A comparison of performance by medical and midwifery students in multiprofessional teaching

AIM: At Dundee University, midwifery and medical students are taught obstetrics together in a 2-week intensive course. We set out to test the hypothesis that staff time and effort could be saved by using shared resources in teaching a multidisciplinary group of students to an acceptable level. METHOD: In order to measure the knowledge gain by two different groups of students, we tested the students before and after a timetabled computer-assisted learning (CAL) session focusing on how to interpret a cardiotocograph (CTG). Also, half of each student group was given extra CTG teaching before the CAL session. RESULTS: The medical students (n=38) increased their median score from 9 to 17 after the CAL (P<0.001) but the midwifery students (n=13) only increased their median score from 12 to 14 after the CAL (n.s.). However, when given a tutorial and CAL, the post-test scores for both medical and midwifery students were similar and significantly higher than pre-test scores (median score increase from 8.5 to 18 for medical students, P<0.001, n=34, and from 9 to 16 for midwifery students, P<0.01 n=11). There was no significant knowledge gain by the medical students who undertook the additional tutorial. CONCLUSION: We conclude that shared resources could be used by medical and midwifery students to reach equivalent levels of skill in CTG interpretation. However, in order to achieve equivalence, staff time and effort was wasted as medical students were given unnecessary tuition.     

How to optimize multiparameter flow cytometry for leukaemia/lymphoma diagnosis

Multiparameter flow cytometry can allow for accurate lineage assignment of leukaemia cell populations in approximately 99% of cases, whereby the emphasis lies in the word 'can'. Despite the fact that the very few markers that are lineage-specific are localized inside the cell (e.g. myeloperoxidase, lactoferrin, cytoplasmic CD3, cytoplasmic CD22), several investigators still shy away from including these essential test elements in their routine panels. Of course, the staining of intracellular antigens requires the added effort of determining optimal conditions. Published suggestions often need to be revised, and cell lines must be used as positive and negative controls. The same holds true for other new and exciting applications of flow cytometry, such as the monitoring of minimal residual disease (MRD) or the establishment of physiological assays (e.g. measuring the activity of drug-efflux pumps). The beauty of-and unfortunately for some, the problem with-multiparameter flow cytometry is that although immunophenotyping by flow cytometry has become a routine approach to the diagnosis of haematological malignancies it is a discipline that is still in development. New antibodies are continually being introduced and new diagnostic and prognostically relevant subtypes are being published in almost every issue of the major scientific journals. It is therefore very important for the flow cytometrist not only to strive for optimal performance of all tests employed but also to keep up with new knowledge and to incorporate it into the interpretation of routine specimens. We owe it to our patients to diagnose their disease accurately and in accordance with accepted standards of interpretation so that the treating physicians can trust immunophenotyping results and act accordingly in the management of their patients.     

Estimating risk and rate levels,ratios and differences in case-control studies

Classic (or 'cumulative') case-control sampling designs do not admit inferences about quantities of interest other than risk ratios, and then only by making the rare events assumption. Probabilities, risk differences and other quantities cannot be computed without knowledge of the population incidence fraction. Similarly, density (or 'risk set') case-control sampling designs do not allow inferences about quantities other than the rate ratio. Rates, rate differences, cumulative rates, risks, and other quantities cannot be estimated unless auxiliary information about the underlying cohort such as the number of controls in each full risk set is available. Most scholars who have considered the issue recommend reporting more than just risk and rate ratios, but auxiliary population information needed to do this is not usually available. We address this problem by developing methods that allow valid inferences about all relevant quantities of interest from either type of case-control study when completely ignorant of or only partially knowledgeable about relevant auxiliary population information.     

"岐黄"考释

成书于战国时期的《黄帝内经》的主要内容以是黄帝、岐伯问答的体裁写成,因而后世即以“岐黄”代称《黄帝内经》。由于《黄帝内经》为中医学奠基之作,至宋代,岐伯与黄帝首次被窦材《扁鹊心书》合称为“岐黄”,并被奉为医学正率之祖,被请进庙堂供奉起来,并开始注入新的含义,不仅仅是岐伯、黄帝二人的简称,而是由此引申为专指正统中医、中医学,当然更多的是是作为中医,中医学的代称,同时,由“岐黄”组合的新词,也各有自己相应的意义。“岐黄之术”、“岐黄之道”,分别指中医学术或医术,中医理论,又“岐黄家”指中医生、中医学家,“岐黄书”指中医书,“岐黄业”指中医行业,等等,由此可见,“岐黄”一词中就蕴含着丰富的中国传统文化。     

超声检查、乳房X线摄影术在乳腺癌筛查和早期诊断中作用的Meta分析

目的评价超声检查(US)、乳房X线摄影术(MAM)及两种方法联合应用对乳腺癌的诊断效能,探讨US在乳腺癌筛查和早期诊断中的作用。方法应用Meta分析方法对有关US、MAM及两种方法联合应用诊断乳腺癌的文献进行定量综合分析,按诊断策略不同分为3组,计算不同诊断方法的合并诊断比值比(DOR),然后绘制出3条综合接受者工作特征(SROC)曲线。结果共纳入8篇文献。超声诊断的合并DOR值为19.10(95%CI为12.62~28.90);MAM诊断的合并DOR值为33.07(95%CI为16.47~66.40);两种方法联合诊断的合并DOR值为78.13(95%CI为27.68~220.59)。SROC曲线分析表明,MAM比US的诊断效能高;MAM与US联合应用,可明显提高乳腺癌诊断的灵敏度,诊断效能最好。结论US对MAM早期诊断乳腺癌起重要的辅助作用。结合我国的实际情况,US可作为定期筛查乳腺癌的首选方法。     

多囊卵巢综合征诊断标准解读

多囊卵巢综合征（PCOS）临床表现呈现高度异质性，诊断和治疗仍存在较多争议，治疗方法的选择也不尽相同。2018年中华医学会妇产科学分会妇科内分泌学组组织国内相关专家制定了中国 “多囊卵巢综合征诊疗指南”，文章就该指南中育龄期女性的诊断标准及依据，结合国外共识及文献作一解读。     

Oral contrast medium in PET/CT: should you or shouldn’t you?

Purpose It has been suggested that the use of computed tomography (CT) positive contrast agents has led to attenuation-induced artefacts on ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET/CT) systems. Consequently, centres may withhold the use of such agents. Whilst there is theoretical evidence to support the aforementioned claim, the clinical relevance of the induced artefacts has not been widely established. Moreover, the potential benefits of bowel enhancement on PET/CT have yet to be formally evaluated. We therefore prospectively examined PET/CT studies to assess whether the use of oral contrast medium induces clinically relevant artefacts and whether the use of these agents is diagnostically helpful.Methods Over a 2-month period, ¹⁸F-FDG PET/CT images were prospectively reviewed from 200 patients following Gastrografin administration 2 h prior to examination. Both a radiologist and a nuclear medicine physician reviewed the images for contrast medium-mediated clinically relevant artefacts. Artefacts were sought on the CT attenuation-corrected images and were compared with the appearance on non-attenuated-corrected images. The number of examinations in which the oral contrast aided image interpretation was also noted.Results There were no oral contrast medium-induced clinically significant artefacts. In 38 of the 200 patients, oral contrast aided image interpretation (owing to differentiation of mass/node from bowel, discrimination of intestinal wall from lumen or definition of the anatomy of a relevant site). In 33 of these 38 patients, the anatomical site of interest was the abdomen/pelvis.Conclusion The use of oral contrast medium in ¹⁸F-FDG PET studies should not be withheld as it improves image interpretation and does not produce clinically significant artefacts.     

Designing Better Radiology Workstations: Impact of Two User Interfaces on Interpretation Errors and User Satisfaction

This paper presents our solution for supporting radiologists interpretation of digital images by automating image presentation during sequential interpretation steps. We extended current hanging protocols with support for stages which reflect the presentation of digital information required to complete a single step within a complex task. We demonstrated the benefits of staging in a user experiment with 20 lay subjects involved in a comparative visual search for targets, similar to a radiology task of identifying anatomical abnormalities. We designed a task and a set of stimuli that allowed us to simulate the interpretation workflow from a typical radiology scenario—reading a chest radiography exam when a prior study is also available. The simulation was enabled by abstracting both the radiologists task and the basic workstation navigation functionality. The staged interface was significantly faster than the traditional user interface, provided a 37% reduction in the interpretation errors, and improved user satisfaction.     

肝脏恶性肿瘤682例手术治疗分析

目的　探讨影响肝脏恶性肿瘤患者手术治疗后长期生存的因素。方法　回顾性分析1989年 1月至 2 0 0 3年 1月施行外科手术治疗的 6 82例肝脏恶性肿瘤患者的临床资料。结果　小肝癌 (直径 <5cm ,n =2 96 )患者术后 3年、5年生存率分别为 (6 1 2 5± 4 4 1) %和 (5 3 84± 5 6 8) % ,巨大肝癌 (直径 >10cm ,n =14 5 )患者术后 3年、5年生存率分别为 (45 90± 6 98) %和 (30 2 1±10 2 3) % ;肿瘤单发患者 (n =4 0 3)术后 3年、5年生存率分别为 (6 1 86± 3 6 9) %和 (5 5 4 0±4 91) % ,肿瘤多发 (2个或 2个以上 )患者 (n =2 4 6 )术后 3年、5年生存率分别为 (38 31± 4 97) %和(2 8 0 1± 6 31) % ;术前肝功能Child分期为Ⅰ期的患者 (n =397)术后 3年、5年生存率分别为 (6 0 6 8± 3 6 8) %和 (5 0 99± 5 10 ) % ,Ⅱ期或Ⅱ期以上的患者 (n =2 85 )术后 3年、5年生存率则为 (43 0 1±5 33) %和 (36 39± 7 5 8) % ;行局部或一段切除的患者 (n =2 98)术后 3年、5年生存率分别为 (6 8 6 5± 4 95 ) %和 (6 5 38± 5 6 9) % ,行两段或两段以上及半肝切除的患者 (n =32 4 )术后 3年、5年生存率分别为 (49 88± 4 13) %和 (37 98± 5 70 ) %。结论　小肝癌     

Children's perception and interpretation of anxiety-related physical symptoms

The present study examined children's perception and interpretation of anxiety-related physical symptoms in a sample of 4-12-year-old primary school children (N = 129). Children were presented with neutral scenarios in which the main character experienced an anxiety-related physical symptom (e.g., hands trembling, heart beating very fast), and asked to attribute various emotions to this character. Children were also interviewed about idiosyncratic experiences with anxiety-related physical symptoms. Results showed that physical symptoms were associated with a broad range of emotions. "Hands trembling", "heart beating fast", and "difficulties with breathing" were the only symptoms that were more frequently linked to fear than to other emotions. Furthermore, developmental patterns were found for fear-related interpretations of physical symptoms. That is, from the age of 7, children more frequently associated physical symptoms to fear. Finally, children reported to experience anxiety-related physical symptoms in daily life, although frequently not in relation to fearful situations and circumstances.