Perceptions of the preparedness of medical graduates for internship responsibilities in district hospitals in Kenya: a qualitative study

Background: Aga Khan University is developing its undergraduate medical education curriculum for East Africa. In Kenya, a 1 year internship is mandatory for medical graduates’ registration as practitioners. The majority of approved internship training sites are at district hospitals. The purposes of this study were to determine: (1) whether recent Kenyan medical graduates are prepared for their roles as interns in district hospitals upon graduation from medical school; (2) what working and training conditions and social support interns are likely to face in district hospital; and (3) what aspects of the undergraduate curriculum need to be addressed to overcome perceived deficiencies in interns’ competencies. Methods: Focus group discussions and semi-structured interviews were conducted with current interns and clinical supervisors in seven district hospitals in Kenya. Perceptions of both interns and supervisors regarding interns’ responsibilities and skills, working conditions at district hospitals, and improvements required in medical education were obtained. Results: Findings included agreement across informants on deficiencies in interns’ practical skills and experience of managing clinical challenges. Supervisors were generally critical regarding interns’ competencies, whereas interns were more specific about their weaknesses. Supervisor expectations were higher in relation to surgical procedures than those of interns. There was agreement on the limited learning, clinical facilities and social support available at district hospitals including, according to interns, inadequate supervision. Supervisors felt they provided adequate supervision and that interns lacked the ability to initiate communication with them. Both groups indicated transition challenges from medical school to medical practice attributable to inadequate practical experience. They indicated the need for more direct patient care responsibilities and clinical experience at a district hospital during undergraduate training. Conclusion: Perception of medical graduates’ unpreparedness seemed to stem from a failure to implement the apprenticeship model of learning in medical school and lack of prior exposure to district hospitals. These findings will inform curriculum development to meet stakeholder requirements, improve the quality of graduates, and increase satisfaction with transition to practic

In vitro anti-viral activity of aqueous extracts of Kenyan Carissa edulis Prunus africana and Melia azedarach against human cytomegalovirus.

The aqueous extracts of three medicinal plants, Carissa edulis (Forssk.) Vahl (Apocynaceae), Prunus africana (Hook.f.) Kalkm (Rosaceae) and Melia azedarach L. (Meliaceae) have shown significant reduction in the replication of human cytomegalovirus (HCMV) in human embryonic lung (HEL) fibroblasts cells in vitro. Using the plaque inhibition assay for the determination of anti-viral activity, the HEL fibroblast cells cultured in 24 well plates were infected with 1 x 102 PFU 91S HCMV and treated with various concentrations of the extracts. The plaques formed were counted after 7 days incubation at 370C in 5% CO2 and the percent plaques inhibited were calculated against infected untreated control. The effective concentrations inhibiting plaque formation by 50% (EC50) was found between 40 to 80 μg/ml for all the extracts. The cell cytotoxic concentrations (CC50) for each of the three extracts, by the trypan blue exclusion test, gave a safe therapeutic index. These results have demonstrated the potential anti-viral activities of the extracts of the three medicinal plants at non-cytotoxic concentrations. African Journal of Health Sciences Vol. 14 (3-4) 2007: pp. 143-14

Antimalarial activity and toxicity evaluation of Kenyan Hugonia castaneifolia Engl. Teclea nobilis Del. and Turraea mombassana C.DC

The aqueous and methanol extracts of three medicinal plants, Hugonia castaneifolia, Teclea nobilis and Turrae mombassana were evaluated for in vitro antiplasmodial activity against a chloroquine sensitive Plasmodium falciparum strain (D6) and in vivo, against a P. berghei ANKA strain in mice. The extracts were also assessed for cytotoxicity in Vero cell lines and acute toxicity in mice. The water extracts were moderately active with IC50 of 33.07 3g/ml for T. mombassana and 23.92 3g/ml for H. castaneifolia while the methanol extracts of T. mombassana, H. castaneifolia and T. nobilis were highly active in vitro with IC50 of 6.1 3g/ml, 8.86 3g/ml and 8.61 3g/ml respectively. The methanol extract of T. mombassana had the highest chemosupppression followed by the methanol extract of H. castaneifolia in vivo. Aqueous extract of H. casteinofolia was weakly cytotoxic against Vero cells CC50 =22.00 3g/ml. No toxic effect or mortality was observed in mice treated orally with any of the extracts at the highest concentration of 5000mg/kg. These results demonstrate antimalarial potential and safety of the three medicinal plants tested, which are used traditionally for the treatment of malaria in Kenya. Keywords: Antiplasmodial; Malaria; Toxicity; Meliaceae; Rutaceae; Linacea

SELECCIÓN DE POSIBLES TALENTOS PARA PRUEBAS DE MEDIO FONDO DE ATLETISMO EN KENIA. - THE SELECTION OF POSSIBLE TALENTS FOR MIDDLE DISTANCE EVENTS OF ATHLETICS IN KENYA

 Resumen“La selección de talentos desempeña un papel fundamental para el inicio de la formación a largo plazo  de un atleta con perspectivas para el alto rendimiento, por lo que las  pruebas de ingreso a utilizar deben ser informativas y exigentes, independientemente de  las características de cada deporte”. Zatsiorski, V. M (1989). Metrología deportiva. En el presente trabajo  se trata de una metodología sustentada sobre argumentos científicos que ofrece indicadores motrices y antropométricos para seleccionar posibles talentos deportivos en atletismo en aria de las pruebas de Medio Fondo Categoría Cadete 15 -17 años para la provincia Rift valley de la República Democrática de Kenia.Key words: selección de talentos, motrices y antropométricosABSTACT“The talent selection plays the most important role for the initiation of a long term training process of athletes with high performance perspectives. Therefore the admission test should be informative and as demanding as possible in dependence of characteristics of a specific sport”. Zatsiorski, V. M (1989). Metrología deportiva.  The present sturdy is about a method based on scientific arguments which offers metric and anthropometric indicators for the selection of possible cadet (15-17 years of age) talents for the middle distance races in Rift Valley province of Democratic Republic of KenyaKey words: talent selection, metric and anthropometric

In vitro anti-viral activity of aqueous extracts of Kenyan Carissa edulis , Prunus africana and Melia azedarach against human cytomegalovirus

The aqueous extracts of three medicinal plants, Carissa edulis (Forssk.) Vahl (Apocynaceae), Prunus africana (Hook.f.) Kalkm (Rosaceae) and Melia azedarach L. (Meliaceae) have shown significant reduction in the replication of human cytomegalovirus (HCMV) in human embryonic lung (HEL) fibroblasts cells in vitro. Using the plaque inhibition assay for the determination of anti-viral activity, the HEL fibroblast cells cultured in 24 well plates were infected with 1 x 102 PFU 91S HCMV and treated with various concentrations of the extracts. The plaques formed were counted after 7 days incubation at 37\ub0C in 5% CO2 and the percent plaques inhibited were calculated against infected untreated control. The effective concentrations inhibiting plaque formation by 50% (EC50) was found between 40 to 80 \u3bcg/ml for all the extracts. The cell cytotoxic concentrations (CC50) for each of the three extracts, by the trypan blue exclusion test, gave a safe therapeutic index. These results have demonstrated the potential anti-viral activities of the extracts of the three medicinal plants at non-cytotoxic concentrations

Larvicidal, antimicrobial and brine shrimp activities of extracts from Cissampelos mucronata and Tephrosia villosa from coast region, Tanzania

<p>Abstract</p> <p>Background</p> <p>The leaves and roots of <it>Cissampelos mucronata </it>A. Rich (Menispermaceae) are widely used in the tropics and subtropics to manage various ailments such as gastro-intestinal complaints, menstrual problems, venereal diseases and malaria. In the Coast region, Tanzania, roots are used to treat wounds due to extraction of jigger. Leaves of <it>Tephrosia villosa </it>(L) Pers (Leguminosae) are reported to be used in the treatment of diabetes mellitus in India. In this study, extracts from the roots and aerial parts of <it>C. mucronata </it>and extracts from leaves, fruits, twigs and roots of <it>T. villosa </it>were evaluated for larvicidal activity, brine shrimps toxicity and antimicrobial activity.</p> <p>Methods</p> <p>Powdered materials from <it>C. mucronata </it>were extracted sequentially by dichloromethane followed by ethanol while materials from <it>T.villosa </it>were extracted by ethanol only. The extracts obtained were evaluated for larvicidal activity using <it>Culex quinquefasciatus </it>Say larvae, cytotoxicity using brine shrimp larvae and antimicrobial activity using bacteria and fungi.</p> <p>Results</p> <p>Extracts from aerial parts of <it>C. Mucronata </it>exhibited antibacterial activity against <it>Staphylococcus aureus</it>, <it>Escherichia coli</it>, <it>Pseudomonas aeruginosa</it>, <it>Salmonella typhi</it>, <it>Vibrio cholera</it>, <it>Bacillus anthracis</it>, <it>Streptococcus faecalis </it>and antifungal activity against <it>Candida albicans </it>and <it>Cryptococcus neoformans</it>. They exhibited very low toxicity to brine shrimps and had no larvicidal activity. The root extracts exhibited good larvicidal activity but weak antimicrobial activity. The root dichloromethane extracts from <it>C. mucronata </it>was found to be more toxic with an LC₅₀value of 59.608 μg/mL while ethanolic extracts from root were not toxic with LC₅₀>100 μg/mL). Ethanol extracts from fruits and roots of <it>T. villosa </it>were found to be very toxic with LC₅₀values of 9.690 μg/mL and 4.511 μg/mL, respectively, while, ethanol extracts from leaves and twigs of <it>T. villosa </it>were found to be non toxic (LC₅₀>100 μg/mL).</p> <p>Conclusion</p> <p>These results support the use of <it>C. mucronata </it>in traditional medicine for treatment of wounds. Extracts of <it>C. mucronata </it>have potential to yield active antimicrobial and larvicidal compounds. The high brine shrimp toxicity of <it>T. villosa </it>corroborates with literature reports that the plant is toxic to both livestock and fish. The results further suggest that <it>T. villosa </it>extracts have potential to yield larvicidal and possibly cytotoxic compounds. Further studies to investigate the bioactive compounds responsible for the observed biological effects are suggested.</p

The do's, don't and don't knows of supporting transition to more independent practice

Introduction: Transitions are traditionally viewed as challenging for clinicians. Throughout medical career pathways, clinicians need to successfully navigate successive transitions as they become progressively more independent practitioners. In these guidelines, we aim to synthesize the evidence from the literature to provide guidance for supporting clinicians in their development of independence, and highlight areas for further research. Methods: Drawing upon D3 method guidance, four key themes universal to medical career transitions and progressive independence were identified by all authors through discussion and consensus from our own experience and expertise: workplace learning, independence and responsibility, mentoring and coaching, and patient perspectives. A scoping review of the literature was conducted using Medline database searches in addition to the authors’ personal archives and reference snowballing searches. Results: 387 articles were identified and screened. 210 were excluded as not relevant to medical transitions (50 at title screen; 160 at abstract screen). 177 full-text articles were assessed for eligibility; a further 107 were rejected (97 did not include career transitions in their study design; 10 were review articles; the primary references of these were screened for inclusion). 70 articles were included of which 60 provided extractable data for the final qualitative synthesis. Across the four key themes, seven do’s, two don’ts and seven don’t knows were identified, and the strength of evidence was graded for each of these recommendations. Conclusion: The two strongest messages arising from current literature are first, transitions should not be viewed as one moment in time: career trajectories are a continuum with valuable opportunities for personal and professional development throughout. Second, learning needs to be embedded in practice and learners provided with authentic and meaningful learning opportunities. In this paper, we propose evidence-based guidelines aimed at facilitating such transitions through the fostering of progressive independence