A Comparison of Surgery and Family Medicine Residents' Perceptions of Cross-Cultural Care Training of Cross-Cultural Care Training

The need for physicians formally trained to deliver care to diverse patient populations has been widely advocated. Utilizing a validated tool, Weissman and Betancourt''s Cross-Cultural Care Survey, the aim of this current study was to compare surgery and family medicine residents'' perceptions of their preparedness and skillfulness to provide high quality cross-cultural care. Past research has documented differences between the two groups'' reported impressions of importance and level of instruction received in cross-cultural care. Twenty surgery and 15 family medicine residents participated in the study. Significant differences were found between surgery and family medicine residents on most ratings of the amount of training they received in cross-cultural skills. Specifically, family medicine residents reported having received more training on: 1) determining how patients want to be addressed, 2) taking a social history, 3) assessing their understanding of the cause of illness, 4) negotiating their treatment plan, 5) assessing whether they are mistrustful of the health care system and/or doctor, 6) identifying cultural customs, 7) identifying how patients make decisions within the family, and 8) delivering services through a medical interpreter. One unexpected finding was that surgery residents, who reported not receiving much formal cultural training, reported higher mean scores on perceived skillfulness (i.e. ability) than family medicine residents. The disconnect may be linked to the family medicine residents'' training in cultural humility — more knowledge and understanding of cross-cultural care can paradoxically lead to perceptions of being less prepared or skillful in this area.     

Effect of tadalafil on blood flow,pain, and function in chronic cold Complex Regional Pain Syndrome: a randomized controlled trial

Background  

This double-blind, randomized, controlled trial investigated the effect of the phosphodiesterase-5 inhibitor tadalafil on the microcirculation in patients with cold Complex Regional Pain Syndrome (CRPS) in one lower extremity.     

Osteosarcoma: use of MR imaging and MR spectroscopy in clinical decision making

Magnetic resonance (MR) imaging was performed on 14 patients with histologically proved osteosarcoma (mean age, 14.4 years). There was excellent correlation of intramedullary tumor extent as determined with MR imaging and pathologic examination (r = 99%). This was facilitated by the presence of a chemical shift artifact at the tumor-marrow interface on the T1-weighted images. The correlation between CT and pathologic findings was not as good (r = 84%). In a single patient, however, a 10-cm length of sclerotic bone was incorrectly interpreted as being tumor. If this case is excluded, the correlation between CT and pathologic findings improves significantly (r = 96%). T2-weighted images were optimal in demonstrating soft-tissue bulk and breach of the epiphysis or cortex. Vascular involvement was also readily defined. The T2 value of the tumor soft-tissue component decreased in patients who were deemed to have responded well to therapy. Two patients with very high T2 values after chemotherapy developed wide-spread metastatic disease and died. Phosphorus-31 MR spectroscopy of five patients with osteosarcoma showed elevated levels of phosphomonoesters (PMEs), inorganic phosphate (Pi), and phosphodiesters (PDEs). PME and PDE peak areas decreased in three patients after chemotherapy, while Pi peak areas increased.     

Cáncer de riñón hereditario

Kidney cancer is the tenth most common cause of cancer death. There are a growing number of genes known to be associated with an increased risk of specific types of kidney cancer.People with Von Hippel-Lindau syndrome have about a 40% risk of developing multiple bilateral clear cell kidney cancers. They can also develop retinal and brain hemangioblastoma, kidneys or pancreas cysts, pheochromocytoma and endolymphatic sac tumor. Four phenotypes with different renal cancer and pheocromocitoma risk have been described depending on the germline mutation.Hereditary papillary renal cell carcinoma syndrome has type 1 papillary renal cell carcinomas associated with protooncogene c-MET germline mutations.Birt-Hogg-Dubé syndrome has FLCN gene mutations associated with fibrofolliculomas, lung cysts with a high risk for spontaneous pneumothorax, and a 15% to 30% risk of kidney cancer (most classified as chromophobe carcinoma, oncocytoma or oncocytic hybrid, but clear cell and papillary kidney cancers have also been reported). Histopathological findings such as oncocytosis and oncocytic hybrids are very unusual outside the syndrome.Hereditary leiomyomatosis and renal cell cancer syndrome shows mutations of Fumarate hydratase gene and cutaneous leiomyomata in 76% of affected individuals, uterine leiomyomata in 100% of females, and unilateral, solitary, and aggressive papillary renal cancer in 10 to 16% of patients. A specific histopathological change is eosinophilic prominent nucleoli with a perinucleolar halo.Tuberous sclerosis complex is one of the most prevalent (1/5.800) hereditary syndromes where renal disease is the second leading cause of death, associated with angiomyolipomas (70%), renal cysts, oncocytomas or clear cell cancer.     

Aged venous thrombi: radioimmunoimaging with fibrin-specific monoclonal antibody

Radioimmunoimaging of fresh canine venous thrombi with a murine monoclonal antibody specific for human and dog fibrin has been reported. Successful imaging of canine deep venous thrombi 1, 3, and 5 days old at the time of antibody injection is reported. Images were positive in all dogs, and the uptake of fibrin-specific antibody was equivalent to that of fresh thrombi.     

福建省高校贫困大学生心理健康水平与人格特征

目的:了解贫困生的心理健康现状和人格特征。方法:于2005-09/11随机抽取福州大学、福建师范大学、福建农林大学、福建中医学院、闽江学院2002-2004级学生2400名。男1478名,女922名,平均(20±1)岁。根据2004-11-04福建省福州市政府办公厅正式下发的《福州市人民政府关于提高城区城镇及农村居民最低生活保障标准的通知》中的规定,即城镇多人户每人每个月210元、单人户230元;农村多人户每人每月155元、单人户175元,本文把家庭人均月收入较少,有一定数额债务,只能缴纳部分学杂费,基本生活费接近于当地居民最低生活保障线(如上规定,本文以230元为基准)的学生定为“贫困生”。采用精神症状自评量表和16种人格因素问卷对高校贫困生的心理健康和人格特征进行调查。结果:发放问卷2400份,收回有效问卷2111份。其中贫困生539份。①贫困生精神症状自评量表的躯体化、强迫、人际敏感、抑郁、焦虑、敌对、恐怖、偏执、精神病性、其他、总症状指数得分均高于非贫困生(贫困生:1.61±0.56,2.02±0.64,1.92±0.63,1.71±0.56,1.65±0.58,1.73±0.68,1.57±0.62,1.81±0.65,1.67±0.54,1.76±0.63,1.74±0.49;非贫困生:1.48±0.45,1.89±0.56,1.79±0.57,1.61±0.51,1.54±0.50,1.61±0.56,1.44±0.49,1.66±0.54,1.54±0.46,1.61±0.53,1.62±0.41,P<0.01)。男女贫困生之间各因子分差异均不显著(P>0.05)。②福建省高校贫困大学生的心理问题检出率为24.5%,其中轻度心理问题(2≤因子分<3)为22.6%;中度心理问题(3≤因子分<4)为1.7%;重度心理问题(4≤因子分<5)为0.2%。心理问题以强迫、人际敏感、偏执、忧郁、敌对、焦虑等心理问题最为突出。③16种人格因素问卷中,贫困生乐群性、聪慧性、兴奋性、敏感性、怀疑性上得分低于非贫困生,有恒性、忧虑性、独立性得分高于非贫困生(贫困生:5.20±1.77,4.70±1.93,5.49±1.87,6.46±1.79,4.29±1.71,4.60±1.63,6.64±1.82,5.07±1.82;非贫困生:5.39±1.74,4.95±1.99,5.82±1.91,6.66±1.75,4.55±1.77,4.36±1.69,6.43±1.94,4.89±1.77,P<0.05～0.01)。④影响贫困生心理健康水平的主要人格因素按其影响作用从大到小有怀疑性、忧虑性、稳定性、兴奋性、自律性。结论:福建省高校贫困大学生的心理健康状况令人担忧,其人格特征对心理健康水平有重要影响。     

Structure and function of murine cytomegalovirus MHC-I-like molecules: how the virus turned the host defense to its advantage

Immunologic Research - The mouse cytomegalovirus (CMV), a β-herpesvirus, exploits its large (~230&nbsp;kb) double-stranded DNA genome for both essential and non-essential functions. Among...