Is parity in the eye of the beholder?

To investigate whether parity status can be predicted by physical examination and which findings are most predictive. A retrospective chart review of 75 postmenopausal nulliparous/parous sister pairs who underwent gynecological examination as part of a study. An examiner, blinded to parity status, predicted parity status based on physical findings recorded on 146 women. Parity status was correctly predicted for 84.9% of the women. Of the 22 women for whom parity prediction was incorrect, 11 were nulliparous and 11 parous. The physical findings most commonly used for prediction were presence or absence of abdominal striae, appearance of the cervical os, and condition of hymen. Absence of the hymen at 6 o’clock alone correctly predicted parity in 11 of 12 parous and 11 of 11 nulliparous women. Parity status can be predicted based on physical exam in the majority of women. Blinding of investigators to parity status may not be feasible.     

Prostate magnetic resonance imaging: The truth lies in the eye of the beholder

Purpose

To determine the diagnostic accuracy and interobserver variability of radiologic interpretation of magnetic resonance imaging (MRI) performed for surgical planning before prostatectomy.

Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder

BACKGROUND: Teamwork is an important component of patient safety. In fact, communication errors are the most common cause of sentinel events and wrong-site operations in the US. Although efforts to improve patient safety through improving teamwork are growing, there is no validated tool to scientifically measure teamwork in the surgical setting. STUDY DESIGN: Operating room personnel in 60 hospitals were surveyed using the Safety Attitudes Questionnaire. Surgeons, anesthesiologists, certified registered nurse anesthetists, and operating room nurses rated their own peers and each other using a 5-point Likert scale (1 = very low, 5 = very high). RESULTS: Overall response rate was 77.1% (2,135 of 2,769). Ratings of teamwork differed substantially by operating room caregiver type, with the greatest differences in ratings shown by physicians: surgeons (F[4, 2058] = 41.73, p < 0.001), and anesthesiologists (F[4, 1990] = 53.15, p < 0.001). The percent of operating room caregivers rating the quality of collaboration and communication as "high" or "very high" was different by caregiver role and whether they were rating a peer or another type of caregiver: surgeons rated other surgeons "high" or "very high" 85% of the time, and nurses rated their collaboration with surgeons "high" or "very high" only 48% of the time. CONCLUSIONS: Considerable discrepancies in perceptions of teamwork exist in the operating room, with physicians rating the teamwork of others as good, but at the same time, nurses perceive teamwork as mediocre. Given the importance of communication and collaboration in patient safety, health care organizations should measure teamwork using a scientifically valid method. The Safety Attitudes Questionnaire can be used to measure teamwork, identify disconnects between or within disciplines, and evaluate interventions aimed at improving patient safety.     

Beauty and the eye of the beholder: social consequences and personal adjustments for facial patients

Patients' pre- and postoperative self-reports were compared with reports of non-medical observers to investigate whether improved self-esteem is a direct result of increased social acceptance in maxillo- and craniofacial patients. Twenty-two children and adolescents undergoing reconstructive surgery for a variety of facial deformities were asked to rate their physical appearance on the Hay's Scale and fill out the Piers-Harris Self-Concept Scale. Their ratings were compared with scores given by a panel of lay volunteers on random presentation of pre- and postoperative photographs of the same patients. Patients rated their appearance as noticeably improved after surgery, their self-esteem rose significantly and they reported more social adeptness and acceptance at home and school. Raters observed only relatively subtle changes. Apparently, quality of life improved for the postsurgical facial patient because of increased self-esteem and confidence, which free him to overcome social barriers.     

Malignancy is in the eye of the beholder: Pathologic diagnosis of challenging follicular neoplasms in the era of noninvasive follicular thyroid neoplasms with papillary-like nuclear features and immunohistochemical and molecular adjuncts

BackgroundClassification of thyroid follicular neoplasms can be challenging for pathologists. Introduction of noninvasive follicular thyroid neoplasms with papillary-like nuclear features, the utilization of immunohistochemistry, and molecular analysis are all thought to be valuable diagnostic adjuncts. Our aim was to determine whether interobserver variability for follicular neoplasms has improved since the application of these adjuncts.MethodsOne representative section from a cohort of follicular neoplasms previously proven difficult for pathologists were examined independently by 7 pathologists and assigned to 1 of 3 diagnostic categories (benign, neoplasms with papillary-like nuclear features, or malignant). This process was carried out separately 3 times: (1) after viewing hematoxylin and eosin stain slides, (2) hematoxylin and eosin stain in conjunction with immunohistochemistry, and (3) hematoxylin and eosin stain/immunohistochemistry in conjunction with molecular analysis. The interobserver variability and overall agreement were then calculated using the free-marginal kappa coefficient.ResultsAgreement on hematoxylin and eosin stain was 57%, with a kappa coefficient of 0.36 (minimal agreement). The agreement improved slightly with the application of immunohistochemistry (kappa coefficient = 0.49 [weak agreement] and a percentage agreement 67%). The level of agreement decreased slightly after the addition of molecular analysis (kappa coefficient = 0.43 [weak agreement] and percentage agreement 62%).ConclusionDespite attempts to standardize the diagnostic criteria for neoplasms with papillary-like nuclear features and the utilization immunohistochemistry and molecular analysis, attaining pathologic consensus for difficult follicular neoplasms of the thyroid remains a challenge.     

Spatial view cells in the primate hippocampus: allocentric view not head direction or eye position or place.

Hippocampal function was analysed by making recordings from hippocampal neurons in monkeys actively walking in the laboratory. 'Spatial view' cells, which respond when the monkey looks at a part of the environment, were analysed. It is shown that these cells code for the allocentric position in space being viewed and not for eye position, head direction or the place where the monkey is located. This representation of space 'out there' would be an appropriate part of a primate memory system involved in memories of where in an environment an object was seen, and more generally in the memory of particular events or episodes, for which a spatial component normally provides part of the context.     

Predictors of blinding or serious eye injury in blunt trauma.

Multivariate analysis was used to identify factors predicting injury and visual outcome in 94 blunt trauma patients evaluated for eye injuries among 6700 admissions to a level I trauma center over a 29-month period. Patients with penetrating eye injuries were excluded from this review. Eye injury was detected in 93% or 87 of the patients evaluated. Seven percent of eye injuries resulted in blindness, 22% were serious (visual acuity between 20/40 and 20/200 or eye injury requiring surgery), and 71% were temporary (final visual acuity of 20/40 or better). The presence of an afferent pupillary defect or a nonreactive pupil was the most important factor in predicting the severity of eye injury (p = 0.0023), followed by facial fractures (p = 0.0084), and no eye opening or eye opening to pain within the Glasgow Coma Scale (p = 0.02). Eye injury is an infrequent complication of blunt trauma. Appropriate consultation for evaluation of this problem can be obtained based on findings from the initial history and screening physical examination.     

Traffic safety education: Panacea,prophylactic or placebo?

Education is one of the strategies available to reduce traffic crashes and the resultant personal injury. It is seen by many as the major strategy for achieving lasting change. However, there is considerable debate as to the effectiveness of traffic safety education programs to date and, in an era when public expenditure is strongly influenced by the results of cost-benefit analyses, the more fundamental traffic safety education programs are under increasing challenge. The literature on effectiveness is indeed confusing. All too often, programs have commenced from a position of blind faith and have been implemented unsystematically, without specific objectives, targets, or evaluative milestones. The problem is compounded by the considerable methodological difficulties which confront the evaluators of long-term programs of behavior change. If traffic safety education is to survive as a viable countermeasure, program planning and execution must become far more scientific and evaluation must become an integral component. There is also an arguable case for the funds for the longer-term behavior change programs to come from the more general public health arena than from the narrower traffic safety field, while the short-term, specific educational programs should compete directly for funds with alternative traffic safety measures available for the given problem.

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Resumen La educación, una de las estrategias disponibles para reducir los accidentes de tránsito y sus resultantes lesiones personales, es considerada por muchos con la estrategia principal para el logro de resultados a largo plazo. Sin embaro, existe considerable debate sobre la eficacia de los programas de educación en seguridad del tráfico realizados hasta la fecha y, en estra época en que el gasto público se halla considerablemente influenciado por los resultados de análisis de costo-beneficio, los programas más fundamentales de educación en seguridad del tráfico se hallan bajo creciente cuestionamiento. La literatura sobre eficacia es ciertamente confusa. Con frecuencia se han iniciado programas bajo fe ciega y han sido implementados en forma no sistemática, sin definición de objetivos específicos, metas o métodos de evaluación. El problema se hace más complejo por las considerables dificultades metodológicas que confrontan los evaluadores de programas de modificación del comportamiento a largo plazo. Si se espera que la educación en seguridad del tráfico sobreviva como una medida viable, su planeación programática y ejecución deben hacerse más científicas y la evaluación debe convertirse en un componente integral. Hay suficiente razón para argumentar que los fondos para los programas de modificación del comportamiento a largo plazo provengan del campo de la salud pública general más que del estrecho campo de la seguridad víal, en tanto que los programas educacionales específicos de corta duración deben competir por financiación directamente con las actividades alternas existentes.

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Résumé L'enseignement est une des stratégies pour réduire le nombre d'accidents de la route et les lésions qui en résultent. Pour beaucoup, il s'agit d'une stratégie majeure capable d'assurer des changements durables. Il existe, cependant, beaucoup de discussion concernant les programmes d'enseignement sur la prévention routière, et, á une époque où les financements sont très influencés par les analyses de coût et bénéfices, ces programmes d'enseignement sont constamment soumis à approbation. La littérature sur l'efficacité prête en effet à confusion. Trop souvent, ces programmes ont été basés sur des croyances sans fondement, et ont été appliqués sans systématisation, sans recherche d'objectifs ou de cibles spécifiques, sans moyens d'évaluation. Le problème est aggravé par les difficultés de méthodologie qui contrent souvent les efforts de ceux qui évaluent les programmes de comportement à long-terme. Si l'enseignement est appelé à garder un rôle dans ces programmes, ceux-ci doivent devenir plus scientifiques et étre évalués. Il importe aussi que le financement des programmes concernant le changement des comportments vienne d'un budget de santé publique plutôt que directement de la prévention routière. Le financement des programmes d'enseignements pourrait être in compétition avec le financement des problèmes de sécurité routière.

     

Simulation and virtual reality in surgical education: real or unreal?

Rapid change is under way on several fronts in medicine and surgery. Advances in computing power have enabled continued growth in virtual reality, visualization, and simulation technologies. The ideal learning opportunities afforded by simulated and virtual environments have prompted their exploration as learning modalities for surgical education and training. Ongoing improvements in this technology suggest an important future role for virtual reality and simulation in surgical education and training.