Radiographic study of osteoarthritic elbows in professional basebal pitchers

We examined radiographs of the elbows of the pitching arms of 79 professional baseball pitchers (mean age, 25.1 years; mean duration of professional career, 4.7 years) and noted the frequency and size of spurs, bone fragments, and intra-articular loose bodies according to site. The influence of duration of professional baseball career on these osteoarthritic changes was also investigated. The olecranon tip was the most frequent site of spurs (62/79; 78.5%), and fragmentation of the spur was detected in 17 joints. The frequency of spurs was also high at the medial margin of the olecranon, the tip of the coronoid process, the medial margin of the sigmoid notch, the medial margin of the trochlea and the olecranon fossa. In 38 subjects, spurs were observed at the distal portion of the radial notch of the ulna. However, few pitchers had osteoarthritic changes in the humeral capitellum or radial head. Intra-articular loose bodies were detected in 4 of 79 joints (5.1%), and bone fragments were present below the medial humeral epicondyle in 25 of 79 joints (31.6%). Osteoarthritic changes in the elbow joint appeared to be attributable mainly to traction stress and impingement associated with extension and valgus strain. Significant osteoarthritic changes were often found in professional pitchers whose careers exceeded 5 years.     

The Future of Clinical Psychology: Board Certification

The present article presents the future of clinical psychology board certification. With the increasing specialization in the field of professional psychology and the generic nature of state licensure, clinical psychology as a specialty will develop into a specialty area in a similar fashion as have specialties in medicine. A brief history of board certification in professional psychology by the American Board of Professional Psychology is reviewed and the process of becoming board certified in either clinical psychology or clinical child and adolescent psychology is discussed.     

以培养目标定位医学生核心能力标准

根据社会需要，以Bloom教育目标分类理论为指导，研究和制定医学生培养目标在世界医学教育界日益广泛受到重视。国际医学教育组织以医学生培养目标定位，制定了“全球医学教育最基本要求”的医学生核心能力标准。     

A framework for systematically improving occupational therapy expert opinions on work capacity

Aim:  To present an evidence-based framework to improve the quality of occupational therapy expert opinions on work capacity for litigation, compensation and insurance purposes.
Methods:  Grounded theory methodology was used to collect and analyse data from a sample of 31 participants, comprising 19 occupational therapists, 6 medical specialists and 6 lawyers. A focused semistructured interview was completed with each participant. In addition, 20 participants verified the key findings.
Results:  The framework is contextualised within a medicolegal system requiring increasing expertise. The framework consists of (i) broad professional development strategies and principles, and (ii) specific strategies and principles for improving opinions through reporting and assessment practices.
Conclusions:  The synthesis of the participants' recommendations provides systematic guidelines for improving occupational therapy expert opinion on work capacity.     

Ⅱ型糖尿病病人红细胞免疫功能的研究

通过测定30例糖尿病病人的红细胞免疫功能表明,糖尿病病人的红细胞C_3b受体花环率(RBC-C_3bRR)降低,红细胞免疫复合物花环率(RBC-ICR)及循环免疫复合物(CIC)增高;且CIC与RBC-ICR呈正相关,与RBC-C_3bRR呈负相关.RBC-ICR与RBC-C_2bRR呈负相关.提示糖尿病病人存在红细胞免疫功能低下,可能为继发性改变.     

Eight years'' experience with a structured clinical examination

A structured clinical examination has been an integral component of the final-year examinations conducted by the Departments of Medicine and Surgery at the University of Adelaide for the last 8 years. It has been used as an alternative to the traditional clinical examination. This paper describes the results of ongoing student and examiner surveys carried out to determine their views and satisfaction with this new approach. It also briefly discusses the feasibility of introducing such an examination into a conventional medical school environment. The surveys showed a remarkable level of acceptance and support by both students and examiners. This positive reaction has been maintained over the 8-year period. The main reasons seem to be its perceived relevance and fairness. Students also appear to be directing their learning in a direction thought desirable by teachers. No significant problems have been encountered with the practical implementation of the method.     

Quantitative assessment of diagnostic ability

This paper describes variables critical to diagnostic thinking that are based on research by Bordage and Grant & Marsden on the diagnostic thinking of medical students and experienced doctors. The purpose of the study is to use their findings to develop an inventory of diagnostic thinking. A 56-item diagnostic thinking inventory was initially developed; each item contains a stem followed by a 6-point, semantic differential scale. The inventory is designed to measure two aspects of diagnostic thinking: the degree of flexibility in thinking and the degree of knowledge structure in memory. The specific goal of the study is to determine which items discriminate best between weaker and stronger diagnosticians and to reduce the inventory to only those items which significantly contribute to the overall score. Thirty subjects from nine groups, each representing a distinct phase of medical education and clinical practice, participated, namely first- and third-year clinical medical students, house officers, senior house officers, registrars, senior registrars, consultants, trainees in general practice, and general practitioners, all from the UK (n = 270). Discrimination indices were calculated for each item. The revised version of the inventory contains 41 items. All the subjects found the exercise meaningful and the resulting scores showed variance and discrimination. The inventory will eventually be used to assess individual student's and clinician's diagnostic thinking and to plan ways of improving their diagnostic thinking.     

Head Start Teaching Center: Differential Training Effects for Head Start Personnel

Driven by research findings regarding the positive relationship between training and enhancement of services, as well as literature on adult learning, the New England Head Start Teaching Center (NEHSTC) was created in 1992 to test the efficacy of participatory, hands-on training. The purpose of this paper is to examine the outcome evaluation results from 4 years of training at the NEHSTC, 1 of 14 federally funded sites, as well as to discuss the implications for delivering this type of participatory training throughout Head Start. Findings suggest that the NEHSTC was successful in implementing high quality, participatory training within the context of an ongoing Head Start program. Head Start staff who participated in the NEHSTC trainings demonstrated gains in knowledge, skills, and expertise compared to similar Head Start employees who did not receive training. Results also reveal a sustained effect of training over time, with NEHSTC participants continuing to demonstrate enhanced knowledge and skills 6 months after training. Similar positive outcomes of training were found for staff with varying levels of experience and holding different Head Start positions. Thus the participatory, hands-on training implemented by the NEHSTC was found to produce positive and lasting outcomes for diverse Head Start staff. An effective and cost efficient model of training Head Start personnel is particularly relevant and timely as Head Start strives to establish universal quality and expansion of services in the 21st Century. The findings are also relevant for improving the quality of all early care and education programs.     

Clinical problem-solving using video simulation: an investigation

This paper examines the use of videotape simulation as a research method for the exploration of clinical problem-solving, the challenges posed and the strategies employed to overcome the difficulties encountered are discussed. The simulation forms part of a larger comparative study of outcomes of pre-registration nurse education programmes, commissioned by the English National Board for Nursing, Midwifery and Health Visiting.