Esophageal lung resection and prosthesis placement in a preterm neonate.

This report describes a successful outcome in a preterm baby with an esophageal atresia and tracheo-esophageal fistula, who initially underwent a primary esophageal repair; but a persistent nonexpanding lung on the side of surgery led to further investigations. A further diagnosis of an esophageal lung resulted in pneumonectomy and prophylactic placement of an intra-thoracic prosthesis to prevent post-pneumonectomy syndrome. To the best of our knowledge, this is the first report of a prophylactic placement of an intra-thoracic prosthesis in a neonate with the condition of esophageal atresia and tracheo-esophageal fistula and associated esophageal lung.

Experience of a workshop on communication skills in health professional education.

BACKGROUND: The teaching of communication skills is gaining increasing attention. However, the opportunities for faculty development are limited. This study highlights an attempt by the Medical Education Unit, King Fahd Hospital of the University, Al-Khobar, to raise the awareness of faculty to this vital area by organizing a one-day workshop. METHOD: A one-day workshop was organized to improve the awareness of the participants to the role of communication skills such as doctor-patient interaction, breaking bad news, counseling and conflict management. In all, 168 participants consisting of faculty members, interns and students, both male and female participated. The sessions included interactive lectures, video demonstrations and role play. RESULTS: The feedback from the participants indicated that the objectives of the workshop were largely realized. The presentations by speakers were of high quality. However, the participants wanted more small group activities and video-demonstrations that were relevant to the local environment. CONCLUSION: By and large, the one-day workshop was found to be a practical model for an initial attempt to raise awareness. Further work is needed to organize more intensive workshops on specific issues related to communication skills.

An audit of assessment tools in a medical school in eastern saudi arabia.

BACKGROUND: Assessment has a powerful influence on curriculum delivery. Medical instructors must use tools which conform to educational principles, and audit them as part of curriculum review. AIM: To generate information to support recommendations for improving curriculum delivery. SETTING: Pre-clinical and clinical departments in a College of Medicine, Saudi Arabia. METHOD: A self-administered questionnaire was used in a cross-sectional survey to see if assessment tools being used met basic standards of validity, reliability and currency, and if feedback to students was adequate. Excluded were cost, feasibility and tool combinations. RESULTS: Thirty-one (out of 34) courses were evaluated. All 31 respondents used MCQs, especially one-best (28/31) and true/false (13/31). Groups of teachers selected test questions mostly. Pre-clinical departments sourced equally from "new" (10/14) and "used" (10/14) MCQs; clinical departments relied on 'banked' MCQs (16/17). Departments decided pass marks (28/31) and chose the College-set 60%; the timing was pre-examination in 13/17 clinical but post-examination in 5/14 pre-clinical departments. Of six essay users, five used model answers but only one did double marking. OSCE was used by 7/17 clinical departments; five provided checklist. Only 3/31 used optical reader. Post-marking review was done by 13/14 pre-clinical but 10/17 clinical departments. Difficulty and discriminating indices were determined by only 4/31 departments. Feedback was provided by 12/14 pre-clinical and 7/17 clinical departments. Only 10/31 course coordinators had copies of examination regulations. RECOMMENDATIONS: MCQ with single-best answer, if properly constructed and adequately critiqued, is the preferred tool for assessing theory domain. However, there should be fresh questions, item analyses, comparisons with pervious results, optical reader systems and double marking. Departments should use OSCE or OSPE more often. Long essays, true/false, fill-in-the-blank-spaces and more-than-one-correct-answer can be safely abolished. Departments or teams should set test papers and collectively take decisions. Feedback rates should be improved. A Center of Medical Education, including an Examination Center is required. Fruitful future studies can be repeat audit, use of "negative questions" and the number of MCQs per test paper. Comparative audit involving other regional medical schools may be of general interest.

Cerebral palsy in Saudi children.

OBJECTIVE: To describe the clinical profile, and identify its risk factors, of cerebral palsy (CP) as seen in a cohort of consecutive Saudi children aged between one and 3 years of age prospectively over a one-year period. METHODS: Saudi children aged 1-3 years with CP (diagnosis based on specified criteria) were selected from children presenting to the Neurology service at the King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia with delayed milestones, seizures, mental retardation and difficulty with walking and evaluated at 3-monthly intervals for one year from January to December 2000. Information on gestation duration, labor and delivery, birth weight and the medical history of the mothers was obtained. Cranial computerized tomography and electroencephalography were carried out in addition to baseline investigations (toxoplasmosis, other, rubella, cytomegalovirus, and herpes simplex virus serology, serum lactate, pyruvate, amino acid screen, thyroid function tests, and chromosome analysis). Somatosensory, molecular genetics and muscle biopsy for histopathologic and histochemical studies were not performed in any of the patients. RESULTS: One hundred and eighty-seven children with CP were seen during the study period: 109 males (mean age 20.3 +/- 8.69 months); 78 females (mean age 20.6 +/- 8.55 months). Seventy-three had microcephaly (<5th percentile) with a mean head circumference of 44.5 +/- 3.69 cms for males and 43.0 +/- 4.16 for females. The main symptoms were inability to walk independently (54%), delayed speech (52%) and seizures (45%). The main neurologic features were motor weakness (85%), spasticity (60%), language dysfunction (42%), mental retardation (31%) and head lag (30%). A history of previous CP in the family was obtained in 8 patients (4%) but none of them had other features of hereditary spastic paraplegia. Electroencephalography abnormalities, present in 113 (73%) were more frequent in those without seizures than with seizures. Cranial computerized tomography abnormalities were mainly cerebral atrophy (60%) and hydrocephalus (53.7%). Twenty-five percent were from twin pregnancies; 56 (34%) were of low birth weight, 20% were pre-term deliveries, birth asphyxia was present in 165 and breech presentation was encountered in 8%. CONCLUSION: The main risk factors identified were twin pregnancy, pre-term delivery, prolonged labor, low birth weight and a history of previous CP in the family. Our findings suggest that improved maternal and childcare particularly in the ante and perinatal periods may reduce the incidence of CP in this environment.