Innovative method of needs assessment for faculty development programs in a Gulf medical school.

BACKGROUND: Faculty development lays the foundation for the quality enhancement in medical education. However, programs are not always based on the needs of the participants, and there is dearth of information on methods to derive faculty's needs. The Medical Education Unit at the University of Dammam, Saudi Arabia, carried out an innovative method to identify and prioritize faculty needs in order to plan future activities. METHODS: A questionnaire was designed, pilot-tested and administered to all faculty members (N=200). The respondents rated the perceived importance (high, moderate, low) and their performance (good, average, poor) on twelve competencies described in the literature. The ratings of perceived importance - high/moderate, and self-rated performance- average/poor, were summed up to determine priority rankings for continuing education. The respondents' rating of various continuing education activities, their willingness to participate and commit time, and their suggestions for strengthening faculty development were also analyzed. RESULTS: All the twelve competencies were perceived as 'highly important' by the subjects. They felt most confident in teaching in large and small groups, attitudes and ethical values, and decision making skills. The competencies prioritized as "gaps" were knowing how to develop learning resources, plan curriculum, evaluate courses and conduct research. The prioritized activities were specialized courses, orientation workshops for the new faculty, and training in educational research skills. This implied a multi-phased approach to faculty development. A majority (62.4%) were willing to devote 2.2 hours per week to faculty development. Respondents suggested initiatives that should be undertaken by the Medical Education Unit and the broader institution. CONCLUSION: We demonstrated a participatory approach to needs assessment by identifying the gaps between "perceived importance" and "self-rated performance", as criteria for determining priorities. Findings also demonstrated the need for adopting a comprehensive approach to faculty development in which both departmental and organizational initiatives are required. Our findings are applicable to the Gulf Region context and our methodology can be applied anywhere.

Early dexamethasone treatment in preterm infants treated with surfactant: a double blind controlled trial.

The objective of the study was to test the hypothesis that early postnatal dexamethasone administration (days 1-5) in preterm infants with respiratory distress syndrome would improve acute respiratory status and therefore decrease long-term neonatal morbidity. This was a prospective, blind randomized controlled trial. Eligible neonates were preterm infants with birthweight < or = 1500 g who developed respiratory distress syndrome requiring mechanical ventilation and surfactant. A 5-day course of dexamethasone or placebo was initiated within the first 6 h after birth. The starting dose of dexamethasone was 0.5 mg/kg/day and it was tapered progressively. Results were analysed with t-test chi 2, Wilcoxon test, and ANOVA. Twenty-nine infants (n = 15 of early dexamethasone and n = 14 of placebo group) fulfilled the inclusion criteria. The dexamethasone group exhibited a significant improvement in arterial to alveolar oxygen ratio only between postnatal days 2 and 5 (p = 0.02). This initial improvement was not associated with long-term benefits. Infants who received dexamethasone had increased systolic blood pressure (p = 0.0001), diastolic blood pressure (p = 0.001), blood sugar (p = 0.02, serum urea (p = 0.03), and creatinine level (p = 0.02). All these side-effects were resolved by postnatal day 7. We concluded that a 5-day course of early postnatal dexamethasone was associated with only a transient improvement in oxygenation with no long-term benefits. Side-effects were more common in the dexamethasone group.

Predictive factors and incidence of complications in apparently healthy full term infants of diabetic mothers.

AIM: To determine the incidence of different complications of the apparently healthy full-term infants of diabetic mothers (IDMs) and whether these complications could be predicted early. METHODS: A prospective study was performed in the Nursery Unit of King Fahd Hospital of the University in Al-Khobar over an 18-month period. Eligible neonates were those full-term IDMs who were asymptomatic at birth, with birth weight ≥ 2000 g and whose mothers had gestational or pregestational diabetes. AUDMs were routinely observed for at least 2 days. A complete blood count, glucose, bilirubin and calcium serum levels were monitored. The morbidity study group included all IDMs who experienced complications requiring treatment or observation for > 48 hours. RESULTS: One hundred and eighty eight infants with a birth-weight of 3411 ± 616 g and with gestational age of 38.5 ± 1.2 weeks were enrolled in the study. Asymptomatic hypoglycemia (31%) was mostly mild and transient. The rate of other complications such as hypocalcemia (4%), polycythemia (13%), hyperbilirubinemia (18%), intrauterine growth retardation (2%) with 30% rate for large gestational age. Using a logistic regression model; maternal insulin therapy, poor diabetic control, birth asphyxia, early neonatal hypoglycemia and polycythemia were found to be highly predictive of morbidity with an odd ratio of 2.41, 2.91, 9.65, 3.88 and 3.74 respectively. CONCLUSION: Complications of apparently healthy IDMs appear to be very mild and transient. These were found to be strongly associated with specific perinatal events.

Ultrasonography: can it differentiate between vasoocclusive crisis and acute osteomyelitis in sickle cell disease?

We prospectively evaluated the results of ultrasonography in 53 patients of sickle cell disease suspected to have vasoocclusive crisis/acute hematogenous osteomyelitis. The average age was 8.4 +/- 3.40 years (range, 1-14). Twenty-six children were boys and 27 were girls. Seventeen (32%) patients had ultrasonographic changes that suggested acute osteomyelitis. The minimal white cell count was 7,200/mm3, and maximal, 9,900/mm3 (mean, 8,190/mm3) in uninfected patients and in 17 patients, the mean was 10,300/mm3 (7,200-13,600/mm3). The mean erythrocyte sedimentation rate in uninfected patients was 32 for the first hour (19-36 mm), and in infected patients, it was 43 for the first hour (35-38 mm). Pus culture was positive in all infected patients, and the infective organism was Salmonella enteriditis in eight, staphylococcal species in six (S. aureus in four and S. epidermidis in two), and Streptococcus species 1 and 2, anaerobic streptococci. All patients with vasoocclusive crisis were treated with analgesics and intravenous fluids and did not require any further treatment. In patients with acute osteomyelitis, the treatment was incision, drainage and drilling of bone, and antibiotic therapy. We conclude that ultrasonography clearly and decisively differentiated acute osteomyelitis from vasoocclusive crisis in patients with sickle cell disease.

Cost-effectiveness of surfactant replacement therapy in a developing country.

A comparison study was conducted to evaluate the cost effectiveness of surfactant replacement therapy in the treatment of hyaline membrane disease (HMD). Study population included neonates admitted because of HMD severe enough to require assisted ventilation with FiO2 greater that 0.4 per cent. This group (n = 44) was compared with the outcome for neonates treated in the same centre 1 year before surfactant became available (n = 39). Comparison between the two groups was made in relation to cost of care depending on the duration of hospitalization. The duration of hospitalization in the survivors of the treated group was shorter (P = 0.06); accordingly, the cost of care was less. A savings of US $11,880 per patient survived in the treated group was expected, the nationwide financial impact of this treatment modality is discussed.

A case control study of neonatal sepsis: experience from Saudi Arabia.

Sixty-one cases of neonatal septicaemia (NNS) identified by positive blood cultures during surveillance of infection at King Fahd Hospital of the University in Khobar, Saudi Arabia from September 1983-September 1988 were studied to evaluate the local pattern of pathogens and the risk factors for sepsis using a case control analysis. The incidence of NNS was 4.9 per 1000 live births (LB). Among inborn infants, birth weight specific sepsis rate ranged from 2 per 1000 liveborns among infants with birth weight > or = 2500 g to 150 per 1000 liveborns in those weighing < or = 1500 g. Factors significantly associated with septicaemia were foetal distress, low Apgar score at 5 min, and requirement for mechanical ventilation and umbilical catheterization. Similar findings were obtained with infants whose mothers had pre-eclampsia. Staphylococci were the major Gram-positive isolate occurring in both 'early' (< or = 48 h) and 'late' (448 h) onset septicaemia. The study highlights the importance of knowledge of local epidemiology of NNS to formulate antibiotic policy. It also suggests the need for reporting birth weight specific rates and for a larger case control study of risk factors for NNS.

Effects of early indomethacin administration on oxygenation and surfactant requirement in low birth weight infants.

A previous study found that early intravenous indomethacin administration prolonged respiratory support in very low birth weight infants. We have, therefore, designed a randomized, double blind controlled study to evaluate the oxygenation, and surfactant requirements in preterm low birth weight infants receiving early indomethacin administration. Premature neonates who received surfactant therapy and on mechanical ventilation were prospectively randomized to receive either placebo or indomethacin (0.2 mg/kg intravenously at 12 postnatal hours and every 24 h for two more doses). Oxygenation was assessed by FiO2 required and arterial/alveolar oxygen (a/A O2) ratio during the first 48 h of life. The doses of surfactant were compared between the two groups. Twenty-seven infants (n = 14 of early indomethacin and n = 13 of placebo group) fulfilled inclusion criteria. At admission to the study, there were no differences in the birth weight, gestational age, sex, Apgar scores, a/A O2 ratio, and FiO2. The control group exhibited a significant improvement in oxygenation (FiO2 requirement and a/A O2 compared with the early indomethacin group at 24 (P = 0.026 and 0.02, respectively) and 48 h of life (P = 0.037 and 0.026, respectively). The requirement of surfactant was significantly larger in the early indomethacin group (P = 0.029). Early indomethacin administration increases oxygen and surfactant requirement.

Career choices among Saudi medical students.

PURPOSE: To identify the career choices, intended practice locations, and reasons for career choices of final-year Saudi medical students. METHOD: A total of 302 final-year students at the four Saudi medical colleges were asked to complete a self-report questionnaire at the end of the 1994 academic year. RESULTS: A total of 253 students (84%) responded (149 men and 104 women). The most frequently chosen specialties were internal medicine (17%), surgery (16%), pediatrics (14%), and obstetrics-gynecology (11%). Twenty-seven percent were not sure of their future career choices. More of the men chose surgery, but more of the women chose obstetrics-gynecology and ophthalmology. The leading reasons for selecting a specialty were "personal interest," "a chance to help people," "availability of postgraduate training," "few specialists in the country," and "prestige." The most frequently chosen locations for postgraduate training were Saudi Arabia (56%) and Canada (40%). The qualifying examinations the students wished to pass were mostly the Canadian boards (49%) and the Arab boards (48%). A majority intended to practice in hospitals (90%) and in cities (85%). CONCLUSION: The small proportions of students who chose family medicine and some other specialties indicate that the current drastic deficiency of trained Saudi primary health care physicians will continue unless targeted strategies to produce more of these physicians are undertaken.

Congenital anomalies among infants of diabetic mothers: a study of 466 cases at King Fahd Hospital of the University, Al-Khobar.

The purpose of the study was to determine the incidence of congenital anomalies among infants of diabetic mothers and compare this with the normal obstetric population in our hospital. Among 17 463 patients delivered at the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia between January 1987 and December 1992 there were 466 diabetic mothers who delivered 466 singleton births. The incidence of diabetes was 2.6%. Among those 466 diabetic patients there were 132 with clinical diabetes which was present before pregnancy and which required insulin treatment during pregnancy and 334 with gestational diabetes. There were 14 lethal congenital anomalies among the infants of diabetic mothers (3%) compared with 69 anomalies in general obstetric population (0.4%). The difference = was very highly significant P = 0.001. Ten anomalies were responsible for 10 stillbirths and the other four anomalies resulted in four neonatal deaths. The most common anomalies were those of the central nervous system and multiple fetal anomalies, followed by cardiovascular system, renal and chromosomal anomalies. All those anomalies occurred in the infants whose mothers had clinical diabetes.

Patient satisfaction survey in a teaching hospital in saudi arabia: preliminary results.

BACKGROUND: Patient satisfaction is a useful indicator of the quality of health care, but there is no one universally acceptable tool for measuring it. In Saudi Arabia, such studies are, few. SETTING: In-patients in a teaching hospital. METHODOLOGY: Opinions of hospital in-patients were sampled by means of a self-administered questionnaire over a period of 12 consecutive months. Fright areas were evaluated: professional services from medical, nursing anal admission staff, and four amenities, i.e. room and linen, meals, and provision for telephone and television. RESULTS: A total of 1,319 patients were surveyed, forming 7.9% of the 17,536 admissions. Patients were satisfied with professional services from medical staff. However, they were dissatisfied with silence in wards during day, taste, temperature and variety of meals, as well as provisions for telephone and television. Remedial actions had been taken. CONCLUSIONS: We concluded that the results indicated areas of patients' dissatisfaction in our hospital, and that such surveys are unique to the hospital involved. We recommend the method used here: it is easy to use, cost-effective, and beneficial to patients.

Urinary tract infections in children in a tertiary care service.

OBJECTIVE: To determine the nature of urinary tract infection (UTI), accompanying anomalies and antibiotic sensitivity in children in a tertiary care centre. DESIGN: Retrospective observational study. SETTING: King Fahd Hospital of the University-Al Khobar. SUBJECTS: Infants and children with proven urinary tract infection (UTI). Age up to 12 years seen between 1988-1993. Investigations included plain xrays, IVU, voiding cystourethrography and ultrasound examination of the abdome. RESULTS: 40% of subjects were referred cases and for the other 60% it was the first contact. 56% were infants below 2 years, males were predominant and proportion of older children diminished with age. Prominent associated anomalies were hypospadias in the male (6.14%), hydronephrosis, prune-belly syndrome, renal parenchymal and anorectal anomalies. Organisms predominantly grown on culture were Escherichia coli, Klebsiella pneumoniae and enterococci. Ampicillin and cotrimoxazole were found to be least effective. CONCLUSIONS: Thereapeutic implications for the observations made are important to improve the outcome.

Neonatal hip instability in Saudi Arabia: Results and cost effectiveness.

The benefits of screening hips at birth for congenital dislocation have been repeatedly confirmed but doubts have been raised about the need for splinting all positive cases. Experience from an ongoing screening program, now in operation for over 11 years, is presented particularly with reference to cost benefit of screening and early surgical intervention. Of 30,651 live born babies screened for congenital dislocation of the hip (CDH) employing Barlow and Ortolani maneuvers, 132 were found to be positive, giving an incidence of two to six per 1000 liver births, averaging 4.3/1000 for the period. The implications of epidemiologic and clinical observations and of management have been discussed. The cost of screening and of surgical management of cases that would not have stabilized without intervention. Cost effectiveness of a screening program for CDH was observed from this 11 year study, fully justifying a sustained program apart from the human misery an overlooked diagnosis may cause.

Volatile substance abuse among school students of eastern Saudi Arabia.

A questionnaire-based cross-sectional epidemiological survey of volatile solvent (VS) abuse in a representative sample of 1778 male Saudi students drawn from nine intermediate and nine secondary schools in three urban areas in Eastern Saudi Arabia showed a prevalence rate of 5.3%. The majority (52%) started their abuse between 112 to 14 years of age and the involvement was mostly once (45%) or occasionally (44%), while daily abuse was rare (11%). Predominantly (63%), the behavior lasted less than a month and solitary abuse prevailed (54%). The commonly abused substances were petrol (27%) and glue (23%). VS abuse was significantly associated with family troubles, truancy and smoking, but neither correlated with socioeconomic status, family structure nor with scholastic achievement. Preventive measures are suggested.

Pediatric liver disease in the eastern province of Saudi Arabia: A clinicopathological study.

This prospective study analyzes the clinical features and histopathological findings in liver biopsies of pediatric patients presenting to the hospital with liver disease during a 10 year period. Only those patients in whom liver biopsy was performed for a tissue diagnosis were included. Fifty patients were investigated, all below the age of 12 years, of whom 36 were male and 14 female. Thirty-two were of neonatal-infantile group, 11 had a diagnosis of neonatal giant cell he hepatitis of infections origin and an intact biliary tree. Two had septic shock and one had leishmaniasis. The remaining 18 patients of the neonatal-infantile group constituted five case of glycogen storage disease, six of infantile obstructive cholangiopathy (biliary atreasia), four of fatty change and one each of congenital hepatic fibrosis, neuroblastoma and nonspecific reactive hepatitis. The eighteen older children had the following diagnoses: thalassemia in five, sickle cell disease in four, two each of Reye syndrome and hepatoblastoma. The remaining were one each of glycogen storage disease, Rotor syndrome, cirrhosis, fatty change and non-Hodgkin lymphoma (NHL). These findings are presented and discussed.

Hearing screening of infants at King Fahd Hospital of the University.

The detection of hearing impairment in neonatal life and prompt intervention prevents the hazards of physical and developmental delay in speech. During a 12-month period between April 1987 and March 1988, the hearing of 151 well babies and 30 high-risk babied aged 6 to 12 months attending the pediatric clinics of King Fahd Hospital of the University (KFHU), Al-Khobar, were screened. The modified Ewing-Stykar test was performed on all babies. Tympanometry, stapedial reflex, and brainstem evoked response (BERA) were carried out in the well babies who failed the screening test and in all high-risk babies. The failure rate was found to be 4.6% and 43.3% and the validity index 71.4% and 92.3% for the well and high-risk babies, respectively. The results of this limited study encourages us to recommend the implementation of this screening test in all the well baby and the high-risk baby clinics in the Kingdom of Saudi Arabia.

Corneal diameter in premature infants.

The size of the cornea is important in the diagnosis of primary infantile glaucoma. Reference values regarding eyes of premature infants are scarce. Such data are of special importance in areas such as the Middle East where infantile glaucoma is common and often evident already at birth. The authors have measured the horizontal corneal diameter of the eyes of 127 premature Saudi infants with a gestational age between 23 and 36 weeks and a birth weight ranging from 540 g to 4720 g. The corneal diameter ranged from 7.75 mm to 10 mm. The smallest diameter (7.75 mm) was found in an infant with a gestational age of 23 weeks and having a birth weight of 520 g. The largest diameter (10 mm) belonged to two infants with a gestational age of 34 and 35 weeks and a birth weight of 2250 g and 2240 g respectively. Corneal diameter was positively correlated (p < 0.001) with gestational age and birth weight. Graphs depicting the regression line of corneal diameter on gestational age and of corneal diameter on birth weight together with the 95% confidence limits for individual values are provided for reference.