Reliability and validity of the direct observation clinical encounter examination (DOCEE)

CONTEXT: The College of Medicine and Medical Sciences at the Arabian Gulf University, Bahrain, replaced the traditional long case/short case clinical examination on the final MD examination with a direct observation clinical encounter examination (DOCEE). Each student encountered four real patients. Two pairs of examiners from different disciplines observed the students taking history and conducting physical examinations and jointly assessed their clinical competence. OBJECTIVES: To determine the reliability and validity of the DOCEE by investigating whether examiners agree when scoring, ranking and classifying students; to determine the number of cases and examiners necessary to produce a reliable examination, and to establish whether the examination has content and concurrent validity. SUBJECTS: Fifty-six final year medical students and 22 examiners (in pairs) participated in the DOCEE in 2001. METHODS: Generalisability theory, intraclass correlation, Pearson correlation and kappa were used to study reliability and agreement between the examiners. Case content and Pearson correlation between DOCEE and other examination components were used to study validity. RESULTS: Cronbach's alpha for DOCEE was 0.85. The intraclass and Pearson correlation of scores given by specialists and non-specialists ranged from 0.82 to 0.93. Kappa scores ranged from 0.56 to 1.00. The overall intraclass correlation of students' scores was 0.86. The generalisability coefficient with four cases and two raters was 0.84. Decision studies showed that increasing the cases from one to four improved reliability to above 0.8. However, increasing the number of raters had little impact on reliability. The use of a pre-examination blueprint for selecting the cases improved the content validity. The disattenuated Pearson correlations between DOCEE and other performance measures as a measure of concurrent validity ranged from 0.67 to 0.79. CONCLUSIONS: The DOCEE was shown to have good reliability and interrater agreement between two independent specialist and non-specialist examiners on the scoring, ranking and pass/fail classification of student performance. It has adequate content and concurrent validity and provides unique information about students' clinical competence.     

A case of renal leiomyoma with remarkable calcification

A case of renal leiomyoma with remarkable calcification is reported. The patient is a 46-year-old female. The tumor is 9 x 10 x 12 cm in size and is occupied by granular minute calcifications. Angiographically segmental arteries are stretched by a tumor, in which there are minute tumor vessels and inhomogeneous tumor stain.     

新式剖宫产术的改良及临床观察(附632例临床分析)

目的:探讨剖宫产术式的进一步改良,寻求更安全、更优越的手术方式。方法:对632例足月妊娠具有手术指征的产妇分别采用改良式剖宫产及子宫下段剖宫产术,观察手术时间、出血量、娩头难易、术后排气时间、术后病率、切口愈合、母乳喂养、恶露干净时间,并进行比较。结果:改良式剖宫产较子宫下段剖宫产手术时间明显缩短(P<0·01),出血量明显减少(P<0·01),术后排气早(P<0·01),切口甲级愈合率达99·30%,纯母乳喂养率高(P<0·05),产后恶露干净所需时间短(P<0·05)。结论:剖宫产术式可不断改良,使其更易于被接受,并可在临床上推广使用。     

First clinical case of tick-borne encephalitis (TBE) in a dog in Greece

Tick-borne encephalitis virus (TBEV) causes tick-borne encephalitis (TBE), affecting human health in Europe and Asia. Reports on canine clinical cases of TBE are rare, although dogs are used as sentinels for assessing human health risks. The first canine clinical TBE case in Greece is reported in this case report. The dog had a history of tick infestation and displayed neurological symptoms, particularly tetraparesis, neck hyperalgesia, and a sudden behavior change. Serum samples were obtained and examined in a commercial ELISA to detect anti-TBEV specific IgG and IgM antibodies. The dog tested seropositive for both IgG and IgM, and based on its history and compatible clinical signs, the diagnosis of TBE infection was reached. The prognosis was initially poor, and treatment included the administration of fluids, corticosteroids, and antibiotics, followed by physical therapy. After a 10-day hospitalization, the dog had a much better prognosis. This case highlights that TBEV does emerge in new locations, increasing human and animal infection risk. Veterinarians should include TBE in their differential diagnosis of canine patients with a history of tick infestations, progressive neurological symptoms, and abnormal behavior.     

Early termination of clinical trials with prolonged observation of individual patients: a case study

Stopping rules for a placebo controlled clinical trial of anticoagulants after acute myocardial infarction were evaluated by means of computer simulation for the case of five interim analyses. The trial will be terminated and the null hypothesis of no treatment effect rejected when the one-sided P-value (logrank test) is lower than 0.005, 0.005, 0.005, 0.014, and 0.023 at the respective interim analyses, and 0.032 at final evaluation. This implies a total size alpha = 0.05 and a power close to that of fixed sample size testing. The trial will also be terminated, without rejecting the null hypothesis, when the one-sided P-value exceeds 0.95, 0.88, 0.81, 0.74, and 0.67 at the respective interim analyses. This modification hardly affects size and power.     

CT（X线）球管的原理、使用和养护

目前CT影像已成为现代医院不可缺少的常规诊断技术,其核心装置CT球管是成本最高的耗材,因此系统了解CT球管的原理,正确掌握其使用方法和常见故障,精心养护延长其使用寿命是极为有意义的工作.     

A case study using the Discipline with a clinical team

Health care delivery in hospitals and clinics promotes an interdisciplinary team approach. This article presents the use of The Discipline though the involvements of the chaplain as part of the Infectious Disease team as together they addressed the inherent spirituality of one HIV/AIDS patient. This narrative recounts the unfolding events of the patient's life and describes the use of The Discipline during a very difficult time period for the patient and the staff. The experience can serve as a model for other health care teams who must manage difficult, deteriorating patients.     

氟尿嘧啶(5-FU)及亚叶酸钙(LV)联合奥沙利铂治疗胃癌26例的临床观察

目的：观察奥沙利铂（L—OPH）联合氟尿嘧啶（5-FU）及亚叶酸钙（LV）治疗术后胃癌的疗效和不良反应。方法：26例胃癌术后患者,采用奥沙利铂（L—OPH）联合氟尿嘧啶（5-FU）及亚叶酸钙（LV）方案治疗,每月重复1次,治疗3个周期后评价疗效。结果：26例患者中,完全缓解3例（11．5％）,部分缓解18例（69．2％）,近期有效率80．8％。主要不良反应为恶心、乏力、感觉神经毒性和腹泻,无化疗相关死亡。结论：奥沙利铂（L—OPH）联合氟尿嘧啶（5-FU）及亚叶酸钙（LV）方案治疗胃癌疗效显著,安全性高,不良反应经处理后均可耐受,无严重不良反应发生,可作为一种供选择方案。