Development,implementation, and evaluation of an integrated multidisciplinary Objective Structured Clinical Examination (OSCE) in primary health care settings within limited resources

Background: In ordinary circumstances, objective structured clinical examination (OSCE) is a resource-intensive assessment method. In case of developing and implementing multidisciplinary OSCE, there is no doubt that the cost will be greater.

Aim: Through this study a research project was conducted to develop, implement and evaluate a multidisciplinary OSCE model within limited resources.

Methods: This research project went through the steps of blueprinting, station writing, resources reallocation, implementation and finally evaluation.

Results: The developed model was implemented in the Primary Health Care (PHC) program which is one of the pillars of the Community-Based undergraduate curriculum of the Faculty of Medicine, Suez Canal University (FOM-SCU). Data for evaluation of the implemented OSCE model were derived from two resources. First, feedback of the students and assessors through self-administered questionnaires was obtained. Second, evaluation of the OSCE psychometrics was done. The deliverables of this research project included a set of validated integrated multi-disciplinary and low cost OSCE stations with an estimated reliability index of 0.6.

Conclusion: After having this experience, we have a critical mass of faculty members trained on blueprinting and station writing and a group of trained assessors, facilitators and role players. Also there is a state of awareness among students on how to proceed in this type of OSCE which renders future implementation more feasible.     

Neurólise do tronco celíaco com o uso de agulha única versus agulha dupla no manejo da dor abdominal maligna: estudo randômico controlado

BackgroundComputerized tomography‐guided celiac plexus neurolysis has become almost a safe technique to alleviate abdominal malignancy pain. We compared the single needle technique with changing patients’ position and the double needle technique using posterior anterocrural approach.MethodsIn Double Needles Celiac Neurolysis Group (n = 17), we used two needles posterior anterocrural technique injecting 12.5 mL phenol 10% on each side in prone position. In Single Needle Celiac Neurolysis Group (n = 17), we used single needle posterior anterocrural approach. 25 mL of phenol 10% was injected from left side while patients were in left lateral position then turned to right side. The monitoring parameters were failure block rate and duration of patient positioning, technique time, Visual Analog Scale, complications (hypotension, diarrhea, vomiting, hemorrhage, neurological damage and infection) and rescue analgesia.ResultsThe failure block rate and duration of patient positioning significantly increased in double needles celiac neurolysis vs. single needle celiac neurolysis (30.8% vs. 0.13.8±1.2 vs. 8.9 ± 1; p = 0.046, p ≤ 0.001 respectively). Also, the technique time increased significantly in double needles celiac neurolysis than single needle celiac neurolysis (24.5 ± 5.1 vs. 15.4 ± 1.8; p ≤ 0.001). No significant differences existed as regards visual analogue scale: double needles celiac neurolysis = 2 (0‐5), 2 (0‐4), 3 (0‐6), 3 (2‐6) and single needle celiac neurolysis = 3 (0‐5), 2 (0‐5), 2 (0‐4), 4 (2‐6) after 1 day, 1 week, 1 and 3 months respectively. However, visual analogue scale in each group reduced significantly compared with basal values (p ≤ 0.001). There were no statistically significant differences as regards rescue analgesia and complications (p > 0.05).ConclusionSingle needle celiac neurolysis with changing patients’ position has less failure block rate, less procedure time, shorter duration of patient positioning than double needles celiac neurolysis in abdominal malignancy.     

Influence of orthodontic appliance type on salivary parameters during treatment

ObjectivesTo evaluate the effect of orthodontic appliances on physicochemical, biochemical, and oxidative stress changes in salivary parameters during treatment.Materials and MethodsA cohort study was conducted with 112 healthy patients. Salivary samples were taken at baseline, 1 month, and 9 months after placement of the orthodontic appliances used in treatment.ResultsA statistically significant difference was observed in certain examined salivary parameters, including enzymes, electrolytes, and oxidative stress markers.ConclusionsThe use of aligners had a lower prevalence of disturbing salivary parameters. Orthodontist must consider these changes to prevent the occurrence of white spot lesions.     

Accuracy and trending of non-invasive hemoglobin measurement during different volume and perfusion statuses

The evolution of non-invasive hemoglobin measuring technology would save time and improve transfusion practice. The validity of pulse co-oximetry hemoglobin (SpHb) measurement in the perioperative setting was previously evaluated; however, the accuracy of SpHb in different volume statuses as well as in different perfusion states was not well investigated. The aim of this work is to evaluate the accuracy and trending of SpHb in comparison to laboratory hemoglobin (Lab-Hb) during acute bleeding and after resuscitation. Seventy patients scheduled for major orthopedic procedures with anticipated major blood loss were included. Radical-7 device was used for continuous assessment of SpHb, volume status [via pleth variability index (PVI)] and perfusion status [via perfusion index (PI)]. Lab-Hb and SpHb were measured at three time-points, a baseline reading, after major bleeding, and after resuscitation. Samples were divided into fluid-responsive and fluid non-responsive samples, and were also divided into high-PI and low-PI samples. Accuracy of SpHb was determined using Bland–Altman analysis. Trending of SpHb was evaluated using polar plot analysis. We obtained 210 time-matched readings. Fluid non-responsive samples were 106 (50.5%) whereas fluid responsive samples were 104 (49.5%). Excellent correlation was reported between Lab-Hb and SpHb (r?=?0.938). Excellent accuracy with moderate levels of agreement was also reported between both measures among all samples, fluid non-responsive samples, fluid-responsive samples, high-PI samples, and low-PI samples [Mean bias (limits of agreement): 0.01 (??1.33 and 1.34) g/dL, ??0.08 (??1.27 and 1.11) g/dL, 0.09 (??1.36 and 1.54) g/dL, 0.01 (??1.34 to 1.31) g/dL, and 0.04 (??1.31 to 1.39) g/dL respectively]. Polar plot analysis showed good trending ability for SpHb as a follow up monitor. In conclusion, SpHb showed excellent correlation with Lab-Hb in fluid responders, fluid non-responders, low-PI, and high PI states. Despite a favorable mean bias of 0.01 g/dL for SpHb, the relatively wide levels of agreement (??1.3 to 1.3 g/dL) might limit its accuracy. SpHb showed good performance as a trend monitor.