ABSTRACT
BACKGROUND: Although national licensing examinations (NLEs) may be a costly process, they can predict performance of medical practitioners for many years following graduation. The current licensing requirements do not fulfill this function as there are no clear performance criteria for them. Therefore, new requirements should be developed and announced. OBJECTIVE: The study aims to develop a framework for the Egyptian Medical Licensing Exam (EMLE) by exploring the opinions and perceptions of Egyptian health practitioners and medical educators. METHODS: This study is a two-phase exploratory mixed-method study. An online discussion forum was conducted with medical practitioners and educators concerning the development of the EMLE. Then, an online survey was distributed to explore the opinions of medical practitioners and educators about the EMLE. RESULTS: Fifty medical practitioners and educators participated in the discussion forum about the development of the EMLE, while 266 participants responded to the online survey. The responses of the participants contributed to the development of a framework for the EMLE that is divided into two main sections, the exam logistics and the exam set up. The exam logistics included the exam committee, prerequisites for the exam, the admission criteria and fees, and validity of the license. The exam set up included exam setting, structure, pass marks, and exam retake policy. CONCLUSION: The study concluded that medical practitioners and educators could contribute greatly to the planning for the EMLE. Their opinions are based on their experiences and include the timing of the exam, blueprinting, assessment methods, psychometrics and retake.
ABSTRACT
INTRODUCTION: The current trend in management of preterm neonates with respiratory distress syndrome is to attempt noninvasive ventilation (NIV) to avoid endotracheal intubation. However, failure of noninvasive ventilation may lead to increased morbidity and mortality. There is a scarcity of studies establishing predictors for the usefulness of NIV in this age group. Our aim here was to determine the predictors of NIV in preterm infants with respiratory distress syndrome (RDS) treated with synchronized nasal intermittent positive pressure ventilation (SNIPPV) for initial respiratory support. MATERIAL AND METHODS: We conducted a follow-up study on 85 infants < 32 weeks of gestational age, and < 1500 g with RDS who received early SNIPPV. Perinatal history, physical characteristics, ventilatory settings, and arterial blood gas analysis results were collected. We recorded the failure rate and potential predictive factors of this failure. RESULTS: There were 12 (14.1%) patients who had SNIPPV failure. The SNIPPV failure group had multiple significantly different characteristics compared to the successful SNIPPV group including gestation age, birth weight, grading of disease, severity of respiratory distress, antenatal steroid use and various ventilatory settings. Further multivariate analysis revealed only 3 predictors in our patients: grade of RDS (OR = 4.48, p = 0.008), antenatal steroid use (OR = 1.09, p = 0.01) and mean airway pressure (OR = 1.98, p = 0.0001). CONCLUSIONS: Failure of early NIV occurred in a small subset of our patients. Predictors of noninvasive ventilation failure may be a useful guide for decisions regarding intubation.
ABSTRACT
BACKGROUND: Juvenile idiopathic arthritis (JIA) is a systemic chronic inflammatory disease. Studies using tissue Doppler imaging (TDI) for the evaluation of cardiac functions of children with JIA are limited. Thus, this study was conducted to evaluate Left ventricular function, left atrial mechanical functions and atrial electromechanical delay in JIA. METHODS: This study was carried out as a across sectional study. A total of 34 patients with active JIA and 34 controls were included. Atrial electromechanical delay and left atrial (LA) mechanical functions in addition to systolic and diastolic left ventricular (LV) functions were measured by using conventional echocardiography and TDI. Assessment of disease activity was done using Juvenile arthritis disease activity score (JADAS-27). RESULTS: JIA patients had abnormal atrial electromechanical coupling as established from prolonged lateral mitral annulus (PA lateral), septal mitral annulus (PA septum), inter-atrial and intra-atrial electromechanical delays compared with healthy controls. Left ventricular filling abnormalities were found characterized by a reduced E/A ratio (1.07 ± 0.56 vs. 1.48 ± 0.16, p = 0.01). E/Em was significantly higher in patients with JIA (7.58 ± 1.79 vs. 4.74 ± 1.45, p = 0.003) denoting impaired diastolic function. Left atrial mechanical functions assessment showed significantly decreased LA passive emptying fraction, increased LA active emptying fraction and LA total emptying volume in JIA patients (p = 0.01, p = 0.01, p = 0.03 respectively). CONCLUSION: Atrial electromechanical coupling intervals, and LA mechanical functions were impaired which can be considered as an early form of subclinical cardiac involvement in JIA patients. Significant diastolic functional abnormalities exist in JIA.