Clinical implications of reconsideration of enthesitis/enthesopathy/enthesial erosion,as tendon attachmentlocalized avulsions and stress fracture equivalents

Recognizing the mechanical origin of enthesitis/enthesopathy and the avulsion-nature of what had previously been considered erosions,it seems inappropriate to attribute it to stresses related to a person’s normal activities.Conversely,sudden or unconditioned repetitive stresses appears the more likely culprit.Studies of enthesial reaction have lacked standardization as to findings present among individuals who appear to be healthy.Clinical evaluation by palpation and mani-pulation may be as effective as application of radiologic techniques.Recognition of the mechanical nature of the disease,including individuals with inflammatory arthritis suggests prescription of mechanical solutions that reduce stresses across the involved enthesis.

Comparison between visual clinical examination and the replica method for assessments of sealant retention over a 2-year period

To compare the levels of agreement and the survival rates of sealant retention for different sealing materials over a 2-year period assessed using the visual clinical examination and replica methods, sealant retention data were obtained by visual clinical examination and from replicas of the same sealed tooth at baseline and at 0.5-, 1- and 2-year evaluation points in 407 children and were compared for agreement using kappa coefficients. Survival curves of retained sealants on occlusal surfaces were created using modified categorisation （fully retained sealants and those having all pits and fissures partly covered with the sealant material versus completely lost sealants that included pit and fissure systems that had /〉 1 pit re-exposed） according to the Kaplan-Meier method. The kappa coefficient for the agreement between both assessment methods over the three evaluation time points combined was 0.38 （95% confidence interval （CI）： 0.35-0.41）. More sealant retention was observed from replicas than through visual clinical examination. Cumulative survival curves at the three evaluation times were not statistically significantly higher when assessed from replicas （P=0.47）. Using the replica method, more retained sealant material was observed than through visual clinical examination during the 2-year period. This finding did not result in a difference in the survival rates of sealants assessed by the two assessment methods. When replicas cast in die stone are used for assessing sealant retention, the level of reliability of the data is higher than that of data obtained through the commonly used visual clinical examination, particularly if such assessments are conducted over time.

The Value of Clinical Breast Examination, Imaging, and Fine Needle Aspiration and the Challenge of Diagnosing Breast Cancer in a Low Resource Setting: A Hospital-Based Analytical Study in Yaounde

Background: Breast cancer is the most common cancer in the world, as well as in Cameroon, where it represents about 20.1% of all cancers recorded in 2020. The number of pathologists in the country is as few as seven for a population of about 26 million. The diagnostic performances of diagnostic modalities other than histology—clinical breast examination (CBE), imaging and fine needle aspiration and cytology (FNA)—in our context are not known. Study Objectives: Our objectives were to estimate the proportions of cases managed with mammography, breast ultrasound and FNA and to estimate the sensitivity, specificity, positive and negative predictive values, and accuracy of CBE, mammography, breast ultrasound and FNA;using histology as reference. Study Methodology: The study was cross-sectional and analytical, and was carried out at the Yaoundé General Hospital. It lasted twelve months, April 2015 through March 2016 and covered the period January 2010 to February 2016. Using histology as reference, we calculated measures of diagnostic accuracy for all four modalities using the statistical methods of Galen and Gambino. Results: We recruited 107 cases, 105 females (98.1%) and 02 males. We had 112 breast lumps, 106 malignant (94.6%) and 6 benign. The mean lump size was 61.1 mm. The most frequently used diagnostic tool after CBE was FNA (49.1%), while the diagnostic accuracies were 76.8%, 79.1%, 82.9%, and 82.0% for CBE, breast US, mammography and FNA. Conclusion: The four baseline diagnostic modalities for breast cancer are used sub-optimally and FNA appears to be the most commonly used in our setting after CBE. We recommend that FNA should be considered for diagnosis as appropriate but a negative result should not stop the quest for histological elimination of presence of malignancy.

Evaluation of Accuracy of Clinical Examination and MRI on Diagnosing Anterior Cruciate Ligament and Meniscal Tears in Comparison to Diagnostic Arthroscopy among Patients Attending at Muhimbili Orthopedic Institute

Routine use of Magnetic Resonance Imaging (MRI) as screening test after clinical diagnosis for meniscal and/or anterior cruciate ligament (ACL) has a detrimental effect on patients in limited resourced countries. This study was done to compare accuracy of clinical examination and that of (MRI) on diagnosing meniscal and or (ACL) tears. Methodology: A cross-sectional-descriptive study was done on 57 knees of patients. Clinical examination, MRI and then diagnostic arthroscopy, as the gold standard, were done to all the cases. Results were recorded;the accuracies of MRI and clinical examination were evaluated and their results were compared. Results: Median age of patients was 40 years. Clinical examination had sensitivity of 93.62% and specificity of 40% for diagnosing meniscal tears;and sensitivity of 100%;and specificity of 97.67% for diagnosing ACL tear. MRI had sensitivity of 85.11%, and specificity of 40% for meniscal tear diagnosis and 71% and 100% respectively for ACL tear diagnosis. Diagnostic accuracy was 84.21% for meniscal and 98.24% for ACL tears by clinical examination and by MRI was 77.19% and 92.98% respectively. Conclusion: Clinical examination has higher accuracy than MRI on diagnosing both ACL and meniscal tear. Thus patients may be scheduled for diagnostic and interventional arthroscopy if clinical examination reveals meniscal and or ACL injuries. MRI use should be reserved when clinical evaluation is inconclusive or cannot be done.

Attitudes of Nursing Faculty Members and Graduates towards the Objective Structured Clinical Examination (OSCE)

The aim of this study was to evaluate the attitudes of faculty and graduates of college of nursing towards Objective Structured Clinical Examination (OSCE) as a valid and reliable method of clinical competency assessment in nursing ten years after its inception. Core nursing courses are based on instructional teaching methods and “hands-on” approach to impact cognitive, psychomotor skills and clinical judgments. Different clinical competency assessment methods are used globally;however, most of them are subjective. A descriptive survey using 16-item five-point likert scale questionnaire was conducted. The study sample consisted of 140 participants: 20 faculty members, 27 graduates of the Bachelor of Science in Nursing (BSN) Degree and 93 graduates of the Associate Degree of Nursing (ADN) programs with OSCE experience during their training. Data collection was carried out between October and November 2015. Eighty percent of faculty members, 74% of BSN and 62.3% of ADN graduates agreed that OSCE represented an objective evaluation method for psychomotor skills. Majority of the graduates perceived their OSCE experience positively although stressful. However, they have suggested the introduction of trial/mock OSCE prior to each exam to minimize the stress associated with it. In conclusion, there appears to be no single “gold-standard” assessment tool for clinical competency. OSCE assesses student nurses’ psychomotor skills in a non-clinical environment, therefore without risks to real patients. In combination with other assessment methods in the clinical settings, OSCE will provide a more comprehensive student psychomotor skill evaluation. OSCE experiences gave new nursing graduates confidence to work as registered nurses in health care settings.

Research on the Application of the OSCE Model in Vocational Nursing Comprehensive Practical Training

The objective of this study is to examine the application effect of the Objective Structured Clinical Examination(OSCE)model in the comprehensive practical training course for higher vocational nursing.Based on the evaluation dimensions of core nursing competencies,the OSCE framework was constructed with the clinical nursing work process as the main focus and supported by a nursing case database.A questionnaire survey revealed that over 80%of students in the experimental group were satisfied with the application of OSCE in the nursing comprehensive practical training course,and more than 90%believed that OSCE assessment enhanced their theoretical knowledge and practical skills.The OSCE was also considered helpful in transforming learned knowledge and skills into professional competencies.

Amino Acid Sensing Using an Ion-Sensitive Field-Effect Transistor

Ion-sensitive field-effect transistor （ISFET）-based biosensor for amino acids was proposed, and the response of the sensor to amino acids was evaluated. As a molecular recognition element, aminoacyl-tRNA synthetase which would be expected to have high selectivity for the corresponding amino acids was used, aminoacyl-tRNA synthetase was coated onto an ISFET electrode, and the response of the biosensor to amino acids was evaluated. The amino acid sensor for tyrosine showed a selective response to tyrosine because of the specific binding ability of aminoacyl-tRNA synthetase for tyrosine and from 300μM to 900 μM of tyrosine could be measured （r2 〉 0.969）.

Association among lifestyle, clinical examination, polymorphisms in CDH1 gene and Traditional Chinese Medicine syndrome differentiation of gastric cancer

OBJECTIVE:To explore the association among lifestyle,clinical examination,polymorphisms in CDH1 gene and Traditional Chinese Medicine(TCM)syndrome differentiation of gastric cancer(GC). METHODS:A hospital-based population of 387 GC patients was investigated in Jiangsu province.Relevant information regarding lifestyle and clinical examination were collected by a standard questionnaire.Four known single nucleotide polymorphisms(SNPs)in CDH1 were investigated by polymerase chain reaction-ligation detection reaction methods.Statistical analysis was conducted by SPSS 16.0 software.RESULTS:The results showed that meal duration and the status of glutamic pyruvic transaminase were significantly associated with TCM syndrome differentiation of GC(both P<0.05).None of the four SNPs in the E-cadherin(CDH1)gene achieved significant differences in their distributions among the nine syndrome types of GC(both P>0.05).However,significant differences were observed in rs13689 genotype distributions between several pairs of syndrome types of GC,suggesting that rs13689 is correlated with the syndrome differentiation of GC.CONCLUSION:Integrated analysis of lifestyle,clinical examination and CDH1 gene polymorphisms can contribute to a better understanding of the GC syndrome types and may improve the efficacy of interventions by stratifying disease according to TCM criteria.

Disruptive behavior in the workplace: Challenges for gastroenterology fellows

To assess first-year gastroenterology fellows’ ability to address difficult interpersonal situations in the workplace using objective structured clinical examinations (OSCE).METHODSTwo OSCEs (“distracted care team” and “frazzled intern”) were created to assess response to disruptive behavior. In case 1, a fellow used a colonoscopy simulator while interacting with a standardized patient (SP), nurse, and attending physician all played by actors. The nurse and attending were instructed to display specific disruptive behavior and disregard the fellow unless requested to stop the disruptive behavior and focus on the patient and procedure. In case 2, the fellow was to calm an intern managing a patient with massive gastrointestinal bleeding. The objective in both scenarios was to assess the fellows’ ability to perform their duties while managing the disruptive behavior displayed by the actor. The SPs used checklists to rate fellows’ performances. The fellows completed a self-assessment survey.RESULTSTwelve fellows from four gastrointestinal fellowship training programs participated in the OSCE. In the “distracted care team” case, one-third of the fellows interrupted the conflict and refocused attention to the patient. Half of the fellows were able to display professionalism despite the heated discussion nearby. Fellows scored lowest in the interprofessionalism portion of post-OSCE surveys, measuring their ability to handle the conflict. In the “frazzled intern” case, 68% of fellows were able to establish a calm and professional relationship with the SP. Despite this success, only half of the fellows were successfully communicate a plan to the SP and only a third scored “well done” in a domain that focused on allowing the intern to think through the case with the fellow’s guidance.CONCLUSIONFellows must receive training on how to approach disruptive behavior. OSCEs are a tool that can assess fellow skills and set a culture for open discussion.

Knowledge and Awareness of Breast Cancer among Young Women in the United Arab Emirates

Background: Breast cancer is the most common cancer among females in the United Arab Emirates (UAE). It carries poor prognosis when detected late. Patients usually present at late stages due to lack of awareness of various aspects of breast cancer. Aim: The objective of this study is to gain insight into the level of knowledge of breast cancer among young adult females in UAE. Methods: A cross-sectional study was conducted among females aged 25 to 45. A total of 492 females were selected using a convenience sampling method. Data were collected through an interview-based questionnaire. Frequency distributions and percentages were used to describe the knowledge tested within the questionnaire. Results: The mean age of the participants was 33.5 years. Almost 27% of our participants received a high school degree. The average total knowledge of our population was 51%. The majority (89%) knew that breast cancer is common and 45% knew that it affects ages above forty. The knowledge of signs and symptoms was 53%, and more than half (57%) knew that the most common presenting sign is a breast lump. The knowledge of risk factors was 43%. Almost 94% knew that cancer can be detected early, and 93% knew that early diagnosis improves outcome. The total knowledge of screening methods was 67%. Conclusion: The study revealed that respondents’ knowledge of breast cancer is less than expected. The increased burden of the disease should be accompanied by powerful means of spreading awareness by implementing campaigns that would improve knowledge deficits.

The Chinese Expert Consensus on Evaluation of Coma after Cardiopulmonary Resuscitation

INTRODUCTIONThe prognosis of patients who suffer from coma after cardiopulmonary resuscitation （CPR） may be poor （defined as cerebral performance categories scores from 3 to 5） Thus, an accurate prediction of their neurological outcomes is an essential component of post-cardiac arrest evaluation, especially for decisions to limit or withdraw life-sustaining care. Since the 1960s, a series of domestic and foreign studies began to focus on the evaluation of coma patients after CPR, and considerable progress has been achieved in this field.