The impact of disability on performance in a high-stakes postgraduate surgical examination: a retrospective cohort study

ObjectiveDespite rising numbers of doctors in the workforce with disabilities, little is known about the impact of disabilities on postgraduate performance. To ensure all groups are treated fairly in surgical training, it is essential to know whether any attainment differences exist in markers of surgical performance. To address this gap, we assessed the impact of disabilities on performance on the Intercollegiate Membership of the Royal College of Surgeons examination (MRCS).DesignRetrospective cohort study.SettingSecondary care.ParticipantsAll UK MRCS candidates attempting Part A (n = 9600) and Part B (n = 4560) between 2007 and 2017 with linked disability data in the UK Medical Education Database (https://www.ukmed.ac.uk) were included.Main outcome measuresChi-square tests and correlation coefficients established univariate associations with MRCS performance, while multiple logistic regressions identified independent predictors of success.ResultsThough MRCS Part B pass rates were similar (p = 0.339), candidates with registered disabilities had significantly lower first-attempt Part A pass rates (46.3% vs. 59.8%, p < 0.001). Candidates with disabilities also performed less well in examinations taken throughout school and medical school, and after adjusting for prior academic performance and sociodemographic predictors of success, logistic regression found that candidates with disabilities were no less likely to pass MRCS than their peers (odds ratio 1.04, 95% confidence interval 0.66 to 1.62). No significant variation was found in MRCS performance between type of disability or degree of limitations caused by disability (p > 0.05).ConclusionAlthough candidates with registered disabilities performed less well in formal, written examinations, our data indicate that they are as likely to pass MRCS at first attempt as their peers who achieved similar grades at high school and medical school. In order to enable equity in career progression, further work is needed to investigate the causes of attainment differences in early career assessments.     

Human cochlear expressed sequence tags provide insight into cochlear gene expression and identify candidate genes for deafness

To identify candidate genes for human hearing disorders and to understand better human hearing at the molecular level, we constructed a human cochlear cDNA library. An aliquot of the unsubtracted cochlear library was contributed to the IMAGE Consortium at Lawrence Livermore National Laboratory for the generation of expressed sequence tags (ESTs) by the Merck/WashU EST project. Over 4000 ESTs were developed from the cochlear cDNA library and deposited in the GenBank EST database. Sequence clustering shows that the majority of clones are in low copy numbers, demonstrating the high complexity of the library. The sequences of 1388 cochlear ESTs (33%) match 517 known human genes. Among these are genes previously shown to cause both syndromic and non- syndromic hearing loss. A number of the cochlear ESTs show high homology to non-human genes, suggesting new gene family members or human homologs of animal genes. We also report the chromosomal map positions of 437 cochlear ESTs. These provide positional candidate genes for 18 different non-syndromic hearing disorders. A Human Cochlear EST Database web site (http://www.bwh.partners. org/pathology ) has been created to provide access to the cochlear clone data for gene discovery investigations.      

氟司喹南与卡托普利用于慢性心衰

标题　治疗慢性心衰的远期疗效研究—ｆｌｏｓｅｑｕｉｎａｎ和Ｃａｐｔｏｐｒｉｌ的一年比较作者　ＣｏｗｌｅｙＡＪ,ｅｔａｌ．ＣａｒｄｉｏｖａｓｅＤｒｕｇｓＴｈｅｒ,１９９４,８：８２９～８３６（英文）　　研究疾病：充血性心力衰竭。目的：比较以ｆｌｏｓｅｑｕｉｎａｎ和卡托普利（Ｃａｐｔｏｐｒｉｌ）治疗中度到重症心衰用利尿剂后仍有症状的病人之疗效。　　设计：随机双盲的多中心研究。病人资料：２０９例中度到重度的心衰患者（ＮＹＨＡⅢ～Ⅳ级）,用速尿（ｆｒｕｓｅｍｉｄｅ）≥８０ｍｇ／ｄ或相当量之利尿剂无效,心…     

CHARACTERISATION OF AUTOANTIBODIES TO PERIPHERAL MYELIN PROTEIN 22 IN PATIENTS WITH HEREDITARY AND ACQUIRED NEUROPATHIES

Lipopolysaccharides (LPS) from Campylobacter jejuni strains isolated from patients with Guillain-Barre syndrome (GBS) display molecular mimicry with GM1. We immunized rabbits with C. jejuni LPS from GBS-associated strains containing a GM1-like epitope. All animals produced high titre anti-LPS antibodies that were cross-reactive with GM1. We conclude that C. jejuni strains from GBS patients are able to induce antibodies that cross-react with gangliosides and LPS. This study further confirms the role of molecular mimicry in the induction of anti-ganglioside antibodies in GBS patients.     

Repeated dose inhaled budesonide versus placebo in the treatment of croup

OBJECTIVE: To investigate the efficacy and tolerance of 12-hourly dosing with 2 mg 4 mL-1 of inhaled budesonide versus placebo in patients admitted to hospital with moderate/severe croup. METHOD: Eighty-two children hospitalised with croup received either 2 mg 4 mL-1 of budesonide or placebo 12 hourly (maximum four doses) via Ventstream nebuliser in a randomised, double-blind manner. Croup scores were performed at 0, 2, 6, 12, 24, 36 and 48 h from initial nebulisation whilst the patient remained hospitalised. Follow-up assessments were made 1 and 3 days after discharge. RESULTS: Improvement was observed in the budesonide group over the 12-h dosing interval when compared to placebo (P = 0.04). Time to attain a significant clinical improvement was superior in the budesonide group (P = 0.01). Three days after discharge seven of 32 placebo-treated patients and one of 34 budesonide-treated patients had sought further medical follow-up (P = 0.02). CONCLUSION: Twelve-hourly dosing with inhaled budesonide significantly improved symptoms of croup as well as decreased relapse rates when compared with placebo.     

Practical Belief Scales Among Private General Dental Practitioners

BACKGROUND: Practice beliefs have been related to service rate variation. The aims of this study were to replicate practice belief scales in Australia and investigate associations with dentist and practice characteristics and services. METHODS: A random sample of Australian dentists completed mailed questionnaires (response rate 60.3 per cent). RESULTS: Private general practitioners (n = 345) provided service data from a typical day. Eight practice belief items were recorded on a five-point Likert scale, yielding four factor-based scales. Approximately 85 per cent of responses were on the agreement side of the midpoint for the scales of Information giving and Patient influence, 45 per cent for Preventive orientation and approximately 10 per cent for Controlling active disease rather than developing better preventive advice. Capital city dentists had higher agreement with the Preventive orientation scale, while males and older dentists showed less disagreement with the Controlling active disease item (Mann-Whitney, Kruskal-Wallis P < 0.05). Those agreeing with the scales (that is scores < or = the median) showed (Poisson regression P < 0.05): a higher rate of crown and bridge, a rate ratio (RR) of 1.31, but lower rates of extraction (RR = 0.76) and prosthodontic services (RR = 0.64) for the Information giving scale; a higher rate of restorative (RR = 1.22) and total services per visit (RR = 1.06) for the Preventive orientation scale; a higher rate of preventive services (RR = 1.14), but a lower rate of crown and bridge services (0.78) for the Patient influence scale; and higher rates of crown and bridge (RR = 1.40) and prosthodontic (RR = 1.59) but lower rates of periodontic (RR = 0.60) and extraction services (RR = 0.62) for the Controlling active disease item. CONCLUSIONS: These findings confirm the factor structure of practice beliefs and demonstrate small to moderate associations with variation in service rates.     

THE OCULAR AND PERIOCULAR FEATURES OF MULTICENTRIC RETICU-LOHISTIOCYTOSIS WITH PARAPROTEINEMIA A report of two cases

Two patients with atypical multicentric reticulohistiocytosis are reported. Skin rigidity with mobile rubbery nodules, and telangiectases, are typical of this disease and occurred around the eyes and elsewhere. One patient also had subconjunctival nodules and corneal crystal formation probably due to her paraproteinaemia.
Some literature on this disease and on the occurrence of corneal crystal deposition in dysproteinaemia is reviewed.