Evaluating the Impact of Basic Science Elective Modules: Medical Students' Perspective

Objectives: We selected pulmonary function test (PFT), a widely used investigation for diagnosis and monitoring of patients having respiratory complaints in Block I (preclinical) Physiology as an elective module since exposure of undergraduate medical students to PFT is inadequate in formal medical training. The elective module in medical curriculum was introduced by national medical commission (NMC) to provide ample opportunity to the students to opt for any course of their choice not covered by traditional syllabus. This will help them to enhance their knowledge, skill, lateral thinking, creativity, experiential learning, communication ability, team-based collaborative learning thus developing their personal and professional confidence in dealing with resource-limited unfavorable circumstances. Hence we introduced this elective to sensitize the future physicians about the importance of PFT, attract their interest in the subject of Physiology and motivate them to choose Physiology as a career preference. Materials and Methods: A quasi-experimental study was conducted in the Department of Physiology to create a time-bound activity schedule on the implementation of PFT as an elective module on 32 Phase III part I M.B.B.S students. We assessed the improvement in knowledge and skill by comparing pre-test and post-test results. We have used the Kirkpatrick evaluation model Level 1 to record the reaction of the students and Level 2 to evaluate their confidence regarding PFT after the course. Thematic analysis was performed on the perception and feedback of students and faculties. Results: We observed that all 32 participating students showed statistically significant (P < 0.0001) improvement in both knowledge gain and skill development. This course helped them increase their confidence to perform PFT independently on patients, interpreting reports, diagnosing various respiratory diseases and enabling them to apply this knowledge to manage the clinical cases in the hospital wards and in the emergency department. Thematic analysis of responses of students pointed out the strengths, weaknesses and suggestions for betterment of the module. The SWOT (Strengths, Weaknesses, Opportunities,Threats) analysis of the perception of faculties guided us to devise a modified framework for the implementation of the PFT module in the future. Conclusion: The elective module on PFT was implemented successfully in our institution with a positive impact on students, assisting them to progress from basic comprehension of the physiology of lung mechanics to independent interpretation of PFT reports to utilising PFT in clinical reasoning and decision-making.

Objective To assess the effect of external diaphragm pacing on pulmonary ventilation, arterial blood gas, exercise tolerance, and quality of life in patients with stable chronic obstructive pulmonary disease(COPD). Methods Screening out 34 patients with stable COPD who had been diagnosed in the Hunan Provincial People′s Hospital from January 2017 to February 2018 and who had been in stable condition and who had been prescribed according to the GOLD 2017 COPD Guidelines.Subgroups were divided according to the GOLD 2017 COPD Guideline Pulmonary Function Grading Criteria and Comprehensive Assessment Grouping criteria, all of which were treated with 20-day in external diaphragm pacing.Before and after external diaphragm pacing treatment, chronic obstructive pulmonary disease assessment test(CAT) scores and improved British Medical Research Council Breathing Difficulties Scale (mMRC) scores, pulmonary ventilation function tests, arterial blood gas analysis, the 6-minute walking distance (6MWD) were performed.Self-control analysis was used to evaluate the treatment effect. Results (1)Forced expiratory volume in the first second (FEV1) changes: there was no significant difference in FEV1 between the moderate group and the group B (t=1.78, 2.47, both P>0.05). The FEV1 in the severe group, the extremely severe group, the group C and the group D increased after treatment (t=6.81, 11.15, 3.07, 7.22, all P 0.05). The PaO2 in the extremely severe group and the group D increased after treatment (t=2.98, 3.08, both P 0.05). The mMRC scores in the severe group, the extremely severe group and the group D were lower than those before treatment (t=2.74, 3.00, 5.34, all P<0.05). Conclusions External diaphragm pacing treatment can improve the pulmonary ventilation function and arterial blood gas index in patients with COPD during stabilization, reduce the patient′s disease symptoms, and improve the patient′s exercise tolerance.And patients with severe impaired lung ventilation and severe symptoms benefit more. Key words: Pulmonary disease, chronic obstructive; Chronic electrical stimulation; Pulmonary rehabilitation; Diaphragmatic muscle

State University of New York Upstate Medical University College of Medicine

COPD patients frequently complain of symptoms such as dyspnoea and leg fatigue during exercise. However, the impact of these symptoms on the health-related quality of life (HRQoL) is not known. This study tested whether dyspnoea and leg fatigue during exercise affects the HRQoL of patients with COPD. In a cross-sectional study, 90 patients with stable COPD (mean age, 76.0+/-0.7 years; FEV(1), 1.11+/-0.04 L) completed the St. George's Respiratory Questionnaire (SGRQ), pulmonary function testing, arterial blood gas analysis, and a 6-min walking distance test (6MWD). Dyspnoea and leg fatigue during exercise were quantitated into 12 grades using the Borg scale (0--10). Correlations between the SGRQ and various variables were determined. In a longitudinal study, 22 patients with COPD (mean age, 71.5+/-1.1 years; FEV(1), 1.31+/-0.08 L) completed a pulmonary rehabilitation program, for which correlations between changes in the SGRQ as well as changes in both dyspnoea and leg fatigue, during the 6MWD before and 3 months after pulmonary rehabilitation, were examined. For the cross-sectional study, the total SGRQ score correlated significantly with the walking distance, dyspnoea and leg fatigue during the 6MWD and FEV(1), respectively. Stepwise multiple regression analysis showed that dyspnoea and leg fatigue during the 6MWD were independent variables for HRQoL measured by the SGRQ. For the longitudinal study, changes in the SGRQ correlated significantly with changes in dyspnoea and leg fatigue, before and 3 months after, pulmonary rehabilitation. Symptoms, such as the degree of dyspnoea and leg fatigue during exercise, are significant variables which influence the HRQoL of patients with COPD. In addition, the improvement in HRQoL following pulmonary rehabilitation may be due to improvements in dyspnoea and leg fatigue in patients with COPD.

Pulmonary Rehabilitation in Patients With Post-Tuberculosis Lung Disease: A Prospective Multicentre Study.

<b>Background:</b> Pulmonary rehabilitation (PR) has been shown to improve dyspnea perception, exercise capacity and quality of life in patients with interstitial lung diseases(ILD). In many studies the duration of the exercise programs varies between 8-12 weeks. However the optimal duration of exercise program is still unknown. <b>Aim:</b> We aimed to compare the results of the eighth week with the results of the twelfth week of the pulmonary rehabilitation programs applied to the patients with ILD. <b>Method:</b> A total of 14 patients with ILD refered to our PR unit [11 IPF, 2 sarcoidosis (stage 3 and 4) and 1 nonspecific interstitial pneumonia] were included in the study. Pulmonary function test, arterial blood gas analysis, 6 minute walk test, mMRC dyspnea scale, quality of life questionnaires and hospital anxiety depression scale were performed before, at the 8th and 12th weeks after the exercise program applied to the patients twice a week. <b>Results:</b> When compared with 8th week; mMRC dyspnea score, six minutes walk distance and quality of life scores significantly improved at 12 weeks (p=0.046, p=0.016, p&lt;0.05, respectively). Although six minutes walking distance, dyspnea, anxiety and depression and quality of life improved both at 8th and 12th week after pulmonary rehabilitation when compared the with the initial assessment (p&lt;0.05), no significant difference was found between pulmonary function test and arterial blood gas results(p&gt; 0.05). <b>Conclusion:</b> Long-term exercise programs results more improvement in functional outcomes in patients with ILD. In these patients; extending the program has no effect on pulmonary functions and arterial blood gas results.

Rationale: Excessive decrease in the flow of the late expiratory portion of the flow volume loop (FVL) or “flattening” reflects small airway dysfunction. The presence of flattening is currently assessed by visual inspection by the pulmonary function test (PFT) interpreters and is thus highly variable. In a previous study, we developed and validated an objective measure, small airway disease index (SADI), to quantify the flattening (Front Physiol. 2022. 13:914972). In this study, we determined how demographic factors affect SADI and the clinical significance of PFTs with abnormal SADI. Methods: PFTs in this study were done between Jan 1, 2014, and Dec 31, 2019. They were downloaded from the electronic medical records at Duke Health in PDF format. PFTs with FEV1/FVC≥0.7, FEV1≥80%pred and FVC≥80%pred were included for the analysis. We digitized and extracted data points of the FVLs using a custom tool written in Python (version 3.7) (https://peps.python.org/pep-0537/) as previously reported (Front Physiol. 2022. 13:914972). SADI is a measurement of the angle formed by two linear regression lines (Figure): one linear segment (AB) between the point of the peak expiratory flow (point A) and the point corresponding to 75% of the expiratory vital capacity (point B), and the other linear segment (BC) between point B and the end of the expiratory portion of the FVL intersecting with the x-axis (point C). We also extracted gender, age, height and weight from PFT reports using pdfplumber 0.11.4 (https://pypi.org/project/pdfplumber/). The study was approved by the Duke Institutional Review Board (Pro00105365). Results: 490 PFTs were included for analysis. Age had a small negative correlation with SADI while height and weight had no effects (Figure). In a previous study (PLoS One. 2024. 19:e0297519), the lower limit of normal (LLN) (mean-1.64 x standard deviation) was found to be 129°. Using this threshold, we found 8 PFTs (1.6%) with abnormal SADI (&amp;lt;129°). All eight PFTs were from female subjects compared to PFTs with normal SADI (F/M = 323/161, p=0.047). Of these 8 PFTs, 5 were from patients with chronic hypersensitivity pneumonitis, one with bilateral lung transplant with chronic rejection, one with mild emphysema and one with diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH). These conditions all have pathology involving small airways. Conclusions: SADI decreased mildly with age, consistent with degeneration of small airways with aging. In patients who have normal FEV1/FVC but abnormal SADI, further evaluation should be considered to determine if small airway diseases are present.

Introduction: Interstitial lung diseases (ILDs) are a heterogeneous group of lung disorders characterized by dyspnea on exertion, exercise-induced hypoxemia and reduced exercise tolerance. There are some evidences that pulmonary rehabilitation (PR) successfully treats these manifestations. Objective: To identify if pulmonary rehabilitation can achieve a clinically significant improvement of functional exercise capacity measured by 6-minute walk test (6-MWT) and arterial blood gases analysis (ABG) in patients with ILDs. Methods: A retrospective secondary analysis of the patients' records from in-patients of a pulmonary rehabilitation center between 2012 and 2015. Profiles of 38 patients who had completed 4-6 PR weeks were included. 6-MWT distance, dyspnea and fatigue Borg score and ABG at baseline and the end of the pulmonary rehabilitation were compared. Results: There was a statistically and clinically significant improvement in 6-MWT distance after PR with a mean difference for change in distance walked of 68.5±54.2 m. The pre post PR variation of dyspnea and fatigue Borg score significantly improved (-2.3±3.7, and -1.7±2.9, always p≤0.001). Among the ABG parameters, only the resting PaO2 showed a significant improvement after PR (Delta PaO2= 4.6±8.5 mmHg, p=0.005). Conclusions: A 4-6 week of PR improves functional exercise capacity and hypoxemia in patients with ILDs. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 245-251).

In the Institute of Medicines report Dental Education at the Crossroads, it was suggested that dental schools across the country move toward integrated basic science education for dental and medical students in their curricula. To do so, dental school admission requirements and recommendations must be closely reviewed to ensure that students are adequately prepared for this coursework. The purpose of our study was twofold: 1) to identify student dentists' perceptions of their predental preparation as it relates to course content, and 2) to track student dentists' undergraduate basic science course preparation and relate that to DAT performance, basic science course performance in dental school, and Part I and Part II National Board performance. In the first part of the research, a total of ninety student dentists (forty-five from each class) from the entering classes of 1996 and 1997 were asked to respond to a survey. The survey instrument was distributed to each class of students after each completed the largest basic science class given in their second-year curriculum. The survey investigated the area of undergraduate major, a checklist of courses completed in their undergraduate preparation, the relevance of the undergraduate classes to the block basic science courses, and the strength of requiring or recommending the listed undergraduate courses as a part of admission to dental school. Results of the survey, using frequency analysis, indicate that students felt that the following classes should be required, not recommended, for admission to dental school: Microbiology 70 percent, Biochemistry 54.4 percent, Immunology 57.78 percent, Anatomy 50 percent, Physiology 58.89 percent, and Cell Biology 50 percent. The second part of the research involved anonymously tracking undergraduate basic science preparation of the same students with DAT scores, the grade received in a representative large basic science course, and Part I and Part II National Board performance. Using T-test analysis correlations, results indicate that having completed multiple undergraduate basic science courses (as reported by AADSAS BCP hours) did not significantly (p < .05) enhance student performance in any of these parameters. Based on these results, we conclude that student dentists with undergraduate preparation in science and nonscience majors can successfully negotiate the dental school curriculum, even though the students themselves would increase admission requirements to include more basic science courses than commonly required. Basically, the students' recommendations for required undergraduate basic science courses would replicate the standard basic science coursework found in most dental schools: anatomy, histology, biochemistry, microbiology, physiology, and immunology plus the universal foundation course of biology.

Introduction: This study aimed to evaluate the effect of gender and anthropometric measurement on pulmonary functions (forced vital capacity [FVC], forced expiratory volume in 1st s [FEV1] and peak expiratory flow rate [PEFR]) of undergraduate medical students to emphasise the need for further research on the aetiology and the prevention of respiratory diseases. Materials and Methods: This cross-sectional study was conducted in the Department of Physiology, Chittagong Medical College (CMC), Chattogram, Bangladesh, from July 2017 to June 2018. A total of 100 participants, aged between 18 and 20 years, studying in the 1st year in CMC, were included by a random sampling method. The participants filled out a questionnaire with general information about previous diseases, medication and family history. Fifty male participants were enrolled in the study group according to inclusion and exclusion criteria. Age and body mass index matched another 50 female participants were included. Respiratory parameters such as FVC, FEV1 and PEFR were measured by a digital spirometer (Chestgraph HI-101, Japan). Readings were taken in normal upright sitting posture. The statistical tests utilised were unpaired Student's t-test and the correlation coefficient conducted using SPSS for windows version 23. Results: Female participants showed significantly lower FVC, FEV1 and PEFR than males. This study observed a significant positive correlation between height and weight and FVC, FEV1 and PEFR. Conclusion: The results of this study help assess pulmonary functions among medical students as pulmonary function tests are one of the indicators of the health status of the individuals.

Pulmonary function testing (PFT) comprises a group of objective diagnostic techniques used to evaluate respiratory mechanics and gas exchange, playing an increasingly important role in veterinary clinical practice. These tests provide quantitative assessment of lung function, aiding in the diagnosis, localization, and monitoring of respiratory disorders in small animals. This review outlines the principles, indications, and clinical applications of commonly used pulmonary function tests, including spirometry, tidal breathing flow-volume loops, lung compliance and resistance measurements, whole-body plethysmography, forced oscillation technique, and tests of pulmonary gas exchange such as arterial blood gas analysis, diffusing capacity, pulse oximetry, and capnography. Emphasis is placed on their utility in assessing obstructive and restrictive airway diseases, peri-anaesthetic respiratory function, and therapeutic responses. While many techniques are non-invasive and safe, appropriate patient selection and awareness of contraindications are essential for reliable results. Advances in equipment and testing protocols have improved the feasibility of performing these tests in conscious animals, enhancing their clinical relevance. Pulmonary function testing offers valuable insights into respiratory physiology and disease severity, supporting evidence-based diagnosis and optimized management of respiratory conditions in veterinary patients.

My Personal Philosophy for Academic Medicine

Objective To investigate the effects of pulmonary rehabilitation on pulmonary function and diaphragm in patients with chronic obstructive pulmonary diseases (COPD). Methods Thirty COPD patients were recruited and randomly divided into two groups, research group (n=15) and control group (n=15). Conventional medication and lower limb exercise training with MOTOmed instrument were performed invariably in both groups.However, to carry out pulmonary rehabilitation precise diaphragmatic muscle training was used in research group while traditional lip type abdominal breathing training was used in control group.Pulmonary function and diaphragmatic muscle strength were evaluated before training, at day 7 and day 15 of the training in two groups. Results Compared with the pulmonary function parameter forced vital capacity, ratio of forced expiratory volume in first second and forced vital capacity before training, no significant improvement was detected on training day 7 in both groups (all P>0.05), while a significant improvement was found on training day 15 in both groups (all P 0.05). Compared with diaphragmatic muscle strength and peak inspiratory airflow velocity before training, no significant improvement was detected at training day 7 in both groups and at day 15 in control group (all P>0.05), while a significant improvement was found on training day 15 in research groups (P<0.01) with a remarkable difference between two groups (P<0.01). Conclusions Precise diaphragmatic muscle training for pulmonary rehabilitation in COPD patients was superior over traditional lip type abdominal breathing training in improvement of diaphragmatic muscle strength and peak inspiratory airflow velocity. Key words: Chronic obstructive pulmonary disease; Pulmonary rehabilitation; Pulmonary function; Diaphragm

Preoperative Pulmonary Consultation at a University Hospital

Objective To investigate the change of serum visfatin level in patients with stable and acute exacerbation phases of chronic obstructive pulmonary disease (AECOPD),and explore the function mechanism and the relationship between visfatin levels,and chronic hypoxia,nutritional metabolism with COPD.Methods Eighty patients with COPD and twenty healthy people were included in the study.According to the course of disease,those patients were divided into acute exacerbation stage and stable stage.Meanwhile,all patients were divided into four groups (BMI1,BMI2,BMI3,BMI4 groups) according to pulmonary function and three groups(the mild hypoxia group,the middle hypoxia group and severe hypoxia group) according to the severity of hypoxia.The level of visfatin,hypoxia inducible factor-1α (HIF-1α),blood glucose and blood lipid (TC,TG,TP,ALB,GLB,HDL-C,LDL-C,APO-A,APO-B) were measured by Enzyme Linked Immunosorbent Assay method (ELLSA).Additionally,arterial blood gas analysis,pulmonary function testing,height,weight and BMI were measured and calculated by same people.Results ①The serum levels of visfatin and HIF 1α were significantly higher in the AECOPD group compared with the stable COPD group and the healthy control group.②The differences of TP,ALB,GLB,HDL-C,LDL-C and GLU among AECOPD group,the stable COPD group and the healthy control group had statistically significance.Compared with the stable COPD group,the levels of TC and TG had statistical differences,but the differences of BMI,Apo-A and Apo-B had no statistically significance.③In AECOPD,the significant differences of visfatin levels among BMI 1-BMI 4 groups,different hypoxia groups and normal control group existed statistically significance.But in stable COPD,there wasn't statistical differences among BMI1-BMI4 groups and the control group.④According to the correlation analysis,it was observed that visfatin and the indexes of nutrition and hypoxia (BMI,TC,TG,TP,ALB,GLB,HDL-C,LDL C,APO-A,APO-B,GLU,HIF-1α,FEV1/FVC,FEV1 ％,PaCO2,SO2 ％,PaO2) existed a significant correlation in AECOPD.But in stable COPD,visfatin had correlation with HIF-1 α,FEV1 / FVC,PaCO2,and SO2 ％.⑤ With visfatin as dependent variable,the indexes of nutrition and hypoxia as independent variable were analyzed with multivariate stepwise regression analysis.TC,TG,GLB,GLU,HIF-1α,FEV1/FVC were the important factors of influencing visfatin level in AECOPD.Furthermore,HIF-1 α,FEV1/FVC were the important influencing factors in stable COPD.Conclusions ① Visfatin levels existed significant change in patients with AECOPD and stable COPD,and it had a significant correlation with HIF-1α and nutritive indexes.② Visfatin could not only reflect the current energy balance condition in some extent,but also had a correlation with the severity of hypoxia and might take part in the regulation of hypoxia via HIF-1α pathway.In addition,visfatin might play an important role of accelerating evolution of COPD. Key words: Chronic obstructive pulmonary disease; Visfatin; Hypoxia inducible factor-1α; Chronic hypoxia; Nutritional metabolism