Quality Appraisal of Clinical Guidelines for Vulvar Disorders Using the AGREE II Instrument ABSTRACT Introduction This systematic review aims to appraise clinical practice guidelines and consensus statements on the management of common benign vulvar disorders using the AGREE II checklist. Methods A systematic search for articles was conducted employing PubMed, EMBASE, Cochrane, and Science Direct from 1 January 2013 to 31 December 2023. The quality of eighteen practice guidelines was independently assessed by four appraisers using the AGREE II checklist. Results Of the eighteen guidelines assessed, one was classified as “recommended”, sixteen were designated as “recommended with modifications” and one as “not recommended”. Conclusion All guidelines proposed similar management strategies for the selected vulvar disorders with only minor variations. Medical practitioners are encouraged to treat patients in accordance with evidence-based recommendations in these guidelines.

VULVODYNIA – A CONTEMPORARY UNDERSTANDING AND PRACTICAL APPROACH IN PRIMARY CARE SETTINGS Vulvodynia manifests as persistent vulvar pain, affecting both sexual well-being and overall quality of life. While the precise cause remains elusive, various multifaceted predisposing and precipitating factors have been identified. Neurobiological and psychosocial elements contribute to a better understanding of the management of this complex disorder. Initial evaluation with detailed history-taking and focused pelvic examination are essential to exclude organic diseases contributing to vulvar pain. Management strategies are based on clinical experience, including non-pharmacological approaches and cognitive behavioural therapy. Oral pain-blocking medications such as serotonin–norepinephrine reuptake inhibitors and gabapentin as well as topical treatments such as oestrogen, lidocaine and gabapentin may be considered. More robust evidence is required for pharmacological treatments. Referral to a multidisciplinary team may be required in a proportion of patients who do not respond to conventional treatment. This concise review highlights the contemporary understanding of vulvodynia and proposes a practical approach within primary care settings.

Background: Problem based learning (PBL) is a student - centered curriculum delivery tool believed to promote active student participation. Though the PBL is student - centered, the facilitator plays an important role in maintaining the integrity of this system by providing balance in group interaction and discussion of learning issues. In International Medical University (IMU) one of the strategies to ensure the quality of the facilitators was the pre and post PBL meetings. This study aimed to gauge its usefulness in ensuring the quality of PBL facilitation. Method: The questionnaire to study the perceptions of PBL facilitators on the pre and post PBL meetings included close ended questions on pre and post PBL meeting’s attendance and their scored opinion in improving PBL facilitation skills, open ended questions inviting suggestions to improve these meetings and PBL facilitation in IMU as a whole and self-evaluation as an effective PBL facilitator using a six point Likert scale to a list of statements. Results: 84.2% of facilitators agreed the meetings were beneficial. Self-evaluation of their facilitator effectiveness showed on average ratings of seven out of ten indicating strong confidence in facilitating skills. Suggestions ensuring facilitator quality included content expert briefing in pre PBL meetings and student appraisals of facilitators given weightage in staff appraisal. Conclusion: Pre and post PBL meetings enhanced facilitator comfort with the triggers, adding to their confidence and provided a venue to obtain feedback on the triggers.