Item analysis of multiple choice questions at the department of paediatrics, Arabian gulf university, Manama, Bahrain

Objectives: The current study aimed to carry out a post-validation item analysis of multiple choice questions [MCQs] in medical examinations in order to evaluate correlations between item difficulty, item discrimination and distraction effectiveness so as to determine whether questions should be included, modified or discarded. In addition, the optimal number of options per MCQ was analysed

Methods: This cross-sectional study was performed in the Department of Paediatrics, Arabian Gulf University, Manama, Bahrain. A total of 800 MCQs and 4,000 distractors were analysed between November 2013 and June 2016

Results: The mean difficulty index ranged from 36.70-73.14%. The mean discrimination index ranged from 0.20-0.34. The mean distractor efficiency ranged from 66.50-90.00%. Of the items, 48.4%, 35.3%, 11.4%, 3.9% and 1.1% had zero, one, two, three and four nonfunctional distractors [NFDs], respectively. Using three or four rather than five options in each MCQ resulted in 95% or 83.6% of items having zero NFDs, respectively. The distractor efficiency was 91.87%, 85.83% and 64.13% for difficult, acceptable and easy items, respectively [P <0.005]. Distractor efficiency was 83.33%, 83.24% and 77.56% for items with excellent, acceptable and poor discrimination, respectively [P<0.005]. The average Kuder-Richardson formula 20 reliability coefficient was 0.76

Conclusion: A considerable number of the MCQ items were within acceptable ranges. However, some items needed to be discarded or revised. Using three or four rather than five options in MCQs is recommended to reduce the number of NFDs and improve the overall quality of the examination

Prediction of glucose-6-phosphate dehydrogenase deficiency in newborns

Objective: To evaluate the positive and negative predictive value of the positive family history of G6PD in predicting the actual G6PD of newborns compared to the mean total serum bilirubin [TSB] level for one-week

Design: A Prospective Study

Setting: Salmaniya Medical Complex and Jidhafs Maternity Hospital, Bahrain

Method: The mothers filled a survey, and the newborns underwent serum bilirubin check during the first week of life [day one, day two to four and day five to seven]. The G6PD activity status was tested as part of the newborn screen for all the newborns in Bahrain

Result: Four hundred twenty-seven newborns were included in the study; males were 219 [51.3%]. Two hundred eighty-eight [67.4%] of the newborns had G6PD normal activity and 139 [32.6%] were G6PD deficient. Two hundred fifty-one [58.8%] had a positive family history of G6PD deficiency while 176 [41.2%] did not have a family history of G6PD deficiency. The positive predictive value [PPV] for family history of G6PD deficiency is 47.4%, while the negative predictive value [NPV] is 89.1%. The mean serum bilirubin level for newborns with G6PD reduced activity was 139 +/- 52 micro mol/L. The serum bilirubin level was higher if the previous sibling required phototherapy, 157 micro mol/L +/- 50 micro mol/L [P-value<0.001]

Conclusion: Family history could be helpful for clinicians but it should be considered with caution. The negative predictive value is 89.1%, which means that 20 [4.7%] of the newborns had no family history of G6PD deficiency and still have G6PD deficiency

Transcutaneous bilirubin measurement correlation with total serum bilirubin in healthy newborns

Objective: To evaluate the relation between the transcutaneous bilirubin [TcB] measurement and the total serum bilirubin [TSB] measurement in the newborns in Bahrain. Setting: Salmaniya Medical Complex and Jidhafs Maternity Hospital, Bahrain. Design: A Prospective Study

Method: Newborns from May to September 2015 were included in the study. Serial transcutaneous bilirubin [TcB] measurements were obtained utilizing the Drager Jaundice Meter JM-103. Simultaneously, TSB measurements were performed for comparison

Result: Eighty-eight newborns were included. One hundred twenty-eight transcutaneous bilirubin TcB measurements were paired with TSB measurement. The mean +/- SD of [TcB-TSB] difference for the 128 paired measurements was 1.09 +/- 2.16 mg/dL, with differences ranging from 6.18 mg/ dL to 7.00 mg/dL. The correlation between the paired measurements was 0.75 [P-value < 0.0005]

Conclusion: TcB measurement is a viable tool for bilirubin screening in newborns