The perceptions of attending doctors of the role of residents as teachers of undergraduate clinical students

INTRODUCTION: Much of undergraduate clinical teaching is provided by residents. An earlier study showed the attitude of residents towards teaching to be generally positive. Little is known, however, about attending doctors' views on their own and residents' roles as teachers of medical students. OBJECTIVES: To examine attending doctors' perceptions of the (dis)advantages of resident teaching, their own teaching abilities and the need for a teacher training programme for residents. METHOD: A questionnaire survey of 76 attending doctors was carried out in the Departments of Obstetrics & Gynaecology and Paediatrics at the teaching hospitals of the Universities of Maastricht and Amsterdam, the Netherlands. RESULTS: Attending doctors perceive teaching by residents to be beneficial for students and residents alike. Although they consider themselves to be better suited than residents to teach medical students, they see teaching as an integral part of residency training and feel it should be recognised as such by departments and medical schools. Attending doctors are in favour of a teacher training programme for residents, which should include communication, clinical and teaching skills as well as skills such as time management and (self-) assessment. DISCUSSION: Despite the uneven distribution of participants between the departments, no significant differences were found between departments. It is interesting that attending doctors perceive teacher training as beneficial to residents' teaching skills, but provide more feedback on residents' attitudes than on their teaching. The results show that, in general, attending doctors share residents' views that teaching is an important component of residency and that a teacher training programme for residents is to be recommended.     

Comparison of CT and sonography in the diagnosis of acute appendicitis: a blinded prospective study

OBJECTIVE: Our objective was to compare the accuracy of CT and sonography in a general community teaching hospital for the diagnosis of acute appendicitis in patients with suspected acute appendicitis. SUBJECTS AND METHODS. In this prospective study, 199 consecutive patients with clinical signs and symptoms of acute appendicitis were examined with sonography (graded compression technique) and CT (focused unenhanced single-detector helical CT [5-mm section thickness]. CT was performed from the L2 vertebral body to the pubic symphysis, and no patients were given oral, rectal, or IV contrast medium. The primary sonographic criterion for diagnosing acute appendicitis was an incompressible appendix with a transverse outer diameter of 6 mm or larger with incompressible periappendicular inflamed fat with or without an appendicolith. The primary CT criterion for diagnosing acute appendicitis was the identification of an appendix with a transverse outer diameter of 6 mm or larger with associated periappendiceal inflammatory changes. The results, independently reported, were correlated with surgical and histopathologic findings. RESULTS: One hundred thirty-two patients had acute appendicitis at surgery, and 67 patients did not. The sensitivity of CT and sonography was 76% and 79%, respectively; the specificity was 83% and 78%; the accuracy was 78% and 78%; the positive predictive value was 90% and 87%; and the negative predictive value was 64% and 65%. CONCLUSION: Unenhanced focused single-detector helical CT and graded compression sonography performed in a general community teaching hospital by both body imaging radiologists and general radiology staff members have a similar accuracy for the diagnosis of acute appendicitis.     

Role of Ca2+-Activated Cl− Current in Ventricular Action Potentials of Sheep During Adrenoceptor Stimulation

Adrenoceptor stimulation enhances repolarising and depolarising membrane currents to different extents in cardiac myocytes. We investigated the opposing effects of the repolarising Ca(2+)-activated Cl(-) current (I(Cl(Ca))) and depolarising L-type Ca(2+) current (I(Ca,L)) on the action potential configuration of sheep ventricular myocytes stimulated with noradrenaline. Whole-cell current-clamp recordings revealed that noradrenaline accelerated and prolonged phase-1 repolarisation. We define the minimal potential at the end of phase-1 repolarisation as "notch level". Noradrenaline (1 microM) caused the notch level to fall from 14 +/- 2.6 to 7.8 +/- 2.8 mV (n = 24), but left action potential duration, resting membrane potential or action potential amplitude unaffected. Whole-cell voltage-clamp recordings showed that 1 microM noradrenaline increased both I(Ca,L) and I(Cl(Ca)), but it had no significant effect on the principal K(+) currents. Blockage of I(Cl(Ca)) by 0.5 mM 4,4'-diisothiocyanatostilbene-2,2'-disulphonic acid (DIDS) in both the absence and the presence of noradrenaline abolished phase-1 repolarisation. In the presence of noradrenaline, DIDS caused elevation of the plateau phase amplitude and an increase in the action potential duration. In conclusion, elevation of the plateau phase amplitude and action potential prolongation associated with an increased I(Ca,L) upon adrenoceptor stimulation is prevented by an increased I(Cl(Ca)) in sheep ventricular myocytes. Experimental Physiology (2001) 86.2, 151-159.     

Development of the ETOC: a European test of olfactory capabilities

A number of smell tests designed to evaluate human olfactory capabilities have been published, but none have been validated cross-culturally. The aim of this study was therefore to develop a reliable and quick olfactory test that could be used to evaluate efficiently the olfactory abilities of a European population. This test, named ETOC and based on a combination of a supra-threshold detection task and an identification task, was designed to be a cross-cultural tool that would measure the decline in olfactory performance with ageing. Two versions of the ETOC, one easy and one less easy, were used to test the olfactory performance of European citizens in three countries (France, Sweden and the Netherlands). The results indicated that neither version of the ETOC is culture-dependent, and that both give scores that well reflect the decrease in olfactory abilities with increasing age. A retest session showed that the less easy (and final) version of the ETOC is also highly reliable.     

Oxidation of Recombinant Human Interleukin-2 by Potassium Peroxodisulfate

Purpose. The oxidation of recombinant human interleukin-2 (rhIL-2) by potassium peroxodisulfate (KPS) with or without N,N,N,N-tetramethylethylenediamine (TEMED), which are used for the preparation of dextran-based hydrogels, was investigated. Methods. The oxidation of (derivatives of) methionine, tryptophan, histidine and tyrosine, as well as rhIL-2 was investigated. Both the oxidation kinetics (RP-HPLC) and the nature of the oxidation products (mass spectrometry) were studied as a function of the KPS and TEMED concentration, and the presence of a competitive antioxidant, methionine. Results. Under conditions relevant for the preparation of rhIL-2 loaded hydrogels, only methionine and tryptophan derivatives were susceptible to oxidation by KPS. The oxidation of these compounds was inhibited once TEMED was present, suggesting that the peroxodisulfate anion, rather than the radicals formed in the presence of TEMED, is the oxidative species. KPS only induced oxidation of the four methionines present in rhIL-2, whereas the tryptophan residue remained unaffected. The radicals, formed after KPS decomposition by TEMED, induced some dimerization of rhIL-2. The oxidation of rhIL-2 could be substantially reduced by the addition of methionine, or by pre-incubation of KPS with TEMED. Conclusions. Only the methionine residues in rhIL-2 are oxidized by KPS. The extent of oxidation can be minimized by a proper selection of the reaction conditions.     

Kontaktallergien bei Patienten mit Ekzemen des äußeren Gehörgangs Ergebnisse des Informationsverbundes Dermatologischer Kliniken und der Deutschen Kontaktallergie-Gruppe

Zusammenfassung Hintergrund und Fragestellung. Ziel der Untersuchung war die Analyse der innerhalb des Informationsverbundes Dermatologischer Kliniken (IVDK) und der Deutschen Kontaktallergie-Gruppe (DKG) erfassten Daten von Patienten mit Geh?rgangsekzemen. Patienten/Methodik. In dem Datenpool des IVDK wurden zwischen 1992 und 1997 145 Patienten mit Geh?rgangsekzemen gefunden. Ausgewertet wurden neben den DKG-Testreihen auch die getesteten patienteneigenen Substanzen. Ergebnisse. Bei einem Drittel des untersuchten Patientenkollektivs wurde ein allergisches Kontaktekzem diagnostiziert. Inhaltsstoffe medizinischer Externa nahmen eine führende Rolle als Kontaktallergene ein. Im Vergleich der populationskorrigierten Sensibilisierungsh?ufigkeiten (PAFS) zeigte sich für Neomycinsulfat im Untersuchungskollektiv eine deutlich h?here, für Nickelsulfat dagegen eine deutlich niedrigere PAFS als im Gesamtkollektiv. Dies zeigt, dass auf topographisch engstem Raum unterschiedliche Kontaktallergene von Bedeutung sind. Schlussfolgerungen. W?hrend Nickelsulfat am ?u?eren Ohr ein wesentliches Allergen darstellt, dominieren bei Geh?rgangsekzemen die Inhaltsstoffe medizinischer Externa, insbesondere Neomycinsulfat und, wie die Auswertung der getesteten patienteneigenen Substanzen ergab, m?glicherweise auch Polymyxin B.     

Management of malignant melanoma: new developments in immune and gene therapy

Thus far, the use of classical anti-cancer treatment modalities had only rarely a beneficial impact on the prognosis of patients with metastatic melanoma. We as physicians have therefore the obligation as well as the chance to develop and test new therapeutic strategies. Our growing knowledge about the genetic basis of melanoma provides one platform to fulfil this task. Another one comes from our increasing understanding of the molecular and cellular mechanisms involved in the induction/modulation of immune responses, as well as the progress made in the field of identification of melanoma antigens, and allows for the development of a new generation of vaccines. The aim of this article is to discuss several of these new concepts towards the use of immune and gene therapy of melanoma.     

The heat-pipe resembling action of boiling bubbles in endovenous laser ablation

Endovenous laser ablation (EVLA) produces boiling bubbles emerging from pores within the hot fiber tip and traveling over a distal length of about 20 mm before condensing. This evaporation-condensation mechanism makes the vein act like a heat pipe, where very efficient heat transport maintains a constant temperature, the saturation temperature of 100°C, over the volume where these non-condensing bubbles exist. During EVLA the above-mentioned observations indicate that a venous cylindrical volume with a length of about 20 mm is kept at 100°C. Pullback velocities of a few mm/s then cause at least the upper part of the treated vein wall to remain close to 100°C for a time sufficient to cause irreversible injury. In conclusion, we propose that the mechanism of action of boiling bubbles during EVLA is an efficient heat-pipe resembling way of heating of the vein wall.