Perception of medical teachers and students regarding objective structured long examination record as an assessment tool- a prospective study

Background: Traditional method of assessment of a long case in practical examinations is broad based. All domains of learning are not evaluated and areas of weakness not categorised.Methods: A structured format, the objective structured long examination record (OSLER) for assessment of post graduate students in anaesthesiology for long case presentations was prepared. The impact of the new tool on the faculty, the students and the overall performance of the students was assessed through questionnaires and scoring systems.Results: We found that 75% students and 100% teachers agreed that the conduct of examination was fair. There was a 100% agreement among both that the OSLER provided an opportunity to the process of learning. 63% accepted that the questions were clear and unambiguous. 88% students agreed upon having exams conducted in a similar format in future. 75% teachers opined that they would like to take an exam in a similar form. 65% teachers agreed that more initial preparation time was needed and 58% thought that training was required.Conclusions: OSLER is a good technique for assessment of a long case in practical examination

Comparison of bupivacaine with fentanyl and bupivacaine with butorphanol for brachial plexus block by axillary approach- a prospective, double blind, randomized study

Background: Brachial plexus block by axillary approach achieves good motor sensory and sympathetic blockade below elbow joint. Addition of opioid compounds to local anesthetics improves the block properties and reduces central opioid related side effects. We compared combination of local anaesthetic bupivacaine with fentanyl and butorphanol in axillary block for upper limb surgeries. Aims and objectives were to compare the block quality, duration of sensory and motor block, post-operative analgesia, safety and side effects in two groups.Methods: 60 patients posted for elective or emergency forearm and hand surgeries were randomly divided into 2 groups of 30 each. group B (n=30) received 40ml of 0.25% bupivacaine with butorphanol (25mcg/kg) and group F (n=30) received 40ml of 0.25% bupicaine with fentanyl (1mcg/kg). Onset and duration of sensory block (pinprick) and motor block (Lovett’s rating scale), hemodynamic parameters, postoperative analgesia and side effects were noted in each group.Results: The mean time of onset of sensory block was earlier in group B (2.29±0.62 min) as compared to group F (7.53±2.24 min) in group B. The mean time of onset of motor block was also rapid in group B (4.13±0.78 minutes) than in group F (9.98±2.94 minutes). The mean duration of motor block was longer in group F (9.73±2.48) hours as compared to group B (7.15±2.20) hours in group A. Post-operatively at the end of 10 hours patients in group F were having discomforting pain (65%) as compared to group B who were having distressing and horrible pain (50%) as evaluated by Mc Gill pain questionnaire. Both the groups were hemodynamically stable, no side effects were noted.Conclusions: Onset of sensory and motor blockade was rapid in group B, however group F showed longer lasting motor block and postoperative analgesia. Both groups were hemodynamically stable and without any side effects

Teaching surgical skills in obstetrics and gynaecology using cadaver simulation: an innovative teaching learning method

Background: Transfer of knowledge from teachers to students traditionally occurs in one direction using blackboards, overhead projectors, power-point presentations and lectures. It has many disadvantages. The main challenge in medical education is to teach surgical skills. For the learning of critical interventions, simulation-based training is structured so that the acquisition of new skills does not harm patients. Thus, the objective of this study was to enhance and improve procedural skills of resident doctors of Obstetrics and Gynaecology department of Government Medical College, Miraj using cadaver simulation in doing abdominal hysterectomy.Methods: Second year resident doctors from Obstetrics and Gynaecology department of GMC, Miraj who had completed their first year successfully in terms of basic orientation regarding surgical procedures were taken for study purpose. They were divided in two groups randomly. The first group underwent conventional method of teaching to learn the abdominal hysterectomy procedure and underwent feedback from them regarding the conventional teaching learning method. Then they were allowed to perform the procedure on a live patient and their performance of procedural skill was assessed by DOPS. (Direct observation of procedural skills). The second group underwent innovative method of use of cadaver simulation for the abdominal hysterectomy procedure and feedback on the same. They were allowed to perform the procedure on a live patient and their performance of procedural skill was assessed by DOPS. (Direct observation of procedural skills). All data was collected, analysed and processed to study the outcome of research project.Results: In group B, all resident were fully satisfied with newer method of teaching and learning for abdominal hysterectomy as surgical procedure. As far as, the advantages and disadvantages of teaching and learning are concerned, all residents pointed out large number of disadvantages in the conventional method. Evaluation of the surgical procedural skill was done by DOPS by senior faculty members of the department as per the questionnaire which showed good performance from group B.Conclusions: The benefit of simulation based medical education (SBME) is that it offers both learners and patients a safe environment for practice and error. In addition, SBME can provide a learning cycle of debriefing and feedback for learners as well as assessment and certification for procedures and competency

Anaesthesia and intensive care management of shoshin beriberi in perioperative period in young adult

Thiamine deficiency presents as dry and wet beriberi. Wet beriberi is a complication of the cardiovascular system. Acute form of wet beriberi known as Shoshin beriberi is an acute presentation of cardiogenic shock which is rapidly reversed with thiamine administration. Here we present successful management of intraoperative acute decompensated heart failure, probably due to thiamine deficiency

Prevalence and clinical profile of glaucoma in rural-based tertiary care hospital

Context: Glaucoma is the second leading cause of world blindness. Considering the scarcity of glaucoma studies in the Western part of Maharashtra, we conducted this study to determine the prevalence of glaucoma among adults aged 18 years and above. Aims: To determine the prevalence and clinical profile of glaucoma in rural-based Tertiary Care Hospital. Settings and Design: A cross-sectional study carried out in an Ophthalmology outpatient department in a rural-based Tertiary care hospital. Materials and Methods: Five hundred and eighty-three patients underwent ocular examination including visual acuity, slit-lamp examination, optic disc evaluation with +78D lens and intraocular pressure measurement with Goldmann applanation tonometer, gonioscopy, visual fields examination by Humphrey Field Analyzer and optic nerve head analysis using optical coherence tomography scan of all the glaucoma suspects. Statistical Analysis Used: The data of patients were tabulated and analyzed using SPSS. Results: Out of 583 cases, 42 cases had primary glaucoma; thus, the overall prevalence of glaucoma was found to be 7.2%. The open-angle group had 38 (90.4%) cases, whereas the narrow-angle group had 4 (9.52%) cases. Out of the total of 113 hypertensive patients, 16 were found to have glaucoma (38.09%, P < 0.01), and out of 84 diabetic patients, 14 cases were glaucomatous (33.33%, P < 0.01). The prevalence of glaucoma was found to be significantly associated with a positive family history, as 6 cases (14.3%) out of 42 had a positive family history (P < 0.01). Conclusions: The prevalence of glaucoma was found to be high in the population of the rural Western part of Maharashtra. Screening for glaucoma among middle-aged people with a positive family history, hypertension, and diabetes would help us in the early diagnosis and management of this irreversible disease

Perception, knowledge, and attitudes of first-year postgraduates toward postoperative pain management: A questionnaire-based study

Context: Inadequately controlled postoperative pain has undesirable physiological and psychological consequences. It increases postoperative morbidity, delays recovery, and hence causes a delayed return to normal daily living. Furthermore, the lack of adequate postoperative pain treatment may lead to persistent pain after surgery, which is often overlooked. Overall, inadequate pain management increases the use of health care resources and health care costs. Aim: To evaluate the knowledge and attitudes of first-year postgraduate students toward postoperative pain. Study Design: This questionnaire-based cross-sectional study was conducted on 42 first-year postgraduate students. Materials and Methods: A 20-point questionnaire was prepared based on the various aspects of postoperative pain services. The students were asked to provide their answers on a five-point Likert scale ranging from “strongly disagree” to “strongly agree.” The responses were kept anonymous, and the results were expressed in terms of percentage. Results: Almost 70% of students had a good knowledge of opioids, 52% strongly felt the need for a structured pain curriculum, 76% were well aware of nonpharmacological methods of pain relief, 48% agreed on the need for a pain physician, and 52% were aware of the advantage of postoperative analgesia. Conclusion: This pilot study helped us to evaluate the current understanding of our first-year postgraduate students and further created awareness on the importance of pain relief postoperatively

Anaesthetic management of a patient with hypertrophic obstructive cardiomyopathy posted for emergency lower segment caesarean section

Hypertrophic cardiomyopathy is characterised by asymmetric hypertrophy of the interventricular septum causing intermittent obstruction of the left ventricular outflow tract. This disease may present to the anaesthesiologist in an undiagnosed form during routine pre-operative visit. Surgery and anaesthesia often complicate the peri-operative outcome in this group of patients. A 22-year-old patient was brought in for emergency lower segment caesarean section. She was a diagnosed case of hypertrophic obstructive cardiomyopathy (HOCM) with severe left ventricular outflow tract obstruction and moderate subaortic stenosis. Factors such as tachycardia, hypovolemia, vasodilatation, and increased cardiac contractility leads to exacerbation of this obstruction. We managed this case successfully considering the pathological issues caused by the disease and pregnancy

Intraperitoneal instillation of bupivacaine and hydrocortisone for postoperative analgesia in laparoscopic cholecystectomy under spinal anaesthesia – A prospective randomized study

Background: Laparoscopic cholecystectomy is a minimally invasive procedure requiring less hospital stay and early mobilization as compared to open procedure. The aim of our study was to compare the efficacy of intraperitoneal instillation of hydrocortisone with bupivacaine for postoperative analgesia in patients undergoing laparoscopic cholecystectomy under spinal anesthesia. Materials and Methods: Sixty patients were enrolled in this prospective randomized study. Patients either received 0.125% bupivacaine (Group B) or 0.125% bupivacaine with 100 mg hydrocortisone (Group H) through intraperitoneal drain at the end of surgery. Pain was evaluated every two hourly using the Visual Analog Scale (VAS) for 24 h. Analgesics were required during this period and the presence of shoulder pain was also noted. Results: Patients in the hydrocortisone group had lower pain scores (2.17 ± 0.47) compared to the bupivacaine group (3.51 ± 1.10). This difference in the mean VAS score was statistically significant (P < 0.01). Similarly, patients requiring rescue analgesia were 60.86% in Group B and 39.14% in Group H and were statistically significant. Time for rescue analgesia was longer in Group H as compared to Group B. Conclusion: Intraperitoneal bupivacaine and hydrocortisone decrease pain and analgesic requirements more effectively than bupivacaine alone after laparoscopic cholecystectomy without causing significant adverse effects