In clinical education, experiential learning can be an important component of the instructional process. We know that in medical college hospitals, learning that takes place at patient’s bed side or in wards is totally different from learning that takes place in the classroom. Each patient encounter is a new learning experience where new information is internalized and applied in the context of previous knowledge and experience. This emphasizes the importance of experiential learning where medical students should have the opportunity to effectively and efficiently internalize, process, and apply new information. However, a major global challenge for the clinical education is the workload placed on the clinical teachers, who struggle to divide time between clinical, teaching, administrative, and other duties. Experiential learning helps to form an integrated approach to clinical teaching that simplifies the relationship between a physician’s clinical and educational duties and erase the distinction between teaching and patient care duties; the students are also benefited. Kolb proposed experiential learning theory, a four-stage cyclical model of knowledge development that combined individuals’ conscious recognition and transformation of experience, which was first published in 1984.Experiential learning can be applied throughout the medical educational environment by institutional development programmes, including longitudinal outcome assessment, curriculum development, student development, and faculty development. The use of experiential learning, where students are purposefully engaged in direct experience with an emphasis on reflection, increases the ability of students to develop clinical skills and competences during their clinical phase of medical education. This review paper aims to discuss how experiential learning can be integrated in clinical education.International Journal of Human and Health Sciences Vol. 06 No. 02 April’22 Page: 155-160
Wasp bite induced allergic reactions or organ dysfunctions are not uncommon in tropical countries. Most people affected with insect bite hardly develop any signs or symptoms; however, about 30 percent of them may show signs of illness which is often overlooked and causes fatality. Among the fatal complications specially anaphylaxis and renal dysfunction have been reported; however, myocardial involvement in the form of myocarditis is very rare. Awareness about such complications is important as these affect the clinical course and outcomes of the patients. We have presented a case of wasp bite induced myocarditis and heart failure here, which was diagnosed at a later stage as patient did not improve being admitted in the emergency department and subsequently transferred to the critical care unit. CBMJ 2023 January: Vol. 12 No. 01 P: 107-110
A randomized prospective single blind trial was conducted in the Department of Anaesthesia, Analgesia, Palliative and Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh, between July 2021 and February 2022, to compare the effects of intravenous pethidine and nalbuphine hydrochloride combating epigastric pain and discomfort during mopping of intraperitoneal blood in lower uterine caesarean section (LUCS) operation. A total of 120 women participated in the study. They were randomly divided into two groups: group A (n=60) received intravenous diluted (with normal saline) 20-25 mg of pethidine, while group B (n=60) received intravenous diluted 10-20 mg of nalbuphine hydrochloride. There were no differences observed in mean age, weight, height, and duration of operation between two groups (P>0.05). However, participants of group B reported less or no epigastric pain and discomfort during mopping of intraperitoneal blood than that of group A (P<0.05), i.e., episode and intensity of pain measured by using visual analogue scales indicated that nalbuphine hydrochloride has a longer duration of action than pethidine. Our study revealed that intravenous diluted nalbuphine hydrochloride works better than pethidine to minimize epigastric pain and discomfort during mopping of intraperitoneal blood in lower uterine caesarean section (LUCS) operation. CBMJ 2023 January: Vol. 12 No. 01 P: 81-86
Context: Selective obturator nerve block (ONB) limits obturator reflex, adductor contraction, and leg jerking in transurethral resection of bladder tumour (TURBT), which ultimately prevents complications such as bleeding, bladder perforation, or incomplete tumor resection. The present study aims to compare the effectiveness of two different techniques of obturator nerve block during TURBT. Methods: A prospective, observational study was conducted in the Department of Anaesthesia, Analgesia, Palliative and Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh, between September 2018 and August 2019 to evaluate the effectiveness of ultrasound guided ONB versus cystoscopy guided ONB in TURBT operation. A total of 60 selected patients were randomly allocated into two groups: ultrasound guided ONB (group A) and cystoscopy guided ONB (group B) i.e. 30 in each group. Then onset of anesthesia (nerve block), tumour removal and patient outcome were assessed at different point during and after surgery. Results: Mean age of the patients was 54.7±8.53 years. In total, 34(57%) cases were male and 26(43%) were female. Male to female ratio was 1.3:1. In group A, 19(63.3%) patients had ASA II status and 11(36.7%) had ASA III status, while in group B, the numbers were 18(60%) and 12(40%) respectively. There was no significant difference in demographics and ASA status between two groups (P>0.05). Average onset of obturator nerve block was faster in group A (8.17±1.4 min) than group B (11.3±2.68 min), (P<0.001). Total resectability of tumours were achieved in 28(93.3%) in group A and 23(76.6%) in group B during operation (P<0.001), while 2(22.22%) and 7(77.77%) tumours had incomplete removal respectively (P<0.05). Among complications, adductor jerks were evident in 2(6.7%) and 7(23.3%), bladder perforation in 1(3.3%) and 4(13.3%), and bleeding in 1(3.3%) and 3(10.0%) cases in group A and group B respectively. The differences were statistically significant ((P<0.05). Conclusion: Although both techniques are safe and easy to perform, ultrasound guided ONB results in faster onset of block and better resectability of tumour with less complication over cystoscopy guided ONB. J Dhaka Med Coll. 2021; 30(2) : 208-213
Context: There is lack of evidence on comparison of crystalloid pre-loading and co-loading in parturients undergoing cesarean section operation under spinal anesthesia in Bangladesh. Hence, the present study was designed to compare the efficacy of crystalloid pre-loading and co-loading in preventing spinal anesthesia induced hypotension and heart rate variability during caesarean delivery. Methods: This single blinded randomized controlled clinical trial was conducted in the Department of Anaesthesia, Analgesia & Intensive Care, Dhaka Medical College Hospital, Dhaka, Bangladesh, from January 2013 to December 2014. A total of 90 patients were selected - 45 patients of group I received co-loading with Ringer’s lactate solution, while another 45 patients of group II received a pre-loading with the same fluid. Blood pressure and heart rate were recorded in both the groups with 3-minute intervals from the beginning of the subarachnoid block for the first 20 minutes, and then with 5-minute intervals up to one hour. Ephedrine was used as the primary rescue drug to treat hypotension. When ephedrine failed to treat hypotension, adrenaline was administered as a potent vasopressor. Results: The incidence of hypotension was 17 (37.8%) in group I (co-loading group) and 27 (60%) in group II (pre-loading group), which was significantly higher in group II (p<0.05). Comparatively higher heart rate was observed in group II, but not statistically significant. Ephedrine was required in 17 cases (37.8%) in group I and 27 cases (60%) in group II. Mean ephedrine required was 9.2±3.6 mg in group I and 11.5±4.3 mg in group II. The difference was statistically significant (p<0.05). Adrenaline was administered in 1 case (2.2%) in group I and in 2 cases (4.4%) in group II, which was not statistically significant (p>0.05). Conclusion: Severity of hypotension and increased ephedrine requirement were evident in patients who received crystalloid pre-loading (group II), which means crystalloid co-loading (group I) was more capable to prevent spinal anaesthesia induced hypotension. J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 12-17
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