Adhesions after abdomino-pelvic surgery are a cause of morbidity and reoperations. The use of human amniotic membrane (HAM) for adhesion prevention has given controversial results. The mode of administration of the amniotic membrane has not been well studied. This study assessed the efficacy of two modes of application of cryopreserved HAM, patch or fragmented in Lactated Ringer (LR) solution, for the prevention of pelvic adhesion formation postabdomino-pelvic surgery in a mice model. After a midline laparotomy incision, a small cautery lesion was done on each side of the abdominal wall peritoneum in mice. In Group A (control; n = 42), the abdomen was closed directly, Group B (n = 42) received 2.5 ml of LR prior to closure. In Groups C (n = 42) and D (n = 42), a 2 cm × 2 cm patch of HAM and another one fragmented and dispersed in 2.5 ml of LR were applied prior to closure, respectively. Two weeks later, a laparotomy was performed, and gross and pathological evaluation of adhesions, fibrosis, angiogenesis, and inflammation were conducted. Group D exhibited a significantly lower rate of gross adhesion formation. Fibrosis was significantly lowest in Group C as compared to the control. Group B had the lowest vascular formation in the adhesions. The use of HAM fragmented in LR solution is associated with a significantly lower incidence of postoperative adhesions in mice when compared to LR alone, HAM patch, or control. The mechanism of action of this reduction needs to be elucidated by future studies.
This randomized controlled study compared self-based learning (SBL) to didactic learning (DL) in teaching medical students medical and surgical skills. Self-based learning is at least as good as didactic learning in teaching medical students. The skills used were IV line insertion and simple interrupted suture. Sixty-four consenting second year medical students were randomly divided into two groups of 32 students each. For the IV line insertion activity, Group 1 was given a short didactic lecture on IV line insertion and Group 2 received a self-based learning task. Both groups were assessed a week later for IV line insertion on a dummy. Then the two groups were crossed over, where Group 2 attended a short didactic lecture and Group 1 underwent a self-based learning task on simple interrupted suturing. Both groups were assessed a week later using a suturing pad model. Statistical analysis of data, collected from assessment forms and questionnaires, was done using χ2 test (chi-square test). The results showed that there was no significant difference between the two groups in terms of their performance assessment, for both skills. However, student satisfaction significantly differed between the two groups with the SBL group expressing higher overall satisfaction in both activities. Self-based learning should be integrated in medical curricula since its comparable to didactic learning in terms of students’ performance and leads to higher student satisfaction.
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