Time’s up on empty zero-tolerance slogans : a national survey concerning sexual harassment

Purpose: The purpose of this paper was to examine the employers’ role in the prevention of sexual harassment within the healthcare workforce. We surveyed all the UK medical schools to inquire about their policies, procedures, complaint numbers and outcomes under the freedom of information law Design/methodology/approach: We submitted freedom of information requests to all 36 medical schools in the UK seeking information on all submitted sexual harassment complaints between January 2008 and January 2018. This included each school disciplinary policies in general and those concerning sexual harassment in specific, the number of formal complaints, and the final outcome of all investigations. Findings: We received interpretable responses from 30/36 contacted medical schools (83%). All 30 schools confirmed having generic code of conduct policies (100%), however, only 12/36 schools (40%) had specific policies and procedures to deal with sexual harassment concerning staff, students or both. None offered any formal training to dealing with sexual harassment. Only three schools confirmed having >5 sexual harassment complaints (3/30, 10%), thirteen had <5 complaints (13/30, 43%) and eleven had no complaints at all (11/30, 37%). Research limitations/implications: Policies, structures and processes alone are not sufficient for addressing sexual harassment. Knowing the policies and procedures alone will not prevent misconduct, keeping to the rules and regulations will. Medical Schools should rise to the challenge through concrete boundaries-related educational interventions, not empty slogans of zero tolerance. Originality/value: This paper highlights the employers’ obligation to engage staff in training to ensure compliance with specific rules and regulations for preventing sexual harassment in the healthcare workplace

Anthropometric measurements as a risk for hypertensive disorders in pregnancy: a hospital based study in South Asian population

Objectives: To determine the relationship between pregnancy induced hypertensive diseases and obesity. Methods: A retrospective case controlled study was performed at Aga Khan University Hospital including records from July 2000 to June 2005. All women developing hypertension with or without proteinuria after 20 weeks of pregnancy (n = 218) were included. Categories of pregnancy induced hypertensive diseases (PIHD) were defined according to National high blood pressure working group and ACOG committee bulletin. Controls were selected randomly with a ratio of 1:1.7 between cases and controls. Results: The estimated prevalence of pre-eclampsia in our institution is 1.9%. Earlier reports suggested mostly non-Asian women primigravida were more likely to develop gestational hypertension when compared with multigravidae (p-value = 0.004). Mean BMI of cases was significantly higher than controls (p = \u3c 0.001). The risks of both non-protienuric hypertension (Mean BMI = 27.16 +/- 5.46) and preeclampsia (Mean BMI = 27.39 +/- 6.15) increased consistently with increasing BMI. This rise was significantly associated with severity of pre-eclampsia and early development of PIH, but not associated with complications like eclampsia. No significant association of height and hypertension was found as most women of both cases and control were 150-165 cm tall. Conclusion: High BMI in pregnant women serves as a significant risk factor for developing hypertension in pregnancy but failed to establish this association with height is the main findings of our study

Factors influencing medical student participation in an obstetrics and gynaecology clinic

Objective: To identify factors influencing medical student participation in an obstetrics and gynaecology (OBGYN) setting.Methods:This was a cross sectional study carried out on patients admitted in OBGYN wards of Aga Khan University Hospital, Karachi, Pakistan. A total of 250 patients consented to participate in this study.Results: Eighty three percent of the people responded \u27yes\u27 to the question of being initially seen by a medical student. People who consented were 3.5 times more likely to know that their primary consultant was a teacher at a medical school i.e. they were initially aware that they were in a teaching hospital (p-value \u3c 0.01). Additionally, people who did consent were 3.5 times more likely to have been admitted because of labour/delivery (p-value \u3c 0.001) and 2.7 times more likely to have a monthly income of more than Rs. 20,000 (p-value \u3c 0.05).Conclusions: A number of factors have been identified in our study along with proposed solutions. Identification of these potentially modifiable factors in the medical student-patient interaction is important to improve the involvement of medical students in the care of the patients

Peripartum hysterectomy: a ten-year experience at a tertiary care hospital in a developing country

Acute bleeding after delivery can be a life-threatening complication. Emergency hysterectomy is usually undertaken as a last resort. This study was conducted in order to estimate the incidence, indications, risk factors and complications associated with peripartum hysterectomy performed at a tertiary care hospital. We retrospectively analysed 39 of 45 cases of emergency peripartum hysterectomy performed at the Aga Khan University Hospital from 1997-2006. Peripartum hysterectomy was defined as one performed for a haemorrhage after delivery which is unresponsive to other treatments. The most frequent indications for peripartum hysterectomy were morbidly adherent placenta (46%) and uterine atony (23 /0).The duration of surgery was shorter (P=0.045) but the complications were higher (P=0.029) in total compared with subtotal hysterectomies. Our results suggest that caesarean deliveries are associated with an increased risk for peripartum hysterectomy, which is of concern given the increasing rate of caesarean deliveries. Subtotal hysterectomy is a reasonable alternative in emergency obstetric hysterectomy

Accuracy of prenatal diagnosis and prediction of lethality for fetal skeletal dysplasias

Objectives: We reviewed all cases with fetal skeletal dysplasia and correlated the accuracy of prenatal diagnoses with the final post-mortem, radiological, or molecular diagnoses. The accuracy of prenatal prediction of lethality was also reviewed. Methods: All cases of fetal skeletal dysplasia referred between October 2002 and August 2010 were reviewed. Perinatal outcome, the accuracy of prenatal diagnosis, and prediction of lethality were ascertained. Lethality was suspected when significant thoracic narrowing, severe micromelia, multiple fractures, or long bone bowing was present. Results: There were 40 cases of skeletal dysplasia. Thirty-nine (97.5%) were singletons and one (2.5%) was a dichorionic twin pregnancy. Twenty-eight (70%) pregnancies were terminated, five (12.5%) were stillborn, and only seven (17.5%) cases were live born. A final diagnosis was established in 28 (70%) cases. In 29 cases with a presumptive prenatal diagnosis, this was confirmed in 23 (79.3%) cases postnatally. Lethality was predicted with 100% certainty. Conclusion: We report higher prenatal/postnatal concordance rates in this series. A precise prenatal diagnosis is frequently difficult and often inaccurate. Prediction of lethality is much easier and often possible with accuracy. Parents need to be aware that the outcome of many skeletal dysplasias is poor

The Role of Anxiety in Simulation-Based Dexterity and Overall Performance: Does It Really Matter?

Background: Essential Skills in the Management of Surgical Cases (ESMSC) is an international undergraduate surgical masterclass which combines ex vivo, dry lab and high fidelity in vivo simulation-based learning (SBL). It consists of 32 stations of skills-based learning, including open reduction internal fixation (ORIF) of fractures. Current literature suggests early involvement in skills-based learning at the undergraduate level is vital. Aims: To compare students' dexterity and skills-based performance with demographic and educational background parameters. Methods: 112 medical students from European Union countries including the United Kingdom, Germany, Greece, Cyprus, Germany, and Bulgaria were selected from a competitive pool of candidates to attend the course. Students undertook ORIF in an ex vivo swine model, and in a simulated fracture on a bamboo rod. Skills-based performance was assessed by two consultant surgeons with validated direct observation of procedural skills (DOPS) forms. Anxiety was self-assessed using the Westside Anxiety Scale prior to the ORIF stations. Dexterity was measured with the O'Connor tweezer dexterity test. Results: Female students had significantly higher dexterity scores (median difference 7, p =.003). Right-handed students achieved higher dexterity than left-handed students (median difference 7, p =.043). There was no difference in students' performance across different medical schools, and across year groups (p <.05 for any correlation). Self-reported anxiety was not correlated with high fidelity skills-based performance (r = 0.032, p =.74). Conclusion: Anxiety does not seem to play a significant role in Simulation Skills-Based learning. Undergraduate surgical curricula should incorporate SBL-based modules to enhance practical skills learning and motivate future orthopedic surgeons