Using a standardized-patient examination to establish the predictive validity of the MCAT and undergraduate GPA as admissions criteria

Performance of senior medical students on an objectively scored examination of clinical competence based on standardized-patient cases was used to assess the predictive validity of the two most commonly used admission measures, the Medical College Admissions Test and the undergraduate grade point average. The students were in the classes of 1986 and 1987 at Southern Illinois University School of Medicine. The correlations of the admissions measures with clinical performances were quite weak, and none of the admissions measures consistently showed a clear advantage as a predictor of clinical performance. Correlations of the admissions measures with scores on National Board of Medical Examiners (NBME) Part I and Part II examinations were small to moderate, although somewhat larger than the correlations with clinical performances. Correlations were corrected for attenuation due to differential unreliabilities of the clinical examination results and the scores on NBME examinations, and for restriction of range due to the stringent medical school selection process. Corrected correlations were small to moderate and showed the same pattern as the uncorrected ones. The study documents that traditional admissions measures are useful for selecting students who will perform effectively in clinical as well as basic science settings.     

The relationship between perceived parenting, adult attachment style and alexithymia in alcoholic inpatients

In this paper we examine the understudied relationship between alexithymia on the one hand, and adult attachment and perceived parenting on the other hand, in a clinical sample of alcoholic inpatients (N=101). We test whether differences between a high and a low scoring group on trait alexithymia can be predicted on the basis of attachment style and perceived parenting. We observed that the avoidant attachment style is a strong predictor. Subsequently we test whether three dimensions of alexithymia - affective, cognitive and social - are meaningfully linked to adult attachment and perceived parenting. We noticed that cognitive alexithymia especially was predicted by the avoidant attachment style and a lack of warmth perceived in the relationship to the father.     

Metastatic disease of screen-detected prostate cancer : characteristics at diagnosis

BACKGROUND: Screening for prostate cancer has not only led to a stage migration, but also to a higher incidence of the disease. A decrease in mortality has occurred in several countries during the same time period. Risk stratification of screen-detected cancers at diagnosis has become more important for the anticipation and interpretation of changing incidence/mortality ratios. METHODS: From 1993 to 1998, 633 men were diagnosed with nonmetastatic prostate cancer in the prevalence screen of the Rotterdam section of the European Randomized study of Screening for Prostate Cancer (ERSPC). The characteristics at diagnosis of men who developed metastatic disease were compared with men without evidence of metastases during follow-up. RESULTS: During the median follow-up of 7.5 years, 41 men developed metastatic disease. After 10 years the metastasis-free survival rate was 89.6%, the overall survival 64.7%. In a Cox-model 2logPSA (prostate-specific antigen), biopsy Gleason score and the number of biopsy cores with prostate cancer were independent predictors for the development of metastases; the latter only predicted metastases that presented within 60 months of follow-up. CONCLUSIONS: The metastasis-free survival of men with prostate cancer detected in a prevalence screening was very high. Whether this was related to the beneficial effects of screening or to overdiagnosis due to screening (or both) remains unclear. The prognostic factors known for clinically diagnosed disease also hold for screen-detected disease.     

Towards the development of a pediatric ventricular assist device

The very limited options available to treat ventricular failure in children with congenital and acquired heart diseases have motivated the development of a pediatric ventricular assist device at the University of Pittsburgh (UoP) and University of Pittsburgh Medical Center (UPMC). Our effort involves a consortium consisting of UoP, Children's Hospital of Pittsburgh (CHP), Carnegie Mellon University, World Heart Corporation, and LaunchPoint Technologies, Inc. The overall aim of our program is to develop a highly reliable, biocompatible ventricular assist device (VAD) for chronic support (6 months) of the unique and high-risk population of children between 3 and 15 kg (patients from birth to 2 years of age). The innovative pediatric ventricular assist device we are developing is based on a miniature mixed flow turbodynamic pump featuring magnetic levitation, to assure minimal blood trauma and risk of thrombosis. This review article discusses the limitations of current pediatric cardiac assist treatment options and the work to date by our consortium toward the development of a pediatric VAD.     

Computerized three-dimensional localization of prostate cancer using contrast-enhanced power Doppler and clustering analysis

OBJECTIVE: To evaluate the potential benefit of semiautomated localization of prostate cancer using clustering analysis on three-dimensional (3-D) contrast-enhanced power Doppler images. METHODS: Thirty patients with biopsy-proven prostate cancer and scheduled for radical prostatectomy underwent a 3-D contrast-enhanced power Doppler scan prior to surgery. A 3-D ellipsoid model was manually fitted around the prostate. The model automatically divided the prostate into 12 zones. After calculation of a so-called clustering map, the clustering values of each zone were calculated. They were compared with whole-mount section histopathology. Region-of-interest (ROI) analysis was performed with bootstrapping to evaluate overall performance. RESULTS: The ROI analysis yielded area under the curve (AUC) values of 0.65 with a corresponding standard error of 0.03. CONCLUSION: Semiautomatic localization based on clustering analysis of blood flow aids in localization of prostate tumors. A clustering map is an easy-to-interpret extension to standard power Doppler images.     

Prevalence, treatment modalities and prognosis of familial prostate cancer in a screened population

PURPOSE: A family history of prostate cancer is an important risk factor for this disease. The clinical presentation and prognosis of familial disease remain uncertain. In this study these entities are evaluated in the first and second rounds of a screening program in The Netherlands. MATERIALS AND METHODS: Of all men randomized in the Rotterdam section of the ERSPC, 19,970 men were eligible for screening. Information regarding the family history was obtained by a self-administered questionnaire at baseline. RESULTS: In the prevalence screen the cancer detection rate in 1,364 men (7.1%) with a positive family history was 7.7% (106 cancers in 1,364 screened men with a positive family history) while the positive predictive value of the biopsies was 32.2% (154 cancers of 532 biopsies). In 12,803 sporadic cases the detection rate was 4.7% and the positive predictive value was 23.6% (p <0.0001 and 0.003, RR 1.63). No clinicopathological differences were found in the 1,559 men diagnosed in the first and second rounds. The overall biochemical-free survival rate after a mean followup of 56.8 months (range 0 to 129.9) was 76.8%, and was not significantly different in familial and sporadic cases (p = 0.840). These findings were consistent for the specific treatment modalities as well. CONCLUSIONS: Although screened men 55 to 75 years old with a father or a brother having prostate cancer themselves are at a substantially greater risk for the disease, the clinical presentation, treatment modalities and prognosis by biochemical progression are not different compared to sporadic cases.