Analysis of PR subintervals in normal subjects and early studies in patients with abnormalities of the conduction system using surface His bundle recordings

Utilizing several different approaches to noise reduction, satisfactory beat by beat His bundle activity was recorded from the chest surface in 41 (80%) of 52 normal subjects. Surface atrial to His intervals (PAH) and His to ventricular intervals (HV) were measured in this group and compared with subintervals of the PR segment recorded endocardially from 47 persons with normal electrophysiologic findings. A recent modification in the selection algorithm allows on-line identification of the four of five possible recording sites for utilization in a spatial summation. The ability to record in less favorable circumstances has been improved to the extent that records of suitable clarity for measurement were also obtained in 17 (77%) of 22 individuals with conduction system abnormalities. Comparison of the surface and endocardially acquired data in the normal group reveals no statistically significant difference in the surface acquired PAH and endocardially acquired high right atrial to His (HRAH) intervals, nor in the HV intervals. In a small subset of patients data were acquired by both techniques and no significant differences were found. Thus, when programmed stimulation or endocardial mapping is not required to answer specific clinical questions, in the majority of persons it is possible to record meaningful subintervals from the body surface from each cardiac cycle. Additionally, in instances in which surface P wave activity is obscure in the routine electrocardiogram, this technique enhances atrial electrical activity.     

计算机模拟病例考试应用研究

计算机模拟病例是新近开展的现代医学考试方法,它提供了对诊疗环境的比较真实的模拟,具有很高的表面效度和内容效度.经过5年的应用和统计学分析表明,计算机模拟病例考试与其他现有的考试方法存在着较弱的相关,主要针对考生的临床诊疗思维和制订医疗决策的能力进行评价,难度较高而区分度较好,但是由于存在病例内容依赖性,应该使用较多的计算机模拟病例考站,或者作为综合考试的一部分,才能保证考试的有效性.     

Impact of the Endoscopic Sinus Surgical Simulator on Operating Room Performance

Objectives/Hypothesis The aim of this study is to evaluate an endoscopic sinus surgical simulator (ESS) as a training device and to introduce a methodology to assess its impact on actual operating room performance. Study Design Prospective evaluation of the endoscopic sinus surgical simulator as a trainer. Methods Ten junior and senior ear, nose and throat residents served as subjects, some of whom had prior training with the simulator. The evaluation team collected several measures, which were analyzed for a statistical correlation, including simulator scores, operating room performance rating, ratings of videotaped operating room procedures, and surgical competency rating. Results These findings suggest the ESS simulator positively affects initial operating room performance across all measures as judged by senior surgeons rating anonymous videotapes of those procedures. The two simulation‐trained residents were rated consistently better than the other two residents across all measures. These differences approached statistical significance for two items: anterior ethmoidectomy (P = .06;P <.05) and surgical confidence (P = .09;P <.05). In addition, the 3 subjects with the highest overall scores on the competency evaluation also had 3 of the 4 highest cumulative simulation times. Conclusions The endoscopic sinus surgical simulator is a valid training device and appears to positively impact operating room performance among junior otolaryngology residents.     

道家认知疗法治疗脑卒中后抑郁的临床研究

目的观察道家认知疗法对脑卒中后抑郁的疗效以及对神经功能康复的影响。方法采用随机对照实验,道家认知疗法合并抗抑郁剂为研究组,单独抗抑郁剂治疗为对照组。在治疗前及治疗后不同时间点观察脑卒中后抑郁患者抑郁症状改善程度及神经功能恢复情况。结果治疗1个月时,研究组HAMD、MESSS及ADL分别为6.48±2.66、14.29±3.93、33.94±4.34,与对照组得分8.13±3.11、17.61±4.01、40.48±3.89相比,差异具有统计学意义(P<0.05);治疗6个月时,研究组HAMD、MESSS及ADL分别为6.93±3.47、10.21±4.69、26.89±4.76,与对照组得分10.54±3.39、13.74±3.17、33.5±3.89相比,差异具有统计学意义(P<0.01);治疗后随访6个月时,研究组HAMD、MESSS及ADL分别为9.23±4.63、8.92±2.49、25.5±3.70,与对照组得分12.81±4.94、13.48±3.54、33.09±5.49相比,差异具有统计学意义(P<0.05),研究组患者抑郁症状改善程度及神经功能恢复均好于对照组。结论道家认知疗法合并抗抑郁剂治疗脑卒中后抑郁优于单独应用抗抑郁剂。     

人格特征对陆军学院学员胜任特征的预测

目的：探讨陆军学院学员胜任特征与人格特征的关系．方法：陆军学院339名学员完成中修订版《MBTI人格类型量表》测验，并采用陆军学院学员胜任特征模型评价量表对其进行评价，进行MBTI人格维度与胜任特征模型评价条目间的相关分析，并比较胜任特征评价优秀组与差组在各人格维度得分上的差异．结果：MBTI人格维度与胜任特征模型评价条目间存在显性相关(P＜0．05)，胜任特征评价优秀组与差组在MBTI4个人格维度得分上存在显性差异(P＜0．05)，优秀组具有外倾、感觉、对事、判断型的人格特征．结论：MBTI人格类型量表对陆军学院学员胜任特征有较好的预测性．     

Adequacy of Online Medical Command Communication and Emergency Medical Services Documentation of Informed Refusals

Background: In the out‐of‐hospital setting, when emergency medical services (EMS) providers respond to a 9‐1‐1 call and encounter a patient who wishes to refuse medical treatment and/or transport to the hospital, the EMS providers must ensure the patient possesses medical decision‐making capacity and obtain an informed refusal. In the city of Cleveland, Ohio, Cleveland EMS completes a nontransport worksheet that prompts the paramedics to evaluate specific patient characteristics that can influence medical decision‐making capacity and then discuss the risks of refusing with the patient. Cleveland EMS then contacts an online medical command (OLMC) physician to authorize the refusal. OLMC calls are recorded for review. Objectives: To assess the ability of EMS to determine medical decision‐making capacity and obtain an informed refusal of transport. Methods: This study was a retrospective review of a cohort of recorded OLMC refusal calls and of the accompanying written documentation by Cleveland EMS. The completeness of the verbal communication between the paramedic and OLMC physician and the written documentation on the nontransport worksheet were measured as surrogate markers of the adequacy of determining medical decision‐making capacity and obtaining an informed refusal. Results: One hundred thirty‐seven OLMC calls for patient‐initiated refusals were reviewed. Vital signs and alertness/orientation were verbally communicated more than 83% of the time. The presence of head injury, presence of alcohol or drug intoxication, and presence of hypoglycemia were verbally communicated less than 31% of the time. Verbal communication stating that the risks of refusing had been discussed with the patient occurred 44.5% of the time. The written documentation of the refusal encounter was more complete, exceeding 95% for vital signs and alertness/orientation, and exceeding 80% for the remaining patient characteristics. The rate of written documentation that the risks of refusing had been discussed with the patient was 48.7%. Discrepancies between the verbal and written paramedic reports were clinically insignificant. Conclusions: Paramedic and OLMC physician communication for patients refusing out‐of‐hospital medical treatment and/or transport is inadequate in the Cleveland EMS system. A written nontransport worksheet improves documentation of the refusal encounter but does not ensure that every patient who refuses possesses medical decision‐making capacity and the capacity to provide an informed refusal.     

Hydatid disease of the liver

Twenty cases of hyadatid disease of the liver are described. The clinical manifestations of hydatid cyst of the liver and diagnostic procedures such as ultrasound and computerized axial tomographic scan of the liver are presented. In the last 10 cases, aspiration of hydatid fluid without opening the exocyst initially reduced the incidence of complications significantly. The application of a vacuum suction to the exocyst postoperatively enhances liver regeneration.     

A method for rapid scoring of respiratory tumors in hamsters

The larynx, trachea, and lung of Syrian golden hamsters treated with diethylnitrosamine were stained with modified Wright's stain and rendered semitransparent by a clearing technique. Areas of dense cell aggregation (tumors) were readily observable under a dissecting microscope. Tumor scoring at this subgross level correlated with subsequent microscopic evaluation, except that several tumors were found on the subgross level which would not have been observed during routine histologic procedures. The clearing method was used successfully to discern differences in tumor incidence in a dose-response study with diethylnitrosamine.     

A study of factors associated with the ability to maintain weight loss.

The purpose of this study was to determine whether it is possible to predict which patients will have the most success in maintaining weight loss following an in-hospital weight reduction program. Subjects included 175 severely obese women who elected hospitalization for 3 weeks while they participated in a weight reduction program (average loss, 15 pounds). They were followed for 18 to 24 months after discharge. During hospitalization the women were studied intensively, and factors associated with the etiology of obesity were measured. The Minnesota Multiphasic Personality Inventory (MMPI) and Michill Adjective Rating Scale (MARS) psychological tests were used along with a comprehensive history questionnaire containing questions on many factors implicated in the etiology of obesity, including weight history, medical history, eating habits, obesity of family members, and demographics. Of the 89 factors examined, only 3 were found to be significantly related to an ability to maintain weight loss following discharge: the Control and Responsibility scales of the MMPI and a combination of number of meals a day and time of strong appetite. These factors, though statistically significant, were not adequate to predict which women would be able to maintain weight loss. The lack of importance of a large number of common etiologic factors in predicting weight loss suggests that future studies should concentrate on determining what etiologic factors change in subjects losing weight and what factors enable these subjects to make the necessary changes.     

Objective Structured Clinical Examinations (OSCEs) compared with traditional assessment methods

Objectives. To compare objective structured clinical examinations (OSCEs) and traditional assessment methods among recent pharmacy graduates.Methods. Individual student performance in OSCEs was compared with performance on traditional pharmacy-practice examinations at the same level of program study.Results. A moderate correlation was found between individual attainment in OSCE examinations and on traditional pharmacy practice examinations at the same level.Conclusions. OSCEs add value to traditional methods of assessment because the 2 evaluation methods measure different competencies.