Δευτέρα 20 Ιουνίου 2016

Diagnosis and Rehabilitation of a Middle Cuneiform Fracture in a Hockey Player

imageABSTRACT: Isolated cuneiform fractures are rare and are often missed on plain radiographs, leading to delayed diagnosis and delayed return to sport. The authors of this study present a 32-year-old male ice hockey player who sustained trauma to his dorsal midfoot from a slap shot. Radiographs were negative for fracture. After inability to wean out of the controlled ankle movement boot, magnetic resonance imaging was ordered, demonstrating a middle cuneiform fracture. The patient was seen in physical therapy, where aquatic therapy, strength training, and cardiovascular conditioning were progressed. He was able to wean out of the controlled ankle movement boot at 7 weeks after injury and return to playing ice hockey. Here, we outline rehabilitation and a diagnostic and rehabilitative algorithm for those who sustain trauma to the dorsal midfoot with suspected fracture.

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Impact of Needle Diameter on Long-Term Dry Needling Treatment of Chronic Lumbar Myofascial Pain Syndrome

imageObjective: To investigate the impact of diameter of needles on the effect of dry needling treatment of chronic lumbar myofascial pain syndrome. Design: Forty-eight patients with chronic lumbar myofascial pain syndrome were randomly allocated to 3 groups. They received dry needling with needles of diameter 0.25 (group A), 0.5 (group B), and 0.9 mm (group C). Visual analog scale evaluation and health survey were conducted at baseline and 3 months after the treatment. Results: Visual analog scale scores were significantly different in all groups from baseline to 3 months. Visual analog scale scores at 3 months showed differences between group C and the other 2 groups. When baseline and 3 months after treatment (0 day and 3 months) in each of the 3 groups was compared, there was a difference between group C and group B. The Short Form (36) Health Survey scores from baseline to 3 months were different within the treatment groups. Conclusions: Visual analog scale score evaluations at 3 months showed efficacy in all groups. Results of 3 months showed that efficacy of treatment with larger needles (0.9-mm diameter) was better than that of smaller ones (0.5-mm diameter). The Short Form (36) Health Survey scores at 3 months indicated that treatments with needles of varying diameters were all effective, and when the results of 3 months were compared, there was no difference between the 3 groups.

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Dynamic Ultrasound Imaging for Ulnar Nerve Subluxation and Snapping Triceps Syndrome

imageNo abstract available

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Radial Extracorporeal Shock Wave Therapy Is Not More Effective Than Placebo in the Management of Lateral Epicondylitis: A Double-Blind, Randomized, Placebo-Controlled Trial

imageObjectives: The aim of this study was to investigate the effects of radial extracorporeal shock wave therapy (rESWT) on pain, function, and grip strength in the treatment of patients with lateral epicondylitis unresponsive to previous treatments. Design: A double-blind, randomized, placebo-controlled trial was conducted in outpatient clinics in a medical faculty hospital. Fifty-six patients with lateral epicondylitis were randomized to rESWT (n = 28) or sham rESWT (n = 28) groups. Both the patients and the outcome assessing investigator were blinded to group assignment. The rESWT was administered to the painful epicondyle at the elbow with a total of 2000 pulses of 10 Hz frequency at a 1.8 bar of air pressure at each session at three once weekly sessions. Sham rESWT was applied without the contact of the applicator at the same area. Study patients were assessed at baseline and at 1 and 3 mos after treatment using a visual analog scale for pain and Roles and Maudsley scale and Patient-Rated Tennis Elbow Evaluation for pain and function. Grip strength of the affected extremity was also measured using a hand dynamometer. Results: Both rESWT and sham rESWT groups showed a significant improvement in all outcome measures at posttreatment follow-up points. Favorable absolute and percentage changes in assessments at 1- and 3-mo posttreatment did not show any significant difference between groups. Conclusions: The rESWT does not seem to be more effective either in reducing pain or improving function or grip strength in patients with lateral epicondylitis at least at 3 mos after treatment when compared with sham rESWT.

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A Speculative Pharmaceutical Cocktail to Treat Spinal Cord Injury

No abstract available

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Myofascial Release Therapy in the Treatment of Occupational Mechanical Neck Pain: A Randomized Parallel Group Study

imageObjective: As myofascial release therapy is currently under development, the objective of this study was to compare the effectiveness of myofascial release therapy with manual therapy for treating occupational mechanical neck pain. Design: A randomized, single-blind parallel group study was developed. The sample (n = 59) was divided into GI, treated with manual therapy, and GII, treated with myofascial release therapy. Variables studied were intensity of neck pain, cervical disability, quality of life, craniovertebral angle, and ranges of cervical motion. Results: At five sessions, clinical significance was observed in both groups for all the variables studied, except for flexion in GI. At this time point, an intergroup statistical difference was observed, which showed that GII had better craniovertebral angle (P = 0.014), flexion (P = 0.021), extension (P = 0.003), right side bending (P = 0.001), and right rotation (P = 0.031). A comparative analysis between therapies after intervention showed statistical differences indicating that GII had better craniovertebral angle (P = 0.000), right (P = 0.000) and left (P = 0.009) side bending, right (P = 0.024) and left (P = 0.046) rotations, and quality of life. Conclusions: The treatment of occupational mechanical neck pain by myofascial release therapy seems to be more effective than manual therapy for correcting the advanced position of the head, recovering range of motion in side bending and rotation, and improving quality of life.

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Self-Selected and Maximal Walking Speeds Provide Greater Insight Into Fall Status Than Walking Speed Reserve Among Community-Dwelling Older Adults

imageObjective: To determine the degree to which self-selected walking speed (SSWS), maximal walking speed (MWS), and walking speed reserve (WSR) are associated with fall status among community-dwelling older adults. Design: WS and 1-year falls history data were collected on 217 community-dwelling older adults (median age = 82, range 65–93 years) at a local outpatient PT clinic and local retirement communities and senior centers. WSR was calculated as a difference (WSRdiff = MWS − SSWS) and ratio (WSRratio = MWS/SSWS). Results: SSWS (P

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Analysis of Postural Control During Quiet Standing in a Population with Diabetic Peripheral Neuropathy Undergoing Moderate Intensity Aerobic Exercise Training: A Single Blind, Randomized Controlled Trial

imageObjective: The aim of this study was to investigate the effect of 8 wks of moderate-intensity aerobic exercise on postural control during quiet standing in type 2 diabetic peripheral neuropathy. Methods: Individuals were included in the study if they had type 2 diabetes with clinical neuropathy, defined by a minimum score of 7 on the Michigan Diabetic Neuropathy Score, following which the patients were randomly assigned to an 8-wk program by computer-generated random number tables to study or control group. Repeated-measures analysis of variance was used for data analysis (P

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The Diagnostic Value of Nerve Ultrasound in an Atypical Palmar Cutaneous Nerve Lesion

imageABSTRACT: Detailed knowledge of the fascicular anatomy of peripheral nerves is important for microsurgical repair and functional electrostimulation. We report a patient with a lesion on the left palmar cutaneous branch of the median nerve (PCBMN) and sensory signs expanding outside the PCBMN cutaneous innervation territory. Nerve conduction study showed the absence of left PCBMN sensory nerve action potential, but apparently, no median nerve (MN) involvement. Nerve ultrasound documented a neuroma of the left PCBMN and a coexistent lateral neuroma of the left MN in the carpal tunnel after the PCBMN left the main nerve trunk. Nerve ultrasound may offer important information in patients with peripheral nerve lesions and atypical clinical and/or nerve conduction study findings. The present case may shed some light on the somatotopy of MN fascicles at the wrist.

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Investigation of the Comparative Effects of Red and Infrared Laser Therapy on Skeletal Muscle Repair in Diabetic Rats

imageObjective: The aim of this study was to evaluate the in vivo response of 2 different laser wavelengths (red and infrared) on skeletal muscle repair process in diabetic rats. Design: Forty Wistar rats were randomly divided into 4 experimental groups: basal control—nondiabetic and muscle-injured animals without treatment (BC); diabetic muscle-injured without treatment (DC); diabetic muscle-injured, treated with red laser (DCR) and infrared laser (DCIR). The injured region was irradiated daily for 7 consecutive days, starting immediately after the injury using a red (660 nm) and an infrared (808 nm) laser. Results: The histological results demonstrated in both treated groups (red and infrared wavelengths) a modulation of the inflammatory process and a better tissue organization located in the site of the injury. However, only infrared light significantly reduced the injured area and increased MyoD and myogenin protein expression. Moreover, both red and infrared light increased the expression of the proangiogenic vascular endothelial growth factor and reduced the cyclooxygenase 2 protein expression. Conclusion: These results suggest that low-level laser therapy was efficient in promoting skeletal muscle repair in diabetic rats. However, the effect of infrared wavelength was more pronounced by reducing the area of the injury and modulating the expression proteins related to the repair.

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Dynamic and Doppler Ultrasound Imaging for the Diagnosis of Triangular Fibrocartilage Complex Injury and Ulnocarpal Wrist Instability

imageNo abstract available

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Effects of Electrical Stimulation on Risk Factors for Developing Pressure Ulcers in People with a Spinal Cord Injury: A Focused Review of Literature

imageABSTRACT: Pressure ulcers (PUs) are a common and serious problem for wheelchair users, such as individuals with a spinal cord injury (SCI), resulting in great discomfort, loss of quality of life, and significant medical care costs. Therefore, it is of utmost importance to prevent PUs. In this literature overview, the effects of electrical stimulation (ES) on the risk factors for developing PUs in people with an SCI are examined and synthesized from January 1980 to January 2015. Thirty-four relevant studies of PU prevention in SCI were identified. Four were randomized clinical trials, 24 were case series, 6 had other designs. Three types of ES modalities were identified. The methodological quality varied from poor to fairly strong, with a large variety in used ES parameters. Twenty-three studies were identified describing short-term effects of ES on interface pressure, oxygenation, and/or blood flow, and 24 studies described the long-term effects of ES on muscle volume, muscle strength, and histology. Whereas there is a lack of controlled studies on the effects of ES on PU incidence, which disallows definite conclusions, there is moderate evidence to suggest that ES-induced muscle activation has a positive influence on several risk factors for developing PUs in people with an SCI.

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Limb-Kinetic Apraxia Due to Injury of the Corticofugal Tract from the Secondary Motor Area in a Stroke Patient

imageNo abstract available

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The Lived Experiences of Transition to Parenthood for Parents of Preterm Infants

Research Poster Presented at NAPNAP's 2016 Posters on the Move, at the 37th National NAPNAP Conference, March 16, 2016, Atlanta, GA

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School-Based Telehealth: An Effective and Innovative Way to Improve Access to Care

Practice Innovation Poster Presented at NAPNAP's 2016 Posters on the Move, at the 37th National NAPNAP Conference, March 17, 2016, Atlanta, GA

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Working Conditions Reported by Pediatric Nurse Practitioners in Hospital Practice

Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Role and Practice Issues, Presented at NAPNAP's 37th National Conference on Pediatric Healthcare, March 17, 2016, Atlanta, GA

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The Development and Validation of a Tool to Assess the Acuity of Children Receiving Home-Based/Community Palliative Care

Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Health Promotion and Disease Prevention, Presented at NAPNAP's 37th National Conference on Pediatric Healthcare, March 17, 2016, Atlanta, GA

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Supporting Clinicians to Write: APN Publication Committee Efforts Successful

Intensified expectations exist for nurses to incorporate evidence-based practice, participate in discipline-specific research, and disseminate knowledge gained from these experiences through presentation and publication. Our advanced practice nurse (APN) governing council leaders recognized that publishing in peer-reviewed journals contributes to the body of nursing science, increases personal prestige, and contributes to organization visibility, ranking, marketing, and branding. Thus an APN publication committee (PC) was created to provide an environment for increased publishing to occur within our nursing division at The Ann & Robert H.

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Emotional Health Among Adolescents Experiencing Family Homelessness

Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Health Promotion and Disease Prevention, Presented at NAPNAP's 37th National Conference on Pediatric Healthcare, March 17, 2016, Atlanta, GA

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The Lazy Days of Summer?

Welcome to the not so lazy days of summer! I am honored to begin my term as your president and to pen my first President's Message. I continue to be amazed by the extraordinary level of expertise shown by our nursing scientists, researchers, educators, and clinicians as presented in the timely content published in this edition of Journal of Pediatric Health Care.

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Society



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Table of Contents



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Barriers and Incentives to Precepting Nurse Practitioner Students in a Pediatric Facility

Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Role and Practice Issues, Presented at NAPNAP's 37th National Conference on Pediatric Healthcare, March 17, 2016, Atlanta, GA

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Editorial Board



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Pavlik Harness Treatment May Not Be Necessary for All Newborns With Ultrasonic Hip Dysplasia

Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Health Promotion and Disease Prevention, Presented at NAPNAP's 37th National Conference on Pediatric Healthcare, March 17, 2016, Atlanta, GA

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Information for Readers



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The CONNECT Instrument and Perception of Illness in Inpatient Pediatrics

Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Role and Practice Issues, Presented at NAPNAP's 37th National Conference on Pediatric Healthcare, March 17, 2016, Atlanta, GA

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Selected Literature Watch

Journal of Caffeine Research , Vol. 0, No. 0.


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Selected Literature Watch

Journal of Caffeine Research , Vol. 0, No. 0.


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Dissolvable Metal Supports for 3D Direct Metal Printing

3D Printing and Additive Manufacturing Jun 2016, Vol. 3, No. 2: 90-97.


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Developing 3D Scaffolds in the Field of Tissue Engineering to Treat Complex Bone Defects

3D Printing and Additive Manufacturing Jun 2016, Vol. 3, No. 2: 106-112.


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3D-Printable Materials for Microbial Liquid Culture

3D Printing and Additive Manufacturing Jun 2016, Vol. 3, No. 2: 113-118.


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Same Intervention-Different Reorganization: The Impact of Lesion Location on Training-Facilitated Somatosensory Recovery After Stroke

Background. The brain may reorganize to optimize stroke recovery. Yet relatively little is known about neural correlates of training-facilitated recovery, particularly after loss of body sensations. Objective. Our aim was to characterize changes in brain activation following clinically effective touch discrimination training in stroke patients with somatosensory loss after lesions of primary/secondary somatosensory cortices or thalamic/capsular somatosensory regions using functional magnetic resonance imaging (fMRI). Methods. Eleven stroke patients with somatosensory loss, 7 with lesions involving primary (S1) and/or secondary (S2) somatosensory cortex (4 male, 58.7 ± 13.3 years) and 4 with lesions primarily involving somatosensory thalamus and/or capsular/white matter regions (2 male, 58 ± 8.6 years) were studied. Clinical and MRI testing occurred at 6 months poststroke (preintervention), and following 15 sessions of clinically effective touch discrimination training (postintervention). Results. Improved touch discrimination of a magnitude similar to previous clinical studies and approaching normal range was found. Patients with thalamic/capsular somatosensory lesions activated preintervention in left ipsilesional supramarginal gyrus, and postintervention in ipsilesional insula and supramarginal gyrus. In contrast, those with S1/S2 lesions did not show common activation preintervention, only deactivation in contralesional superior parietal lobe, including S1, and cingulate cortex postintervention. The S1/S2 group did, however, show significant change over time involving ipsilesional precuneus. This change was greater than for the thalamic/capsular group (P = .012; d = –2.43; CI = –0.67 to –3.76). Conclusion. Different patterns of change in activation are evident following touch discrimination training with thalamic/capsular lesions compared with S1/S2 cortical somatosensory lesions, despite common training and similar improvement.



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Inter-individual variability in the patterns of responses for electromyography and mechanomyography during cycle ergometry using an RPE-clamp model

Abstract

Purpose

To examine inter-individual variability versus composite models for the patterns of responses for electromyography (EMG) and mechanomyography (MMG) versus time relationships during moderate and heavy cycle ergometry using a rating of perceived exertion (RPE) clamp model.

Methods

EMG amplitude (amplitude root-mean-square, RMS), EMG mean power frequency (MPF), MMG-RMS, and MMG-MPF were collected during two, 60-min rides at a moderate (RPE at the gas exchange threshold; RPEGET) and heavy (RPE at 15 % above the GET; RPEGET+15 %) intensity when RPE was held constant (clamped). Composite (mean) and individual responses for EMG and MMG parameters were compared during each 60-min ride.

Results

There was great inter-individual variability for each EMG and MMG parameters at RPEGET and RPEGET+15 %. Composite models showed decreases in EMG-RMS (r 2 = −0.92 and R 2 = 0.96), increases in EMG-MPF (R 2 = 0.90), increases in MMG-RMS (r 2 = 0.81 and 0.55), and either no change or a decrease (r 2 = 0.34) in MMG-MPF at RPEGET and RPEGET+15 %, respectively.

Conclusions

The results of the present study indicated that there were differences between composite and individual patterns of responses for EMG and MMG parameters during moderate and heavy cycle ergometry at a constant RPE. Thus, composite models did not represent the unique muscle activation strategies exhibited by individual responses when cycling in the moderate and heavy intensity domains when using an RPE-clamp model.



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Community Safety Director - Highlands County Board of County Commissioners

This is a professional and administrative position directing and providing administrative oversight to the Community Safety Division (Emergency Medical Services, Fire Services, Emergency Management, and Animal Services) of the Highlands County Board of County Commissioners. Direct supervision over assigned Directors and Managers to include indirect supervision of numerous staff who report to other supervisors ...

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How to prepare EMS students to succeed in high-stress environments

Educators must use these four steps when planning to add stress to a drill for EMT and paramedic students

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Assay of neonatal cord blood lipid levels and its correlation with neonatal gestational age, gender and birth weight: a single center experience

2016-06-20T08-05-25Z
Source: International Journal of Contemporary Pediatrics
Yashaswini Kenchappa, Narendra Behera.
Background: It is a well-documented fact that atherosclerosis can originate in the fetal period itself. There is evidence that children with cholesterol levels in upper quartiles are at increased risk of subsequent atherosclerosis and numerous antenatal and perinatal factors may influence this atherogenesis. The current study tried to determine the levels of total cholesterol, triglycerides, LDL cholesterol, VLDL and HDL cholesterol in cord blood and correlate levels of these lipoproteins with various factors including fetal gender, gestational age, birth weight and gestational maturity and see whether these factors influence lipid profile in neonates. Methods: Cord blood lipid profile including assessment of total cholesterol, triglycerides, LDL cholesterol, VLDL and HDL cholesterol was done involving 90 neonates. Results: The low birth weight group and preterm neonates had higher and statistically significant levels of total cholesterol, triglycerides and LDL. They also had higher levels of HDL and VLDL, but the levels of these lipids were not statistically significant. No significant difference in lipid profile was noted based on gender and gestational maturity. Conclusions: Our study results reaffirm the relation between cord blood lipid profile and perinatal factors. With the significantly unhealthy lipid profile among the preterm and low birth weight babies we might safely say that the preterm and low birth weight babies are exposed to a more hypercholesterolemic and potentially more atherogenic environment than their term counterparts and early lifestyle modifications may be required to prevent their progression to coronary artery disease.


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6 success steps for diagnosing altered level of consciousness

Focus on assessing and treating the patient's basic life threats before interrogating bystanders or investigating the scene

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6 success steps for diagnosing altered level of consciousness

Patients with an altered level of consciousness are among the toughest to assess since there is no classic, "one size fits all" presentation.

The clinical presentation is often subtle, which makes recognizing changes in mental status a challenging endeavor. And, the underlying conditions that cause an ALOC have one of the largest differential diagnoses you may encounter in the prehospital setting.

Despite the many challenges, EMTs and paramedics who follow a structured approach with these patients are often able to find the cause and rule out worst-case scenarios. When you're called to help someone who isn't oriented to time, place or person, here are six ways to facilitate a successful patient contact.

1. Start with the ABCs
Avoid trying to discover the underlying reason for the patient's ALOC before you do a primary assessment and treat any immediate life threats. If there is a deficit in one of the patient's ABCs that isn't the primary cause, it will certainly make the patient worse if left untreated.

An unstable airway will lead to hypoxia and central nervous system depression. Inadequate breathing will contribute to high levels of carbon dioxide in the blood and respiratory acidosis. Poor circulation will cause hypoperfusion in the brain.

Only after you've methodically checked a patient's ABCs and treated any life threats, should you take a set of vital signs, inquire about the history of the present illness and obtain a SAMPLE history.

2. Do a detailed physical exam
Performing a physical exam is often the key to ruling in — or out — a possible cause for a patient's ALOC. For a stroke, look for a lack of movement on one side of the patient's body, unequal pupils or the presence of the Babinski's reflex (the big toe of an adult fanning upwards) by firmly stroking on the sole of the patient's foot with a pen or penlight.

Seizure patients may present with oral trauma or incontinence.

The skin of patients with hypoglycemia is often pale, cool and clammy. Patients with hyperglycemia often present with hot and dry skin.

Look for constricted pupils on patients who have overdosed on opiates and cyanosis in patients who are hypoxic.

To search for possible infection sources, scan the patient for signs of dialysis devices and catheters.

Always examine the patient to search for trauma and obtain an ECG to make sure a cardiac event isn't causing the mental status changes.

3. Search for underlying causes
After you've completed a primary assessment, physical exam and obtained a set of vital signs, begin your detective work to find or confirm the underlying cause. An altered mental status is not a disease state in itself, but is always caused by some underlying factor.

If the mnemonic AEIOU-TIPS (acidosis, alcohol, epilepsy, infection, overdose, uremia, trauma, tumor, insulin, psychosis, stroke) is difficult to remember on-scene try something different. I use the mnemonic SNOT (stroke, seizure, sugar, narcotics, oxygen, trauma, toxins, telemetry/EKG). This mnemonic is easier for me to remember and lists the most common causes for an altered mental status.

4. Interview multiple sources on scene
Since we can't obtain reliable historical data from someone with an ALOC, enlist information from family members, friends, caretakers, nursing home workers and witnesses.

Begin by asking, "Is this normal for the patient"" which will immediately rule out dementia, Alzheimer's or other pre-existing conditions that can cause chronic mental status changes.

Then, ask what they see different about the patient" Can they describe specifically how the patient is different" When did the change start and what they think might have caused it" Once you have this information, consider it in light of your other findings to discover a possible cause.

5. Assess the environment
Every time you walk on scene — especially one involving an ALOC patient — take a moment to assess the environment and answer these questions.

  • Where was the patient found and in what position"
  • What are they wearing"
  • What objects, such as liquor bottles, medications or needles, surround the patient"

Over time, you'll begin to see a correlation that sometimes exists between the environment and the chief complaint. For example, drug addicts often get high in out-of-the-way places such as bathrooms or vehicles.

Alleys are frequently the scene of assaults and someone who has a syncopal event after sitting on the toilet has often had a vagal episode, causing a drop in blood pressure and cerebral perfusion.

6. Treat what you can and follow up
At the end of the day, EMTs and paramedics don't need to know the exact cause for a patient's ALOC in the prehospital setting. All we need to do is treat the symptoms we can treat using the tools we have and transport the patient rapidly to the hospital for definitive care.

However, don't fall into the trap of letting the call end when you hand over patient care. Follow up with the ED staff to learn what tests they performed and what they discovered, and keep a journal to document your interesting calls.

By keeping the mentality of always being a student and never a master, you will continue to learn and grow throughout your EMS career.



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Prospective study of uterine corpus lesions over a period of one year in tertiary care centre

2016-06-20T06-32-03Z
Source: International Journal of Research in Medical Sciences
Janagam Chandralekha, Guntur Roda Sumanlatha, Botta Venkata Satya Kartheek, Atla Bhagyalakshmi.
Background: Hysterectomy is the most commonly performed gynaecological surgery throughout the world. Few studies have been performed describing the pathologic findings in hysterectomy specimens and examining the relationship between the preoperative clinical indication, gross findings and pathologic diagnosis. This study was undertaken to identify the different types of pathologies in hysterectomy specimens and to correlate the findings with the clinical indications and gross findings. Methods: In the present study, five hundred and forty four cases were studied over a period of one year. Surgical specimens were formalin fixed and the tissue was adequately processed for histopathological examination. The sections were stained routinely with hematoxylin and eosin stain. Results: Menorrhagia and fibroid uterus were the most common clinical indications for hysterectomy. Of the 544 cases, 52.75% cases were encountered in the age group of 40 - 49 years which was the most common age group. The most common pathology identified was leiomyoma in myometrium. Histopathological examination confirmed the clinical and gross diagnosis in majority of the cases. Conclusions: The present study provides a fair insight into the histological patterns of lesions in hysterectomy specimens in our institution. A wide range of lesions are encountered when hysterectomy specimens are subjected to histopathological examination. Though the histopathological analysis correlates well with the clinical and gross diagnoses, a few lesions were also encountered as incidental findings and mismatch diagnoses. Hence, it is mandatory that every hysterectomy specimen should be subjected to detailed gross and histopathological examination to ensure proper postoperative management of patients.


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A comparative study of two doses of magnesium sulphate in attenuating haemodynamic responses to laryngoscopy and intubation

2016-06-20T06-32-03Z
Source: International Journal of Research in Medical Sciences
Manish B. Kotwani, Deepti M. Kotwani, Vandana Laheri.
Background: Laryngoscopy and intubation evoke a presser response in the human body by causing catecholamine release due to sympatho-adrenal stimulation. Various drugs have been tried to attenuate haemodynamic response to laryngoscopy and intubation during general endotracheal anaesthesia. In the last few years there has been an explosion of interest in both the physiological and pharmacological properties of magnesium and its clinical use. We planned this comparative, prospective dose response study compare the efficacy of two doses (30 mg/kg and 40 mg/kg) of intravenous magnesium sulphate in attenuating the cardiovascular response to laryngoscopy and intubation. Methods: Seventy five patients aged 15-50 years, scheduled for elective surgery under general anaesthesia, were randomly assigned to one of the three pre-treatment groups of 25 each, group C- control group, group T (MgSO4 30 mg/kg) and group F (MgSO4 40 mg/kg). Study drug was given 90-120 seconds before tracheal intubation. Heart rate, systolic blood pressure and rate pressure product were recorded at different intervals (baseline values, after study drug, after induction, at laryngoscopy, after intubation, 2 and 3 minutes after intubation). Results: Mean heart rate and systolic blood pressure was significantly high (P


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Levetiracetam: an open label study on safety and efficacy in newly diagnosed partial onset seizures as monotherapy

2016-06-20T06-20-24Z
Source: International Journal of Basic & Clinical Pharmacology
Jacob Jesurun R.S., Manimekalai K., Somasundaram G., Subash K.R..
Background: The Common neurological disorder in pediatric population is epilepsy. Despite having many medications and with recent approval of levetiracetam (LEV) as an adjunctive treatment in children, there is a need to evaluate safety and efficacy of this drug in Indian population. The aim was to study the efficacy and tolerability of levetiracetam as monotherapy, in newly diagnosed partial onset seizures. Methods: Newly diagnosed partial seizure patients attending the neurology outpatient department were considered for the study based on the inclusion criteria. After the patients were started on the minimal therapeutic dose of the allocated drug LEV 500 mg twice daily over a period of 2 weeks, if there is no adequate seizure control, the dose of medication was further stepped up. Dose level 2 was taken as 1000 mg twice daily for levetiracetam over next 2 weeks. Dose level 3, 1500 mg twice daily for levetiracetam for the final 2 weeks (Maximum dose tried). After 6 weeks of dose stabilization, all patients had a final evaluation at the end of 6 months to assess for 6 month seizure free period. Results: Out of 37 subjects who had first visit eligibility on screening 5 did not give consent 2 were in exclusion criteria with 30 involved in study three were lost in follow up. Among 28 children in levetiracetam group 17 (62.96%) had seizure control at 6 months with dose level 1 (20 mg/kg/day) itself. 8 patients (25.92%) had control on dose level 2 (30 mg/kg/day). 2 patients (7.40%) had seizure control at maximum dose level 3 (40 mg/kg/day). In 1 patient, seizures were not controlled in spite of maximum dose. This patient was started on alternative drugs. The commonest discomfort faced by the subjects include nausea 14 (51.85 %), drowsiness 11 (40.74%), unsteadiness 6 (27%), diplopia 6 (20%) and headache 6 (20%). Conclusions: Though the present study is an analysis of small population and open labeled, the results are clear levetiracetam as monotherapy is effective in majority of study population at a dose of 20 to 40 mg/kg/day. The cost effectiveness and safety of the drug has also given promising results for its usage among pediatric age group. A study on large group with comparison to existing gold standard drugs with proven efficacy in children like gabapentin, topiramate, oxcarbazepine and lamotrigine can give more information as monotherapy and its use as adjunctive drug.


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Student’s perception of mind mapping in Problem-based learning

2016-06-20T02-24-29Z
Source: Journal of Contemporary Medical Education
Sneha Ravindranath, Warnakula Kusum de Abrew, Vishna Devi Nadarajah.
Background: Problem based learning enables active learning but an inherent disadvantage is that the knowledge is perceived to be unorganized. The use of concept maps and flow charts has been suggested to enhance reflection in PBL. The objective of the study was to determine if the PBL experience can be enhanced using a mind map for summary writing. Methods: Semester 2 medical students were briefed on the process of mind mapping for summarizing the PBL group discussion. Students who consented to participate in the study completed a pre intervention questionnaire on the perception of PBL learning process. Each student constructed a mind map at the end of every PBL session for three consecutive triggers. The students completed a post intervention questionnaire on the perception of PBL learning process at the end of the module. Data analysis of the pre and post intervention questionnaires was carried out using Independent t-test. Results: Students perception of the PBL learning process continued to be positive after the intervention of summary writing with mind map and there was a difference in the ranking of the PBL learning processes with summarizing and structuring concepts at the top after mind mapping. Students comments indicated that the mind mapping exercise was useful although it was time consuming. Conclusions: Mind mapping can help in summarizing the PBL discussion however, not all students may find that it enhances the PBL learning process. The findings of this study support the use of mind maps only as an optional tool for summarizing PBL discussion and may be used to complement the learning process in PBL based on students learning needs.


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The impact of self-efficacy beliefs on learning strategies: towards learning Human Anatomy at College of Medicine

2016-06-20T02-24-29Z
Source: Journal of Contemporary Medical Education
Lackson Harrison Tembo, Flemmings Fishani Ngwira.
Objective: The study was designed first, to find out from the medical students if their perceived self-efficacy is related to their use of cognitive learning strategies; second, to asses if, in terms of gender and parent education, differences do exist in their levels of self-efficacy and their use of the cognitive strategies. Method: This was a cross section study which employed a pre-tested questionnaire, Motivated Strategies for Leaning Questionnaire (MSLQ), scored on a Likert Scale. The study population was made up of first year medical students after consenting to take part in the study. There was an 86% response rate. Results: Self-efficacy positively predicted both learning strategies of shallow [β = 0.47] and deep [β = 0.42]. There were no significant differences between male and female students on both shallow and deep learning strategies, and self-efficacy beliefs (p

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Flipping the switch: The feasibility of a “think aloud” flipped-classroom approach to clinical reasoning instruction

2016-06-20T02-24-29Z
Source: Journal of Contemporary Medical Education
Roy E Strowd, Charlene E Gamaldo, Anthony B Kwan, Tiana E Cruz, Rachel Marie E Salas.
Background: Clinical reasoning is a fundamental skill in medical and allied health professions. Implementation of the evidence-based think aloud method (i.e. describing cognitive processes through verbalization) for teaching clinical reasoning has been variable due to time and resource constraints in healthcare education. Materials & Methods: To explore the feasibility of implementing the think aloud method for teaching clinical reasoning, we piloted a flipped-classroom model of instruction to free live-synchronous educational time in a medical school clerkship. Two asynchronous web-based videos were implemented prior to synchronous case-based discussion applying the think aloud method. Performance was assessed by baseline and end-of-clerkship examination and NBME shelf exam; clinical skills by clinical evaluation; satisfaction and student learning styles by survey. Results: The flipped-curriculum was piloted in 38 students; mean age 25+2.2 years; 63% male. Baseline knowledge was low (mean baseline score 43+21%) and improved significantly (mean final score 70+23%; increase 29%, 95%CI 20-37%, p


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Final year medical students’ satisfaction with clinical education and family medicine module. Suez Canal University. Egypt

2016-06-20T02-24-29Z
Source: Journal of Contemporary Medical Education
Hend Mikhail Salama, Hebatallah Nour-Eldein.
Background: Satisfaction is an indirect performance measure to the effectiveness of a curriculum. Faculties which provide professional education should be concerned with students satisfaction as an educational process outcomes. Objective 1- to evaluate medical students satisfaction with clinical education and factors in the organizational domain that could influence their satisfaction. Objective 2- to evaluate the students satisfaction with family medicine module. Methods: This was a cross sectional descriptive analytic study carried out between September and October, 2015. Convenience sampling was used and It included all 136 final year medical students in Suez Canal University. The first questionnaire was used to evaluate the medical students satisfaction with clinical education. Student Perception of Module (SPOM) questionnaire with 18 items was used to evaluate the students perception of family medicine (FM) module. Results: The study included 136 students and the mean age was 23.5 (0.45) years. Overall satisfaction with clinical education was 86.8%. The majority of study sample (85.3%) was satisfied with outpatient training. Most of the study sample was satisfied with bedside and theoretical training (76.5% & 77.9 %) respectively. Students satisfaction with family medicine modules revealed that across 80% of the 18 items, strong satisfaction ranged from 61.8% to 42.6%. Conclusion: Future reevaluation of clinical education in Suez Canal University is recommended with consideration of the variety of diseases and improving instructor experience in bedside teaching. Reviewing FM module is recommended with special concern to make the students look the profession in positive way and to be intellectually more stimulating.


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Music medicine course for medical students in Hungary

2016-06-20T02-24-29Z
Source: Journal of Contemporary Medical Education
Janos Kollar, Pal Kovago, Edit Czegledi.
Objective: In 2006 a Music Medicine credit course was initiated on Medical and Health Science Centre of University of Debrecen, Hungary for helping the medical students to gain more knowledge about Music Medicine and to dissolve prejudices and misbeliefs about the topic. The aims of the study besides the introduction of the course was thematic quantitative and qualitative analysis of the students evaluation about the course (n=150). Methods: A short, six-item questionnaire concerning the evaluation of the course was constructed for the purpose of this study. We used both qualitative and quantitative analysis. All of the participants (n=150) in the cross sectional survey were 1th to 6th year medical university students Medical and Health Science Centre of University of Debrecen, (Hungary). Data were collected between the years 20062012. Results: Evaluation of the course proved to be especially favourable regarding every measured aspects. The most favourable score showed the evaluation of the teacher and the least one was the individual participation. Content analysis resulted in four content categories, namely group cohesion, self-awareness, practical focus, and new perspective. Conclusions: Besides transferring useful information regarding the possibilities of applying music in medical practice a new as a side-effect the course improved the group cohesion between students, and helped them to overcome their shyness, and be more open to their fellow students.


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Determining competencies for the development of curriculum of Community Medicine and Family Medicine for undergraduate medical students

2016-06-20T01-53-40Z
Source: Journal of Contemporary Medical Education
Pankaja Ravi Raghav, Dewesh Kumar, Pankaj Bhardwaj.
Objective: This research was planned to determine the set of competencies for training of undergraduate medical students in the Department of Community Medicine & Family Medicine (CMFM), so that the graduates can develop the skills to perform the expected roles in providing health care to the community. Methods: Different qualitative methods were used for determination of competencies in phases, amongst which the Delphi was the important technique for this study to arrive at a consensus regarding core competencies and skills to be acquired during undergraduate training. Two Delphi rounds were conducted. The experts from different specialties e.g. academicians, consultants, researchers etc were invited to participate through e-mail and data collection was done through this process only.Results: In Delphi I round 46 participants responded and after analysis of Delphi I round, the modified questionnaire was sent to all the Delphi I participants again. In Delphi-II, only 26 participants responded. These responses were considered in the preparation of final lists of competencies and skills. Based on the findings, the consensus was made on the core competencies and skills. Conclusion: The various skills listed in the document will help in developing competency-based curriculum in CMFM which needs to be reviewed time to time as per the requirement.


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