The Antibiogram of Isolated Pathogens from Tracheal Aspirate among Intubated patients 2 months – 5 years old with very Severe Community Acquired Pneumonia Admitted in Pediatric Intensive Care Unit of a Tertiary Hospital in Cebu City from 2013-2016

Objective@#To determine the antibiogram of tracheal aspirate cultures (TACS) among intubated children aged 2 months to 5 years old with very severe community acquired pneumonia (CAP). @*Methodology@#A retrospective chart review using total enumerative sampling. @*Results@#66 out of the 343 patients had positive TACS. The top 5 most common isolates were Klebsiella pneumoniae(37.8%), Pseudomonas aeruginosa (25.7%), Acinetobacter baumanii (15.1%), Enterobacter cloacae (12.1%) and Methicillin Resistant Staphylococcus aureus (MRSA) (6%). The gram-negative isolates were highly sensitive to amikacin and carbapenems. Majority of these patients (92.42%) had history of Pentavalent immunization. Majority of patients who were TACS positive had history of antibiotic use prior to admission (92.42%), mostly second-generation cepahalosporin (cefuroxime, 32.42%). High rates of resistance to ampicillin and gentamicin were noted for patients with Klebsiella pneumoniae and Enterobacter cloacae isolates. Majority of patients with Klebsiella pneumoniae, Acinetobacter baumanii and MRSA expired. @*Conclusion/Recommendation@#Majority of those patients with positive isolates had MDR organisms thus for patients with very severe CAP who already received antibiotic as outpatient, broad spectrum antibiotics should be considered as empiric therapy and TACS be done on all patients with very severe CAP.

Trial of medical English education using a website of dynamic images for patient education / 医学教育

1) The need for Japanese medical students to learn medical English increases each year. However, recruiting native-English-speaking academic staff with medical knowledge to work in various regions of Japan, such as Wakayama prefecture, is extremely difficult.2) Wakayama Medical University is now testing a new method of medical English education for second-year students. The method involves the employment of a native (United States)-speaking teacher of general English, who also works at other universities, and the use of dynamic image software developed in the United States for patient education to explain diseases.3) This method may be effective for medical English education in regions where recruiting native English-speaking teaching staff with medical knowledge is difficult. In addition to learning medical English, students might also enhance their knowledge of a broad range of diseases.

The Maintenance of Competence of Rural District Hospital Practitioners

Introduction: It is important for rural district hospital practitioners to maintain their competence to provide equitable health service for rural communities. The scope of their practice dictates that they must stay up-to-date with a large variety of knowledge and skills despite limited educational opportunities. Rural practitioners use continuing professional development (CPD) activities that are most accessible to them; but it is not known whether these activities are educationally sound and effective.Aim: We designed a study to investigate the content and methods used for the maintenance of competence by rural district hospital practitioners in the Western Cape Province; South Africa.Methods: Expert opinion was sought to evaluate the topics requiring up-dating and the validity of the learning methods to maintain competence in practice. This was achieved by employing the Delphi technique to reach consensus on content and methodology. Categorical data analysis and a principal factor analysis were performed. The qualitative data were developed into themes and presented as a conceptual framework.Results: Consensus was reached on the principal content areas requiring updating. Methods that were found most useful were in-service learning under supervision; structured courses; small group discussions and practical workshops. Rotations in tertiary hospitals; lectures by specialists; journal reading and Internet learning were less supported.Conclusion: This study provides a practical model for continuing instruction plus self-directed learning in context. Three content domains were established namely; commonly encountered areas of practice; identified gaps and needs specific to the practitioner and the setting. The implementation of external updating programmes must be tailored to suit the practitioners while the self-directed aspects should include reflective practice. Priority areas are identified and classified as well as educational methods which can contribute towards the maintenance of competence of rural practitioners