Integrating complementary and alternative medicine instruction into health professions education: organizational and instructional strategies.

A few years ago, the National Institutes of Health National Center for Complementary and Alternative Medicine funded a program called the Complementary and Alternative Medicine (CAM) Education Project. Grantees were 14 medical and nursing schools and the American Medical Student Association, which funded six additional medical schools. Grants were awarded in cohorts of five per year in 2000, 2001, and 2002-2003.The R25 grant recipients identified several major themes as crucial to the success of integrating CAM into health professions curricula. The rationale for integrating CAM curricula was in part to enable future health professionals to provide informed advice as patients dramatically increase the use of CAM. Success of new CAM education programs relied on leadership, including top-down support from institutions' highest administrators. Formal and informal engagement of key faculty and opinion leaders raised awareness, interest, and participation in programs. A range of faculty development efforts increased CAM-teaching capacity. The most effective strategies for integration addressed a key curriculum need and used some form of evidence-based practice framework. Most programs used a combination of instructional delivery strategies, including experiential components and online resources, to address the needs of learners while promoting a high level of ongoing interest in CAM topics. Institutions noted several benefits, including increased faculty development activities, the creation of new programs, and increased cross- and inter-university collaborations. Common challenges included the need for qualified faculty, crowded and changing curricula, a lack of defined best practices in CAM, and post-grant sustainability of programs.     

MRI of the Stener lesion

Objective. To assess the utility of MR in detecting surgically induced Stener lesions (displaced thumb ulnar collateral ligaments) in cadaveric models. Design. Six cadaver thumbs had ulnar collateral ligament (UCL) tears created surgically. MR examinations (2D STIR and 3D GRASS) were performed identically on all specimens both before displacement (non-Stener) and after displacement (Stener lesion) of the UCL. The MR images were then randomly numbered. Each image was evaluated separately in blinded fashion by four musculoskeletal radiologists for the presence or absence of a Stener lesion. Each radiologist reinterpreted the images after an interval of several days. The interpretation was based on previously published criteria for Stener lesion diagnosis by MR. Results. The sensitivity of GRASS ranged from 0.17 to 0.67 with the most experienced reader scoring the lowest. The specificity of GRASS ranged from 0.33 to 1.0 (most experienced reader 0.67, 0.83). STIR had a sensitivity of 0.00–0.17 and a specificity of 0.53–0.83. The values for inter- and intraobserver agreement were measured. The intraobserver for GRASS was 0.27–0.75 (most experienced reader 0.75). Conclusions. 2D imaging is probably inadequate for the evaluation of Stener lesions. The most likely reason is that the STIR slice thickness of 3 mm limits resolution of small UCLs. The poor sensitivity and specificity of GRASS as well as poor interobserver agreement suggest that MR may not be sufficiently accurate for Stener lesion evaluation.     

Computerized bone densitometric analysis: operator-dependent errors

PURPOSE: To determine the nature and relative frequency of operator-dependent data analysis errors in dual x-ray absorptiometry. MATERIALS AND METHODS: Over 40 months, 2,528 dual x-ray absorptiometric examinations of the forearm, femoral neck, and lumbar spine were performed by 11 technologists by using standard techniques and software. Each analysis was reviewed by a radiologist; errors were recorded and corrected. RESULTS: There were no forearm analysis errors. There were 24 (0.9%) femoral neck analysis errors, of which 23 resulted from misplacement of the analysis region. There were 33 (1.3%) spinal analysis errors, of which 24 resulted from misplacement of intervertebral disk space markers. Analysis errors of the femur and spine resulted in six misdiagnoses (0.2%). CONCLUSION: Misdiagnosis due to analysis errors is rare. Femoral neck analysis errors were easily detectable, but accurate spinal analyses depended on accurate identification of vertebral end plates and posterior elements. Nonetheless, these potentially serious errors can be detected and corrected if the analyses are reviewed and interpreted by a supervising physician who is familiar with the relevant anatomy, proper analysis techniques, and factors--such as artifacts--that adversely affect the accuracy of the analysis.     

Successful reconstruction of natural femoral anteversion using a short femoral stem in total hip arthroplasty surgery

ObjectiveTotal hip arthroplasty (THA) involves postoperative risks, such as thigh pain, periprosthetic fractures, and stress yielding. Short, anatomical, metaphyseal-fitting, cementless femoral stems were developed to reduce these postoperative risks. This study aimed to examine the “MiniMAX” prosthesis, which is a new generation, short, anatomical femoral stem made by Medacta.MethodsPatients underwent a low-dose computed tomography scan. Femoral anteversion was measured. We assessed the position and anteversion of the femoral component and compared them with the unoperated side. We also assessed the patients’ satisfaction and functional levels at 6 months postsurgery using the Harris Hip Score (HHS) and the Oxford Hip Score (OHS).ResultsNineteen individuals were recruited in this study. We found no significant difference in femoral anteversion between the operated hip and the native hip. Using the HHS and OHS questionnaires, we found clinical improvement in the 6-month postoperative scores compared with the preoperative scores.DiscussionThe new-generation, short, anatomical femoral stem made by Medacta is successful in reproducing natural femoral anteversion, while also improving patients’ functioning and lifestyle. Future large-scale, prospective comparison trials are required to further investigate this topic.     

Imaging of Chronic Thromboembolic Disease

Lung - Acute pulmonary embolism (PE) is a leading cause of cardiovascular morbidity. The most common long-term complication of acute PE is chronic thromboembolic disease, a heterogenous entity...     

Restoration of a phosphaturic response to parathyroid hormone in the immature rat

Recent studies have shown that immature rats display a diminished sensitivity to the phosphaturic effects of parathyroid hormone (PTH), and that the responsiveness to PTH increases with age. The attenuated phosphaturia may reflect an inability of the neonate to respond to the hormone because of functional immaturity of the developing kidney. Alternatively, PTH may actually inhibit tubular phosphate reabsorption in the neonate but, due to other phosphate conservation mechanisms, no phosphaturia occurs. Our objective was to determine whether a phosphaturic response to PTH would be elicited in immature rats during infusion of moderate amounts of phosphate (Pi). Clearance experiments were performed on 26 acutely thyroparathyroidectomized immature Wistar rats (3-5 wk of age) fed a normal Pi diet (0.63%). In response to infusion of either Pi (1 mumol/min.100 g) (group I) or PTH (8.3 ng/min.100 g) (group II) alone, the fractional excretion of phosphate rose minimally (from 0.01 +/- 0.01% to 4.9 +/- 1.9% and from 0.12 +/- 0.12% to 2.9 +/- 1.4% for groups I and II, respectively). However, when Pi and PTH were combined either Pi first followed by PTH (group III) or PTH first followed by Pi (group IV), the fractional excretion of Pi rose dramatically (from 0.01 +/- 0.01 to 21.8 +/- 3.5% and from 0.04 +/- 0.04 to 27.7 +/- 3.3% for groups III and IV, respectively). A significant increase in urinary cAMP excretion occurred during infusion of PTH even when Pi excretion was minimal, but there was no further increase in urinary cAMP during the combined infusion of Pi and PTH.(ABSTRACT TRUNCATED AT 250 WORDS)     

PACS and RIS: approaches to integration

PACS and RIS have traditionally been discrete information systems with separate databases. Maintaining more than one database containing identical data sets creates the potential for outdated information being used in parallel with accurate information. Today, because of increased implementation of PACS and improved Web technology, this problem must be solved. Furthermore, as PACS technology is applied to areas outside radiology such database issues become more critical. Application of XML offers a cost-effective and workable solution to many of the thorniest problems that will likely become more prevalent in the post-Y2K era.     

Utilization of CT-PA in an emergency department with readily available V/Q scintigraphy

Purpose: To describe the role of computed tomographic pulmonary angiography (CT-PA) in the emergency department of an institution which utilizes ventilation–perfusion (V/Q) scintigraphy as its primary imaging modality for the diagnosis of pulmonary embolism. Methods and materials: We retrospectively identified and reviewed the records of 24 consecutive patients evaluated in the emergency department from October 1998 to September 2000 who were suspected of having pulmonary embolism. The inclusion criterion was that the images from the emergency department and work-up included CT-PA, which was the initial imaging test after chest radiograph. There were 10 men and 14 women with a mean age of 63. Results of CT-PA were categorized as positive, negative, limited negative (no main or lobar pulmonary emboli but not all segmental arteries visualized), or nondiagnostic. Each chart was reviewed with reference to clinical presentation, relevant history, results of Doppler ultrasonography of the legs, V/Q scan and pulmonary angiography, and discharge diagnosis. During the same study period, approximately 400 V/Q scans were performed from the emergency department. Results: Each patient had a clinical presentation consistent with pulmonary embolism. CT-PA diagnosed pulmonary emboli in 21% (5/24), was negative in 33% (8/24), was limited negative in 38% (9/24), and was nondiagnostic in 8% (2/24). Chest radiographs were abnormal in 71% (17/24). V/Q scans were performed in 17% (4/24; 1 near normal, 2 low probability, 1 intermediate probability). None of these four patients was discharged with a diagnosis of pulmonary embolism. Doppler ultrasound leg exam was performed in 38% (9/24). Among the 5 patients diagnosed with pulmonary embolism, 1/3 examined had Doppler evidence of deep vein thrombosis (DVT). Among the 19 patients not diagnosed with pulmonary embolism, 3/6 examined had Doppler evidence of DVT. No patient with a negative or limited negative CT-PA was discharged with a diagnosis of pulmonary embolism. CT-PA provided alternative diagnoses explaining the patient's symptoms in 68% (13/19) of those not diagnosed with pulmonary embolism. During the most recent 12 months of the study period, 210 V/Q scans were performed from the emergency department, with results available in 194 cases as follows: normal/near normal 32% (n=62), low probability 47% (n=92), intermediate probability 14% (n=28), high probability 6% (n=12). Conclusion: V/Q scintigraphy is the primary imaging modality for suspected pulmonary embolism in our emergency department. However, when utilized, CT-PA played an important role in patient management by confirming or excluding pulmonary embolism or providing an alternative diagnosis in the majority of patients suspected of having pulmonary embolism. Electronic Publication