Mobile Content and Scenario-Based Manikin for Improving Learning Outcomes in Obstetrics of Preclinical Medical Students.

Background: Multimedia programs have emerged in higher education institutions, including medical school. There is no clear evidence that such a movement can improve medical student's learning, application, and self-confidence especially high clinical skill procedures that are required to prepare before clinical year. Objective: To assess learning outcomes of knowledge, skill, application in medical students' performance, and self-confidence in Leopold maneuver after using instructional media, mobile content compared with scenario-base manikin. Material and Method: All of third year medical students received standard objective structural clinical examination guide prior to perform maneuver then self-study with Suranaree University of Technology (SUT) mobile content before traditional lecture and scenario-based manikin in laboratory room. Student's learning outcome, knowledge skill, application, and selfconfidence in obstetrics maneuver were assessed. Paired t-test was used to analyze data. Results: All 60 medical students completed the basic obstetrics, Leopold maneuver in introduction to clinical medicine course. Knowledge about indication, contraindication, and complication in scenario-based manikin, was higher than SUT mobile content significantly (p = 0.03). Clinical skills are statistically significant different between SUT mobile content and scenariobased manikin (p<0.01), except fourth step of Leopold maneuver, fetal heart sound assessment and interpretation. Preparation before procedure in first, second, and third step of Leopold maneuver, scenario-based manikin was significantly higher than SUT mobile content (p = 0.03, p<0.01, p = 0.04 and p = 0.04, respectively). Application in knowledge to publish and selfconfidence is better in scenario-base manikin (p = 0.01 and <0.01, respectively). Teacher has better ability of knowledge transfer to medical students in SUT mobile content than manikin (p = 0.01) but the use of learning time is no different. Conclusion: SUT mobile content has reported increased learning outcomes to performed Leopold maneuver in knowledge and clinical skills. The application in knowledge to interpretation and applied to real practice were not different in both groups. The scenario-based manikin has higher self-confidence than mobile content.

Comparison of Cleaning up Eyelids after Taking off False Eyelashes between Eye Makeup Remover Alone and Eye Makeup Remover with Ocusoft®.

Background: Hirschsprung's disease (HD) is the most common intestinal obstruction in newborn. The Transanal Endorectal Pull -Through (TERPT) is a new surgical procedure that has rapidly replaced traditional ones. Objective: We have reviewed early post-operative complications after TERPT of childhood HD in Thailand. Material and Method: The clinical course and a 1 year outcome of all pediatric HD undergoing TERPT from 5 pediatric surgical centers in Thailand between 2008 and 2011 were reviewed. Results: Seventy-six patients (66 males and 10 females) of HD were included. The average age of diagnosis and surgery are 199 (0-4,015) and 297 (9-4,075) days, respectively, where ages and classification of HD are not related. The associated conditions are Down syndrome (DS) 6.6% and congenital heart disease (CHD) 5.3%. The most common presented symptom was intestinal obstruction. Other symptoms were Hirschsprung, which are associated with enterocolitis (HAEC) 13.1% and intestinal perforation 2.6%. The patients were diagnosed by barium enema (BE) 93.4%, rectal biopsy (RB) 6.6% and anorectal manometry (ARM) 6.6%. HAEC is the most common both pre- and post-operative complications (23.7% and 22.4%). Other post-operative complications are incontinence 13.2%, perianal excoriation 9.2%, anastomosis stricture 7.9%, anastomosis leakage 2.6%, retained aganglionic segment 2.6%, anastomosis volvulus 1.3% and anovaginal fistula 1.3%. One patient died due to anastomosis leakage (1.3%). Five patients were associated with DS, 3 patients (60%) were incontinent, 1 patient had anastomosis stricture (20%) and 2 patients (40%) was HAEC. Conclusion: Most of HD were diagnosed and treated in the newborn period. TERPT is safe and also feasible in all pediatric age groups. The associated DS are related to have more morbidity. HAEC is the most common complication. Even though there are limitations in the diagnostic investigation those did not achieve the standard diagnosis of HD in this study; but the outcomes are not different from the reviews. The improvement in laboratories and pathological investigation services will reflect the surgical service and outcome of pediatric HD in this region. The awareness of post-operative complications will lead to the prevention and early management in the postoperative period.

Long-Term Outcomes of Sacrococcygeal Germ Cell Tumors in Infancy and Childhood.

Purpose. The aim of this study was to evaluate long-term outcomes of sacrococcygeal germ cell tumors (SC-GCTs) over a 15-year period. Materials and Methods. A retrospective review was conducted of all pediatric patients treated for SC-GCTs at our hospital from 1998 to 2012. Results. Fifty-seven patients were treated for SC-GCTs with the most common in Altman's classification type I. Age at surgery ranged from one day to 5.6 years. Tumor resection and coccygectomy were primarily performed in about 84% of the cases. Pathology revealed mature, immature, malignant sacrococcygeal teratomas (SCTs), and endodermal sinus tumors (ESTs) in 41 (72%), 4 (77%), 6 (10.5%), and 6 (10.5%), respectively. Recurrence of discase occurred in 3 of 41 patients with mature teratomas (7.3%); 2 recurrences with mature teratomas and one recurrence with EST. Five of 6 malignant SCTs and 3 of 6 ESTs responded well to the treatment. Alpha-fetoprotein (AFP) level was elevated in both malignant teratomas and ESTs. No immediate patient death was noted in any of the 57 cases, but 4 patients with malignant tumors and distant metastasis succumbed at home within 2 years of the initial treatment. Conclusion. Benign SCTs have a significant recurrence rate of approximately 7%. Close follow-up with serial AFP level monitoring should be done for 5 years after initial tumor resection and coccygectomy. The survival rate for malignant SC-GCTs with distant metastasis was unfavorable in the present study.