Management of acute pyelonephritis in the emergency department observation unit.

INTRODUCTION: This study aimed to assess the effectiveness of the emergency department observation unit (EDOU) for patients with acute pyelonephritis in a Singapore tertiary academic medical centre. METHODS: We reviewed the clinical records of consecutive patients who presented with pyelonephritis between 1 July 2012 and 31 October 2014 to collect information on demographics, symptoms, signs, laboratory and radiological results, treatment, and clinical outcomes. RESULTS: Of 459 emergency department (ED) patients who were identified as having pyelonephritis, 164 (35.7%) were managed in the EDOU. Successful management in the EDOU was achieved in 100 (61.0%) patients. Escherichia coli was the predominant (64.6%) micro-organism in urine cultures and was positive in 106 patients. Patients diagnosed with acute pyelonephritis who were successfully managed in the EDOU had a lower incidence of nausea (32.0% vs. 60.9%, p < 0.001) and vomiting (15.0% vs. 50.0%, p < 0.001) compared to those who were not successful. CONCLUSION: EDOU is useful for both observation and treatment of patients with acute pyelonephritis. Urine cultures are sufficient for the identification of the culprit micro-organism. Patients who present with prominent symptoms of vomiting should have routine administration of antiemetics, while consideration for second-line antiemetics is recommended for those with persistent symptoms.

Cross-sectional study of perceptions of qualities of a good medical teacher among medical students from first to final year.

INTRODUCTION: Defining the characteristics of a good medical teacher has implications for faculty selection and development. Perceptions of characteristics may differ with cultural context and level of training, as medical students progress from didactic preclinical training based on cognitivist learning theory to more complex integration of theory and practice in specific contexts in clinical training based on constructivist learning theory. METHODS: We modified a validated questionnaire with permission from the original authors at Melaka Manipal Medical College, Melaka, Malaysia. Participants rated 35 characteristics on a 5-point Likert scale. The modified questionnaire was validated in a pilot pool of medical students (n = 69), with a Cronbach's alpha of 0.90, and administered to Year 1-5 medical students (n = 917) at the Yong Loo Lin School of Medicine, National University of Singapore, Singapore. RESULTS: Based on the proportion of favourable Likert scoring, four top desirable characteristics were common across Year 1-5 students: good communication skills (84.4%); sound knowledge of subject (82.7%); enthusiasm (78.4%); and providing effective explanations (74.4%). Approachability (p = 0.005), encouraging participation (p < 0.001) and constructive criticism (p < 0.001) were more important to clinical students (Year 3-5) than preclinical students (Year 1-2). CONCLUSION: The top four characteristics were consistent across all years of medical students in this study. Characteristics emphasised in the clinical years facilitate active learner participation, consistent with constructivist learning theory.