Effect of abdominal massage on feeding intolerance among premature baby with mechanical ventilation in neonatal intensive care unit in indonesia

BackgroundFeeding intolerance in premature infants is due to the immaturity of the gastrointestinal system which is aggravated by the installation of mechanical ventilation. The impact of premature babies is delaying enteral nutrition, NEC, the risk due to parenteral nutrition and the high cost of care. Abdominal massage is one of the recommended actions to prevent it.ObjectiveThe study aimed to determine the effect of abdominal massage on feeding intolerance in premature infants with mechanical ventilation in the NICU.MethodsThis study was conducted using quasi-experimental with nonequivalent control group pretest and posttest design in the neonatal intensive care unit (NICU). The study was conducted on 34 premature infants, 17 groups who did abdominal massage and 17 as a control group. Feeding intolerance is determined by the presence of one or more symptoms such as increased gastric residue, abdominal distension and frequency of vomiting observed on the first (pre) and fifth (post) days. Abdominal massage is carried out twice a day for 15 min in a 5 day period. Data can be seen the difference on the first day and the last day.ResultsThe results showed a decrease in average gastric residue difference of 0.65 cc and abdominal distension of 0.59 cm in the intervention group (p < 0.05). Whereas in the control group gastric residue increased 3.59 cc and abdominal distension 1.88 cm (p < 0.05). The mean difference in vomiting frequency decreased in both groups, a decrease of 0.118 in the intervention group and 0.18 in the control group (p = 0.63). There was a significant difference in the occurrence of feeding intolerance between groups after the intervention (p = 0.05), where the incidence of feeding intolerance did not increase (0%) in the intervention group, while the control group increased by 9 (52.9%) respondents. There was a significant contribution to the confounding factor of the type of mechanical ventilation in the amount of gastric residue after the intervention (p = 0.02).ConclusionThere is an effect of abdominal massage on the incidence of feeding inolerance in premature infants with mechanical ventilation, so researchers recommend SPO abdominal massage to be considered as a treatment for intolerance feeding in premature infants with mechanical ventilation in the NICU.     

Large-scale multi-site OSCEs for national competency examination of medical doctors in Indonesia

Background: Implementing large-scale multi-site objective structured clinical examination (OSCEs) for national competency examination in a low resource country is challenging.

Aims: To describe the first national OSCE for national competency examination of medical doctors in Indonesia and evaluate the reliability, validity, feasibility, acceptability, and educational impact.

Methods: We collected electronically the OSCE scores from 49 out of 73 medical schools that participated to assess reliability and validity. We conducted electronic survey to examiners, examinees, SP trainers, and OSCE coordinators to assess feasibility, acceptability, and educational impact.

Results: The Cronbach’s alpha coefficient across station was 0.79. There was strong correlation between rubric and global rating scores in each station (coefficient correlation ranges from 0.705 to 0.82). The content validity ratio was 0.97. The coefficient correlation between OSCE and MCQ was 0.335 (p?=?0.00). All 49 medical schools were able to conduct OSCE simultaneously. Examiners, examinees, SP trainers, and OSCE coordinators had good perception regarding feasibility and acceptability of OSCE. Both examiners and examinees indicated good educational impact of OSCE application. The cutting score based on the borderline regression method was 61.96%. There were 67.39% of the examinees achieved similar or above the cutting score.

Conclusion: With 12 stations 15?min each, the reliability coefficient across station is intermediate. Content validity is good. It is feasible and acceptable to implement large-scale multi-site OSCEs in Indonesia. Examiners and examinees perceive good educational impact on OSCE implementation.