REVISE: e-aluating the nhibition of tress rosions in the ICU: a randomised trial protocol.

Introduction: The e-aluating the nhibition of tress rosions (REVISE) Trial aims to determine the impact of the proton pump inhibitor pantoprazole compared with placebo on clinically important upper gastrointestinal (GI) bleeding in the intensive care unit (ICU), 90-day mortality and other endpoints in critically ill adults. The objective of this report is to describe the rationale, methodology, ethics and management of REVISE.

Methods And Analysis: REVISE is an international, randomised, concealed, stratified, blinded parallel-group individual patient trial being conducted in ICUs in Canada, Australia, Saudi Arabia, UK, US, Kuwait, Pakistan and Brazil.

Teaching the Teacher: Assessing Barriers to Identity Formation of Clinical Teachers in a Developing Country.

Phenomenon: Clinical teachers' identity formation is understudied in developing countries like Pakistan. Despite producing thousands of international medical graduates per year, Pakistani medical education is still in its infancy. The application of Western medical education methods and theories is beset by unique socio-cultural challenges.

Obstructive Sleep Apnoea in Pakistan: A Single Tertiary Care Center Experience.

Introduction: Considerable interest has been shown in the field of sleep medicine in recent decades. Obstructive sleep apnoea (OSA) is a common condition that remains neglected in most parts of the world. Data are scarce, if any, when it comes to developing countries.

Experience with Ambulatory Management of Pleural Pathologies Utilizing Small-Bore Indwelling Pleural Catheters.

Introduction Pleural effusion is the excess fluid that accumulates in the pleural space. Pneumothorax is the collection of free air in the pleural cavity, while empyema is the collection of pus in the pleural cavity. Such pleural pathologies pose a great challenge to patients and health care professionals alike.

A Simplified MCQs Interpretation Guide for Faculty.

Objective: To devise a guide for faculty to interpret Psychometric Analysis of MCQs followed by its assessment.

Study Design: Across-sectional study.

Place And Duration Of Study: Shifa College of Medicine, Islamabad, from January to July 2009.

Delivering endocrinology and reproduction in an integrated modular curriculum.

Objective: To ascertain the perceptions of students and faculty of Shifa College of Medicine, Islamabad regarding the delivery of Endocrinology and Reproduction module as a component of the newly introduced Integrated Modular Curriculum.

Methods: A descriptive study, using mixed qualitative and quantitative method, starting from June 6 to August 15 2008. A period of 10 weeks was spent on the study including 8 weeks of planning, 2 weeks of delivery and assessment and a 2 weeks period of post hoc analysis and data collection.

Online role-playing for faculty development.

Background: There has been a rapid growth of online teaching in the past few years, yet the implementation of role-play for formal educational activities in an online setting is growing more slowly. The use of online role-playing for the development of health professions educators is virtually un-documented in the literature.

Innovation: In the project reported here we use role-playing as a method to motivate and increase active participation in an online web-based discussion on community-based medical education (CBME).

Competency-based integrated practical examinations: Bringing relevance to basic science laboratory examinations.

Background: The practical examinations in subject-based curriculum have been criticized for lack of relevance and clinical application. We developed competency-based integrated practical examinations (IPEs) for first two years incorporating basic science principles with clinical relevance in our integrated curriculum.

Aim: To bring relevance to basic science laboratory practical examinations by conducting competency-based IPEs.

Intralobar pulmonary sequestration: a masqurader in tuberculosis prevalent population.

Intra pulmonary sequestration is a rare congenital disorder that is characterized by malformation of pulmonary tissue having no connection to normal tracheobronchial tree and pulmonary arteries. This is a case history of 20 years old man initially misdiagnosed as Tuberculosis and later diagnosis of intra-lobar pulmonary sequestration was confirmed. There are few reports of this rare disorder globally and we are reporting the first case of Intrapulmonary Sequestration in Pakistan.

Assessment of knowledge about evidence based medicine in medical students and doctors in a Pakistani health care setting.

Background: Evidence based practice promotes self assessment and ensures delivery of up to date care to patients. The concept of Evidence Based Medicine (EBM) in developing countries is still in its infancy where strong opinions drive patient care.

Methods: We conducted a cross sectional survey to explore the knowledge, perceptions and attitudes regarding EBM in final year medical students and physicians of our institution.

Percutaneous tracheostomy in critically ill patients: 24 months experience at a tertiary care hospital in United Arab Emirates.

Objective: We assessed the safety and complications related to percutaneous tracheostomy (PCT) without bronchoscopic guidance in our intensive care unit (ICU).

Methods: The prospective data over a period of 24 months were collected for patients who underwent PCT. Major, minor and long-term complications were recorded.

Experience with a theme-based integrated renal module for a second-year MBBS class.

Integrated learning is the need of the hour. We at Shifa College of Medicine switched to an integrated modular curriculum last year. In the present article, we describe our experience with the renal module in year 2 of a 5-yr undergraduate medical curriculum.

Revising an objective structured clinical examination in a resource-limited Pakistani Medical School.

Introduction: The objective structured clinical examination (OSCE) has not been used extensively in undergraduate medical education in resource-constrained locations, including Pakistan. The Shifa College of Medicine (SCM) in Islamabad modified an end-of-clerkship OSCE assessment in internal medicine for final year medical students from a previous static, pattern-recognition format to an interactive, clinical reasoning and skill-based format.

Methods: We modified the OSCE to be more dynamic and effective by creating a customized clinical skills laboratory, using standardized patients, developing competency checklists for OSCE stations, and stimulating more active participation from faculty members.

Making evidence-based medicine (EBM) doable in developing countries: a locally-tailored workshop for EBM in a Pakistani institution.

Objective: To demonstrate that evidence-based medicine (EBM) training can be imparted in developing countries using minimal resources.

Design: Development of a minimal cost workshop with validation of gain in EBM skills using the Berlin questionnaire.

Setting: Teaching hospital in Pakistan.

Low haemoglobin levels, its determinants and associated features among pregnant women in Islamabad and surrounding region.

Objective: To estimate the haemoglobin levels in pregnant women and to determine the socio-demographic factors associated with anaemia in pregnancy.

Patients And Methods: In this cross-sectional survey, a total of 200 patients visiting prenatal clinic of Shifa International Hospital/Shifa Foundation Community Health Centres, Islamabad over the period of six months, both booked and non-booked were included. A detailed questionnaire was filled and complete blood count, peripheral smear and absolute values were performed in all cases.

The structure and function of a new clinical skills and medical informatics laboratory (SCIL) in a developing country--a two year institutional experience.

Objective: To combine clinical skills and medical informatics learning by offering a combined 'SCIL' rotation to third year medical students and to determine its long-term impact.

Methods: A combined clinical skills and medical informatics laboratory (SCIL) was set up at our institution with international collaboration. Nine months to one year after formal third year SCIL rotations were conducted, a questionnaire rated on (1-5) Likert Scale was administered to the inaugural class undergoing this rotation.

Efficacy and safety of total dose infusion of low molecular weight iron dextran in the treatment of iron deficiency anemia during pregnancy.

Objective: To determine the efficacy and safety of Total Dose Infusion (TDI) of low molecular weight iron dextran for the treatment of iron deficiency anemia compared to oral iron replacement during pregnancy through improvement in hemoglobin (Hb) after intervention.

Study Design: Non-randomized control trial.

Place And Duration Of Study: Section of Gynaecology and Obstetrics, Shifa International Hospital and Shifa Community Health Centre, Islamabad during January 2005 to January 2006.

Hypocalcemia in a Saudi intensive care unit.

Objective: Hypocalcemia has been a common abnormality in the West, seen in patients admitted to the intensive care unit (ICU). It has also been linked with disease severity. We undertook this study to determine the frequency of hypocalcemia in patients admitted to the intensive care unit.

Paving the way for evidence-based medicine in Pakistan.

Evidence-based Medicine (EBM) is the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimal clinical care to patients. EBM has become popular due to: the need for valid information about diagnosis, prognosis, therapy and prevention during patient care; traditional sources such as textbooks and expert opinion being frequently out-of-date; and knowledge of current best evidence declining with time from graduation from medical college. EBM has become feasible for practicing clinicians due to: new strategies for appraising studies; availability of systematic reviews (summaries) of current best evidence; and information technology (computers with Internet access).

Preliminary experience with learner-centered evidence based format morning report.

Objective: To observe the advantages of implementing learner - centered evidence based format morning report at King Abdulaziz National Guard Hospital, Alhasa, Saudi Arabia.

Methods: We modified conventional morning report by changing to a semicircular seating pattern to promote small group interactive discussions during case presentations. A facilitator was appointed to guide the sessions and asking problem based questions emanating from patient centered discussions.

Quality assurance in an adult intensive care unit, Eastern region, Saudi Arabia.

Objective: Quality assurance (QA) is an increasingly important element in the administrative management of Intensive Care Unit (ICU). This is not only to improve clinical practices and patient's outcome, but also helps in proper resource utilization. We introduced a comprehensive quality assurance program in ICU at King Abdulaziz National Guard Hospital, Alhasa, Saudi Arabia, based on the existing medical evidence.