in group L. Duration oflaryngoscopy was significantly longer in group L (32 seconds) compared to group S (12 seconds) [p \u3c 0.001]. 78% of the Patients in group S had Cormack and Lehane grade 1 versus nil in group L. External pressure was required in 58% Patients in group L and 5% in group S. In intra-group comparison at specified time lines no difference was observed in HR but the changes in BP were significantly higher in the lateral position (P-value \u3c 0.001). Conclusion: Ventilation and intubation in lateral position was more difficult technically than in the suprine position, and the BP response was exaggerated in the lateral position

A national survey into desirable personality traits in anaesthesia trainees in a developing country

OBJECTIVE: To explore personality traits considered to be important in selection of trainees by consultant anaesthetists in a developing country. METHODS: A questionnaire listing 28 traits was sent to 125 consultant anaesthetists. The raters were asked to mark each trait on a scale of 1 to 10, with one being least desirable and 10 as most desirable. Listing of five most desirable and one least desirable trait was also required. RESULTS: The response rate was 79%. The most desirable trait was identified as reliability by 40%, followed by honesty 17%, functionality under stress 9%, punctuality 7%, and discipline 4%. The least desirable trait was considered as resourcefulness (21%), sense of humour (20%), unassuming mannerism (15%), high self esteem (11%), inquisitive (5%) and expedious (5%). CONCLUSION: Some traits have been identified as more desirable than others for trainees in our country. We plan to assess these in structured behavioural interviews in our residency programme