Developing counseling skills through pre-recorded videos and role play: a pre- and post-intervention study in a Pakistani medical school

<p>Abstract</p> <p>Background</p> <p>Interactive methods like role play, recorded video scenarios and objective structured clinical exam (OSCE) are being regularly used to teach and assess communication skills of medical students in the western world. In developing countries however, they are still in the preliminary phases of execution in most institutes. Our study was conducted in a naïve under resourced setup to assess the impact of such teaching methodologies on the counseling skills of medical students.</p> <p>Methods</p> <p>Fifty four 4^thyear MBBS students were identified to be evaluated for communication skills by trained facilitators in a pre-intervention OSCE. The same group of students was given a demonstration of ideal skill level by means of videos and role playing sessions in addition to real life interaction with patients during hospital and community rotations. A post-intervention evaluation was carried out six months later through OSCE and direct observation through structured checklist (DOS) in hospital and community settings. The combined and individual performance levels of these students were analyzed.</p> <p>Results</p> <p>There was a statistically significant difference in the communication skills of students when assessed in the post-intervention OSCE (p = 0.000). Individual post-intervention percentages of study participants displayed improvement as well (n = 45, p = 0.02). No difference was observed between the scores of male and female students when assessed for two specific competencies of antenatal care and breast feeding counseling (p = 0.11). The mean DOS (%) score of 12 randomly selected students was much lower as compared to the post-intervention (%) score but the difference between them was statistically non significant, a result that may have been affected by the small sample size as well as other factors that may come into play in real clinical settings and were not explored in this study (59.41 ± 7.8 against 82.43 ± 22.08, p = 0.88).</p> <p>Conclusions</p> <p>Videos and role play in combination with community and clinical exposure are effective modes of teaching counseling skills to medical students. They can be successfully utilized even in a limited resource setup, as demonstrated by our trial.</p

Nutritional Therapy Leads To Complete Recovery of Left Ventricular Dysfunction in Anorexia Nervosa: A Case Report

This case highlights the cardiac complications associated with anorexia nervosa and how early recognition and treatment significantly affects overall prognosis. A few cases have been reported in literature where cardiomyopathy associated with anorexia nervosa was reported but this is the first case where adequate medical management and metabolic support lead to complete recovery

Rescue left bundle branch area pacing in coronary venous lead failure or nonresponse to biventricular pacing : results from International LBBAP Collaborative Study Group

BACKGROUND: Cardiac resynchronization therapy (CRT) using biventricular pacing (BVP) is effective in patients with heart failure, left bundle branch block (LBBB) and reduced left ventricular function. Left bundle branch area pacing (LBBAP) has been reported as an alternative option for CRT. OBJECTIVE: The aim of this study was to assess the feasibility and outcomes of LBBAP in patients who failed conventional BVP due to coronary venous lead complications or were non-responders to BVP. METHODS: At 16 international centers, LBBAP was attempted in patients with conventional CRT indication who failed BVP due to either, coronary venous (CV) lead complications, or lack of therapeutic response to BVP. We are reporting heart failure hospitalizations (HFH) and death, echocardiographic outcomes, procedural data, pacing parameters, and lead complications including CV lead failure. RESULTS: LBBAP was successfully performed in 200 patients (CV lead failures-156; non-responders-44): age 68±11years, female-35%, LBBB-55%, RVP-23%, ischemic cardiomyopathy-28%, nonischemic cardiomyopathy-63%, LVEF ≤35% in 80%. Procedure and fluoroscopy duration were 119.5±59.6 and 25.7±18.5 min. LBBAP threshold and R-wave amplitudes were 0.68±[email protected] and 10.4±5mV at implant and remained stable during mean follow-up of 12±10.1 months. LBBAP resulted in significant QRS narrowing from 170±28ms to 139±25ms (p<0.001) with V6 R-wave peak times of 85±17ms. LVEF improved from 29±10% at baseline to 40±12% (p<0.001) during follow-up. The risk for death or HFH was lower in CV lead failure compared to non-responders (HR-0.357;95%CI 0.168-0.756,p=0.007) CONCLUSION: LBBAP is a viable alternative for CRT in patients who failed conventional BVP due to CV lead failure or were non-responders