Clinical Examination Of Respiratory System Research Articles

Assessment of performance and confidence level of simulation based clinical examination of respiratory system in undergraduate medical students of a medical college: a comparative cross-sectional study

Introduction: Students in the preclinical phase have adequate clinical exposure to normal physiological findings of clinical examinations performed in healthy peers but do not have exposure to pathological findings other than theoretical knowledge, which is challenging for students during the clinical phase of curricula in examining actual patients. Simulation based medical education (SBME) has recently emerged to address this gap. This study aimed to assess performance and confidence level of simulation based clinical examination of respiratory system in preclinical undergraduate medical students of a medical college. Methods: A comparative cross-sectional study was conducted in the Department of Human Physiology of Medical College. All second year medical students using purposive sampling were taken. Students were divided into three groups and subdivided into six subgroups and each subgroup carried out examination in either healthy subjects or both healthy subjects and manikin. Predesigned proforma was used for assessment of students and the clinical examination process was invigilated by certified physiologists. Results: Students who received both simulation and conventional tutoring methods were able to accurately identify all lung sounds better as compared to those with conventional tutoring with the percentage difference being maximum in identifying vesicular (29 vs 6), stridor (28 vs 6), and bronchial (25 vs 6) breath sounds and least in identifying coarse crackles (3 vs 2). Majority (39 out of 41) of the students receiving SBME of respiratory system were satisfied with the simulation based practice and 34 of those students were even confident on clinical examination. Conclusion: SBME increases performance status and confidence level in medical students. A practical curriculum can be planned to incorporate simulation based clinical examination in preclinical medical students in practical sessions.

Maternal and infants outcomes in asthmatic pregnant women in Mosul

Background: Asthma affects between 3% and 12% of pregnant women worldwide and the prevalence among pregnant women is rising, its often unrecognized and suboptimal treated. The course of asthma during pregnancy varies; it improves, remains stable, or worsens in similar proportion of women. The risk of an asthma exacerbation is high immediately postpartum, but the severity of asthma usually returns to the preconception level after delivery and often follows a similar course during subsequent pregnancies. Good control of asthma is essential for maternal and fetal wellbeing. Patients and Methods: A prospective cohort study was adopted to achieve the study aim. The study conducted from January 2003 through September 2003. Asthmatic and non-asthmatic pregnant women were randomly selected from the outpatient clinics, in patient clinics and emergency department of Al-Razi Teaching Hospital in Mosul city, the data obtained including age, height and weight, parity and gravid, history with a clinical examination of respiratory system and history of maternal and fetal complications. These points were recorded in an especially designed collection form for all women examined after they were consent a form 102 asthmatics pregnant and 115 non-asthmatics pregnant were enrolled in the study; 92 and 93 of them respectively were followed to delivery by researcher and the assessment of maternal and fetal outcomes was done. Percentages, relative risk ratio, p-value and 95% confidence interval were calculated with SPSS version 18.Results: The age interval (25-34) represents 58.7% of the asthmatic pregnant. The first, second and third trimesters correspond to 6.2%, 32.6% and 60.8% of asthmatic pregnant respectively. Regarding the symptoms, the study shows that Dyspnoae is the most common symptoms among them follows by wheeze, cough and chest tightness and lastly expectoration with percentage of 65.2%. Moreover finds out that 59 (64.2%) had worsening of symptoms during the three trimesters of pregnancy, 28 (30.4%) had No change in the severity of asthma and remainder 5 (5.4%) of them show improvement. The adverse maternal outcomes; hyperemesis gravid arum (RR of 1.43), recurrent hospital admission (RR= 2.26) and the severity of asthma in pregnant women with boys (RR= 2.29) occurs with high significant association. Also the infant outcomes; that the wheezy chest, fetal death and congenital anomalies occur in high significant statistical association among the asthmatic pregnant group with RR (1.66, 1.72, and 1.66 respectively).Conclusion: Symptoms of asthmatic patients during the pregnancy are more severe than without pregnancy. The symptoms are more sever in third trimester, which are caused by mechanical factors and the severity of asthma is more in mothers bearing boys. More over some adverse maternal and infant outcomes were significant statistically associated with asthma.

Use of mini-CEX as a teaching learning method in physiology for undergraduate medical students

Background: Most of the assessments of medical students are at the end of the term or year leaving hardly any scope for feedback. Mini-clinical evaluation exercise (mini-CEX) is a hybrid tool that allows assessment as well as immediate feedback from a knowledgeable assessor which is its main strength. At NKPSIMS and RC Nagpur it was observed that Undergraduate medical students in physiology practicals show underperformance in clinical physiology section especially. The feedback part associated with mini-CEX made us think to use it as an assessment and learning tool in physiology as it gives immediate feedback to the students, there is one to one interaction between the teacher and student and students are made accountable for their own learning. Aims and Objectives: (i) To improve clinical examination skills of I MBBS students, (ii) To improve the performance of the students in clinical examination of respiratory system in physiology, (iii) To give constructive feedback to the students, and (iv) To make the students accountable for their own learning. Materials and Methods: 75 students of I MBBS 2014 batch were included in the study and 150 encounters were planned. Students were taught clinical examination of respiratory system and were called twice in next 2 successive weeks. Each student was assessed twice with a check list for the competencies required and providing feedback. The standard nine-point scale was adopted for rating the students. The data collected during all the encounters was analyzed. Results: The scores in all the 5 competencies (inspection, palpation, percussion, auscultation, and communication skills) in the 2nd encounter shows a significant improvement which was statistically significant (P < 0.001). Conclusion: We have successfully implemented mini-CEX as a teaching learning and assessment tool for undergraduates and found its feasibility and acceptability for preclinical subjects.

A cross sectional study of prevalence of respiratory morbidity and assessment of quality of life among elderly population at a village in Bangalore urban district

Background: The prevalence of respiratory morbidity among elderly in rural area ranges between 31- 35%. Quality of life is a subjective measure of wellbeing. Multiple morbidities have effect on quality of life. Aims & Objective: (1) To study the prevalence and risk factors of respiratory morbidity among the elderly at a village in Bangalore Urban district; (2) To assess the quality of life among them. Materials and Methods: This study was a cross sectional study conducted at Tarabanahalli, Bangalore Urban District, Karnataka. Study subjects consisted of elderly population aged ≥ 60 years residing at Tarabanahalli for at least 6 months. Data collection was done using a structured interview schedule based on SGRQ- C (St George’s respiratory questionnaire for COPD) and WHOQOL-BREF. Brief clinical examination of respiratory system was also done. Data analysis was done using SPSS for frequencies, measures of central tendencies, independent sample T test. Results: Total number of study subjects was 64. Males were 23(36%) and females were 41 (64%). Majority of the study subjects i.e 44 (68.75%) belonged to the age group 60- 69 years. Longest held job by most of the respondents was agriculture 61(95.3%).100% reported that they had ‘moderate’ occupational exposure to dust. 24 (37.5%) of the study subjects had the respiratory morbidity. Inadequate ventilation in the kitchen and use of firewood as cooking fuel were significantly associated with respiratory morbidity. There was no significant association between age, gender, type of job, years of exposure to dust, level of exposure at workplace, H/o smoking tobacco ever, current smoking, passive smoking & respiratory morbidity. Conclusion: A significant negative association was found between respiratory morbidity and ‘Physical health’ domain of quality of life.