Social responsiveness: The key ingredient to achieve social accountability in education and health care.

While social accountability (SA) is regarded as an obligation or mandate for medical school administration, it runs the danger of becoming a bureaucratic checkbox. Compassion which leads to social responsiveness (SR), in contrast, is often recognized as an individual characteristic, detached from the public domain. The two, however, complement each other in practice.

Exploring rural medical education: a study of Canadian key informants.

Introduction: Recruiting and retaining primary healthcare professionals is a global healthcare problem. Some countries have been using medical education as a strategy to aid in the recruitment and retention of these healthcare professionals. The purpose of this study is to engage with key informants and explore the learning processes that support medical students to prepare for a rural career.

Community engagement: A central feature of NOSM's socially accountable distributed medical education.

Background: Northern Ontario School of Medicine (NOSM) serves as the Faculty of Medicine of Lakehead and Laurentian Universities, and views the entire geography of Northern Ontario as its campus. This paper explores how community engagement contributes to achieving social accountability in over 90 sites through NOSM's distinctive model, Distributed Community Engaged Learning (DCEL).

Methods: Studies involving qualitative and quantitative methods contribute to this paper, which draws on administrative data from NOSM and external sources, as well as surveys and interviews of students, graduates and other informants including the joint NOSM-CRaNHR (Centre for Rural and Northern Health Research) tracking and impact studies.

Needs of the many: Northern Ontario School of Medicine students' experience of generalism and rural practice.

Objective: To explore the Northern Ontario School of Medicine (NOSM) student and graduate experience of generalism in rural practice, in the context of a growing discourse on generalism.

Design: Qualitative analysis.

Setting: Northern Ontario School of Medicine in multiple sites across northern Ontario, which is the NOSM campus.

Usefulness of surveillance cultures in neonatal extracorporeal membrane oxygenation.

Sepsis is difficult to identify in patients treated with extracorporeal membrane oxygenation (ECMO). This study evaluates the usefulness of surveillance cultures obtained during ECMO. We retrospectively reviewed the records of 187 patients from four ECMO centers with birth weights 1,574 to 4,900 gm and gestational ages 33-43 weeks, over a 4 year interval.

A multicenter trial of 6-aminocaproic acid (Amicar) in the prevention of bleeding in infants on ECMO.

Background/purpose: Intracranial hemorrhage (ICH), is a major source of morbidity and the leading cause of death in neonates treated with extracorporeal membrane oxygenation (ECMO). Anecdotal reports have suggested that epsilon-aminocaproic acid (EACA) can decrease the risk of ICH. The purpose of this study was to evaluate, in a multiinstitutional, prospective, randomized, blinded fashion, the effect of EACA on the incidence of hemorrhagic complications in neonates receiving ECMO.

Utility of daily head ultrasonography for infants on extracorporeal membrane oxygenation.

Background/purpose: Intracranial hemorrhage (ICH) is a major concern during extracorporeal membrane oxygenation (ECMO). Daily cranial ultrasonography has been used by many ECMO centers as a diagnostic tool for both detecting and following ICH while infants are on bypass. The purpose of this patient review was to look at the usefulness of performing daily cranial ultrasonography (HUS) in infants on ECMO in detecting intraventricular hemorrhage of a magnitude sufficient to alter patient treatment.

Pediatric wound infections: a prospective multicenter study.

Objective: Surgical wound infections remain a significant source of postoperative morbidity. This study was undertaken to determine prospectively the incidence of postoperative wound infections in children in a multi-institutional fashion and to identify the risk factors associated with the development of a wound infection in this population.

Summary Background Data: Despite a large body of literature in adults, there have been only two reports from North America concerning postoperative wound infections in children.

Successful separation of ischiopagus tripus conjoined twins with comparative analysis of methods for abdominal wall closure and use of the tripus limb.

The authors report the successful delivery, preoperative management, and postoperative courses of ischiopagus tripus twin girls successfully separated at 5 months of age. Surgical objectives were predicated on survival and optimum postseparation reconstructive potential for both girls. Each twin has subsequently undergone additional procedures, and both are doing well 2 years after separation.

Outcome of infants requiring cardiopulmonary resuscitation before extracorporeal membrane oxygenation.

Background/purpose: Cardiopulmonary resuscitation (CPR) is reported to be used in a significant number of neonates before initiation of extracorporeal membrane oxygenation (ECMO). This report establishes the incidence of infants who require CPR before initiation of ECMO and elucidates survival rates and long-term neurological outcomes. In addition, the authors sought prognostic factors that could reliably predict survival or long-term neurological outcome before initiating ECMO support.

Heparin-associated thrombocytopenia and thrombosis as the cause of a fatal thrombus on extracorporeal membrane oxygenation.

A rare state of acquired hypercoagulability known as heparin-associated or heparin-induced thrombocytopenia and thrombosis (HATT, HITT) exists. It appears to be caused by an antibody reaction with heparin-platelet factor 4 complexes. A mild and severe form exist, but both varieties occur after exposure to heparin.

Complications after surgical intervention for necrotizing enterocolitis: a multicenter review.

Necrotizing enterocolitis (NEC) is a serious condition affecting predominantly the premature infant. The purpose of this study is to report a multicenter experience of complications in 252 infants requiring surgical therapy for NEC. Data from eight institutions for the years 1980 through 1990 were collected and analyzed for infants undergoing surgical therapy for NEC.

Predicting ventilation failure in children with inhalation injury.

Despite advances in mechanical ventilatory support for patients with smoke inhalation injury, including the use of high-frequency flow-interruption ventilators such as the VDR, inhalation injury alone may increase mortality by as much as 20% in patients with thermal injury, and up to 60% when pneumonia occurs. Inhalation injury causes a primary large and small airway epithelial insult that results in ventilation abnormalities, rather than a primary alveolar lesion that results in oxygenation abnormalities as occur in multiple-system organ failure. Patients with inhalation injury requiring high ventilatory pressures experience complications of barotrauma and frequently succumb to necrotizing tracheobronchitis and oxygenation abnormalities after 2 to 4 weeks of mechanical ventilation.

Hemorrhagic complications and repair of congenital diaphragmatic hernias: does timing of the repair make a difference? Data from the Extracorporeal Life Support Organization.

The authors reviewed the Extracorporeal Life Support Organization (ELSO) data base of all neonates placed on extracorporeal membrane oxygenation for whom CDH was diagnosed between January 1989 and December 1991. For 483 neonates, there were complete data concerning timing of the hernia repair in relation to ECMO. The overall incidence of hemorrhage was 43% (57% among nonsurvivors, 32% among survivors; P < .

Endobronchial hamartoma treated by bronchoscopic excision.

Endobronchial hamartoma is a rare lesion, with only 65 cases previously reported in the English literature. An additional case is reported here. The patient was successfully treated by bronchoscopic excision of the hamartoma.

Prosthetic diaphragm reconstruction in the growing animal.

Widespread use of extracorporeal membrane oxygenation (ECMO) has allowed an increasing number of infants with total agenesis of the diaphragm to survive. Polytetrafluoroethylene (PTFE) is the most widely used material for reconstruction. However, recurrent hernia is a growing problem; PTFE also does not grow with the patient.

The atonic baggy rectum: a cause of intractable obstipation after imperforate anus repair.

Three children with successful imperforate anus repairs had chronic, intractable obstipation and recurrent fecal impaction refractory to diligent medical therapy. All had massive stool-filled rectums up to 14 cm in diameter on abdominal radiographs. They responded well to resection of the baggy atonic rectum with low anterior anastomosis.

Persistence of Barrett's esophagus in children after antireflux surgery: influence on follow-up care.

Adenocarcinoma arising in Barrett's esophagus has recently been described in two children aged 11 and 14 years. The long-term follow-up of Barrett's esophagus in children is not well described. We evaluated 16 cases of Barrett's esophagus in children treated at this institution during the last 16 years.

Changing trends in necrotizing enterocolitis. Experience with 302 cases in two decades.

Three hundred two infants with necrotizing enterocolitis (NEC) were treated from 1972 to 1990. One hundred eighteen were treated medically while 184 infants required operation. Comparisons were made between two treatment periods, 1972 to 1982 (n = 176) and 1983 to 1990 (n = 126).

Digital artery embolization as a result of fibromuscular dysplasia of the brachial artery.

A 74-year-old woman was admitted to the hospital with sudden onset of a blue, painful right index finger, and the condition progressed to digital ulceration. The ulcer gradually healed over a period of 2 months. Peripheral pulses, Doppler-derived brachial and radial systolic pressures, and results of an echocardiogram were normal.

Open lung biopsy in the critically ill newborn.

Experience with 17 open lung biopsies in critically ill premature neonates was reviewed. Despite their small size, prematurity, and near maximal ventilator requirements, the infants suffered no significant complications. In three cases, an infectious agent was identified.

The hidden mortality in surgically treated necrotizing enterocolitis: fungal sepsis.

From 1979 to 1986, 82 infants underwent surgical treatment for necrotizing enterocolitis (NEC), with 36 deaths. The records of 30 of the 36 infants who died were available for review. Fungal colonization and sepsis, the sites of infection, and timing of diagnosis and therapy were determined.