The introduction of a new assessment system in restorative dentistry: the undergraduate and patient experience

In 2000, the University of Bristol Dental School Division of Restorative Dentistry carried out a review of the assessment methods used within the undergraduate programme. Following this review, a number of key recommendations were made and the system of formative assessment within the division was changed. Audits were conducted immediately prior to the introduction of the new system and 2 years after it had been introduced, the results of these audits are presented. There was no change in the number of failed appointments between the initial audit and the second audit. There was a reduction in the number of patients treated by more than one student from 25% to 14% (approximating to 3% if student withdrawal from the course is taken into account). The length of time taken to complete treatment reduced between the two audits with more than half of all patients having their treatment completed within 3 months of their initial examination in the second audit. Ninety-five percent of treatment plans were completed in the second audit compared with only 62% in the first audit. In the second audit, the outstanding 5% of cases were signed off as incomplete for satisfactory reasons by the member of supervisory staff (e.g. patients who had moved away or were discharged due to poor attendance). Student comments were mostly positive, the small number of negative comments related to some students being confused by the paperwork in the new system. The overall process has been an extremely positive experience which has resulted in an assessment system with increased clarity which appears to have reduced the stress levels reported by the undergraduate students on the programme and improved the quality of patient care within restorative dentistry.     

大中学生预防艾滋病生活技能需求

目的了解我国学生对学校预防艾滋病教育中生活技能的需求情况,为今后开展以生活技能为基础的预防艾滋病教育提供依据。方法对北京市5所初中3、所高中和2所大学的1207名学生进行问卷调查。结果无论初中、高中还是大学生,多数学生都认为这些生活技能要素在开展预防艾滋病教育中能够起到重要的作用。不同学段学生对9类技能的认知重要程度不同,初中生认为认识和解决问题能力最重要,高中生认为创造性思维能力最重要,大学生认为批判性思维能力最重要。结论根据学生年龄有所侧重地开展以生活技能为基础的学校预防艾滋病教育十分重要。     

用ROC曲线评价肿瘤标志物LDH在急性白血病早期诊断中的临床价值

目的 探讨肿瘤标志物乳酸脱氢酶（LDH）在急性白血病早期诊断中的临床价值。方法 应用受试者工作特性曲线（ROC曲线）及其曲线下面积（AUC）抛物线估算法（以金标准计算准确度和敏感度），对51例急性白血病的早期患者及部分经治疗后缓解的患者、61例非急性白血病患者、61例健康体检者进行了LDH的检测及分析。结果 AUC为0．954，其可信区间为0．935－0．973，其下限0．935远离0．5，经治疗缓解的白血病患者LDH检验结果与治疗前数据经t检验证实＜0．0001。结论 LDH对急性白血病的早期诊断以及治疗效果与预后的评估均有着重要及较好的临床价值。     

Granulosa cell metabolism and the assessment of oocyte quality in IVF

The progesterone production of the granulosa cells of the cumulus– oocyte complex correlates very well with the cleavagepotential of embryos in an IVF system. The method is simpleand can be easily performed by any laboratory associated withIVF. Furthermore, high intratubal progesterone levels in theimmediate post-ovulatory period are probably important in prolongingthe intra-ampullary residence of the oocyte or embryo untilthe uterine endometnum is optimal for implantation.     

全国细菌药敏试验的室间质量评价

目的：了解全国大中型医院细菌药敏试验（AST）状况，提高检测水平和质量。方法：定期向全国各参加评价实验室发放冻干标本，要求在规定时间内报告可疑感染的病原菌及其药敏结果，对回报结果给予数据统计、分析和评价。结果：2000年全国489个细菌室对常见耐药菌的检测正确率分别为：超广谱β－内酰胺酶63％（ESBLs)；苯唑西林敏感金黄色葡萄球菌（MSSA）74％；苯唑西林耐药凝固酶阴性葡萄球菌（MRSCoN)48％；对青霉素不敏感肺炎链球菌7％；氨基糖苷类高水平耐药肠球菌95％；产β－内酰胺酶流感嗜血杆菌正确率35％。结论：通过细菌药敏试验的室间质量评价反映出我国的细菌耐药性检测水平急待提高。     

Assessment of postoperative pain: impact of clinical experience and professional role

Background: Unrelieved postoperative pain is still reported to be a rather common clinical problem which may be related to inadequate routines for pain assessment. Therefore, the aim of the study was to describe strategies used by experienced and less experienced nurses and physicians in their assessment of postoperative pain and to relate different approaches, clinical experience, and professional role to the accuracy of the pain ratings.
Methods: Data collection was based on repeated interviews with nurses (n=30) and physicians (n=30) in connection with clinical pain assessments (n=180) including VASscoring
Results: Commonly used strategies in the pain assessment were: - how the patient looks, - what the patient says, - the manner of talking, and - past experience of similar circumstances. The mean VAS-score given by the patients (6.1±21.1) was significantly (P<0.001) higher than that rated by the staff members (4.9±21.2). Nurses as well as physicians overestimated low and underestimated high levels of pain indicated by the patients. The accuracy of the ratings by nurses, especially by more experienced ones (≤10 years in nursing), was found to be less precise than that of physicians. The pain assessment of these very experienced nurses was characterized by a systematic underestimation.
Conclusions: The present study emphasizes a need for definition of more precise strategies for clinical postoperative pain assessment which better take into consideration the pain experiences and needs of individual patients     

Surgically debulked malignant pleural mesothelioma: Results and prognostic factors

Background: We analyzed morbidity and mortality, sites of recurrence, and possible prognostic factors in 95 (78 male, 17 female) patients with MPM on phase I–III trials since 1990. A debulking resection to a requisite, residual tumor thickness of ≤ 5 mm was required for inclusion. Methods: Preoperative tumor volumes were determined by three-dimensional reconstruction of chest computerized tomograms. Pleurectomy (n=39) or extrapleural pneumonectomy (EPP; n=39) was performed. Seventeen patients could not be debulked. Preoperative EPP platelet counts (404,000) and mean tumor volume (491 cm³) were greater than that seen for pleurectomy (344,000, 114 cm³). Results: Median survival for all patients was 11.2 months, with that for pleurectomy 14.5 months, that for EPP 9.4 months, and that for unresectable patients 5.0 months. Arrhythmia (n=14; 15%) was the most common complication, and there were two deaths related to surgery (2.0%). Tumor volume of >100 ml, biphasic histology, male sex, and elevated platelet count were associated with decreased survival (p<0.05). Both EPP and pleurectomy had equivalent recurrence rates (27 of 39 [69%] and 31 of 39 [79%], respectively); however, 17 of 27 EPP recurrences as opposed to 28 of 31 pleurectomy recurrences were locoregional (p₂=0.013). Conclusions: Debulking resections for MPM can be performed with low operative mortality. Size and platelet count are important preoperative prognostic parameters for MPM. Patients with poor prognostic indicators should probably enter nonsurgical, innovative trials where toxicity or response to therapy can be evaluated. Presented at the 49th Annual Cancer Symposium of The Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996.     

Responsiveness and calibration of the general well-being adjustment scale in patients with hypertension

We examined the discriminant ability and responsiveness of the General Well-Being Adjustment Scale in patients enrolled in a randomized clinical trial of antihypertensive therapy. We also tried to translate the effects of physical symptoms on general well-being. This secondary analysis used demographic, clinical, physical symptom, and general well-being data for 545 white, male hypertensive patients. General well-being was measured by the General Well-Being Adjustment Scale (GWB) collected on 2 occasions over 8 weeks of treatment. Patients with any one of 14 physical symptoms or problems, compared to those without symptoms, had lower GWB scores (p < 0.003 to p < 0.0001). Decreases of 2.83–8.76 points in GWB scores were observed in patients developing physical symptoms over the 8 week study period (p < 0.05 to p < 0.0001). These effects were demonstrated in patients developing cold sensitivity, sexual problems, chest pain, shortness of breath, loss of taste, nausea, hot or cold spells, numbness and tingling, dry mouth, blurred vision, and dizziness. We conclude that the GWB is responsive to clinically meaningful changes in symptoms and may provide a more complete evaluation of the effects of medical treatment. The GWB is a valid and responsive measure of health status outcomes in the evaluation of antihypertensive treatment.     

Evidence for differential effects of 8-OH-DPAT on male and female rats in the Anxiety/Defense Test Battery

The Proxemics/Activity test and the Eat/Drink test, two components of the Anxiety/Defense Test Battery, were developed to measure defensive reactions to situations associated with a natural predator (cat). In the present studies the behavioral effects of 8-OH-DPAT treatment (0.01–1.0 mg/kg, SC) were entirely consistent with anxiety/fear reduction. These effects included an increase in time spent near the cat compartment, and a complimentary decrease in time spent farthest from this compartment, together with an increase in transits and locomote behavior. 8-OH-DPAT (1.0 mg/kg) also increased eat frequencies and durations (highly preferred food) both during and following cat presentation, without influencing drinking. This finding is discussed with reference to previous findings with 8-OH-DPAT in studies assessing both food intake and anxiolysis. Interestingly, 8-OH-DPAT was more potent in a majority of its effects in female subjects, a finding consistent with recent neurochemical data. These findings provide important behavioral evidence for a sexual differentiation in 5-HT function, and support the case for greater emphasis on female subjects in animal models of anxiety.Supported by NIH MH42803 and RCMI Grants RR03061 and RR01825     

Stressors in ICU: patients’ evaluation

Objective: To study the physical and psychological stressors in the intensive care unit (ICU) and to correlate stressors with different demographic variables. Design: Cross-sectional analytical survey. Setting: Intensive care unit of a private hospital. Patients and participants: 50 randomly selected ICU patients during the first week of their ICU stay. Measurements and results: The Intensive Care Unit Environmental Stressor Scale was administered to 50 patients. Pain and the impossibility of sleeping due to noise and having tubes in the nose and mouth were considered the most important physical stressors. Loss of self control and lack of understanding about the attitudes and procedures were the main psychological stressors. Conclusions: Interventions should be aimed at relieving the patient's pain and at controlling the level of noise to make sleep possible. From the psychological standpoint, the independence of the patient should be encouraged, thus stimulating the recovery of self-control. The team should also inform the patient about the procedures which will be carried out. Received: 1 April 1997 Accepted: 24 September 1997