Training teachers to teach bioethics: evaluation using Kirkpatrick model

Bioethics helps define the values and guidelines governing decision making in health profession practice. Teaching ethics to medical students demand teachers trained in bioethics. With this aim, “Teachers Training Workshop on Bioethics†was arranged with the objective to get feedback from the participants on effectiveness of bioethics teaching. Twelve faculty members participated in four days Teachers Training Workshop on Bioethics during Dec 27-30, 2016, at Patan Academy of Health Sciences, Nepal. Sixteen thematic topics were chosen from UNESCO Bioethics Core Curriculum. There were four rounds of presentations, and each round had four topics. Small group discussions, presentations and case scenarios were main methods used in the training. Written feedback was taken on semi-structured questionnaire with items- four closed ended and three open ended. Descriptive analysis was done. The level of confidence of the participants after participation in training workshop enhanced for teaching Bioethics, taking ethical decision and resolving ethical dilemma. As per participants open ended responses, “Active participation of the participants†and “Interactive sessions†were good points whereas “More references required, not only of UNESCO curriculum†was the area for improvement. The training enhanced overall confidence level of the participants.    Keywords: bioethics, feedback, Nepal, teachers’ training, UNESC

Revisit the hospital policy in the era of COVID-19

Key-points Patient with recent history of dry cough, fever and breathlessness (influenza-like or severe acute respiratory illness) without alternative explanation/diagnosis needs to be managed as COVID-19 unless proved otherwise. Suspected COVID-19 patient having fever and recent loss of taste and smell be tested for COVID-19. Patient with severe acute respiratory illness of unknown aetiology be tested for COVID-19. Patient with bilateral consolidation on chest X-ray or ground glass appearance on chest CT or interstitial oedema on chest ultrasound (not fully explained by volume overload) be tested for COVID-19 in moderate to high risk communities/countries. Suspected COVID-19 patients with lymphopenia, high ESR or rise in C-reactive protein and suspected of viral fevers be tested for COVID-19. Screening of pregnant women for COVID-19 with rapid testing preferably with Elisa in moderate to high risk communities/countries. Screening with rapid testing preferably with Elisa prior to invasive interventions, including operations, in moderate to high risk communities/countries. Limit the exposure of hospital staff who are susceptible to develop severe complications of COVID-19. Hospitals provide PPE to staff depending upon exposure as per international/national/local guidelines. Hospitals implement infection prevention control measures meticulously in context of COVID-19

COVID-19 And Lockdown: Be Logical in Relaxing It

Cambridge Dictionary defines ‘lockdown’ as a situation in which people are not allowed to enter or leave a building or area freely because of an emergency. Merriam-Webster outlines three definitions of lockdown: a) the confinement of prisoners to their cell for all or most of the day as a temporary security measure, b) an emergency condition in which people are temporarily prevented from entering or leaving a restricted area during a threat of danger and c) a temporary condition imposed by governmental authorities as during theoutbreak of an epidemic disease in which people are required to stay at their homes and refrain from orlimit activities outside the home involving public contact. Our focus, here, is on lockdown strategy adopted to contain corona virus disease 2019 (COVID-19) pandemic

Nepal\u27s response to contain COVID-19 Infection

Nepal is a landlocked country bordering two most populous countries, India and China. Nepal shares open border with India from three sides, east, south and west. And, in north with China, where the novel coronavirus infection (CVOVID-19) began in late December 2019. The first confirmed imported case in Nepal was reported in 2nd week of January 2020. The initial response of Nepal to COVID-19 were comparably slow but country geared efforts after it was declared a \u27global pandemic\u27 by WHO on 11 March, 2020. Government of Nepal\u27s steps from 18 March, 2020 led to partial lock down and countrywide lockdown imposed on 24 March, 2020. Government devised comprehensive plan on 27 March, 2020 for quarantine for peoples who arrived in Nepal from COVID-19 affected countries. This article covers summary of global status, South Asian Association of Regional Cooperation (SAARC) status, and Nepal\u27s response to contain COVID-19 infection discussed under three headings: Steps taken before and after WHO declared COVID-19 a global pandemic and lab services regarding detection of COVID-19. Nepal has documented five confirmed cases of COVID-19 till the end of March 2020, first in second week of 15 January, 2020 and 2nd case 8-weeks thereafter and 3rd case two days later, 4th on 27 March and 5th on 28 March. Four more cases detected during first week of April. Non-Pharmacological interventions like social distancing and excellent personal habits are widely practiced. Country has to enhance testing and strengthen tracing, isolation and quarantine mechanism and care of COVID-19 patients as Nepal is in risk zone because of comparably weak health system and porous borders with India. The time will tell regarding further outbreak and how it will be tackled. Keywords: COVID-19; lockdown; Nepal; pandemic; response

Exploring the State of the Art in Legal QA Systems

Answering questions related to the legal domain is a complex task, primarily due to the intricate nature and diverse range of legal document systems. Providing an accurate answer to a legal query typically necessitates specialized knowledge in the relevant domain, which makes this task all the more challenging, even for human experts. QA (Question answering systems) are designed to generate answers to questions asked in human languages. They use natural language processing to understand questions and search through information to find relevant answers. QA has various practical applications, including customer service, education, research, and cross-lingual communication. However, they face challenges such as improving natural language understanding and handling complex and ambiguous questions. Answering questions related to the legal domain is a complex task, primarily due to the intricate nature and diverse range of legal document systems. Providing an accurate answer to a legal query typically necessitates specialized knowledge in the relevant domain, which makes this task all the more challenging, even for human experts. At this time, there is a lack of surveys that discuss legal question answering. To address this problem, we provide a comprehensive survey that reviews 14 benchmark datasets for question-answering in the legal field as well as presents a comprehensive review of the state-of-the-art Legal Question Answering deep learning models. We cover the different architectures and techniques used in these studies and the performance and limitations of these models. Moreover, we have established a public GitHub repository where we regularly upload the most recent articles, open data, and source code. The repository is available at: \url{https://github.com/abdoelsayed2016/Legal-Question-Answering-Review}

Does supportive supervision intervention improve community health worker knowledge and practices for community management of childhood diarrhea and pneumonia? Lessons for scale-up from Nigraan and Nigraan plus trials in Pakistan

Background: Lack of programmatic support and supervision is one of the underlying reasons of the poor performance of Pakistan\u27s Lady Health Worker Program (LHWP). This study describes the findings and potential for scale-up of a supportive supervision intervention in two districts of Pakistan for improving LHWs skills for integrated community case management (iCCM) of childhood diarrhea and pneumonia.Methods: The intervention comprised an enhanced supervision training to lady health supervisors (LHSs) and written feedback to LHWs by LHSs, implemented in Districts Badin and Mirpur Khas (MPK). Clinical skills of LHWs and LHSs and supervision skills of LHSs were assessed before, during, and after the intervention using structured tools.Results: LHSs\u27 practice of providing written feedback improved between pre- and mid-intervention assessments in both trials (0% to 88% in Badin and 25% to 75% in MPK) in the study arm. Similarly, supervisory performance of study arm LHSs was better than that in the comparison arm in reviewing the treatment suggested by workers\u27 (94% vs 13% in MPK and 94% vs 69% in Badin) during endline skills assessment in both trials. There were improvements in LHWs\u27 skills for iCCM of childhood diarrhea and pneumonia in both districts. In intervention arm, LHWs\u27 performance for correctly assessing for dehydration (28% to 92% in Badin and 74% to 96% in MPK), and measuring the respiratory rate correctly (12% to 44% in Badin and 46% to 79% in MPK) improved between baseline and endline assessments in both trials. Furthermore, study arm LHWs performed better than those in comparison arm in classifying diarrhea correctly during post-intervention skills assessment (68% vs 40% in Badin and 96% vs 83% in MPK).Conclusion: Supportive supervision including written feedback and frequent supervisor contact could improve the performance of community-based workers in managing diarrhea and pneumonia among children. Positive lessons for provincial scale-up can be drawn. Trial registration Both trials are registered with the \u27Australian New Zealand Clinical Trials Registry\u27. Registration numbers: Nigraan Trial: ACTRN1261300126170; Nigraan Plus: ACTRN12617000309381