A nationwide virtual research education program for medical students in Pakistan: Methodological framework, feasibility testing, and outcomes

Introduction: Equipping young medical trainees with fundamental research skills can be a promising strategy to address the need for professionals who can understand and responsibly communicate evolving scientific evidence during a pandemic. Despite an ardent interest to partake in research, most educational institutions in Pakistan and other low-middle income countries have not yet adopted a comprehensive strategy for research skills education. The authors aimed to design and assess the feasibility of implementing the first nation-wide virtual research workshop for medical students in Pakistan. Methods: The course Beginners Guide to Research, designed as a nation-wide virtual research workshop series, was conducted for medical students across Pakistan in June 2020. Four interactive live workshops took place online on alternate days from June 22nd, 2020, to June 27th, 2020, each lasting 1-2 h. Outcomes included: (i) reach, (ii) efficacy as indexed by pre-post change in score pertaining to knowledge and application of research and (iii) self-rated perceptions about understanding of research on a Likert scale. Results: 3,862 participants enrolled from 41 cities and 123 institutions. Enrolled participants belonged to the following provinces: Sindh (n = 1,852, 48.0%), Punjab (n = 1,767, 45.8%), Khyber Pakhtunkhwa (n = 109, 2.8%), Azad Jammu and Kashmir (n = 84, 2.2%) Balochistan (n = 42, 1.1%). We also saw a few registrations from international students (n = 8, 0.2%). Mean (SD) age of enrolled medical students was 21.1 (2.1) years, 2,453 (63.5%) participants were female and 2,394 (62.0%) were from private-sector medical colleges. Two thousand ninety-three participants participants filled out all four pre-test and post-test forms. The total median knowledge score improved from 39.7 to 60.3% with the highest improvements in concepts of research bioethics and literature search (p \u3c 0.001) with greater change for females compared to males (+20.6 vs. +16.2%, p \u3c 0.001) and private institutions compared to public ones (+16.2 vs. +22.1%, p \u3c 0.001). Conclusion: The overwhelming enrollment and significant improvement in learning outcomes (\u3e50% of baseline) indicate feasibility of a medical student-led research course during a pandemic, highlighting its role in catering to the research needs in the LMICs

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Pakistan'da Ücret karşılığı çalışan ve çalışmayan ergenlerin özguveni ve yaşam doyumu

Thesis (M.A.)--Özyeğin University, Graduate School of Social Sciences, Department of Psychology, August 2016.The present study is a mixed method study conducted with adolescents. The quantitative part of the study aims to examine the level of life satisfaction and selfesteem of a) working and non-working adolescents b) of adolescents who are forced to work and those who work on their own volition and c) the effect of family interdependence on the life satisfaction and self-esteem of working adolescents. Analysis revealed that working adolescents had higher levels of life satisfaction than non-working adolescents. The interaction between gender and the working status was also significant indicating that working girls had higher levels of life satisfaction as compared to non-working girls, whereas the difference between the life satisfaction scores of working and non-working males was not significant. Although results for self-esteem yielded no significant results, univariate analyses revealed that working girls had significantly higher levels of self-esteem than nonworking girls. The qualitative part aimed to provide an in-depth understanding of the meaning of working adolescents as it is perceived by working and non-working adolescents. The sample included 25 adolescents and thematic analyses revealed positive evaluations such as "enjoying working", "financial benefits" and "assisting family", whereas negative evaluations reflected themes such as "loss of educational opportunities", "heavy work demands", and that "adolescence is not the time to work". Cultural context of Pakistan, the school-attendance of the working adolescents as well as the female empowerment by bringing in money for the household are factors considered when discussing the results.Bu tez çalışması ergenlerle gerçekleştirilmiş karma-yöntemli bir çalışmadır. Araştırmanın niceliksel bölümü a) bir işte çalışan ve çalışmayan ergenlerin yaşam doyumu ve özgüven düzeylerini b) zorunlu olarak çalışan ve kendi isteği ile çalışan ergenlerin yaşam doyumu ve özgüven düzeylerini ve c) aile bağlılığı düzeyinin çalışan ergenlerin yaşam doyumu ve özgüveni üzerindeki etkisini incelemeyi amaçlamaktadır. Analiz sonuçları çalışan ergenlerin çalışmayan ergenlere kıyasla daha yüksek yaşam doyumu düzeyine sahip olduklarını göstermiştir. Ancak cinsiyet faktörünün analizi bu farkın çalışan kızlardan kaynaklandığını ortaya koymuştur. Buna göre, çalışan kızların yaşam doyumu çalışmayan kızlardan fazladır, ancak çalışan ve çalışmayan erkekler arasında istatistiksel olarak anlamlı bir fark bulunmamaktadır. Özgüvene ilişkin analizler yine çalışan kızların çalışmayan kızlardan daha fazla özgüvene sahip olduğunu göstermiştir. Araştırmanın niteliksel bölümü hem çalışan hem de çalışmayan ergenler açısından bu yaşta bir işte çalışmanın anlamını daha derinlemesine anlamayı amaçlamaktadır. Tematik analizler bir işte çalışmaya ilişkin hem olumlu hem de olumsuz anlamlar atfedildiğini göstermiştir. Olumlu anlam temaları şunları içermektedir: "çalışmaktan keyif almak", "maddi avantajlar" and "aileye destek olmak". Negatif temalar ise şunlardır: "eğitim fırsatının kaçırılması", "ağır iş koşulları" ve "ergenliğin bir işte çalışma zamanı olmaması". Pakistan'ın kültürel bağlamı, çalışan ergenlerin okula devamı ve kız ergenlerin eve maddi destek olarak güçlendirilmesi araştırmanın bulgularının tartışılmasında ele alınan konulardır

A national virtual research training workshop for 3800 medical students: A mixed-methods evaluation of a novel research education program

Background: Research training is necessary to fill the burgeoning global decline in physician-scientists, which is further pronounced in developing countries. This has generated much interest within institutions across the world to increase research exposure for students as part of medical school curricula. In order to produce a cadre of aspiring physician-scientists, the Student Research Forum (SRF) at Aga Khan University conducted a series of online research workshops leveraging innovative technological solutions during the COVID-19 pandemic. Our study aims to explore students’ perceptions of engaging undergraduate medical students in online research training workshops and to evaluate the effectiveness of such interventions in improving the knowledge and skillset of participating students.Methods: A Beginners Guide to Research’ was a nation-wide virtual research workshop series conducted for medical students across Pakistan in June 2020. A mixed-methods study design was employed to evaluate course efficacy in terms of course content, duration and strategy. Dissemination of quantitative feedback forms alongside simultaneous conduction of qualitative interviews were used to receive feedback for the workshop and obtain the perspectives of medical students on the effectiveness of educational interventions in improving research-related knowledge.Results: A total of 3,862 medical students enrolled in the national workshop series. The feedback form was completed by 2,754 participants, hailing from 113 universities across 37 cities in Pakistan. 2,311 (84.0%) participants stated that the course helped them improve their overall research knowledge and 2,333 (84.7%) felt confident that the skills learnt would help them in future research projects. 40 participants from 25 institutions across Pakistan participated in the qualitative interviews. 24 (60.0%) participants had no prior knowledge of research, 23 (57.5%) found virtual screen-sharing to be the most useful learning strategy and 22 (55.0%) students expressed interest in initiating/expanding their institutional research platforms.Conclusion: This nation-wide series presented a way in which alternative pedagogies can be used for the dissemination of research knowledge and skills to medical students with a strong inclination towards research. Efforts must be made by institutions to provide opportunities to medical students for engaging in meaningful scientific research during the COVID-19 pandemic and beyond

Impact of COVID-19 in hematopoietic stem cell transplant recipients: A systematic review and meta-analysis.

BACKGROUND: Hematopoietic stem cell transplant (HSCT) recipients are at increased risk of mortality and morbidity with coronavirus disease 2019 (COVID-19) due to severe immune dysfunction. METHODS: A literature search was performed on PubMed, Cochrane, and Clinical trials.gov from the date of inception to 12/08/2021. We identified 19 original studies reporting data on COVID-19 in HSCT recipients after screening 292 articles. Data were extracted following preferred reporting items for systematic reviews and meta-analysis guidelines. Quality evaluation was done using the National Institutes of Health (NIH) quality assessment tool. Inter-study variance was calculated using Der Simonian-Laird Estimator. Pooled analysis was conducted using MetaXL. A random-effects model was used to estimate the proportions with 95% confidence intervals (CI). RESULTS: Of 6711 patients in 19 studies, 2031 HSCT patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were analyzed. The median age of patients was 56.9 (range 1-81.6) years, and 63% patients were men according to 14 studies. The median time from transplant to SARS-CoV-2 infection for autologous (auto) and allogeneic (allo) HSCT patients was 23.2 (0.33-350.5) months and 16.4 (0.2-292.7) months, respectively. The median follow-up time after COVID-19 diagnosis was 28 (0-262) days. The COVID-19 mortality rate was 19% (95% CI 0.15-0.24, I CONCLUSIONS: HSCT recipients have a high risk of mortality and clinical complications due to COVID-19. There is a need for ongoing vigilance, masks, and social distancing, vaccination, and aggressive management of SARS-CoV-2 infection in HSCT recipients

Patient-derived xenograft culture-transplant system for investigation of human breast cancer metastasis.

Metastasis is a fatal disease where research progress has been hindered by a lack of authentic experimental models. Here, we develop a 3D tumor sphere culture-transplant system that facilitates the growth and engineering of patient-derived xenograft (PDX) tumor cells for functional metastasis assays in vivo. Orthotopic transplantation and RNA sequencing (RNA-seq) analyses show that PDX tumor spheres maintain tumorigenic potential, and the molecular marker and global transcriptome signatures of native tumor cells. Tumor spheres display robust capacity for lentiviral engineering and dissemination in spontaneous and experimental metastasis assays in vivo. Inhibition of pathways previously reported to attenuate metastasis also inhibit metastasis after sphere culture, validating our approach for authentic investigations of metastasis. Finally, we demonstrate a new role for the metabolic enzyme NME1 in promoting breast cancer metastasis, providing proof-of-principle that our culture-transplant system can be used for authentic propagation and engineering of patient tumor cells for functional studies of metastasis

Preneoplastic stromal cells promote BRCA1-mediated breast tumorigenesis

Women with germline BRCA1 mutations (BRCA1+/mut) have increased risk for hereditary breast cancer. Cancer initiation in BRCA1+/mut is associated with premalignant changes in breast epithelium; however, the role of the epithelium-associated stromal niche during BRCA1-driven tumor initiation remains unclear. Here we show that the premalignant stromal niche promotes epithelial proliferation and mutant BRCA1-driven tumorigenesis in trans. Using single-cell RNA sequencing analysis of human preneoplastic BRCA1+/mut and noncarrier breast tissues, we show distinct changes in epithelial homeostasis including increased proliferation and expansion of basal-luminal intermediate progenitor cells. Additionally, BRCA1+/mut stromal cells show increased expression of pro-proliferative paracrine signals. In particular, we identify pre-cancer-associated fibroblasts (pre-CAFs) that produce protumorigenic factors including matrix metalloproteinase 3 (MMP3), which promotes BRCA1-driven tumorigenesis in vivo. Together, our findings demonstrate that precancerous stroma in BRCA1+/mut may elevate breast cancer risk through the promotion of epithelial proliferation and an accumulation of luminal progenitor cells with altered differentiation

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)