Communication Skills in Standardized-Patient Assessment of Final-Year Medical Students: A Psychometric Study

The purpose of this study is to investigate the content-specificity of communication skills. It investigates the reliability and dimensionality of standardized patient (SP) ratings of communication skills in an Objective Structured Clinical Examination (OSCE) for final year medical students. An OSCE consisting of seven standardized patient (SP) encounters was administered to final-year medical students at four medical schools that are members of the California Consortium for the Assessment of Clinical Competence (N = 567). For each case, SPs rated students' communication skills on the same seven items. Internal consistency coefficients were calculated and a two-facet generalizability study was performed to investigate the reliability of the scores. An exploratory factor analysis was conducted to examine the dimensionality of the exam. Findings indicate that communication skills across the seven-case examination demonstrate a reliable generic component that supports relative decision making, but that a significant case-by-student interaction exists. The underlying structure further supports the case-specific nature of students' ability to communicate with patients. From these findings, it is evident that individual's communication skills vary systematically with specific cases. Implications include the need to consider the range of communication skill demands made across the OSCE to support generalization of findings, the need for instruction to provide feedback on communication skills in multiple contexts, and the need for research to further examine the student, patient, and presenting problem as sources of variation in communication skills.     

Habitats and distribution of Anopheles sinensis and associated Anopheles hyrcanus group in Japan

Mosquito collections were carried out in August 2002 and July 2003 in Japan. Anopheles sinensis of the Hyrcanus Group, Myzomyia Series of Anopheles, was the most common species encountered. The distribution and habitats of 5 Anopheles Hyrcanus Group species are included. Eight species belonging to Aedes, Culex, and Uranotaenia were found associated with An. sinensis in rice paddies and a variety of other larval habitats.     

Doctor of nursing practice program development: reengineering health care

In this article, we describe the developmental process of a Doctor of Nursing Practice (DNP) program that uses interdisciplinary resources to create unique DNP curriculum opportunities. Other schools may benefit from this experience in the development of their own DNP programs. The program delivers an innovative curriculum from post-baccalaureate to doctorate, emphasizing health care engineering and interdisciplinary collaboration among faculty, hospitals, community leaders, and policymakers. This DNP program is uniquely situated to provide leadership in solving complex clinical problems through its partnership with the Regenstrief Center for Healthcare Engineering, the School of Pharmacy, the Homeland Security Institute, and the Center on Aging and the Life Course. Doctoral coursework, interdisciplinary collaboration, health care engineering/systems approaches, and new knowledge result in uniquely qualified providers. Post-baccalaureate students complete the university's Adult Nurse Practitioner program or its developing Pediatric Nurse Practitioner program during the first 2 years of the 4-year curriculum. A total of 83 post-baccalaureate credit hours include 1,526 hours of supervised clinical practice, a health policy residency, and cognate residencies in an area of specialization. The seven core competencies recommended by the American Association of Colleges of Nursing are incorporated into the curriculum.     

阿司匹林与埃索美拉唑合用较氯吡格雷减少高危患者再次溃疡出血的发生

问题：在有阿司匹林诱发溃疡出血史的患者中，用氯毗格雷预防溃疡出血复发，是否不次于小剂量阿司匹林加埃索美拉唑？[编者按]     

Fulminant neonatal liver failure in siblings: probable congenital hemophagocytic lymphohistiocytosis.

Familial hemophagocytic lymphohistiocytosis (HLH) is an autosomal recessive disorder of immune regulation characterized by fever, splenomegaly, cytopenia, hypertriglyceridemia, hypofibrinogenemia, and hyperferritinemia. Although presentation usually occurs during the first 2 years of life, congenital presentation is rare. We report siblings with a presumptive diagnosis of familial HLH who presented with hydrops fetalis and severe hepatic involvement ultimately resulting in their deaths. This report emphasizes the difficulty of confirming the diagnosis of HLH. However, establishing the diagnosis has important implications for genetic counseling and family planning. HLH should be considered in the setting of perinatal liver failure. The immunologic basis of the disease is incompletely understood but testing for natural killer cell function, and perforin defects may be helpful in establishing a diagnosis. HLH can be treated with chemotherapy, immunotherapy, and stem cell transplantation.     

The Johns Hopkins University School of Hygiene and Public Health, Lloyd E. Rozeboom mosquito collection

The Lloyd E. Rozeboom mosquito collection from the Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD, has been transferred to the National Museum of Natural History, Smithsonian Institution, Washington, DC. This historically and taxonomically important collection has specimens representing 32 genera, 78 subgenera, and 763 species from most mosquito faunal areas of the world. The collection consists of 12,015 individually pinned and labeled adults, and 7,179 microscope slide preparations of immature stages and male and female genitalia. A tabulation of genera, subgenera, species, countries, faunal areas, and number of specimens for each type of preparation is provided.     

Bone marrow in sickle cell anaemia at time of anaemic crisis

Samples of bone marrow from 33 Ghanaian children with homozygous sickle cell anaemia who presented with profound anaemia (haemoglobin less than 5 g/dl) were studied. The principal finding was depression of erythropoiesis (aplastic crisis) in 14 children and erythroid hyperplasia in 17. A splenic sequestration crisis was clinically diagnosed in the remaining two children. Stainable iron was absent in the marrow of 14 children and reduced in another five. Megaloblastic changes compatible with folate deficiency were present in 8 children. It is suggested that iron and folate deficiencies may complicate sickle cell anaemia in children living in geographical areas where nutritional deficiencies are prevalent.     

The effect of different bovine viral diarrhea virus genotypes and biotypes on the metabolic activity and activation status of bovine peripheral blood mononuclear cells

The effects of cytopathic (cp) and non-cytopathic (ncp) bovine viral diarrhea virus (BVDV) on the cellular metabolic activity and activation status of bovine peripheral blood mononuclear cells (PBMC) were investigated. Cellular DNA and protein synthesis was determined by [3H]thymidine and [3H]valine incorporation, respectively, in phytohemagglutinin (PHA)-stimulated PBMC. All cp strains and most ncp BVDV strains significantly inhibited DNA synthesis in PHA-stimulated PBMC; however, only cp BVDV strains inhibited protein synthesis. A plaque assay and immunofluorescence test confirmed productive BVDV infection of PBMC. In addition, viral RNA synthesis was demonstrated in BVDV-infected PBMC by RT-PCR. The interleukin-2 receptor (IL-2R) was used as a marker for the activation status of BVDV-infected PBMC. The expression of IL-2R was preserved in virus-infected cells, even though DNA and protein synthesis was suppressed. These findings suggest a novel mechanism of virus-induced immune suppression in which BVDV inhibits basic metabolic activities of bovine PBMC. The activation signals, however, are maintained.     

New and rapid method for detection of pyuria by leukocyte esterase reaction

A method for a rapid detection of leukocytes in the urine is available in the form of a "dipstick." The reaction (color change) occurs within one minute and has a high index of reliability.