Blended learning in radiology: is self-determined learning really more effective?

Objective To investigate whether there are differences in learning outcomes after the application of self-determined (intrinsic motivation) or mandatory (extrinsic motivation) use of e-learning units in an undergraduate radiology internship.Methods 96 medical students undergoing a one-week radiology internship were included in this study. Ten electronic cases (e-cases) were created for a blended learning approach. The e-learning environment was accessed on a self-determined (group B; n = 32) or a mandatory basis (group C; n = 32). A group without access to the e-learning environment served as control group (group A; n = 32). Usage parameters of the e-cases were recorded. Results of a pre- and post-course assessment were used to quantitatively analyze learning outcomes.Results In group B 19/32 (59%) students processed at least one e-case, while in group C all students processed at least one e-case. There was a trend towards a higher improvement in knowledge in students exposed to a blended learning approach (group B: 13.7%; group C: 15.4%) than in the control group (group A: 8.5%; p = 0.5356). Group C processed (p = 0.0093) and passed (p = 0.0078) significantly more e-cases, than with group B. There were no significant differences in the mean time per e-case and the total time on e-cases between both groups.Conclusion Extrinsic motivation results in a more extensive use of e-learning units in an undergraduate radiology internship when compared with intrinsic motivation. The choice of the teaching strategy has a bigger influence on learning outcomes than the type of motivation, highlighting the need for qualified medical teachers.     

Mammography: will adequate manpower exist?

Data exist that clearly demonstrate the dominant role of screening mammography in breast cancer mortality reduction with an ever-increasing population of women who are eligible to receive the benefits of screening. The critical question now concerns the current and future availability of those who perform and interpret these life-saving examinations.     

ACL injury prevention, more effective with a different way of motor learning?

Purpose  

What happens to the transference of learning proper jump-landing technique in isolation when an individual is expected to perform at a competitive level yet tries to maintain proper jump-landing technique? This is the key question for researchers, physical therapists, athletic trainers and coaches involved in ACL injury prevention in athletes. The need for ACL injury prevention is clear, however, in spite of these ongoing initiatives and reported early successes, ACL injury rates and the associated gender disparity have not diminished. One problem could be the difficulties with the measurements of injury rates and the difficulties with the implementation of thorough large scale injury prevention programs. A second issue could be the transition from conscious awareness during training sessions on technique in the laboratory to unexpected and automatic movements during a training or game involves complicated motor control adaptations. The purpose of this paper is to highlight the issue of motor learning in relation to ACL injury prevention and to post suggestions for future research.     

Science in the courtroom: is there,and should there,be a better way?

Abstract

Justice Stephen Breyer of the US Supreme Court once wrote: ’In this age of science, science should expect to find a warm welcome, perhaps a permanent home, in our courtrooms… Our decisions should reflect a proper scientific and technical understanding so that the law can respond to the needs of the public.’ That was nearly two decades ago. The ‘welcome’ science receives in our courtrooms has been at times controversial for at least a century, if not more, and is still problematic, difficult and often contentious. Balancing the victim’s and the community’s interest in the detection and punishment of crime, the defendant’s right to a fair trial, and the state’s interest in a fair, accessible and just judicial system, all make the entry of the world of science in our courtrooms, and the use of science by fact-finders and tribunals, a fundamental and continuing question that needs continually to be addressed and answered in our courts. As another American Judge once said: ‘You are going to be playing in my ballpark and by my rules …’. Is there, and should there, be a better way?     

Real-Time Sonoelastography Performed in Addition to B-Mode Ultrasound and Mammography: Improved Differentiation of Breast Lesions?

RATIONALE AND OBJECTIVES: The goal of the present study was to compare the sensitivity and specificity of elastography with that of B-mode ultrasound (US) and mammography. MATERIALS AND METHODS: A total of 300 patients with histologically confirmed breast lesions (168 benign, 132 malignant) were included. Evaluation was by means of the three-dimensional finite-element method. The data are color-coded and superimposed on the B-mode US scan. The images were evaluated by two independent readers. The results were compared with mammography, histology, and the data obtained by previous US investigations. Sensitivities and specificities were calculated. RESULTS: Sensitivity and specificity in the differentiation of benign and malignant lesions were 87% and 85%, respectively, for mammography and 94% and 83% for B-mode US. The two examiners were in very good agreement in their evaluation of the elastograms (kappa: 0.86). Elastography had a sensitivity of 82% and a specificity of 87%. Elastography was superior to B-mode US in diagnosing Breast Imaging Reporting and Data System (BI-RADS) 3 lesions (92% vs. 82% specificity) and in lipomatous involution (80% vs. 69% specificity). CONCLUSION: Elastography in breast lesions showed a higher specificity and a lower sensitivity in comparison with B-mode sonography. Elastography may be beneficial in BI-RADS 3 lesions and in lipomatous involution.     

Digital Mammography: Are There Advantages in Screening for Breast Cancer?

The clinical trials to date have demonstrated the overall diagnostic accuracy of DM is equivalent to that of SFM for breast cancer screening. However, DM has higher diagnostic accuracy in specific patient populations (ie, women younger than 50 years of age and those with heterogeneously dense or extremely dense breasts). Whether this would result in an improvement in long-term outcomes for patients has yet to be determined. The US studies did not demonstrate a statistically significant difference in recall rates. However, the two European trials did demonstrate higher recall rates for DM. The overall recall rates for both DM and SFM were higher in the US studies than in the European trials, which likely reflect a difference in the medico-legal environments. However, despite a lack of substantially improved diagnostic accuracy in the screening population, DM has much potential for advanced applications. Some of the applications, such as telemammography, may improve the ability to deliver expert interpretation and care to underserved populations. Contrast-enhanced DM and tomosynthesis may improve diagnosis of breast cancer.     

Femoroacetabular impingement: is hyaluronic acid effective?

Purpose

Femoroacetabular impingement may predispose to the development of hip osteoarthritis. Conservative treatments are effective in the short term, but surgery is often required. Aim of this paper was to report the short-term results on hip pain and function after ultrasound-guided injections of hyaluronic acid.

Methods

In this open prospective trial, twenty patients suffering from mild femoroacetabular impingement were enrolled. Each patient received a 2-ml intra-articular ultrasound-guided injection of hyaluronic acid at baseline and after 40 days; the same dosing schedule was repeated after 6 months. The clinical evaluation was performed at baseline and after 6 and 12 months of follow-up. Pain score, Lequesne Index, Harris Hip Score and anti-inflammatory medication consumption were measured. Adverse events were also registered.

Results

Twenty-three hips (3 bilateral cases) were treated. Pain decreased from 6.7 ± 1.3 to 3.7 ± 1.8 and to 1.7 ± 1.8 after 6 and 12 months, respectively; Lequesne Index was reduced and the mean Harris Hip Score improved from 83.3 ± 6 before treatment to 88.2 ± 4.7 at 12 months. Consumption of anti-inflammatory drugs was also reduced, from 14 to 4 subjects and from 3.6 ± 2.2 to 1.3 ± 1.3 tablets/week. Local side effects after injection were observed only in 2 cases.

Conclusions

Hyaluronic acid is safe and effective in the treatment of mild femoroacetabular impingement, with significant pain reduction and function improvement.

Level of evidence

IV.     

Is it more effective for highly trained swimmers to live and train at 1200?m than at 1850?m in terms of performance and haematological benefits?

Objectives

The effects of living and training have not been compared at different altitudes in well trained subjects.

Methods

Nine international swimmers lived and trained for 13 days similarly at 1200 m (T1200) and 1850 m (T1850). The two altitude training periods were separated by six weeks of sea level training. Before and after each training trip, subjects performed, at an altitude of 1200 m, an incremental exercise test to exhaustion of 5 × 200 m swims and a maximal test over 2000 m.

Results

There was no difference in V̇o₂max after each training trip: the before values were 58.5 (5.6) and 60.4 (6.7) ml/kg/min and the after values were 56.2 (5.2) and 57.1 (4.7) ml/kg/min for T1200 and T1850 respectively. The 2000 m performance had improved during T1200 (1476 (34) to 1448 (45) seconds) but not during T1850 (1458 (35) v 1450 (33) seconds). Mean cell volume increased during T1850 (86.6 (2.8) to 88.7 (2.9) µm³) but did not change during T1200 (85.6 (2.9) v 85.7 (2.9) µm³). The proportion of reticulocytes decreased during T1200 (15.2 (3.8)% to 10.3 (3.4)%) and increased during T1850 (9.3 (1.6)% to 11.9 (3.5)%).

Conclusions

The short term effects of 13 days of training at 1200 m on swimming performance appear to be greater than the same type of training for the same length of time at 1850 m. As mean cell volume and proportion of reticulocytes only increased during training at 1850 m, the benefits of training at this altitude may be delayed and appear later on.     

Image-guided radiofrequency ablation of hepatocellular carcinoma (HCC): Is MR guidance more effective than CT guidance?

Objectives

The purpose of the study was to retrospectively compare technique effectiveness of computed tomography (CT)-guided versus magnetic resonance (MR)-guided radiofrequency (RF) ablation of hepatocellular carcinoma (HCC).

Materials and methods

In 35 consecutive patients 53 CT-guided (n = 29) or MR-guided (n = 24) ablation procedures were performed in the treatment of 56 (CT: 29; MR: 27) HCC. The entire ablation procedure was performed at a multislice CT-scanner or an interventional 0.2-Tesla MR-scanner. Assessment of treatment response was based on dynamic MR imaging at 1.5 Tesla. The mean follow-up was 22.9 months. Primary technique effectiveness was assessed 4 months after ablation therapy. Secondary technique effectiveness was assessed 4 months after a facultative second ablation procedure. Primary and secondary technique effectiveness of CT-guided and MR-guided RF ablation was compared by using Chi-Square (likelihood ratio) test.

Results

Primary technique effectiveness after a single session was achieved in 26/27 (96.3%) HCC after MR-guided RF ablation and 23/29 (79.3%) HCC after CT-guided RF ablation (Chi-Square: p = 0.04). Secondary technique effectiveness was achieved in 26/27 (96.3%) HCC after MR-guided RF ablation and in 26/29 (89.7%) HCC after CT-guided RF ablation (Chi-Square: p = 0.32). A local tumor progression was detected in 8/52 (15.4%) tumors after initial technique effectiveness. Major complications were detected after 3/53 (5.7%) ablation procedures.

Conclusions

CT-guided and MR-guided RF ablations are locally effective therapies in the treatment of HCC. Due to a higher rate of primary technique effectiveness MR-guided RF ablation may reduce the number of required sessions for complete tumor treatment.     

Communicating Mammography Results: By What Method and How Quickly Do Women Want Their Screening Mammogram Results?

The purpose of the survey study was to understand the majority preference with regards to the wait time for screening mammogram results, whether prompt communication of mammogram results was of importance to patients, whether the time frame to schedule an additional imaging follow-up appointment after an abnormal screening mammogram was important to patients, and how patients preferred to be given their screening mammogram results. There were 2,245 patients who participated in the survey. A majority of patients preferred to receive screening mammogram results on Friday (n = 1,868, 85.4%), even if their mammogram was abnormal, requiring a follow-up appointment that could not be scheduled until the following week. Most individuals preferred to schedule their follow-up appointments soon after their initial appointment, preferring either the next day or within 1 to 2 days. Finally, over half of the sample preferred to be contacted via a telephone call, with letter and text messaging being the next most preferred methods and e-mail being the least preferred. Survey results suggest that the preferred wait time for screening mammogram results was either to wait at the time of screening mammogram appointment or to receive results within 48 hours. These suggestions can help clinics and providers make changes to how they communicate screening mammogram results. The strong preference of patients receiving their screening mammogram results more promptly should help trigger alternative methods toward improving communication between the radiologist and the patient.