Curriculum Integration of Pregnancy Termination and Family Planning in Didactic Medical Education

Background: Given that one in four women will seek an abortion before age 45, there is an urgent need to demystify abortion-related topics and expand providers’ foundational knowledge about pregnancy termination and family planning. An effective way of addressing gaps in women’s reproductive healthcare is integration of the public health importance, legal factors, and counseling surrounding family planning and pregnancy termination into medical school curricula in accordance with Association of Professors of Gynecology and Obstetrics (APGO) guidelines. Objective: Determine whether Indiana University School of Medicine’s (IUSM’s) current pregnancy termination and family planning curricula follow proposed APGO educational guidelines. Evaluate medical student preparedness and interest surrounding family planning and pregnancy termination. Methods: To assess the alignment between IUSM and APGO educational guidelines, session learning objectives (SLOs) from the didactic course Endocrine, Reproductive, Musculoskeletal, Dermatologic Systems (ERMD) syllabus were compared to the relevant APGO objectives. Data was collected through a survey via Qualtrics disseminated to all IUSM students which was intended to assess students’ feelings of preparedness providing accurate medical information regarding reproductive health topics, including contraception, abortion, ethical and legal implications of pregnancy termination, personal values clarification, and others, as well as interest in integrating those topics into IUSM curriculum. Results: Participants (n=303) were primarily female (61.72%) and White (74.43%) and included students who had completed the Reproductive Block of the Endocrine, Reproductive, Musculoskeletal, and Dermatologic Systems (ERMD) Course and the OB/GYN Clerkship (35.64%), only the ERMD Course (25.08%), or neither (39.27%). Across all levels of undergraduate medical education, the majority (60.80%) of students expected to learn about family planning and contraception in preclinical or clinical years of medical school. Overall, 85.67% of students believed that IUSM should enhance its reproductive and sexual health coverage in the current curriculum, including expanding family planning and contraception didactic training

Role of CB-NAAT in diagnosing extra pulmonary tuberculosis in correlation with FNA in a tertiary care center

Background: The diagnosis of extra-pulmonary tuberculosis (EPTB) is challenging due to the pauci-bacillary nature of disease. Recently, WHO recommends GeneXpert/CBNAAT to be used as the initial diagnostic test in patients suspected extra-pulmonary tuberculosis (EPTB). The study was done to assess the role of Cartridge Based Nucleic Acid Amplification Test (CB-NAAT) in the diagnosis of EPTB. Aims and objectives was to study the role of FNAC, CBNAAT and Fluorescent LED in diagnosing extra-pulmonary tuberculosis (EPTB).Methods: This is a descriptive observational study carried out over a period of 12 months (April 2017 to March 2018) at department of Pathology, Andhra Medical College. All presumptive cases of extrapulmonary tuberculosis and purulent aspirates from the various sites between the age group of <10yrs to 60 years of age were included in the study. FNA was done and material sent to CBNAAT and fluorescent LED (Light-emitting Diode) microscopy in all the cases and results tabulated.Results: The total number of cases with presumptive extra pulmonary Tb were 289. Majority of the aspirates are from lymph nodal and cervical swellings 94.1% (272/289). CBNAAT has detected 6.5 % of cases (19/289) which were not detected by FNA and 9.3% of cases (27/289) LED negative cases. Resistant to rifampicin was identified in 2.1% (3/142 cases) of CBNAAT positive cases.Conclusions: FNA still remains the cheapest test to diagnose TB. In cases with Granulomatous lymphadenitis and purulent aspirates CBNAAT has an important role in diagnosing EPTB. In addition it offered rapid detection of rifampicin-resistant M. tuberculosis strains which is an added advantage

Student-Perceived Preparedness in Contraceptive and Abortion Counseling

Project Background: Upwards of 25% of women will seek an abortion by age 45; however, 17% of accredited American medical schools lack any formal abortion-related curriculum, and only 50% offer a clinical elective exposing students to abortion counseling and procedures. The gap between the large number of women seeking this care and the small amount of curriculum designed to prepare students to effectively counsel and provide this care is stark, and it represents an urgent area of study and curriculum re-design. Methods: We performed a cross-sectional survey of students at all levels of medical training to assess student-perceived level of preparedness to provide non-directive counseling on reproductive health topics, such as contraception and abortion. Preparedness was measured on a 6-point preparedness scale (1=very unprepared and 6=very prepared). Mean scores were analyzed as a whole and stratified by training level. We also performed a comparative analysis of the Association of Professors of Gynecology and Obstetrics (APGO) abortion-related learning objectives (LOs) and the corresponding LOs in our didactic reproductive health course curriculum at our institution. Results: Our preliminary survey population (n=57) included majority female (66.7%) and underclassmen (MS1 = 42.1%, MS2 = 31.6%), and varied in intended specialty. Mean preparedness to provide contraception and abortion counseling score was 2.26±0.55. When stratified to include only students in their clinical years (MS3/4, dual degree), mean preparedness score only slightly increased to 2.97±0.75. Our curriculum analysis revealed that LOs from our didactic reproductive health course covered all 5 APGO LOs on Family Planning, but did not cover 2 of the 4 APGO LOs on Pregnancy Termination. Conclusions: We identified gaps in our institution’s Pregnancy Termination curriculum, as defined by the nationally recognized APGO LOs. We also identified that current didactic and clinical training at our institution inadequately prepares medical students to provide comprehensive reproductive health counseling to women, based on mean self-reported preparedness scores. The next step is to disseminate a more in-depth survey from Feb-Mar 2021 to the same student population to further evaluate student perceptions about preparedness for reproductive health counseling compared to preparedness to counsel about hypertension management to determine whether student preparedness in family planning significantly lags preparedness in other areas of medicine. Our ultimate goal is to positively influence curriculum enhancement in comprehensive reproductive health care at our institution

Vascular malformations: a hospital based study

Background: Vascular anomalies comprise a widely heterogeneous group of lesions. Diagnosis and management of these lesions present challenges to the surgeons, radiologists and histopathologists. Accurate classification of these lesions results in appropriate therapy. Aim of the study is to study the role of histopathology and histochemical stain in the diagnosis of vascular malformationMethods: The present study is a hospital based observational study on vascular malformations over a period of three years from 2016 to 2018 done in department of Pathology and Plastic Surgery at tertiary care centre, Visakhapatnam.Results: Out of 107 specimens of vascular anomalies received, 72 cases were vascular neoplasms, 35 were vascular malformations. Majority of the vascular malformations were seen in the cervicofacial region (43%) followed by extremities (37.1%). Most common malformation in the present study was arterio venous malformations (60%) followed by venous malformations (22.8%). Verhoeff’s VanGieson stain demonstrated discontinuity of internal elastic lamina in cases of arteriovenous malformation and helped in differentiating the lesions from capillary malformation and vascular tumors.Conclusions: Histopathology, special histochemical stains along with imaging features can be used to reduce diagnostic difficulties and in helping proper management of vascular malformations

Development and Implementation of Pregnancy Options Counseling Curriculum in Preclinical Medical Education

INTRODUCTION: Pre-clinical education during medical school is an opportunity to lay a strong foundation for clinical skill development. Options counseling for pregnancy is one such topic that is essential for students to learn early in their education. The most recent estimates from the CDC report that 102.1 per 1,000 women aged 15–44 will be pregnant. Teaching medical students the skills for pregnancy options counseling centers patient goals and prevents significant adverse outcomes, particularly those that come from being denied appropriate abortion counseling. In a previous assessment of student preparedness and interest, we found that Indiana University School of Medicine (IUSM) adequately covers family planning topics, but has gaps in abortion counseling during preclinical education. Our survey definitively showed that IUSM medical students are interested in learning about options counseling and feel unprepared to counsel about abortion; additionally, abortion counseling preparedness did not improve in our sample even after completing the OBGYN clerkship. Based on these findings, we sought to implement curriculum change in the form of a panel-based discussion that would improve student education and comfort with this crucial healthcare topic. STUDY OBJECTIVE: 1) Introduce options counseling education into IUSM preclinical reproductive education and 2) evaluate changes in student preparedness and 3) satisfaction with the panel discussion METHODS: We used data from prior surveys that demonstrated high student interest and poor preparedness regarding complete options counseling to approach faculty regarding adding options counseling to preclinical curriculum. We subsequently collaborated with pre clinical education course faculty to design and implement a panel discussion about options counseling for the preclinical reproductive coure. We then developed a survey in Qualtrics to distribute to students following the panel. The survey has 17 questions including 3 free response prompts. The survey evaluates whether students feel prepared to provide options counseling after the panel, how well topics were covered, and satisfaction overall. RESULTS: The panel will take place on February 7, 2022 and the survey will be open for weeks after the panel, at which point we will analyze student responses. We expect that our post-panel survey will demonstrate increased preparedness to counsel patients about options during pregnancy. CONCLUSIONS/IMPLICATIONS: Future panels and additional course development will fill gaps in preclinical education regarding options counseling, while expanding the skills of medical students. In addition, being prepared to offer patient centered care could better prepare students for clerkships and clinical experiences. This is a promising start to enhance preclinical education regarding women’s health

Impacts of the COVID-19 pandemic on access to HIV and reproductive health care among women living with HIV (WLHIV) in Western Kenya: A mixed methods analysis

Results: We analyzed 1,402 surveys and 15 in-depth interviews. Many (32%) CL participants reported greater difficulty refilling medications and a minority (14%) reported greater difficulty accessing HIV care during the pandemic. Most (99%) Opt4Mamas participants reported no difficulty refilling medications or accessing HIV/pregnancy care. Among the CL participants, older women were less likely (aOR = 0.95, 95% CI: 0.92–0.98) and women with more children were more likely (aOR = 1.13, 95% CI: 1.00–1.28) to report difficulty refilling medications. Only 2% of CL participants reported greater difficulty managing FP and most (95%) reported no change in likelihood of using FP or desire to get pregnant. Qualitative analysis revealed three major themes: (1) adverse organizational/economic implications of the pandemic, (2) increased importance of pregnancy prevention during the pandemic, and (3) fear of contracting COVID-19

Development of a social-media concept for a start-up company

Diese Arbeit beschäftigt sich mit der Erstellung eines Social-Media Konzepts. Zuerst wird das Start-up Unternehmen Sahay vorgestellt. Im Anschluss werden die theoretischen Grundlagen von Social-Media thematisiert. Daraufhin wird eine Nutzwertanalyse erstellt. Diese arbeitet die passende Plattform für das Unternehmen heraus. Im folgenden kommt es zum Hauptteil, der Social-Media Strategie, die zur praktischen Umsetzung des Konzepts führen soll. Zusammenfassend werden das Fazit und der kritische Ausblick auf das Soziale Web aufgezeigt

Cellular Responses in ESCHERICHIA COLI to Lethal and Sublethal Doses of Ozone

Ozone is a major component of photochemical smog. High levels of this pollutant, sufficient to affect human health are found in many urban areas worldwide. Though limited studies in humans are supported by extensive findings from animal experiments, a difficulty in interpreting the results of these experiments has lead to an ambiguity on the biochemical mechanism of ozone toxicity. To elucidate the mechanism by which ozone causes cell damage and eventual cell death we conducted a comprehensive study using Escherichia coli K-12 as a model. Studies on the comparative inactivation of bacteriophage lambda (λ), Escherichia coli, and Candida albicans showed that λ was significantly more sensitive to ozone, in buffered solutions. The quenching effect of antioxidants in body fluids decreased the inactivation rate of λ. Short interval exposure of E. coli K-12 transformed with pACYC184 plasmid DNA resulted in protein and nucleic acid leakage and production of thiobarbituric acid reactive substances, without affecting cell viability. The intracellular components, protein and plasmid DNA, remained intact. The enzymes malate dehydrogenase, lactate dehydrogenase and glutathione disulfide reductase were unaffected, while glyceraldehyde-3-phosphate dehydrogenase activity decreased significantly. Glutathione and total sulfhydryl compounds were also very sensitive to ozone oxidation. With longer duration of ozone exposure cell viability decreased with a more significant increase in lipid oxidation and protein and nucleic acid leakage. The total intracellular proteins and plasmid DNA showed progressive degradation corresponding to the decrease in cell viability. Cell survival, induction of lipid oxidation and intracellular protein and DNA damage in two strains of E. coli K-12 (recA and wild type) were shown to be equally susceptible to ozone. Rec A protein levels decreased subsequent to ozone exposure indicating that this enzyme is not involved in the DNA repair process after ozone-induced damage. The membrane components are the primary targets of ozone damage with subsequent reactions involving the intracellular components, protein and DNA. The sulfhydryl groups of cytoplasmic components are preferentially oxidized by ozone. E. coli therefore offers a convenient model system for studying short- and long term ozone-induced cellular damage