DREEM and beyond; studies of the educational environment as a means for its enhancement.

CONTEXT: Educational environment makes an important contribution to student learning. The DREEM (Dundee Ready Educational Environment Measure) questionnaire is a validated instrument for assessing educational environment, but used alone it has little value for identifying means of remediation of poor aspects of environment. AIMS: This study used qualitative analysis, in association with the DREEM questionnaire, to evaluate the educational environment across all five years of a large undergraduate medical school, and identify areas for change to enhance student experience. METHOD: The DREEM questionnaire was administered to 968 undergraduate students, together with an open question asking for suggested changes to current medical school practices. Items of concern highlighted by this study were further defined through qualitative analysis, using focus groups, email questionnaires and introduction of Stressful Incident reporting. RESULTS: Through responses to the open question, two items with low scores on the DREEM questionnaire were identified as requiring remediation. Focus groups and email questionnaires were used to define the underlying causes of poor scores, which varied by student year group. Stress resulting from experiences on clinical placement was highlighted by some students, but on closer investigation found to be rare. Remedial steps to improve student support are described. CONCLUSIONS: The qualitative data have substantially enhanced questionnaire interpretation, and allowed actions to address common causes for student dissatisfaction to be undertaken. This combined methodology is recommended to other institutions wishing to improve the educational environment, and thus the overall quality of educational provision.

Topiramate for drug-resistant epilepsies.

Topiramate is a new anti-epileptic drug with proven efficacy against partial seizures in adults. A retrospective assessment of the use of topiramate in drug-resistant childhood epilepsy was undertaken. Thirty-four children (median age of 10 years; range 2-18 years) were treated for a median of 9 months (range 6-18 months). The starting dose was 0.25-2.0 mg/kg/day increasing to a maximum of 13 mg/kg/day. Generalized seizures occurred in 27 patients, partial seizures in 15 and infantile spasms in two. Epilepsies were localization-related in 15 patients and generalized in 18. One patient had severe myoclonic epilepsy in infancy. Two patients had Lennox-Gastaut syndrome, five (two currently and three previously) had West syndrome and one had epilepsy with myoclonic absences. Twenty patients had a substantial (> 50%) reduction in seizure frequency; two of whom became seizure-free. Two-patients had an increase in seizures. Efficacy was seen against simple and complex partial seizures, generalized tonic-clonic seizures (primarily generalized), atonic and tonic seizures, myoclonic seizures and infantile spasms. There was no response in the one patient with myoclonic absence seizures. Adverse effects were reported in nine patients; appetite suppression occurred in five patients, behaviour disturbances in three, somnolence in two and poor concentration in one patient. Topiramate is efficacious in a wide spectrum of childhood epilepsies and is well tolerated.

Student feedback: influencing the quality of teaching in a paediatric module.

The aim of this study was to assess the impact of feedback on the quality of tutorials. Students completed structured feedback questionnaires on the perceived usefulness of teaching sessions. They perceived significant differences in the quality of tutorials delivered by experienced and inexperienced teachers (P < 0.01), although the differences tended to become less throughout the year. In the second year, teachers had advice from an experienced tutor in planning the sessions, in addition to receiving feedback from the students. During the second year, the students did not perceive any difference in the usefulness of these tutorials to them. The study showed that the quality of tutorials can be improved by passing structured feedback to the teacher, but that some skills training was also required to completely eliminate perceived differences.

A prospective comparison of central and peripheral vein access for parenteral nutrition in the newborn.

Central venous parenteral nutrition (PN) is frequently used in preterm infants. Although central venous catheters (CVC) permit reliable delivery of hypertonic solution, they may be associated with more serious complications than when a peripheral venous infusion is used. The aim of this randomised prospective study was to compare complications of central versus peripheral venous access using Silastic catheters identical expect for intravascular length. Eighty such devices were inserted, 38 central (CVC), 42 peripheral (PVC). Catheter life was not significantly different between groups: median (range) CVC 10d (2-25); PVC 7d (1-22) with no difference in overall complication rate. Although peripherally sited catheters tended not to function for as long as CVCs, they offer a useful alternative to central venous catheterisation.

A new system for cotside display and analysis of the preterm neonatal electroencephalogram.

Continuous EEG monitoring is considered to be a sensitive indicator of changes in cerebral function. This paper describes a system for cotside display and analysis of EEG discontinuity and amplitude in one-minute epochs, with provision for simultaneous recording of the EEG. It has been successfully used to monitor continuously the EEGs of more than 30 babies in a neonatal intensive care unit for periods of up to nine days. This system rapidly provides indications of changes in cerebral function, which can allow early intervention and possible prevention of morbidity.