A practical guide to using the World Federation for Medical Education standards. WFME 2: educational program

Background  

Preparing a medical school for institutional review of all aspects of the school’s programs requires an understanding of the international standards being used and adequate preparation and planning (MacCarrick et al. in Med Teach 32(5):e227, 2010; MacCarrick in Ir J Med Sci, 2010). This series examines each of the nine standards developed by the World Federation for Medical Education (WFME) (World Federation for Medical Education in Basic medical education WFME global standards for quality improvement, WFME Office, University of Copenhagen, Denmark, 2003) with practical advice on their use in both self-review and independent accreditation processes.     

What has happened to people affected by thalidomide 50 years on?

Introduction  

There have been reports of thalidomide-affected people suffering a deterioration in their disability over time [1, 2]. This study assessed changes in disabilities among thalidomide-affected people in the Irish population.     

Melanoma of unknown origin: a case series

Introduction  

The natural history of metastatic melanoma involving lymph nodes, in the absence of a known primary site (cutaneous, ocular or mucosal) has, to date, been poorly defined; and the optimal management of this rare subtype of disease is therefore unclear. Melanomas of unknown primary site (MUP) are estimated to comprise between 3.7 and 6% of all melanomas (Anbari et al. in Cancer 79:1861–1821, 1997).     

A practical guide to using the World Federation for Medical Education Standards. WFME 3: assessment of students

Background  

Preparing a medical school for institutional review of all aspects of a medical school’s programs requires an understanding of the international standards being used and adequate preparation and planning (MacCarrick et al. in Med Teach 32 (5):e227, 2010). This series examines each of the nine standards developed by the World Federation for Medical Education (World Federation for Medical Education Basic Medical Education WFME Global Standards for Quality Improvement. WFME Office: University of Copenhagen, Denmark, 2003) with practical advice on their use in both self-review and independent accreditation processes.     

Patterns of participation of patients in cancer clinical trials in Ireland

Background  In the United States the overall participation in cancer clinical trials (CCT) is less than 3% [Avis et al. in J Clin Oncol 24:1860–1867 (2006); Lara et al. in J Clin Oncol 19:1728–1733 (2001)]. In Europe there is little data on participation in such trials. Aim  We aim to gather information on factors influencing CCT enrolment in Ireland. Methods  From November 2005 to 28 February 2006 all consecutive patients considered for systemic therapy were assessed for eligibility re participation in available CCTs. Results  A total of 290 patients were included. Overall 2.4% of patients were recruited to one of the available CCTs. The main reasons for failure of trial recruit were: no trial for cancer type (60%), no trial for stage (21%), ineligible by trial criteria (16.1%), patient declined (0.3%), and physician discretion (2.6%). Only one patient, who was otherwise eligible, declined entry into a clinical trial. Conclusions  Irish patients with cancer are very willing to participate in CCTs. Current levels of recruitment compare favourably with international levels. Presented in part for a poster presentation at the 31st European Society of Medical Oncology (ESMO) congress. Poster number 619. Annals of Oncology 17 (Supplement 9): ix191, 2006. The Cancer Centre Beaumont Hospital is affiliated to NSABP, ECOG, ICORG, HRB.     

Pneumococcal meningitis: clinical outcomes in a pre-vaccine era at a Dublin paediatric hospital, 1999–2007

Aim  

To document the long-term outcomes of pneumococcal meningitis in children presenting to a Dublin paediatric hospital in the pre-pneumococcal conjugate vaccine (PCV7) era (1998–2007).     

J Wave Syndromes: A Decade of Progress

Objective:

The objective was to provide a brief history of J wave syndromes and to summarize our current understanding of their molecular, ionic, cellular mechanisms, and clinical features. We will also discuss the existing debates and further direction in basic and clinical research for J wave syndromes.

Data Sources:

The publications on key words of “J wave syndromes”, “early repolarization syndrome (ERS)”, “Brugada syndrome (BrS)” and “ST-segment elevation myocardial infarction (STEMI)” were comprehensively reviewed through search of the PubMed literatures without restriction on the publication date.

Study Selection:

Original articles, reviews and other literatures concerning J wave syndromes, ERS, BrS and STEMI were selected.

Results:

J wave syndromes were firstly defined by Yan et al. in a Chinese journal a decade ago, which represent a spectrum of variable phenotypes characterized by appearance of prominent electrocardiographic J wave including ERS, BrS and ventricular fibrillation (VF) associated with hypothermia and acute STEMI. J wave syndromes can be inherited or acquired and are mechanistically linked to amplification of the transient outward current (I_to)-mediated J waves that can lead to phase 2 reentry capable of initiating VF.

Conclusions:

J wave syndromes are a group of newly highlighted clinical entities that share similar molecular, ionic and cellular mechanism and marked by amplified J wave on the electrocardiogram and a risk of VF. The clinical challenge ahead is to identify the patients with J wave syndromes who are at risk for sudden cardiac death and determine the alternative therapeutic strategies to reduce mortality.     

Initial experience with lingual mucosal graft urethroplasty for anterior urethral strictures

Background

To present the feasibility of lingual mucosal graft urethroplasty in anterior urethral strictures and appraisal of donor site morbidity.

Methods

From November 2007 to December 2010, 14 patients underwent dorsal onlay lingual mucosal graft urethroplasty for anterior urethral strictures. Lingual mucosal graft was harvested from the lateral and undersurface of the tongue. Check micturating cystourethrograms were done 2 weeks after catheter removal and uroflowmetry after 3 months. Success was defined as normal uroflowmetry rates at 3 months in the absence of any postoperative instrumentation. Tongue was assessed for any residual pain, taste disturbances or restricted movement at 3 months.

Results

Four patients had submucosal fibrosis of the oral cavity and their buccal mucosa was unfit for grafting. Mean (range) stricture length was 5 (3–16) cm and the operation time 170 (140–210) min. Graft width averaged 1.6 cm. Average length of harvested graft was 6.5 cm. Mean duration of follow-up was 12.8 months. Two patients developed stricture at the proximal anastomotic site. There were no donor site complications.

Conclusions

Lingual mucosal graft harvesting is simple, gives graft lengths comparable to buccal mucosa and is associated with negligible donor site morbidity.     

Governance and Performance: The Performance of Dutch Hospitals Explained by Governance Characteristics

This paper describes the efficiency of Dutch hospitals using the Data Envelopment Analysis (DEA) method with bootstrapping. In particular, the analysis focuses on accounting for cost inefficiency measures on the part of hospital corporate governance. We use bootstrap techniques, as introduced by Simar and Wilson (J. Econom. 136(1):31–64, 2007), in order to obtain more efficient estimates of the effects of governance on the efficiency. The results show that part of the cost efficiency can be explained with governance. In particular we find that a higher remuneration of the board as well as a higher remuneration of the supervisory board does not implicate better performance.     

2nd Annual HIV and AIDS and Nutrition Research Dissemination Conference: Abstracts from symposiom held at College of Medicine in January 2007

Objective

Compare the effectiveness of 2 supplementary foods, ready-touse therapeutic food (RUTF) and corn/ soy blend (CSB), given to wasted patients beginning the standard ART protocol, in improving the nutritional and clinical outcomes after 3.5 months.

Site

QECH adult ARV clinic

Methods

490 wasted (Body mass index, BMI < 18.5) adults starting ART were randomized to receive isoenergetic amounts of RUTF or CSB as dry rations. Weight, fat free body mass measured by bioelectrical impedance, CD4 count measured by FACS count machine and significant clinical events (hospitalizations + deaths) were measured at the monthly visits. The primary outcomes were BMI and fat free body mass, and the secondary outcomes were CD4 count and significant clinical events. Outcomes were compared with a Student''s t-test for continuous parameters and with a Chi-Square test for dichotomous outcomes.

Results

On enrollment subjects had a mean BMI of 16.5 and fat free body mass of 95. After 3.5 months of therapy patients receiving RUTF (n=161) had a weight gain 5.7 ±4.6 kg and BMI gain 2.2 ±1.8, compared to patients receiving CSB with weight gain of 4.5±4.2kg and BMI gain of 1.7±1.6. There were significant improvements in the weight gain, BMI, Fat-Free Mass and the CD4 cell count at 3.5 months of study participation in patients of both supplementary food groups. However, the increase in weight, BMI and the CD4 cell count of patients in the RUTF supplementary food group, were statistically significantly higher than in patients of the CSB supplementary food group, 5.7 (±4.6), vs 4.5 (±4.2) kg, 2.2 (±1.8) vs 1.7 (±1.6) and 165 (±137) vs 155 (±142) cells × 106/L, respectively, (p <0.05). Of the study participants who have completed the 3.5 months of nutritional intervention, less deaths occurred in patients of the RUTF than in the CSB supplementary feeding group, 17.1% vs. 20.0%. Less drop- outs occurred in patients of the RUTF than in the CSB supplementary feeding group, 7.3% vs. 8.5%, respectively.

Conclusion

Supplementary feeding with specially formulated RUTF, was associated with more increase in weight, BMI and CD4 cell count, but there were no differences in the survival of the wasted HIV-infected patients on ART Program.

• Malawi Med J. 2007 Jun; 19(2): 96–101.
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• A2: Prevalence of Acute Malnutrition and Eligibility for RUTF amongst HIV+ Patients followed at Baylor Clinical Center of Excellence

Malawi Med J. 2007 Jun; 19(2): 96–101.

A2: Prevalence of Acute Malnutrition and Eligibility for RUTF amongst HIV+ Patients followed at Baylor Clinical Center of Excellence

A Dave and M KimAuthor information Copyright and License information DisclaimerBaylor Children''s Clinical Center of Excellence, MalawiCopyright © 2007, Malawi Medical Journal     

Anti-fatigue effect of Renshen Yangrong decoction (人参养荣汤) in mice

Objective  

To explore the anti-fatigue effect of Renshen Yangrong Decoction (人参养荣汤, RYD): in mice.     

Effect of Xinfeng Capsule (新风胶囊) on the cardiac function in patients with rheumatoid arthritis

Objective  

To study the changes in cardiac function of rheumatoid arthritis (RA) patients and: to observe the effect of Xinfeng Capsule (新风胶囊, XFC) on them.     

Diagnostic pediatric cardiac catheterization: Experience of a tertiary care pediatric cardiac centre

Background

Cardiac catheterization was considered gold standard for confirmation of diagnosis and analyzing various management issues in congenital heart diseases. In spite of development of various non invasive tools for investigation of cardiac disorders diagnostic catheterization still holds an important place in pediatric patients.

Methods

300 consecutive diagnostic cardiac catheterization performed since April 2007 were included in this study. The study was undertaken to evaluate the profile of patients undergoing diagnostic cardiac catheterization, its results, assess its safety and its contribution toward solving various management issues.

Result & Conclusion

Children who underwent cardiac catheterization ranged in weight from 1.6 kg to 35 kg, with their age range 0 day–12 years. The information obtained was of great importance for further management in over 90% cases. The procedure of cardiac cath is invasive, still it was proved to be quite safe even in smallest baby.     

Effect of Shenshao Tablet (参芍片) on the quality of life for coronary heart disease patients with stable angina pectoris

Objective： To observe the effect of Chinese medicine Shenshao Tablet （参芍片, SST） on the quality of life in coronary heart disease （CHD） patients with stable angina pectoris （SAP）. Methods： Sixty-six patients with SAP confirmed by coronary angiography were enrolled and assigned to two groups by means of PROC PLAN using a SAS 6.12 software in a double-blinded, randomized, placebo-controlled design. Patients in the treated group were treated with SST, and the others in the control group were given placebo. The weekly angina frequency, quality of life scale [Seattle Angina Questionnaire （SAQ）] and incidence of important clinical events were observed to evaluate the intervention effect of SST on the quality of life for CHD patients with SAP. Results： During the study, one case dropped out in the treated group and two cases in the control group, respectively, and 63 cases including 32 cases in the treated group, and 31 cases in the control group completed the trial. After four weeks of treatment, the weekly angina frequency of the treated group （5.32± 2.46 times per week） was significantly less than that of the control group （7.32± 3.20 times per week, P 〈 0.05）. The total score of the quality of life in the treated group （71.30± 5.44） was obviously higher than that in the control group （63.50± 4.60, P 〈 0.01）, and the angina stability, angina frequency, and treatment satisfaction were significantly superior to those in the control group （P〈 0.01）. The incidence of important clinical events of the treated group （3.1%） was lower than that of the control group （6.5%） during the six-month follow-up period, but the difference was insignificant （P 〉 0.05）. Conclusion： SST could lower the angina frequency and greatly improve the quality of life in CHD patients with SAP.     

Effect of Aike Mixture(艾可合剂) on the Inflammatory Infiltration in Patients with Chronic Prostatitis Type Ⅲ A

Objective  

To observe the effect of Aike Mixture (艾可合剂, AKM) on prostatic inflammatory: infiltration in patients with chronic prostatitis type III A (III A-CP/CPPS) and evaluate its anti-inflammatory action.     

Computational pharmacology study of Tougu Xiaotong Granule (透骨消痛颗粒) in preventing and treating knee osteoarthritis

Objective： To study the pharmacological properties of Tougu Xiaotong Granule （透骨消痛颗粒, TGXTG） in preventing and treating knee osteoarthritis （KOA） at the molecular level. Methods： The computational methods, including principal component analysis, molecular docking, target-ligand space distribution, and the predictions of absorption, distribution, metabolism, excretion and toxicity （ADMET）, were introduced to characterize the molecules in TGXTG. Results： The structural properties of molecules in TGXTG were more diverse than those of the drug/drug-like molecules, and TGXTG could interact with significant target enzymes related to KOA. In addition, the cluster of effective components was preliminarily identified by the target-ligand space distributions. As to the results of ADMET properties, some of them were unsatisfactory, and were merely regarded as references here. Conclusion： Based on this computational pharmacology study, TGXTG is a broad- spectrum recipe inhibiting many important target enzymes, which could effectively postpone the degeneration of cartilage by coordinately inhibiting the biological effects of cytokines, matrix metallopeptidase 3, and oxygen free radicals.     

Efficacy of Ursodeoxycholic Acid Combined with Tongdan Decoction(通胆汤) on Immunological Indices and Histopathological Changes in Primary Biliary Cirrhosis Patients

<正>Objective:To observe the efficacy of ursodeoxycholic acid(UDCA) combined with Tongdan Decoction(通胆汤) on immunological indices and histopathological changes in patients with primary biliary cirrhosis(PBC) ofⅡorⅢhistological stage.Methods:Sixty PBC patients were assigned randomly and equally to the control group treated with UDCA alone and the treatment group treated with UDCA combined with Tongdan Decoction.The immunological indices and histopathological changes were detected before and after 24-week treatment,and the follow-up lasted for 1-3 years.Results:After 24-week treatment,CD4~+CD28~- in the peripheral blood was lowered and CD4~+CD25~+ was increased in both groups,and better effect was shown in the treatment group(P0.01).The levels of IgM,IgG,and IgA decreased markedly after 96-week treatment in the treatment group(P0.05,P0.01),while in the control group,only the latter two showed significant decrease after 148 week(all P0.05).At the end of the 3-year follow-up,the medians of histopathological inflammation grading and fibrosis staging declined to a lower rank,and the effect on inflammation was superior in the treatment group to the control group shown by non-parameters Wilcoxon paired symbols test(Z = 2.761, P=0.006).Conclusion:Combined therapy of Tongdan Decoction and UDCA showed a better therapeutic effect than UDCA monotherapy on PBC,especially in improving immunological indices and histopathological hepatic changes.     

Alleviation of Cancerous Pain by External Compress with Xiaozheng Zhitong Paste(消癥止痛方)

<正>Objective:To observe the clinical effectiveness of a topical application of Xiaozheng Zhitong Paste(消癥止痛方,XZP)in alleviating the cancerous pain of patients with middle/late stage cancer.Methods:By adopting a random number table,124 patients enrolled were randomized into the treatment group(64 patients) and the control group(60 patients).In addition to the basic therapy[including the three-ladder(3L)analgesia] used in both groups,topical application of XZP was given to patients in the treatment group for pain alleviation. The analgesic efficacy was recorded in terms of pain intensity,analgesia initiating time and sustaining time, and the optimal analgesic effect revealing time.Meanwhile,the quality of life(QOL)and adverse reactions that occurred in patients were recorded as well.Results:The total effective rate in the treatment group was 84.38%(54/64),and in the control group it was 88.33%(53/60),showing no significant difference between them(P0.05),but the analgesia initiating time and the optimal analgesia effect revealing time in the treatment group were significantly shorter(both P0.01).Moreover,XZP was better in improving patients' QOL,showing more significant improvements in the treatment group than those in the control group in aspects of mental condition,walking capacity,working capacity,social acceptability,sleep and joy of living(P0.05 or P0.01). Lower incidence of adverse reactions,such as nausea,vomiting,mouth dryness,dizziness,etc.,especially constipation,was noted in the treatment group(P0.05 or P0.01).Conclusion:Applying an external compress of XZP showed a synergistic action with 3L analgesia for shortening the initiating time and the optimal effect revealing time,and could evidently enhance patients' QOL with fewer adverse reactions.