Management of Radioactive Spills in Nuclear Medicine; Teaching and Assessing with Objectively Structured Assessment of Technical Skills

Routine work in nuclear medicine requires the careful elution of radioactivity and its subsequent, storage and handling. Though all effort is maintained to prevent any spill of this radioactivity, accidents are bound to happen. The response to this spill is a methodically worked out a plan that is written and adopted as a standard operating procedure. This protocol is taught to all involved in the area of working as a mock drill/apprenticeship model. No formal evaluation of learning is in place except for the mock drills. The objectively structured assessment of technical skills (OSATS) is a variation on the Objective Structured Clinical Examination, which is a form of workplace based assessment. The OSATS is cited in the Accreditation Council of Graduate Medical Education evaluation toolbox on the website as the most desirable evaluation tool for the patient care topics. It is the objective of this paper is to introduce the OSATS for teaching, and assessment of the learning, of the protocol for the management of radioactive spill. As a review of the literature on the subject failed to reveal any such teaching protocol/material/document for this important technical skill, we hope that it may act as a landmark for the development of teaching and assessment of other technical skills also

Correlations of skin fold thickness and validation of prediction equations using DEXA as the gold standard for estimation of body fat composition in Pakistani children.

OBJECTIVE: To determine the correlation between dual energy X-ray absorptiometry (DEXA) and skin fold thickness (SKF) equations for estimation of body fat (BF) composition in secondary school children and validation of prediction equations by Slaughter, Goran and Dezenberg. DESIGN: Cross sectional analytical study. SETTING: Joint Commission for International Accredited (JCIA) tertiary care hospital of Karachi, Pakistan from January 2010 to May 2010. PARTICIPANTS: The study was approved by the Hospital\u27s ethical review committee. Written and verbal consents were obtained from principals of two schools and parents of 99 children (mean age of 14±1.89 years; min-max 9-19 years; 54 men and 45 women) accrued in study. DEXA scan was acquired and SKF was measured at angle of the scapula, iliac crest and mid-arm for bicep and tricep skin folds using Holtain Callipers. Correlations were established between estimated fat mass (FM) and per cent BF (%BF) calculated by DEXA and those predicted by prediction equations. On obtaining significant correlation of \u3e0.5, overall accuracy, precision and bias was calculated. RESULTS: There was an overall increased adiposity in females with FM of 3.57 kg and %BF 6.2% higher than male counterparts (p CONCLUSIONS: We conclude that Slaughter equation for estimating %BF showed reasonable validation with DEXA. Nevertheless further studies with consideration for maturity and ethnicity are warranted for better results. However, for estimation of FM, previously formulated equations by Goran and Dezenberg showed significant difference in our population. We do recommend further studies for developing and validation of skin fold equations specific to Pakistani paediatric populatio

Simulation based medical education; teaching normal delivery on intermediate fidelity simulator to medical students

Objective: To assess the effectiveness of medium fidelity simulator in teaching normal vaginal delivery to medical students. Methods: The quasi-experimental study was conducted at the professional development centre of the Jinnah Sindh Medical University, Karachi, from June to December 2015, and comprised medical students. Third-year medical students were included. They were divided into two groups. Group A was taught normal delivery through traditional PowerPoint and group B through simulator. The instruments used for assessing knowledge were pre-test and post-test, for skills of labour/delivery checklist of performance was used, and perception forms were filled to evaluate workshops/learning environment by students. Results: Of the 76 participants, there were 36(47.4%) in group A and 40(52.6%) in group B. The overall mean age of the participants was 20.86±0.76 years in group B and 20.60±0.95 years in group A (p=0.19). The mean grade point average of the participants was 2.89±0.47 in group A and 2.87±0.48 in group B (p=0.81).Group B performed much better in skill of delivery having a mean score of 8.91±3.20compared to group A which had mean of 5.67±1.84 (p\u3c0.01).Conclusion: Simulation-based skill learning showed significantly better results

99mTc-Nannocolloid Localization of Lymphorenal Fistula Causing Chyluria

Chyluria is an abnormal condition in which chyle appears in the urine because of a fistulous communication between the lymphatics and the urinary tract. It is not life-threatening and spontaneous regression is reported in 50% of cases. Lymphangiography has been the main imaging modality for localization of the site of fistula, but it is invasive and requires expertise. Lymphoscintigraphy using Tc-99m labelled colloid is a safe, non-invasive, reproducible technique, which bears less radiation exposure. A 67-year-old male presented with 7-month history of chyluria following a spinal surgery. Bilateral lower limb lymphoscintigram revealed sluggish lymph flow in the left lower limb and visualization of tracer in the left kidney consistent with lymphorenal fistula. Subsequent cystography revealed appearance of chylous urine from left ureter. Patient refused surgery

The cauldron of social accountability : searching for the right potion

The Vision and Mission of the Aga Khan University has service of the Muslim Ummah and the developing world\u27 at its heart. From this vision, evolves AKU\u27s strategic planning and working. This concept of service to the community is also seen at the heart of the WHO declaration and the Global Consensus on Social Accountability (GC-SA) defined for all medical education institutions. Consequently, it was a great surprise when AKU-MC did not win the SA Award of the Aspire initiative in 2013. This thesis looked into the possible causes for the loss of this award in order to suggest recommendations that will help the institution in its future journey towards SA. Method: Using a case study approach, seven in-depth interviews with key-informants were conducted within AKU of individuals closely associated with the Aspire submission and held key Leadership positions in the university. In addition, one Dean each from a private and a public medical school were also interviewed. A deductive iterative theming of the data was then conducted. Results: From the data analysis two themes emerged; one that looked into the various causes of deviation from the vision and mission that lead to the loss of the Aspire initiative and the second is a beacon to light the path to attain socially accountability. Theme One was \u27Turning Wounds into Wisdom\u27 and identified issues related to the following: inadequate community services and community-based education in the curriculum due to change in leadership and geopolitical causes; to a laid-back attitude for data gathering because of faculty\u27s lack of self-belief, indifference to the award and pressures of the business model of the institution; and to the student\u27s goal to attain international education rather than serve the nation. Theme Two was the Rise of the Phoenix and identified measures that would help to re-establish a socially accountable institution, which include reviewing the curriculum; faculty development for social accountability; instil strengthening the doctor-patient bond and a more humanistic approach even in the business patient-care model; and a more discerning admissions policy. Conclusion: While it is imperative to accept any defeat, more important is to learn from it and carve out a path that will help achieve SA by AKU-MC. By institutionalising Theme Two the Phoenix may rise from the brunt pyre, for AKU-MC to attain SA. These recommendations would enhance SA not AKU-MC, but all medical schools nationally, regionally and internationally