El odontólogo, custodio de la función masticatoria / The dentist, guardian of masticatory function

La masticación tiene como objetivo la adecuada preparación de los alimentos para su deglución y digestión. Cualquier alteración en el sistema estomatognático puede deteriorar la masticación. El odontó- logo es el profesional responsable de mantener y/o restaurar la función masticatoria. La evaluación de la función masticatoria puede hacerse de forma subjetiva utilizando cuestionarios para medir la percepción del paciente sobre su capacidad masticatoria o de forma objetiva analizando la fuerza oclusal, la actividad electromiográfica de los músculos mas- ticadores, la trayectoria de la mandíbula al masticar o la capacidad de trituración de los alimentos. Estos métodos se utilizan en proyectos de investigación, pero en la clínica ¿evaluamos si existe alguna alteración al masticar y al finalizar el tratamiento si cumplimos con el objetivo de restaurar la función masticatoria? ¿Realmente nos preocupamos por mantener y/o restaurar la función masticatoria? Por lo general no, ni en los consultorios, ni en las clínicas universitarias. Es esencial que nos concienticemos de nuestra responsabilidad y para ello es necesario que se le dé mayor peso curricular a la función masticatoria y cómo evaluarla. Seamos realmente custodios de la función masticatoria de nuestros pacientes (AU)

The goal of chewing is to properly prepare food for swallowing and digestion. Any problem in the stomatognathic system can deteriorate chewing. The professional responsible of maintaining and/or restoring masticatory function is the dentist. Masticatory function can be evaluated subjectively through questionnaires to measure the patient's perception of his/her masticatory capacity or objectively analyzing occlusal force, the electromyographic activity of the masticatory muscles, the movements of the mandible during chewing or the individual's capacity to breakdown food. These methods are used in research projects but, do we examine if there is any problem during chewing and if we are achieving our goal of restoring masticatory function at the end of the treatment in our offices? Do we really focus on maintaining and/or restoring masticatory function? Not truly, not in our offices or university clinics. It is imperative that we acknowledge our responsibility but for that it is essential that masticatory function and how to evaluate it is given more weight in the curriculum. Let us be genuine guardians of the masticatory function of our patients (AU)

Dynamic monitoring of scar changes by B-mode ultrasound / 中华医学美学美容杂志

Objective:To study the application of B-mode ultrasound in objective evaluation and dynamic monitoring of scar.Methods:The subjects were patients with scar in the outpatient and inpatient department of plastic surgery in the First Affiliated Hospital of Zhengzhou University from March 2018 to June 2020. According to the type of scar, they were divided into 3 groups: 21 patients in the normal scar group, 23 patients in the hypertrophic scar group, and 15 patients in the keloid group. All 59 patients were regularly scanned by B-mode ultrasound for scar images and the scar thickness was measured.Results:B-mode ultrasonic images of scars were analyzed in each group: The echo intensity of dermis of normal scar was uneven, hypertrophic scar and keloid dermis showed obvious hypoecho, and some cases of keloid presented a small amount of blood flow. There was no significant change in the ultrasonic images of scar in each group within 1 year. Changes in scar thickness were observed in each group. The normal scar thickness did not change significantly within 1 year. The thickness of hypertrophic scar showed a trend of first increasing and then stabilized within 1 year.Conclusions:B-mode ultrasound can assist to identify different scar types according to ultrasonic performance. B-mode ultrasound can be used to measure scar thickness objectively and accurately and monitor the dynamic changes of scars.

Rol de la simulación en el entrenamiento de cirugía mínimamente invasiva. Artículo de revisión / Role of simulation in minimally invasive surgery training

La cirugía laparoscópica ha sido uno de los grandes adelantos de la medicina moderna, sin embargo, la incorporación de esta tecnología a la práctica quirúrgica trajo consigo implicaciones en la enseñanza de la cirugía. La cirugía laparoscópica es una técnica más difícil de dominar que la cirugía abierta, en la cual se realizan procedimientos y maniobras particulares que requieren de laadquisición de habilidades específicas. La tendencia en la enseñanza de nuevas técnicas o procedimientos se ha enfocado en el uso de la simulación como una herramienta que permite adquirir las destrezas necesarias en un ambiente seguro, sin comprometer la seguridad y eficacia de los procedimientos. Por otro lado, decidir el momento en el cual el cirujano en entrenamiento ha alcanzado las destrezas necesarias para incorporarse a cirugíasin vivo, requiere de objetivos métodos de evaluación . En la búsqueda de alternativas de mayor objetividad, la tendencia mundial durante los últimos años ha sido dirigir la atención hacia el estudio depatrones de movimientos al momento de realizar determinada tarea o procedimiento(AU)

Laparoscopic surgery has been one of the great advances in modern medicine, however the incorporation of this technology into surgical practice brought with it implications in the teaching of surgery, laparoscopic surgery is a more difficult technique than open surgery, in which particular procedures and maneuvers are performed that require the acquisition of specific skills. The trend in the teaching of new techniques or procedures has focused on the use of simulation as a tool that allows acquiring the necessary skills in a safe environment, without compromising the safety and effectiveness of the procedures. On the other hand, deciding the moment in which the surgeon in training has reached the necessary skills to join in vivo surgeries requires objective evaluation methods. In the search for more objective alternatives, the global trend in recent years has been to direct attention towards the study of movement patterns when performing a certain task or procedure(AU)

Morphological and functional evaluation of digital technology combined with endoscope-assisted surgery of crooked nose / 中华医学美学美容杂志

Objective:To explore the clinical effect of digital endoscopic-assisted one-stage rhinoplasty and septoplasty by using subjective and objective methods.Methods:Thirty-two patients with skeletal crooked nose and nasal septum deviated who underwent endoscopic-assisted rhinoplasty and septoplasty were included in this study from January 2015 to January 2020. This study used objective measurements such as 3D digital imaging technology and CT scans, as well as subjective measurements such as Visual Analogue Scale (VAS), Rhinoplasty Outcomes Evaluation (ROE) scale, Nasal Obstruction Symptom Evaluation (NOSE) and Functional Rhinoplasty Outcome Inventory (FROI-17) to evaluate the crooked nose morphology and nasal respiratory function before and after surgery.Results:Compared with preoperatively, postoperative 3D facial imaging results showed that the deviation distance and deviation angle of the crooked nose were significantly improved (both P<0.05), and the long-term effect of the operation was stable. Subjectively, the patient＇s appearance VAS score and ROE score were significantly higher than those before surgery, while the NOSE score and FROI-17 score of nasal congestion symptoms were lower than those before surgery. Conclusions:Endoscope-assisted one-stage rhinoplasty and septoplasty can achieve the purpose of repairing the nose appearance and improving the nasal respiratory function at the same time. Through a combination of subjective and objective evaluations, our study found that this procedure had the advantages of minimally invasive, stable effect and shorter recover time; meanwhile, this procedure has high patients＇ satisfaction and is worthy of clinical promotion.

Progress in evaluating the postoperative effect of cleft lip / 口腔疾病防治

@#The postoperative evaluation of cleft lip is an important means to improve the operation method and the effect of the restoration. In recent years, the methods of cleft lip repair, such as Chinese western rotary propulsion, reconstruction of labial and nasal muscle tension band+trefoil flap, etc., have been developed. However, at present, there are still many secondary deformities, such as obvious scars and alar collapse. In this paper, in a review of the previous literature, the existing methods, advantages and disadvantages, and the application of the evaluation of the postoperative effect of cleft lip were reviewed. To date, there are many methods that can be used to evaluate the effect of cleft lip surgery. These research methods can be divided into subjective evaluation and objective evaluation, such as subjective evaluation, direct measurement, photo measurement, and three-dimensional scanning measurement. Among them, the subjective evaluation is simple, but the reliability is poor, and this method is suitable for all patients with cleft lip. The direct measurement has a low cost and is only suitable for one-dimensional information measurement, but the accuracy is poor, so it is difficult to determine the endpoints. The time of the photo measurement method is short, which can avoid tissue deformation, but it is easy to produce errors; this method is suitable for patients with cleft lip who can cooperate. The three-dimensional scanning measurement has a high accuracy, is time consuming and is a simple method but has a high cost and is suitable for areas with appropriate equipment conditions. Overall, the evaluation of the postoperative effect of cleft lip surgery should combine subjective evaluation with objective evaluation, dynamic evaluation with static evaluation, and utilize long-term follow-up to obtain comprehensive and accurate information and provide a reference for clinicians to carry out cleft lip surgery.

Evaluation methods for sensitive skin / 中华皮肤科杂志

Compared with people with non-sensitive skin,people with sensitive skin are more likely to have some undesirable feelings and symptoms in response to stimuli from the external environment,such as itching and pain sensations,and even erythema after chemical stimulation of the skin.Few reviews are related to evaluation methods for sensitive skin in China and other countries.This review introduces subjective,semi-subjective and objective evaluation methods for sensitive skin,summarizes evaluation methods suitable for different types of sensitive skin,and analyzes advantages and limitations of various evaluation methods.

The noise analysis of CT imaging based on noise power spectrum of different reconstruction type / 中国医学装备

Objective: To evaluate the noise characteristic of different reconstruction type CT image by using the noise power spectrum (NPS), and analyze the correlation between this results and subjective vision noise evaluation. Methods: QA water phantom of CT equipment was scanned and 8 common reconstruction algorithms were applied to dispose image. NPS peak value, the peak frequency and standard deviation (SD) were compared with the subjective evaluation measurements, such as granularity, contrast, sharpness and optical noise level, by using the correlation analysis. Results: Each reconstruction algorithm owned different peak value and peak frequency. Granularity negatively correlated with the peak frequency. A positive correlation was found between contrast and peak value. Sharpness was positively correlated with both peak value and peak frequency. All of the subjective evaluation measurements were correlated with SD. Conclusion: Comparing with SD, NPS can reflect both intensity and morphological feature of the noise and possess applicative potential as a more comprehensive evaluation index.

Fluorescence labeling method for evaluating the efficacy of hospital environment cleaning / 中国感染控制杂志

Objective To evaluate the effectiveness of hospital environmental cleaning practice by fluorescence labeling method.Methods From January to February 2015,312 ward rooms in 7 hospitals were chosen,high touch object surface were labeled with fluorescence,after object surface being cleaned by cleaners,clearance rates of fluorescence labeling were calculated (as baseline survey data),training and on-site guidance for cleaners were performed(intervention measures),fluorescence labeling clearance effect before and after intervention was compared.Results A total of 110 ward rooms were performed baseline survey,the fluorescence labeling clearance rate of 2 856 touched clean surface was only 50.81％,the quantitative evaluation value was 45.70;after intervention,202 rooms were surveyed,fluorescence labeling clearance rate of 3 992 touched clean surface enhanced to 79.23 ％,the quantitative evaluation value was 76.30;there was significant difference in fluorescence labeling clearance rate between before and after intervention (x2 =612.14,P＜0.05).In the baseline survey,the clearance rates of fluorescence labeling on touched surface of medical instruments,hospital beds,and toilets were 46.07％,37.80％,and 25.20％ respectively;after intervention,the clearance rates were 80.59％,75.90％,and 51.70％,respectively.After intervention,fluorescence labeling clearance rates of beepers,toilet seat covers,toilet electrical switches,and chairs were low,the clearance rates of these touched surface in baseline survey were＜ 30％,after intervention were 47.03 ％-68.32％;the clearance rates of other high touch surface were all＞75 ％.Conclusion Fluorescence labeling method can directly reflect the operation quality of cleaners,and improve the cleanliness of ward environment,it is a simple,inexpensive and objective globally popular method for evaluating hospital environment cleanliness.

Practice and reflection of objective assessment of subjective indexes in medical graduate scholarship evaluation / 中华医学教育探索杂志

In the evaluation of medical postgraduate scholarship, objective method is adopted to evaluate subjective indicators. According to the specific practices for experts and the views of students to establish a set of subjective and objective indicators combined with the evaluation index system, objective indicators including research ability, academic achievement, various school activities, subjective indicators such as ethics, communication and coordination ability, innovation ability etc. To evaluate the subjective index according to the analysis, the inherent requirements of subjective index application case scenario simulation and peer evaluation and other objective methods, we aim to eliminate the scholarship evaluation process of subjective indicators "passing" or "useless" phenomenon, more fair and equitable selection of truly outstanding students.

Impact or push-off lameness presentation is not altered by the type of track surface where horses are trotted / Claudicação de impacto ou elevação não é alterada pelo tipo de superfície onde os cavalos são troteados

This study aimed to evaluate the influence of the track surface on which horses are examined, regarding the phase of lameness presentation. Ten horses with lameness in at least one limb were evaluated with wireless inertial sensors on three track surfaces (concrete, loose sand and grass). Six crossover track sequences were established. The variables vector sum, maximum and minimum height of the head and pelvis, variation coefficient of the maximum and minimum height of the head and pelvis were analyzed using ANOVA, followed by Tukey test to compare means between track surface and sequence, at 5% significance level. The lameness phase (impact or pushoff) was analyzed considering the proportion of affected animals. There were no differences on vector sum, maximum and minimum height or variation coefficient of head and pelvis. Difference was observed on the number of strides registered on sand compared to grass and concrete (p <0.0001) for fore and hindlimbs. Impact lameness on forelimbs was presented by a larger number of animals on the concrete surface; pushoff lameness was more evident on the grass surface. In the hindlimbs, impact lameness was more evident on the grass surface, while pushoff lameness was in greater number of animals on concrete surfaces. The track sequence on which horses were trotted during evaluation does not seem to be a factor, but the number of lame horses and the phase of lameness manifestation can vary between track surfaces, as some horses showed impact lameness on soft ground and elevation lameness on hard ground.

Este estudo teve como objetivo avaliar a influência do tipo de superfície em que os cavalos são examinados em relação à fase de apresentação da claudicação. Dez cavalos com claudicação em pelo menos um dos membros foram avaliados com sensores inerciais sem fio em três tipos de superfície (concreto, areia e grama). Seis sequências de cruzamento de tipo de superfície foram estabelecidas. As variáveis soma vetorial, altura máxima e mínima da cabeça e da pélvis, o coeficiente de variação da altura máxima e mínima da cabeça e da pélvis foram analisadas utilizando uma Análise de Variância, seguida do teste de Tukey para comparação das médias entre tipos de superfície e sequências, a um nível de significância de 5%. A fase da claudicação (impacto ou elevação) foi analisada considerando a proporção de animais afetados. Não houve diferença na soma vetorial, altura máxima ou mínima e coeficiente de variação da altura máxima e mínima da cabeça e pélvis. Foi observada diferença no número de passos registrados na areia em comparação com grama e concreto (p <0,0001) para membros torácicos e pélvicos. Claudicação de impacto nos membros torácicos foi apresentada em um número maior de animais na superfície de concreto, já claudicação de elevação foi mais evidente na superfície de grama. Em membros pélvicos, a claudicação de impacto foi mais evidente na superfície de grama, enquanto claudicação de elevação esteve em maior número de animais na superfície de concreto. A sequência de superfícies em que os cavalos foram troteados durante a avaliação não foi um fator importante na manifestação da claudicação, mas o número de cavalos claudicantes e a fase de manifestação da claudicação podem variar entre as superfícies, visto que alguns cavalos mostraram claudicação de impacto em solo macio e claudicação de elevação em solo duro.

Enforcement and analysis of the Objective Structured Teaching Evaluation / 医学教育

In Japan, awareness has increased in recent years of the importance of evaluating clinical educators. In Europe and North America, the Objective Structured Teaching Evaluation (OSTE), which employs standardized students, multiple stations, video recording, and scoring by multiple observers, is used to evaluate clinical educators. We report on the implementation of an OSTE in Japan.1) Ten clinician-educator physicians participated in the OSTE, which comprised 5 stations and included standardized residents. The stations were video-recorded, and the educators were assessed by 7 different evaluators.2) The educators were evaluated with a checklist and a 5-point scale. We assessed the reliability and validity of the checklist and analyzed the background characteristics of the clinician educators.3) The factors most closely associated with high ratings on the checklist and the 5-point scale were: having a history of attendance at a seminar for clinician-educators, having greater than 5 years experience as an educator, and not being an internist. There was no interobserver variability among the evaluators.4) The generalizability of the checklist was 0.81, and its reliability index was 0.83. The correlation coefficient between the total scale score and the checklist score was 0.8. 5) Although biases by participants were identified, our project suggests that the OSTE could be used in Japan to objectively evaluate the teaching skills of clinician-educators. Further research on the OSTE in Japan is warranted.

The Objective Structured Teaching Evaluation / 医学教育

1)With the implementation of mandatory clinical residency in Japan, resident evaluations have become an important part of clinical education. Recently, however, a greater emphasis has been placed on the evaluation of physician instructors. In the West, research examining the teaching skills of clinical physicians has been ongoing since the 1970s and is reviewed in this paper.<br>2)The Objective Structured Teaching Evaluation (OSTE), which uses standardized students, multiple stations, video recordings, and scoring by observers, was developed in the 1990s.<br>3)Unlike the Objective Structured Clinical Examination, which is an evaluation tool for medical students and residents, the OSTE is rarely used to evaluate individual performances or used as a part of certification exams. Instead, the OSTE serves as a tool for faculty development or as an outcome measure for the effectiveness of faculty development education initiatives.<br>4)If available in Japan, the OSTE would be an excellent resource for improving the teaching skills of physicians and would be a useful tool for training sessions for physician instructors. More research is needed to facilitate the introduction of the OSTE to Japan in the future.

Objective Evaluation of Secondary Cleft Lip Nose Deformity by Analysis of Nostril Shape

Cleft lip is one of the most common congenital deformities in craniofacial region. However, despite many reports on the outcome of various surgical techniques from individual medical centers, the evaluation of the outcome has been based on the subjective observation. Therefore, developing a new technique of objective and scientific evaluation for the nasal deformity of secondary cleft lip and nasal deformity is important to improve the management of the cleft lip patients. The authors have proposed a new scoring model to evaluate objectively the nasal deformity. The authors put 'x' axis on the nostril sill of noncleft side and 'y' axis on nasal tip at a right angle to x axis. The nostril of noncleft side was turned around the y axis to form the mirror image on the cleft side, and following four parameters were recorded: (1) angle difference between two nostril axis, (2) center of the nostril and distance between two centers, (3) the overlapped area of two nostrils and (4) the overlapped area ratio of two nostrils. The post-surgery images were evaluated by the three plastic surgeons, using the scale of 5 percentiles. The four parameters of each image were measured using a newly developed software and correlation coefficients of each parameter and the evaluation scale by the surgeons were obtained. Among the scores from scoring model, errors greater than 10 percents were found only in 2 of 14 cases (2/14=14%), but among the scores from examiners, errors of greater than 10 percents were 4 from 14 cases (4/14=29%). Based on the results, deviation among the individual examiners can be reduced using the objective evaluation program developed in this study. The correlation coefficients between the normalized overlap area (0.78) and the distance between the centers of two nostrils (-0.82) with the evaluated scale by surgeons were high. However, the relative area and the degree difference of two nostril axis were found to be not such a good parameters in the evaluation of the nasal deformity. We developed scoring model from analysis of nostril shape and neural network which is able to evaluate cleft lip nasal deformity objectively after selection of proper parameters.

Clinical Study with Objective Methods in Tinnitus Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus is the perception of a sound produced involuntarily inside the body. Tinnitus can be divided into two major categories: (1) tinnitus generated by para-auditory structure, usually from vascular or myoclonic sources: and (2) tinnitus generated by the sensorineural auditory system. With the recent advent of magnetic resonance imaging and auditory brain stem response, it is now possible to diagnose objectively the lesion as causes of intractable tinnitus while they are still quite rare. So, we can consider the surgical treatment on objective causes of tinnitus. MATERIALS AND METHODS: The authors analysed forty patients with tinnitus, who had visited the OPD of our ENT dept. from 1998 April to 1998 September, through history taking, physical examination, many objective auditory tests including auditory brain stem response (ABR) and MRI scan. RESULTS: In ABR test, conduction pathway of BAEP (Brain stem auditory evoked potential) was abnormal in 31 (59.6%) patients. Average latency of I-III, III-V and I-V were 2.29 msec, 1.92 msec and 4.22 msec. The 22 of 31 patients who had abnormal conduction pathway of BAEP showed hearing disturbance. Two patients showing normal conduction pathway of BAEP had hearing disturbance. In MRI scan, abnormal findings were observed only in 13 (25%) patients. CONCLUSION: The use of ABR and MRI to diagnose intractable tinnitus might be valuable in routine tests.

Evaluation of Undergraduate Clinical Training Based on Clinical Clerkships in Medical School / 医学教育

We evaluated our undergraduate clinical clerkship system in 1992, using the multiplication method advocated by the Working Group on “Evaluation of clinical skills of medical students ” of the Japan Society for Medical Education. We divided the clinical training period into three terms: the first term was held from May through June, the second from September through October, and the third from December through January. We determined scores using checklists and rating scales in ten categories, totalled the scores for each period, and compared them between periods. The total scores for the third period were the highest, followed by those for the second period. Scores for basic knowledge, data gathering, and basic technical procedures increased with increase in the number of training hours. However, scores for manner, attitude, and interviewing skills were already high in the first period. We conclude that the multiplication method is useful for objectively evaluating students' clinical skills.