RETROSPECTIVE ANALYSIS OF FUNCTIONAL OUTCOME OF TOTAL KNEE REPLACEMENT IN RURAL TEACHING SETUP

Background:Indian population is mainly residing in two areas- urban and rural. The literature has shown consistent results following knee joint replacement surgeries, however these studies have been done in highly efficient and equipped hospitals in urban areas. Aim: The aim of this study was to compare outcome at a rural set-up with those at a high-end teaching or corporate hospital in urban set-up from published literature. Materials and Methods: This study was an observational and retrospective analysis. Observation data was collected from January, 2020 and April, 2021. This study included follow-up of 60 total knee joint replacements. Results: In our study of total knee joint replacement surgeries in rural teaching set- up, we achieved 95.39% results (excellent) while the remaining 4.61% results were good. Conclusion: This study confirmed that results of total knee replacement are comparable to any other highly well equipped urban center, if all basic surgical principles including aseptic precautions are stringently followed-up. Further the clinical outcomes in our cases was more surgeon dependent rather than technology dependent as all surgeries were performed by one single surgeon.

MATERNALAND FETAL OUTCOME OF BURNS DURING PREGNANCY IN A RURAL TEACHING HOSPITAL IN EASTERN PART OF INDIA

Burns during pregnancy inuence maternal as well as fetal outcome. Keeping this in view this study was undertaken to evaluate the maternal and fetal outcome in relation to burn extent, gestational age and etiology of burns. This descriptive observational study was performed over three years period. Atotal of 16 cases of burn females with pregnancy were analyzed. There were 6 (37.5%) maternal death and 9 (56.25%) fetal deaths in our study. The mean percentage of total burn surface area (TBSA) was signicantly higher in cases of maternal or fetal death (p ≤0.0001 and 0.0001 respectively). The maternal and fetal mortality rates were also signicantly higher when the burn was suicidal (p≤0.001 and p=0.001, respectively). Gestational age appeared unrelated to maternal mortality and the rate of fetal mortality decreased with increasing gestational age. Percentage of TBSAburn, suicidal burn injury was correlated with a higher maternal and fetal mortality.

AUDIT OF CESAREAN SECTION IN A RURAL TEACHING HOSPITAL AS PER WHO GUIDELINES (ROBSON’S TEN GROUP CLASSIFICATION SYSTEM)

Background: Rate of cesarean section (CS) is one of the most frequently used indicators of healthcare quality at the national and international levels for clinical governance. Audit of indications of CS and to propose measures to reduce the rate of CS in our institution Methods: Prospective observational study was conducted at Department of Obstetrics and Gynaecology at Dr Rajendra Prasad Government Medical College Kangra at Tanda (HP) Results: In our study, previous CS (group 5) contributed the most (30.44%) of overall CS.Second largest contributor was nulliparous women with cephalic presentation at term (group 1 and 2).Induction of labor (group 2) was associated with higher CS (23.66%), as compare spontaneous labor (group1). Women with breech presentation (group 6 and 7) also showed high CS rate. Conclusion: In conclusion, RTGCS permits the easy identification of the leading contributing groups to CS increases. RTGCS is an internationally accepted classification that is much needed to scientifically study the effects of the rising CS rate. It identifies the contributors to differences in the CS rate but does not provide any explanation for these differences across various subgroups. Keywords: RTGCS, CS, NVD, Women.

Depression in females: comparison of patients visiting urban and rural teaching hospitals of Peshawar, Khyber Pakhtunkhwa

Introduction: Even though frequency of depression is documented globally, the spectrum of depression and its inciting factors in Pakistan are unique to the local cultural and social beliefs. Objective: To compare the status of depression and its provoking socio-cultural factors among urban and rural females attending selected hospitals of Peshawar. Materials & Methods: A cross-sectional comparative study was conducted from March to May 2017 on 93 female patients attending two selected urban and rural teaching hospitals of Peshawar. Data were collected on Beck Depression Inventory through convenience sampling, and were analyzed for descriptive statistics by SPSS version 20. Comparisons were done by the Chi Square test and the Student’s T test keeping p≤0.05 as significant. Results: Out of 93 female patients, a final 89 females (53 urban and 36 rural) were included due to incomplete data entries. More urban females were in the normal, mild or borderline clinically depressed categories (38/53, 71.7%), compared to rural females (15/36, 41.7%), more of whom were in moderate, severe and extremely depressed categories (21/36, 58.3%); the difference was significant (p=0.025). Among the many factors leading to depression, there were significant differences in poor socio-economic status (p=0.011), illiteracy (p=0.003) and hostile in-laws (p=0.016), all of which were mainly due to females of rural area rather than urban females. Conclusion: Rural females suffered significantly greater depression compared to their urban counterparts related to poor socio-economic status, illiteracy, and hostile in-laws. Keywords: Depression; Anxiety; Stress; Female; Marriage; Domestic Violence.

The impact of urban-based family medicine postgraduate rotations on rural preceptors/teachers

Background: The use of rural rotations within urban-based postgraduate programs is the predominant response of medical education to the health needs of underserved rural populations. The broader impact on rural physicians who teach has not been reported. Methods: This study examined the personal, professional, and financial impact of a rural rotations for urban-based family medicine (UBFM) residents on Canadian rural teaching physicians. A survey was created and reviewed by community and academic rural physicians and a cohort of Canadian rural family physicians teaching UBFM residents was sampled. Survey data and free-text responses were assessed using quantitative and qualitative analyses. Results: Participants with rural residency backgrounds perceived a negative impact of teaching UBFM (p = 0.02 personal and professional) and those in a primary rural environment (as defined below) perceived impact as positive (p < 0.001). Rural preceptors often held contrasting attitudes towards learners with negative judgements counter-balanced by positive thoughts. Duration in practice and of teaching experience did not have a significant impact on ratings. Conclusion: Being a rural preceptor of UBFM residents is rewarding but also stressful. The preceptor location of training and scope of practice appears to influence the impact of UBFM residents.

How to increase the attractiveness of undergraduate rural clerkships? A cross-sectional study among medical students at two German medical schools

ObjectivesWhile literature provides substantial evidence that undergraduate rural clerkships may contribute to attract medical students to rural careers, so far little is known about how to convince medical students to choose rural teaching sites for their clerkships, which is usually optional. Thus, this study aimed to investigate students’ preferences and perceptions regarding different rural teaching and clerkship formats, important side conditions and suitable communication strategies to promote rural clerkships.DesignCross-sectional study based on a quantitative survey among medical students in advanced study years.SettingTwo German medical schools (Leipzig and Halle-Wittenberg).ParticipantsMedical students in third to fifth year (of six).ResultsResponse rate was 87.1% with n=909 analysable questionnaires. Participants’ mean age was 25.0 years and 65.2% were women. For 97.9% of the students completing some kind of rural clerkship was imaginable, for 90.8% even participation in a rural clerkship of 4 weeks and longer. Nearly half of the students (48.0%) specified that a rural clerkship 4 weeks and longer was ‘absolutely imaginable’. Younger age, having grown up in a rural or small-town region, being able to imagine future working in a small-town or rural area, and general practice as favoured, or at least conceivable career option were independently associated with a higher willingness to complete longer rural clerkships. Financial and organisational issues including remuneration of the clerkship, cost absorption for travelling and accommodation, and accessibility by public transport were the most important side conditions to increase the attractiveness of rural clerkships. Experience reports by fellow students, social media and informational events were stated to be the most suitable ways to advertise rural teaching offers.ConclusionsThe majority of the students are open-minded regarding even longer rural clerkships. This study adds new insights into measures that should be taken to convince them to actually chose this option.