Assessment of clinical competence using objective structured examination.

To avoid many of the disadvantages of the traditional clinical examination we have introduced the structured clinical examination. In this students rotate round a series of stations in the hospital ward. At one station they are asked to carry out a procedure, such as take a history, undertake one aspect of physical examination, or interpret laboratory investigations in the light of a patient''s problem, and at the next station they have to answer questions on the findings at the previous station and their interpretation. As they cannot go back to check on omissions multiple-choice questions have a minimal cueing effect. The students may be observed and scored at some stations by examiners using a check list. In the structured clinical examination the variables and complexity of the examination are more easily controlled, its aims can be more clearly defined, and more of the student''s knowledge can be tested. The examination is more objective and a marking strategy can be decided in advance. The examination results in improved feed-back to students and staff.     

Rectal examination in general practice.

OBJECTIVE--To investigate factors influencing a general practitioner''s decision to do a rectal examination in patients with anorectal or urinary symptoms. DESIGN--Postal questionnaire survey. SETTING--General practices in inner London and Devon. SUBJECTS--859 General practitioners, 609 (71%) of whom returned the questionnaire. MAIN OUTCOME MEASURES--Number of rectal examinations done each month; the indication score, derived from answers to a question asking whether the respondent would do a rectal examination for various symptoms; and the confidence score, which indicated the respondent''s confidence in the diagnosis made on rectal examination. RESULTS--279 General practitioners did five or fewer rectal examinations each month and 96 did more than 10 each month. Factors significantly associated with doing fewer rectal examinations were a small partnership and being a female general practitioner, and the expectation that the examination would be repeated. Lack of time in the surgery, and a waiting time of less than two weeks for an urgent outpatient appointment were also important. General practitioners were deterred from doing rectal examinations by reluctance of the patient (278), the expectation that the examination would be repeated (141), and lack of time (123) or a chaperone (39). Confidence in diagnosis was significantly associated with doing more rectal examinations, the perception of having been well taught to do a rectal examination at medical school, and being a male general practitioner. CONCLUSIONS--Factors other than clinical judgment influence the frequency of rectal examination in general practice. Rectal examination may become commoner with the trend towards larger group practices and if diagnostic confidence is increased and greater emphasis put on rectal examination in undergraduate and postgraduate teaching.     

提高临床医学生微生物检验 见习教学质量的探索与实践

临床微生物室见习是临床医学专业学生了解微生物检验的重要窗口,提高其见习教学质量,使其认识到微生物检验在感染性疾病诊治中的作用。除了系统介绍临床微生物检验的工作内容及流程外,我们更注重临床医生与微生物检验的密切联系,强调临床医生对微生物检验前质量控制的重要性。案例教学法联合问题导向教学法,将临床感染病例与微生物检验紧密结合。举例讲解临床医生该如何正确解读微生物检验报告结果,从而合理选择抗菌药物进行有效的抗感染治疗。最后提醒临床医学生注意生物安全及医院感染的发生。通过我们的见习教学,临床医学生表示获益颇丰,意识到微生物检验对感染性疾病诊治的重要作用。     

EEG Based Evaluation of Examination Stress and Test Anxiety Among College Students

BackgroundAdolescence is a crucial chapter in life and the presence of stress, depression, and anxiety at this stage is a great concern. Prolonged stress is one of the risk factors that may induce suicidal thoughts, destructive ideation, abuse of alcohol, and drugs in adulthood. Based on a record from National Crime Records Bureau, In India over 2320 children were committed suicide per year because of failure in examinations. This raised number implies the severity of this issue and its major impact on society.ObjectivesThe main objective of this paper is to analyze the cognitive stress in students during examination period using EEG biomarkers.Methods and ResultsEEG signal was acquired in two different test conditions such as before examination with 12 minutes and after examination with 3 minutes from 14 subjects with eight electrodes located using wireless Enobio device (Neuro electrics) with 10-20 international lead system. The three brain waves such as theta, alpha, beta relative band energies were considered, and EEG band ratios such as heart rate, neural activity, arousal index, vigilance index and cognitive performance attentional resource index extracted between before and after examination condition using db4 wavelet family with 6 level decomposition. The statistical results suggest that after examination the relative sub-band energies α, β, and θ were decreased significantly (p < 0.05) as compared to before examination. Also, the EEG band ratio such as heart rate and vigilance index shows significant (p < 0.05) decrease after the examination as compared to before examination. It was found that there was a significant (p < 0.05) rise in the arousal index, Cognitive performance attentional resource index (CPARI), and neural activity after the examination as compared to before examination.ConclusionThe experimental results found that the memory and concentration were high before examination, which concludes that adolescence group examination stress was high before examination period as compared to after examination. In the case of gender group comparison, theta energy band for male students was found high compared to female students in before examination state such that it concludes that male students were highly stressed (before examination) than female students. Overall, our results suggest that after examination male students with lower heart rate index than female students which implies the male students control their stress levels as compared to females in the same stress situation.     

Influence of the unified state examination on the functional state in high school students

The results of a local comparative experiment are presented in the course of which physiological reactions to emotional and mental stress related to the situation of taking an examination in two forms—a traditional examination and the unified state examination (USE)—were compared. It was shown that the physiological stress during the USE is slightly higher than during the traditional examination.     

可手术乳腺癌基线检查研究现状

乳腺癌的治疗手段随临床分期不同而有很大差异,临床分期主要通过基线检查获得。常规的乳腺癌的相关基线检查主要有基本检查项目和备选检查项目。其中包括病史及体检、实验室检查、乳腺的影像学检查、病理检查及免疫组化、腹部及盆腔影像学检查、胸部影像学检查、骨扫描、脑核磁、PET/CT检查。这些检查是临床分期的基本依据,其中基本检查项目是所有乳腺癌患者必须采用的常规检查,而不同临床分期的乳腺癌所需要的备选检查项目却存在差别。手术治疗是乳腺癌治疗的主要手段,本文对可手术乳腺癌的基线检查及各项检查的临床应用情况做一综述。     

Dyspepsia: is a trial of therapy appropriate?

Dyspepsia is a common, benign condition that may be distinguished from gastroesophageal reflux, irritable bowel syndrome and pancreatobiliary, coronary or musculoskeletal disease by a careful history and physical examination. However, the presence or absence of a peptic ulcer in dyspepsia can be determined only by an endoscopic examination or a barium-contrast radiograph. Although the American College of Physicians has recommended trying drug therapy for patients with dyspepsia before diagnostic tests are done, new data support early diagnosis. Although therapy is initially cheaper than endoscopic examination, over a year the costs even out because most patients with dyspepsia eventually need an endoscopic examination, and many patients with nonulcer dyspepsia are given medication unnecessarily. Endoscopic examination, if available to general practitioners, is the most cost-effective approach to dyspepsia. An approach that does not include endoscopy lacks the opportunity to offer patients convincing reassurance that their illness is not serious, which is arguably the most important treatment in cases of nonulcer dyspepsia. Studies supporting the use of endoscopic examination predate the treatment of peptic ulcers with antibiotics, which makes an initial endoscopic examination to determine whether the patient has an ulcer even more important.     

健康体检人群甲状腺结节多普勒超声检查结果及影响因素分析

目的:研究健康体检人群甲状腺结节多普勒超声检查结果及影响因素。方法:将从2018年1月~2019年12月,于医院接受体检的健康体检人员5270例纳入研究,对所有受试者均进行多普勒超声检查,分析超声检查结果和体检人群基线资料的关系,分析甲状腺结节多普勒超声特征。采用单因素以及多因素Logistic回归分析健康体检人群甲状腺结节的影响因素。结果:在5270例健康体检人群中,甲状腺结节检出率为51.86%(2733/5270),女性甲状腺结节检出率为52.83%(2355/4458),高于男性的46.55%(378/812),且随着年龄的不断增长,健康体检人群甲状腺结节检出率呈逐渐升高趋势(均P<0.05)。甲状腺结节患者的多普勒超声检查特征以低回声以及结节直径<2 cm为主(均P<0.05),但是结节数目以及病变部位比较无明显差异(均P>0.05)。经单因素分析发现:吸烟、甲状腺疾病家族史、高血压及糖尿病的健康体检人员甲状腺结节检出率高于不吸烟、无甲状腺疾病家族史、无高血压及无糖尿病的健康体检人员(均P<0.05),而不同民族、受教育年限、体质量指数(BMI)、是否饮酒的健康体检人员甲状腺结节检出率比较无统计学差异(均P>0.05)。经多因素Logistic回归分析发现:女性、年龄、吸烟、甲状腺疾病家族史、高血压及糖尿病均是健康体检人群甲状腺结节发生的独立危险因素(均OR>1,P<0.05)。结论:甲状腺结节多普勒超声检查特征以低回声以及结节直径≤2 cm为主,其影响因素包括年龄、性别、吸烟、甲状腺疾病家族史、高血压及糖尿病,值得临床重点关注。     

革兰染色对患者阴道分泌物的检验价值

目的探讨革兰染色对患者阴道分泌物的检验价值。方法选择2015年4月至2017年4月于诸暨市中心医院进行阴道分泌物检验的阴道炎患者为研究对象,共1 600例。采用生理盐水镜检法和革兰染色法对分泌物进行检验,比较两种检验方法对分泌物病变的检出情况,同时比较两种检验方法的特异性和敏感性。结果革兰染色法对分泌物病变的检出率为32.50%,生理盐水镜检法的检出率为28.50%,二者差异有统计学意义(P0.05)。革兰染色法对阴道分泌物检验的准确性、敏感性及特异性分别为95.61%、96.34%、97.87%,均高于生理盐水镜检法,差异有统计学意义(P0.05)。结论阴道分泌物检验是诊断阴道炎最便捷的方法。与常规的生理盐水镜检法相比,革兰染色法具有更高的准确性、特异性和敏感性,对阴道炎的早发现、早治疗具有较高的应用价值。     

隐匿性胫骨平台骨折MRI、CT检查的影像学表现及其诊断价值对比的回顾性研究

目的:研究对比隐匿性胫骨平台骨折(TPOF)磁共振成像(MRI)、电子计算机断层扫描(CT)检查的影像学表现及其诊断价值。方法:回顾性分析我院自2016年1月至2019年12月拟诊断为TPOF且X线检查表现为阴性的89例患者的临床资料,分别对所有受试者进行MRI、CT检查,且以手术检查为金标准,比较上述两种影像学检查手段诊断TPOF的效能。此外,比较MRI、CT检查诊断TPOF的表观扩散系数以及节段各向异性值以及对TPOF类型的检出率。结果:MRI检查诊断TPOF的灵敏度、特异度及准确度分别为98.61%、94.12%、97.75%,均高于CT检查的79.17%、64.71%、76.40%(均P<0.05)。MRI检查诊断TPOF的表观扩散系数高于CT检查,而节段各向异性值低于CT检查(均P<0.05)。MRI检查对骨皮质骨折的检出率低于CT检查,而对骨小梁骨折的检出率高于CT检查(均P<0.05)。结论:MRI检查诊断TPOF的价值高于CT检查,且在骨小梁骨折的检出率方面优于CT检查,但CT检查应用于骨皮质骨折的诊断价值更高。临床工作中可能通过联合MRI以及CT检查,继而达到提高TPOF检出率的目的。     

Culdoscopy

Cul-de-sac puncture for introduction of a culdoscope is easily made with the patient in the knee-chest position. With the use of the instrument, the pelvic organs can be viewed clearly. Culdoscopic examination of 45 patients was carried out. In all cases in which laparotomy was done after the examination, the culdoscopic observations and diagnosis were confirmed. In no case in which tubal pregnancy was present, was the diagnosis missed in culdoscopic examination. Patients were only slightly uncomfortable after the examination. There was no evidence of pelvic peritonitis in any patient, and no pregnant patient aborted as a result of the procedure.     

首次报道中国北方Fonsecaea monophora所致着色芽生菌病1例及其相关实验研究

目的首次报道中国北方1例由Fonsecaea monophora所致着色芽生菌病。方法患者男性,58岁,主因"右腕部皮损伴瘙痒8~9a"就诊。对皮损脓液直接镜检,皮损组织病理检查,真菌培养,并对培养获得菌株进行形态学,分子生物学鉴定等实验室研究。结果脓液直接镜检可见多个圆形、厚壁、棕色硬壳细胞,皮损组织病理表现为慢性肉芽肿样改变,并可见硬壳小体。真菌培养可见暗棕色,橄榄色至黑色菌落生长,生长速度较慢,镜下可见枝孢型和喙枝孢型产孢。ITS区序列分析鉴定为Fonsecaea monophora。依据临床及实验室检查确诊该例为Fonsecaea monophora所致的着色芽生菌病。口服伊曲康唑200mg,1次/d;特比萘芬250mg,1次/d。治疗3个月后,皮损消退痊愈。结论 Fonsecaea monophora感染也可见于我国北方地区的着色芽生菌病患者,而ITS区序列分析是该菌种鉴定的重要手段,伊曲康唑联合特比萘芬治疗本例患者显示较好疗效。     

CULDOSCOPY

Cul-de-sac puncture for introduction of a culdoscope is easily made with the patient in the knee-chest position. With the use of the instrument, the pelvic organs can be viewed clearly. Culdoscopic examination of 45 patients was carried out. In all cases in which laparotomy was done after the examination, the culdoscopic observations and diagnosis were confirmed. In no case in which tubal pregnancy was present, was the diagnosis missed in culdoscopic examination. Patients were only slightly uncomfortable after the examination. There was no evidence of pelvic peritonitis in any patient, and no pregnant patient aborted as a result of the procedure.     

Examination for the Certificate in Advanced Practice in Cervical Cytology – the first year''s experience

Following the decision to establish an Advanced Biomedical Scientist Practitioner grade for senior biomedical scientists in the NHS Cervical Screening Programme, a conjoint examination board has been appointed by the Royal College of Pathologists and Institute of Biomedical Science to oversee the Certificate in Advanced Practice in Cervical Cytology examination. The examination consists of a multiple-choice paper, short-answer written questions and practical microscopy sections covering screening of unmarked slides, and more complex discussion cases. In the first year there were 58 entries with 29 successful candidates, a pass rate of 50%. The standard of performance in the examination showed a wide range, and some candidates appear to have underestimated the degree of preparation, knowledge or level of microscopy skill required.     

The effect of an academic examination on salivary norepinephrine and immunoglobulin levels

Forty-six college students provided saliva samples just after taking an examination, one hour and 45 minutes later, and several days later, at a period of rest. As compared with baseline levels, the power stress of an examination was associated with an increase in salivary immunoglobulin A (S-IgA), a measure of B-cell immune function, and with an increase in norepinephrine (NE) concentrations in the saliva. The increase in NE was greater for those for whom n power was greater than n affiliation rather than for those for whom the reverse was true. Greater increases in, and levels of, NE at the examination and after were associated with greater subsequent drops in S-IgA, which reached below baseline levels for those for whom n power was stronger. The examination stimulated adrenergic activity, which in the long run depressed immune function for those with a strong power motive who had been most aroused adrenergically by the examination.     

Self examination of the breast: is it beneficial? Meta-analysis of studies investigating breast self examination and extent of disease in patients with breast cancer.

The question whether the aggregated published research suggests that breast self examination is beneficial was explored in a meta-analysis of 12 studies including a total of 8118 patients with breast cancer that related the practice of breast self examination to regional lymph node state or tumour diameter. Based on the six studies for which data were available, 39% of patients (1115/2852) who reported having done breast self examination at least once before their illness had evidence of cancer in the lymph nodes compared with 50% of women (1348/2713) who had not done the examination. Logistic regression analysis showed this difference to be significant (odds ratio 0.66, confidence interval 0.59 to 0.74). Combining six studies which reported the circumstances of detection disclosed that 42% of women (272/652) who found their tumour while doing breast self examination had evidence of cancer in the nodes compared with 46% of women (871/1901) who found the tumour accidentally; this difference was not significant. Analysis of eight studies which used the diameter of the tumour to indicate the extent of disease tended to confirm the findings on lymph node state, in particular the benefit of premorbid breast self examination. Significantly fewer women who had practised the examination before the illness (56%; 1205/2137) had tumours of 2 cm or more diameter compared with women who had not practised the examination (66%; 1500/2260). The combined odds ratio for that analysis was 0.56, confidence interval 0.38 to 0.81. These findings appear to be good evidence of the benefit of encouraging women to practise self examination of the breasts regularly.     

Clinical Breast Examination As the Recommended Breast Cancer Screening Modality in a Rural Community in Malaysia; What Are the Factors That Could Enhance Its Uptake?

Breast cancer is the most common cause of deaths and the most frequently diagnosed cancer among women worldwide. This study aimed to determine the prevalence of breast cancer screening, specifically on clinical breast examination, and the predictors of its uptake among women in Malaysia. A cross-sectional study was carried out in five selected districts whereby women aged between 20 to 64 years old, from a total of 1000 households were interviewed. A total of 1192 women responded to the survey of which 53.3% reported had ever done clinical breast examination. Significant associations with clinical breast examination were noted for income and distance from the hospital. These factors should be considered in developing interventions aimed at promoting clinical breast examination. In particular, healthcare providers should be proactive in raising awareness about clinical breast examination among women in Malaysia.     

Comparison of the clinical application value of mo-targeted X-ray,color doppler ultrasound and MRI in preoperative comprehensive evaluation of breast cancer

ObjectiveTo investigate the clinical application value of the Mo-targeted X-ray examination, color Doppler ultrasound and magnetic resonance imaging (MRI) in the diagnosis and preoperative comprehensive evaluation of breast cancer.MethodsAmong 170 breast cancer patients, they underwent Mo-targeted X-ray examination, color Doppler ultrasound and MRI before surgery to evaluate the lesions in breast, axillary lymph nodes and the availability of breast-conserving surgery.ResultsThe detection rates using color Doppler ultrasound examination and MRI were higher than that in the Mo-targeted X-ray examination, which were 90%, 94% and 82%, respectively (P < 0.01 or 0.05). With the result of pathological examination as the golden criteria, we found that specificities of Mo-targeted X-ray examination, color Doppler ultrasound examination and MRI in evaluating the metastasis in axillary lymph nodes were similar (85.11%, 77.66% and 79.79%; P > 0.05). Before surgery, the sensitivities and accuracies of the color Doppler ultrasound examination and MRI were higher than those using the Mo-targeted X-ray examination, which were 73.21%, 82.14%, and 28.57%, 76.00%, 80.67% and 64.00% (P < 0.01 or 0.05). Before surgery, the accuracy rate of MRI in evaluating the breast-conserving surgery was higher than those of Mo-targeted X-ray examination and color Doppler ultrasound (92.00%, 83.33% and 84.67%; P < 0.05).ConclusionCombined application of Mo-targeted X-ray examination, color Doppler ultrasound and MRI shows a higher accuracy in diagnosis of breast cancer and evaluation of axillary lymph node metastasis, which is conducive to the selection of surgical methods.     

The role of magnetic resonance imaging in the management of vascular malformations of the trunk and extremities

Vascular malformations can usually be diagnosed on clinical grounds. They have a well-defined appearance on magnetic resonance imaging, which can effectively determine their tissue and flow characteristics. However, the role of cross-sectional imaging in the management of vascular malformations is not well defined. Most reviews suggest that magnetic resonance imaging should be reserved for cases in which the extent of the lesion cannot be estimated on physical examination. However, to date no group has compared the accuracy of physical examination alone to that of magnetic resonance imaging in determining this extent. A review was performed of all the patients evaluated for vascular malformations at the New York University Trunk and Extremity Vascular Anomalies Conference between July of 1994 and August of 1999. Patients who underwent magnetic resonance evaluation at other institutions and whose images were not available for review were excluded. All study patients either underwent magnetic resonance imaging examination at New York University Medical Center or had outside films reviewed at the center. The physical examination findings were compared with the magnetic resonance findings and the surgeon and radiologist made a joint decision about whether there was a correlation between the magnetic resonance and physical examination findings. Fifty-eight patients met the study criteria, 44 (76 percent) of whom were found to have more extensive disease on magnetic resonance examination than appreciated on physical examination. Of the 51 patients with low-flow vascular malformations (venous vascular malformations, lymphatic malformations, and capillary malformations), 39 (76 percent) had more extensive disease on magnetic resonance examination than on physical examination. Of the seven patients with high-flow arteriovenous malformations, five had more extensive disease on magnetic resonance. In all of the 44 patients whose magnetic resonance imaging findings did not correlate with those of the physical examination, therapeutic decision making was affected. Contrary to the conventional wisdom of published reviews, physical examination findings significantly underestimated the extent of vascular malformations in the majority of cases. Magnetic resonance imaging should be performed in all patients with vascular malformations of the trunk and extremities before therapy is planned. In an age when physicians are asked to justify their decisions, especially where the use of expensive diagnostic modalities is concerned, the situations in which these tests are indispensable must be clearly defined or else patients will be denied access to them.     

水体中大肠杆菌的生物检测法—斑贝检测法

大肠杆菌是水体污染程度的重要指示菌 ,因而对其要求快速、准确的检测。常规检测法的优点是简便、快速 ,但缺点是当菌数过多会影响准确计数 ,而菌体过少则会出现漏检的情况。综述了一种新的大肠杆菌生物检测法 ,该法应用斑贝作为预测水体中菌密度升高的一种指示生物 ,因其具备快速积累并保留水体中大肠杆菌的能力 ,可有效地避免低菌数时的漏检情况 ,能使水域管理者降低正常监测大肠杆菌临界量所需的取样频率 ,因而提供了一个更高效的细菌污染的河水监测方案。