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Quality assessment of large language models\u27 output in maternal health
No full textOptimising healthcare is linked to broadening access to health literacy in Low- and Middle-Income Countries. The safe and responsible deployment of Large Language Models (LLMs) may provide accurate, reliable, and culturally relevant healthcare information. We aimed to assess the quality of outputs generated by LLMs addressing maternal health. We employed GPT-4, GPT-3.5, GPT-3.5 custom, Meditron-70b. Using mixed-methods, cross-sectional survey approach, specialists from Brazil, United States, and Pakistan assessed LLM-generated responses in their native languages to a set of three questions relating to maternal health. Evaluators assessed the answers in technical and non-technical scenarios. The LLMs\u27 responses were evaluated regarding information quality, clarity, readability and adequacy. Of the 47 respondents, 85% were female, mean age of 50 years old, with a mean of 19 years of experience (volume of 110 assisted pregnancies monthly). Scores attributed to answers by GPT-3.5 and GPT-4 were consistently higher [Overall, GPT-3.5, 3.9 (3.8-4.1); GPT-4.0, 3.9 (3.8-4.1); Custom GPT-3.5, 2.7 (2.5-2.8); Meditron-70b, 3.5 (3.3-3.6); p = 0.000]. The responses garnered high scores for clarity (Q&A-1 3.5, Q&A-2 3.7, Q&A-3 3.8) and for quality of content (Q&A-1 3.2, Q&A-2 3.2, Q&A-3 3.7); however, they differed by language. The commonest limitation to quality was incomplete content. Readability analysis indicated that responses may require high educational level for comprehension. Gender bias was detected, as models referred to healthcare professionals as males. Overall, GPT-4 and GPT-3.5 outperformed all other models. These findings highlight the potential of artificial intelligence in improving access to high-quality maternal health information. Given the complex process of generating high-quality non-English databases, it is desirable to incorporate more accurate translation tools and resourceful architectures for contextualization and customisation
Efficacy and safety of direct oral anticoagulants compared to no anticoagulation for stroke prevention in atrial fibrillation patients with prior intracranial hemorrhage: A systematic review and meta-analysis
No full textDischarge opioid prescriptions following pediatric appendectomy: A NSQIP-P study
No full textIntroduction: This study aimed to evaluate national patterns in opioid prescriptions following discharge for appendectomy in children with appendicitis using the National Surgical Quality Improvement Program - Pediatric (NSQIP-P) database. Furthermore, we aimed to analyze the association between opioid prescriptions at discharge and emergency department (ED) visits and readmissions in this patient cohort.Methods: The NSQIP-P database was queried for all patients under 18 years of age who underwent laparoscopic appendectomy for simple or complicated appendicitis in 2023. Patients were stratified based on whether they received an opioid prescription at discharge. Demographics, clinical characteristics and postoperative outcomes were compared between patients receiving opioid prescriptions versus those who did not. Multivariable logistic regression was used to identify predictors of opioid prescribing and its association with ED visits and unplanned readmissions.Results: Among 22,148 pediatric appendectomy patients, 5.2 % received opioids at discharge. In patients with simple appendicitis, older age (p \u3c 0.001), male sex (p = 0.027), Black/African American race (p = 0.012), computed tomography (CT) without ultrasound (p \u3c 0.001) and shorter hospital stay (p = 0.002) were independent predictors of opioid prescription. In cases of complicated appendicitis, independent predictors of opioid prescription included older age (p = 0.001), CT without ultrasound (p \u3c 0.001) and shorter hospital stay (p \u3c 0.001). Discharge opioids were associated with increased odds of ED visits (aOR 1.28, 95 % CI: 1.00-1.60), but not unplanned readmissions (aOR 1.13, CI 95 %: 0.75-1.64).Conclusion: Despite declining national rates, variation in opioid prescribing following appendectomy persists. Poor radiation stewardship and patient demographics appear to be associated with prescribing patterns. Efforts to optimize pain management and reduce unnecessary opioid exposure are warranted.Type of study: Retrospective Comparative Study.Level of evidence: III
Diabetes and obesity susceptibility genes: A cross-sectional analysis of methylation patterns from Karachi, Pakistan
No full textPurpose of study: Environmental factors are pivotal in shaping disease outcomes for obesity, diabetes, and metabolic syndrome (MetS), especially in the Pakistani population. This study aimed to determine whether promoter methylation levels of 12 diabetes and obesity susceptibility genes are associated with MetS phenotypes and risk of T2DM in Pakistani individuals.Study design: A cross-sectional study was undertaken whereby methylation-specific PCR assays were conducted on 203 adult subjects recruited from the community in Karachi, Pakistan. Participants were stratified into four groups based on their metabolic health and BMI (MOU n = 39, MHO n = 43, MUHNW n = 51, MHNW n = 70). Biochemical and biophysical data were statistically analyzed to determine the association of methylation levels with MetS phenotypes.Results: Low chemerin promoter methylation was observed in metabolically unhealthy participants, irrespective of BMI, while higher methylation levels were observed for POMC and PCSK1. Unsupervised machine learning showed that the methylation status of Chemerin, IGF2, POMC, PCSK1 (P \u3c .001), and FNDC (P \u3c .05) was independently linked with the risk of developing MetS. Hierarchical clustering analysis revealed distinct genetic clusters that partially aligned with the original MetS and BMI categories, indicating the presence of unique genetic profiles and the potential misdiagnosis of high-risk individuals.Conclusion: Chemerin, IGF2, POMC, PCSK1, and FNDC\u27s methylation status shows independently linked trends with the risk of developing MetS and obesity. Distinct genetic clusters for MUHNW and MHO exhibit similar phenotypic profiles, implying misdiagnosis risks and comparable risks of developing cardiometabolic disorders in the future. Large-scale methylation studies are needed to confirm the association. Key message What is already known on this topic: Genetic susceptibility contributes significantly to complex disorders like obesity, diabetes, and MetS. Prior research has highlighted the role of genetic polymorphisms but hasn\u27t extensively explored the influence of promoter methylation in Pakistani populations. Understanding genetic and epigenetic factors in disease etiology is crucial for tailored interventions, particularly in populations with diverse genetic backgrounds and environmental exposures. What this study adds: Distinct trends of methylation patterns were observed in genes like Chemerin, IGF2, POMC, PCSK1, and FNDC, independently linked with MetS and obesity risk. Potential misdiagnosis risks and comparable risks of developing cardiometabolic disorders in individuals with metabolically unhealthy normal weight individuals and metabolically healthy phenotypes were observed. How this study might affect research, practice, or policy: Incorporating epigenetic biomarkers into risk assessment algorithms could enhance disease prediction accuracy and facilitate early intervention strategies. Recognizing misdiagnosis risks associated with MUHNW and MHO phenotypes could inform clinical practice and public health policies for improved disease screening and management
Development and validation of the chart stimulated recall (CSR) tool for removable partial denture (RPD) design by prosthodontic residents in a tertiary care hospital.
No full textBackground: The removable partial denture (RPD) is used to replace one or multiple missing teeth in partially edentulous patient. It is commonly taught in both undergraduate dental schools, and post-graduate Prosthodontic residency around the globe. There is inconsistency in the teaching of RPD designing, with no published workplace-based assessment (WPBA) tool. Literature has highlighted that the patient were provided less than optimal quality of prosthesis which is reflection of poor understanding of the clinician. Therefore, the aim of this study is to develop and validate WPBA tool for the teaching of RPD designing. Methodology: A tool development and validation study were designed in Aga Khan University, Hospital (AKUH). The tool was developed following the published literature and validated by national and internation subject experts (07) and medical educationalist (02). The newly validation tool was tested among all the eight Prosthodontic residents of AKUH by six senior prosthodontic faculty on three different cases on two different assessment days. The data collected was tabulated and statistical tests were run using SPSS (Version 19). Results: The content validation index (Avg/S-CVI) demonstrated high expert agreement (0.96 for clarity, 0.99 for relevance, and comprehensiveness), indicating that the tool effectively captures essential aspects of RPD design assessment. In terms of reliability, the CSR tool showed excellent internal consistency with Cronbach’s Alpha values 0.947. Interrater reliability (ICC) of 0.947 (ranging from 0.903 to 0.978). However, its ability to distinguish between junior and senior residents was not statistically significant. Conclusion: The newly developed CSR for RPD designing has excellent content validity, high reliability (internal consistency and interrater reliability), reflecting the tool’s robustness in measuring key competencies. The results highlight that the learning has occurred during this intervention reflecting the strong utility of this tool in teaching of RPD designing
Environmental and climate change dictionary: Part II
Full text linkWhen we published our first environment and climate change dictionary in 2023 at IED (https://ecommons.aku.edu/books/117/), I was surprised by the response we received. Many people reached out to us to tell us how they hear these terms in their workplaces and how our dictionary helps them understand the words better. I wanted to make sure that we continue to add words to the dictionary in order to increase the understanding of others but also our own understanding of many terms we hear on a day-to-day basis. This year with the participants of “Introduction to Climate Change” course at FAS we continued with our dictionary and have added 105 more words to the list of already existing 130 words. We hope that we will continue to co-create such resources for broader community education in the future as well. This year I asked each participant to add 3–5 words which were not to be a repetition of the words already given in our first edition. I reviewed the words twice and students changed the definitions accordingly. After the final review they had to add these words to our Canva page. Later in summer 2025, two FAS interns Aiman Gohar and Alefiya Najam with the help of Yamna Sarwar and M. Wasiq Imran (Teach for Pakistan) interns finalized the Canva version and edited the words further. I reviewed the words one last time before finalizing the book. The participants of Introduction to Climate Change who have contributed to this book include (as they appear in the document) Kamran Abid Khan, Ruyab Jahan, Syed Ali Arsalan, Maheen Azar, Syeda Shamael Riaz, Urooj Nisar, Sheeza Fakhruddin, Sadia Khuwaja, Natasha Ali, Abdus Salam, Shahrayar Morani, Faisal Nabi, Hania Shoaib, Faiza Zafar, Anisa Khan, Syed Samsam Ali, Arjumand Mir, Sana Hameed, Imran Uddin, Moeen Akhtar, Nadia Afsheen, Tahira Nargis, Nizar Alam, Alisha Rashid Majeed, Muhib Afzal, and Najeeb ur Rehman. Please note that some student input is missing as they did not complete the final step of the publication. I hope this work encourages students to contribute more in the future and helps expand our collective knowledge. We warmly invite everyone to use this dictionary with open hearts. Thank you for supporting our mission to advance climate change education.https://ecommons.aku.edu/books/1193/thumbnail.jp
Effects of World Health Organization’s educational interventions on clinical competency of community midwives in managing postpartum hemorrhage
Full text linkBackground: Postpartum hemorrhage (PPH) is considered to be one of the most important causes of maternal mortality especially in low resource countries such as Pakistan. Community midwives (CMWs) have a very important role in the provision of midwifery care and their clinical competency are very crucial for the handling of PPH. This study evaluates the effect of a World Health Organization (WHO)-based educational intervention on the clinical competency of CMWs in Hazara Town, Quetta, in managing PPH.Objective: This study aimed to determine the effectiveness of a WHO based educational intervention on improving the clinical competency of CMWs in managing PPH.Methods: One group quantitative quasi-experimental, pretest-posttest design was used in assessing the effect of the educational intervention by WHO on the clinical competency of 34 community midwives in the management of postpartum hemorrhage (PPH). Participants were selected using purposively sampling and data were processed using the SPSS version 23. Reliability of data was established as well as normality by carrying out Shapiro-Wilk, Kolmogorov-Smirnov and Bateman tests. Descriptive statistics were used for demographic characteristics while paired t test was used to compare and analyze change in clinical competency of community midwives in managing postpartum hemorrhage before and after the intervention. Intervention was found to be statistically significant with p value (\u3c 0.05).Data Collection: Data were collected using the Regional Competency Assessments tool and management demographic questionnaires before and after the intervention.Results: The research showed considerable improvement in the clinical competency of community midwives in post-partum care following the educational intervention of the WHO. Most of the participants 25–35 years (67.6 %) and 3–5 years’ working experience (58.8 %). 44.1% scored in the specific low competency area (\u3c51) before the intervention whereas, 82.4% post intervention attained high competency scores (\u3e75). The mean scores increased significantly from a competence score of 49.41 ±11.06 to 79.38 ± 7.46 with p values of 0.001. All the skills observed were significantly improved with mean score differences of -0.529 to -2.882 and p values of 0.000 (p \u3c 0.05).Conclusion: WHO based education intervention significantly improved the clinical competency of CMWs in the management of PPH. The findings support the need for ongoing competency-based training programs to enhance maternal health outcomes. Broad implementation of similar interventions could contribute to reducing maternal mortality and improving healthcare quality in resource limited settings
Knowledge, attitudes, and practices of healthcare workers regarding early childhood development: A mixed-methods study at secondary care maternal and child care hospitals in Karachi, Pakistan
Full text linkIntroduction: Early childhood development (ECD) is a critical period that lays the foundation for a child\u27s future growth and overall well-being. Healthcare settings play a significant role in shaping these developmental outcomes. However, there is limited research evaluating healthcare professionals\u27 knowledge, attitude, and practices on ECD in Pakistan. This study aims to assess the awareness, attitudes, and practices of healthcare providers working in secondary hospitals regarding ECD.Methods: A sequential explanatory mixed-methods approach was used. The study initially recruited healthcare workers, including physicians, nurses, trainees, and midwives from two secondary care hospitals. Participants completed the Caregiver Knowledge of Child Development Inventory (CKCDI) to assess their ECD knowledge. This was followed by semi-structured interviews to explore their perceptions and practices concerning ECD. Quantitative data were analyzed using SPSS, while qualitative data were analyzed thematically.Results: The study revealed that 78.6% (n=125) participants demonstrate low knowledge of ECD. Only 3 participants reported having received specific ECD training. Qualitative interviews highlighted the crucial role of nurturing care by parents and caregivers, the importance of the doctor-patient/caregiver relationship, and the need for continuous learning and training programs regarding ECD parenting education. Challenges to ECD services integration within secondary hospitals include time constraints and lack of resources.Conclusion: This study emphasizes the need for comprehensive educational interventions and continuous training programs to address the evident knowledge gaps among healthcare professionals. Implementing targeted initiatives, policy measures, and regular ECD training in healthcare settings is vital for fostering a nurturing environment that supports optimal child development
Intersectoral interventions: integration for impact on preterm birth
Full text linkProgress: The last two decades have seen a growing focus on intersectoral interventions to improve maternal and newborn health and well-being outcomes, as refected in eforts to achieve the Millennium Development Goals (MDGs) and advance the Sustainable Development Goals (SDGs). Preterm births are linked to cross-sectoral determi‑ nants that afect health outcomes and human capital across the life-course, necessitating an intersectoral approach that addresses these multifaceted challenges.
Programmatic priorities: Recognizing that social, biological and economic determinants signifcantly infuence health outcomes, it is critical that robust health systems are reinforced by a comprehensive intersectoral approach. Evidence suggests that the factors infuencing preterm birth, and the health of small and sick newborns are vast and varied, requiring interventions that address equity and rights, education, economic factors, environmental condi‑ tions, and emergency responses, i.e., a new framework entitled fve Es .
Pivots: Improving outcomes for newborns, including preterm and small for gestational age babies, and prevent‑ ing stillbirths, requires enhanced measurement and accountability within intersectoral programs across the ’fve Es’. Investment in equity-focused, gender-transformative, and rights-based policies and programs across various sec‑ tors is crucial. Priority areas include ensuring equitable and inclusive education, particularly comprehensive sexual and reproductive health education; developing innovative fnancing schemes that protect and support families with complicated pregnancies and vulnerable infants; creating environmentally adaptive systems that prioritize maternal and newborn health; and implementing emergency response plans that guarantee the continuity of mater‑ nal and newborn health services. Evidence-based intersectoral interventions ofer a promising pathway to reducing preterm births and improving health outcomes across generations. By addressing the fve Es, intersectoral interven‑ tions can create a healthier future for preterm babies, children, adolescents, women, and society as a whole
Towards the era of systematic reviews in Education: Promoting evidence-informed decisions in the Global South
No full textThis paper aims to propose systematic reviews as a viable solution to bridge the gap between research and policy/practice in low- and middle-income countries (LMICs). It also presents the current trend and scope of systematic reviews across the globe. In this, two approaches were used to develop the arguments. The first part is theoretical to take forward the longstanding debate about the gap between research and policy/practice. The second part used a systematic approach to search databases for existing published articles on systematic reviews to find the trend and scope. The results revealed a consistent upward trend in the publications of systematic reviews at the global level with an overwhelming majority of systematic reviews coming from high-income countries. Encouragingly, systematic reviews are gaining momentum in LMICs, though there is still scarcity. Furthermore, the coronavirus disease 2019 pandemic has led to a significant increase in the publication of systematic reviews, especially in education technology and teaching learning