Quality of written narrative feedback and reflection in a modified mini-clinical evaluation exercise: an observational study

Background

Health care professionals with positive attitudes towards the functional abilities of patients with low back pain are more likely to encourage activity and avoidance of rest as per recommended guidelines. This study investigated whether medical student training fosters positive attitudes towards patients with back pain and their ability to function.

Methods

First (n = 202) and final (n = 146) year medical students at the University of Glasgow completed the Health Care Professionals' Pain and Impairment Relationship Scale (HC-PAIRS) questionnaire. This measures attitudes of clinicians towards the functional ability of patients with back pain. A group of first (n = 62) and final year (n = 61) business students acted as non-health care controls. Attitudes were compared using two-way ANOVA with year of study and discipline of degree as independent variables.

Results

Both year of study [F(1,465) = 39.5, p < 0.01] and discipline of degree [F(1,465) = 43.6, p < 0.01] had significant effects on total HC-PAIRS scores and there was a significant interaction effect [F(1,465) = 9.5, p < 0.01]. Medical students commenced their course with more positive attitudes than non-health care students (65.7 vs. 69.2 respectively; p < 0.01) - lower scores translating into more positive attitudes. In their final year, the difference between the two student groups had widened (56.4 vs. 65.3; p < 0.01).

Conclusions

Undergraduate medical training promotes positive attitudes towards the functional ability of patients with back pain, suggesting that students may be more likely to develop an evidence-based approach to this patient group after qualification. Some adjustments to training may be warranted to encourage a more positive shift in attitudes.     

Cross-sectional pilot study about the health status of diabetic patients in city of Misurata, Libya

Background

Being a leading cause of death worldwide, epidemiological studies about diabetes mellitus have encouraged governments to initiate or improve local diabetes monitoring and prevention strategies.

Objective

The main objective of this study was to examine the profile of diabetic patients in the city of Misurata, the third largest city in Libya.

Methods

260 diabetic cases of both gender randomly selected from the total number of patients admitted to the centre of diabetes and endocrine disorders, Misurata -Libya for the period between January to March 2008. Data collected from patients'' files and by directly questioning the patients. SPSS software version 13 was used for the statistical analysis and presentation of the data.

Results

87% of all patients were type 2 diabetics, while only 9.9% were type 1. 73% of all patients had family history of diabetes. 52% of all diabetic patients were obese, with more obesity in females (70% of females) than males (33.8% of males). Obesity was more pronounced in type 2 patients (56.8%) than in type 1 patients (11.5%). 38% of all patients were treated with insulin while 35.4% were treated with oral hypoglycemics. Meanwhile 32.6% of type 2 diabetic patients were treated with insulin. Only 9.2% of all patients had fasting blood sugar below 140 mg/dl, whereas 55% had levels in the range of 140–180 mg/dl, while 35.8% had levels above 180 mg/dl. Microvascular complications included retinopathy (16.2% of all patients), neuropathy (11.2%), nephropathy (1.5%) and combination of neuropathy and retinopathy (6.5%).

Conclusion

High percentage of risk factors including obesity, family history of diabetes, hypertension and microvascular complications requires a Libyan national policy for the surveillance, prevention and control of diabetes and its complications.     

Epistaxis in Kaduna,Nigeria: a review of 101 cases

Background

Epistaxis is defined as a hemorrhage from the nostril, nasal cavity, or nasopharynx. Sufferers and clinicians may develop significant anxiety despite the fact that majority of patients are treated successfully by the first attending physician.

Objective

To review aetiology and management outcomes of epistaxis in a resource constrained setting.

Methodology

A retrospective review of 101 patients seen with epistaxis at the National Ear Care Centre, Kaduna over 7years (January 2002– December 2008).

Results

The age of patients ranged between 2 and 75years. The incidence of epistaxis of 0.5% was recorded out of total patient visit and slight male preponderance with a male:female ratio of 1.4:1. Dry-hot and cold harmattan weather had the highest prevalence. Trauma and infections were the main aetiological factors identified but over 40% of cases are idiopathic in origin. About 25% presented with active bleeding and 11% required admission. All were managed conservatively. Less than 2% received blood transfusion.

Conclusion

Epistaxis is a common emergency that requires prompt intervention to reduce further morbidity and prevent mortality. Non operative intervention was a satisfactory approach in this study.     

Positron emission tomography to assess hypoxia and perfusion in lung cancer

In lung cancer, tumor hypoxia is a characteristic feature, which is associated with a poor prognosis and resistance to both radiation therapy and chemotherapy. As the development of tumor hypoxia is associated with decreased perfusion, perfusion measurements provide more insight into the relation between hypoxia and perfusion in malignant tumors. Positron emission tomography (PET) is a highly sensitive nuclear imaging technique that is suited for non-invasive in vivo monitoring of dynamic processes including hypoxia and its associated parameter perfusion. The PET technique enables quantitative assessment of hypoxia and perfusion in tumors. To this end, consecutive PET scans can be performed in one scan session. Using different hypoxia tracers, PET imaging may provide insight into the prognostic significance of hypoxia and perfusion in lung cancer. In addition, PET studies may play an important role in various stages of personalized medicine, as these may help to select patients for specific treatments including radiation therapy, hypoxia modifying therapies, and antiangiogenic strategies. In addition, specific PET tracers can be applied for monitoring therapy. The present review provides an overview of the clinical applications of PET to measure hypoxia and perfusion in lung cancer. Available PET tracers and their characteristics as well as the applications of combined hypoxia and perfusion PET imaging are discussed.     

Pediatrics: A unique and volatile risk

Pediatric risk is both unique and volatile. Children are more vulnerable when treated in any healthcare environment, but especially in the acute care setting. Children with chronic healthcare conditions are more challenging to treat and more susceptible to medical errors. Despite marked improvement in the national medical malpractice environment, the most volatile claims involve severely injured patients under age eighteen and especially those patients in the first year of life. This article provides the context of pediatric care in reviewing the demographics of children and the healthcare delivery system. The unique factors of pediatric care that create increased risk are also reviewed. Low frequency/high severity claims involving children are discussed in detail as well as physician claims in the specialty of general pediatrics. Risk management solutions for pediatric issues are proposed.     

Effectiveness of the universal prevention program 'Healthy School and Drugs': Study protocol of a randomized clustered trial

Background  

Substance use is highly prevalent among Dutch adolescents. The Healthy School and Drugs program is a nationally implemented school-based prevention program aimed at reducing early and excessive substance use among adolescents. Although the program's effectiveness was tested in a quasi-experimental design before, many program changes were made afterwards. The present study, therefore, aims to test the effects of this widely used, renewed universal prevention program.