PERCEPTION OF FIRST YEAR MBBS STUDENTS TOWARDS ECE (EARLY CLINICAL EXPOSURE) IN PHYSIOLOGY.

Introduction : Early Clinical Exposure is a teaching learning method which enables student to learn basic sciences effectively and retain the information which bene?ts patient and promotes better patient care. Hundred students selected after applying inclusion exclusion criteria divided into 2 groups A and B taught Methodology : basal ganglia and thyroid physiology in conventional method and other in ECE integrated method respectively and after interchanging groups, demonstrating the clinical features of parkinsonism and hypothyroidism for ECE group. A pretest and post-test were conducted preceding and following lecture in both settings. The results obtained were interpreted using Results : excel. The mean of pre-test marks for Traditional teaching and ECE integrated teaching are 5.62±2.42 and 4.58±2.33 respectively and the post-test scores of Traditional and ECE teaching are 10.62±2.52 and 12.8±2.46 respectively. Discussion : Majority considered that the synchronisation of classroom learning with clinical experiences was bene?cial, and the majority believed that integrated teaching improved understanding of the practical applications of physiology. Through Conclusion : this study we conclude that ECE integrated teaching is more effective in imparting knowledge in ?rst MBBS students as the gap of imagination was bridged by live demonstration with help of patient which is re?ected in the Likert scale and in the scores. Though the ECE integration is a tough job for the teacher, it is a great learning tool for students.

Sex Differences in Computed Tomographic Angiography in Patients with Low and Intermediate Pretest Probability of Coronary Artery Disease

Background: Multi-slice computed tomography (MSCT) coronary angiography has become one of the hot spots in cardiovascular imaging technology. Many of the sex-based research have shown that women have different pathogenesis, clinical presentation and complication related to coronary artery disease (CAD) as compared to the males. The aim of this study investigated the relationship between gender and coronary artery calcium (CAC) in patients with chest discomfort with low and intermediate pretest probability of CAD who underwent Coronary computed tomography angiography (CCTA) and referrals by gender for subsequent invasive coronary angiography and revascularization. Methods: This prospective cohort study included 200 patients suspected to have coronary artery disease, negative or equivocal stress tests, with no prior known coronary artery disease (CAD), intermediate pretest probability for CAD according to the scoring method of (15-65 points), and Low likelihood for CAD (< 15 points). Patients were divided into two groups according to gender and were followed up. All patients underwent Full history taking, full clinical examination, routine laboratory investigation, resting and exercise ECG, echocardiography, CT coronary angiography and invasive Coronary angiography. Results: Patients with mild calcium score level were significantly higher in no CAD group than CAD group (p <0.001) and patients with high calcium score were significantly higher in CAD group than no CAD group (p <0.001). In univariate regression analysis age, typical chest pain, obesity, coronary Ca score, and hyperlipidemia are independent predictors for CAD in females. In multivariate regression analysis, age, typical chest pain, hypertension, and coronary Ca score are predictors for CAD in males. Coronary calcium score is a good predicator for CAD (AUC =0.901, 95% CI =0.851-0.938, p value <0.001). At cut off value > 101, it has 70.97% sensitivity, 90.79% specificity, 92.6% PPV, and 65.7% NPV. Moreover, it is a good predicator for CAD in females (AUC =0.894, 95% CI =0.823 – 0.944, p value <0.001). At cut off value > 101, it has 60.71% sensitivity, 91.67% specificity, 87.2% PPV, and 71.4% NPV. Conclusions: In patients with chest discomfort with low and intermediate pretest probability of CAD who underwent CCTA and subsequent invasive coronary angiography and revascularization, female patients had lower age, hypertension, pretest probability score, calcium score, atypical angina, nonanginal chest pain and obstructive CAD but had higher BMI, typical angina than males’ group. In females, coronary calcium score is a good predicator for CAD. When its level exceeds 100, it has 60.71% sensitivity and 91.67% specificity. In addition, it was found that in females typical chest pain and coronary Ca score are predictors for CAD and in males, age, typical chest pain, hypertension, and coronary Ca score are predictors for CAD.

Effectiveness of self-directed learning in physiology-students’ perspective

Background: Self-directed learning (SDL) is an important adult learning educational approach where the learner makes all the effort to study on his own with or without the help of a facilitator. SDL gives the learner greater autonomy and freedom over his own learning process. Aim and Objectives: (1) To compare lecture-based and SDL methodologies using pre-test and post-test on 1st year MBBS students in physiology. (2) To know the effectiveness of SDL methodology sessions from a student’s perspective using questionnaires. Materials and Methods: The present study was conducted among 1st year MBBS students in the Department of Physiology. After taking ethical clearance from the institutional ethical committee, total of 150 students were divided into two groups comprising 75 each. Each group attended two sessions of SDL and lecture where pre-test and post-test was given in the form of MCQs. Pre-test and post-test scores of each session were compared. Student’s perspectives about SDL were assessed via questionnaires. Data entry and analysis were carried out using Microsoft excel datasheet and SPSS software (Ver. 22). The test of significance for paired data was done using Wilcoxon Signed rank test. Results: In our study, it was found that the mean value of the post-test scores of SDL group were greater than that of the lecture session. Majority of students perceived the SDL sessions to be more effective. It helped them know their objectives and proactively establish their learning goal. Conclusion: SDL sessions are more effective than lecture sessions in teaching physiology to 1st year MBBS students. It ensures that the learner becomes more independent, which is a highly desirable trait for a medical graduate.

A pretest model of obstructive coronary artery disease based on machine learning: from the C-Strat study / 中华内科杂志

Objective:To develop a pretest probability model of obstructive coronary artery disease with machine learning based on multi-site Chinese population data.Methods:Chinese regiStry in early deTection and Risk strAtificaTion of coronary plaques (C-Strat) study is a prospective multi-center cohort study, in which consecutive patients with suspected obstructive coronary artery disease and ≥64 detector row coronary computed tomography angioplasty (CCTA) evaluation were included. Data from the patients were randomly split into a training set (70%) and a test set (30%). More than 50% of coronary artery stenosis by CCTA was defined as positive outcome. A boosted ensemble algorithm (XGBoost), 10-fold cross-validation and Bayesian optimization were used to establish a new prediction model-CARDIACS(pretest probability model from Chinese registry in eARly Detection and rIsk stratificAtion of Coronary plaques Study), and a logistic regression was used to establish a model-LOGISTIC in training set. The test set was used for validation and comparison among CARDIACS, LOGISTIC, UDFM (updated Diamond-Forrester Model) and DFCASS(Diamond-Forrester and CASS).Results:The study population included 29 455 patients with age of (57.0±9.7) years and 44.8% women, of whom 19.1% (5 622/29 455) had obstructive coronary artery disease. For CARDIACS, the age, the reason for visit and the body mass index (BMI) were the most important predictive variables. In the independent test set, the area under the curve (AUC) of CARDIACS was 0.72 (95% CI 0.70-0.73), which was significantly superior to that of LOGISTIC (AUC 0.69, 95% CI 0.68-0.71, P=0.015), UDFM (AUC 0.64, 95% CI 0.62-0.65, P<0.001) and DFCASS (AUC 0.66, 95% CI 0.64-0.67, P<0.001), respectively. Conclusion:Based on Chinese population, the study developed a new pretest probability model--CARDIACS, which was superior to the traditional models. CARDIACS is expected to assist in the clinical decision-making for patients with stable chest pain.

Considering the probable differential diagnosis

@#Differential diagnosis is the method of limiting the possible causes of the patient’s symptoms before making a final diagnosis. For experienced clinicians, it is the process of using clinical experience alongside the patient’s symptoms and test results to prioritize the list of possibilities until the diagnosis can be identified with confidence.

Efectividad de intervención de enfermería en conocimientos sobre prevención de caídas en ancianos que la experimentaron / Effectiveness of a Nursing Intervention regarding Knowledge about Falls Prevention in Elderly Affected by Such Events

Introducción: El conocimiento sobre prevención de caídas resulta indispensable en la reducción de su incidencia en ancianos, la intervención de enfermería puede ser la vía para lograrlo. Objetivo: Evaluar la efectividad de una intervención de enfermería sustentada en el modelo de Jean Watson en el nivel de conocimientos sobre prevención de caídas en ancianos que la han experimentado. Métodos: Investigación cuantitativa, pre-experimental con pre-test y post-test, contextualizada en 37 consultorios del Policlínico "Dr. Rudesindo Antonio García del Rijo", provincia Sancti Spíritus, Cuba, del 2018 a 2019. Universo conformado por 42 ancianos que presentaron caídas en el último año. El conocimiento se midió con encuestas validadas por expertos y pilotaje con alfa de Cronbach > 0,5. Para los ejes temáticos y metodológicos de la intervención (sustentada en los 10 factores asistenciales de la teoría de Jean Watson), se revisó bibliografía sobre el tema, se tuvieron en cuenta las necesidades de conocimiento identificadas. Se procesó la información con frecuencias absolutas, porcentajes, media, desviación típica, valor mínimo y máximo. Para contrastar la hipótesis se utilizó la Prueba no paramétrica de rangos con signo de Wilcoxon. Resultados: Previo a la intervención, el nivel cuatro de conocimiento lo presentó el 9,52 por ciento de los ancianos, aplicada la intervención ascendió al 90,47 por ciento, con significación z = -5,249, p < 0,05. Conclusiones: La intervención de enfermería sustentada en el modelo de Jean Watson resultó efectiva en el incremento del nivel de conocimientos sobre prevención de caídas en ancianos que la han experimentado(AU)

Introduction: Knowledge about falls prevention is essential in reducing incidence in the elderly; nursing intervention may be the way for achieving it. Objective: To assess a Jean Watson's model-based nursing intervention's effectiveness in the level of knowledge about falls prevention in the elderly who have experienced it. Methods: Quantitative and pre-experimental research with pre-test and post-test, contextualized in 37 family medical offices belonging to Dr. Rudesindo Antonio García del Rijo Polyclinic (Sancti Spíritus Province, Cuba), and carried out from 2018 to 2019. The universe was made up of 42 elderly people who had falls in the last year. Knowledge was measured with surveys validated by experts and piloting with Cronbach's alpha higher than 0.5. For the thematic and methodological axes of the intervention (based on the ten care factors of Jean Watson's theory), the bibliography on the subject was reviewed, as well as the identified knowledge needs were taken into account. The information was processed with absolute frequencies, percentages, mean, standard deviation, as well as with minimum and maximum value. The Wilcoxon's signed rank test was used to test the hypothesis. Results: Prior to the intervention, level four of knowledge was shown by 9.52 percent of the elderly. Once the intervention was applied, it amounted to 90.47 percent, with significance of -5.249 and P < 0.05. Conclusions: A nursing intervention based on Jean Watson's model was effective in increasing the level of knowledge about falls prevention in the elderly who have experienced it(AU)

Assessment of training need and training efficacy for national program for prevention and control of cancer, diabetes, cardiovascular diseases and stroke among medical officers of West Bengal, India

Background: The national program for prevention and control of cancer, diabetes, cardiovascular diseases and stroke (NPCDCS) has been rolled out in West Bengal, with its implementation initiated through state-wide training of Medical Officers (M.O). For attaining requisite competency for meeting NPCDCS objectives, MOs have been trained at their respective district levels. Present study aimed to assess the training need, training efficacy and need for further training.Methods: A repeat cross-sectional study was conducted from May-July 2018 for M.Os of six randomly chosen districts of West Bengal, out of those whereat NPCDCS was launched in first phase. 40-45 M.Os were randomly selected from each district in liaison with district level health authorities. The total sample size was 352 with Finite population correction. On the days of training, pre and post training surveys were conducted with an identical semi-structured, pre-tested and validated questionnaire (Cronbach’s alpha >0.8) covering different levels of cognitive domain, with a maximum possible score of 100 marks. No negative marking was done for incorrect responses. Training was imparted by the Principal Investigator (accredited trainer). Ethical clearance was granted by the State Health Directorate. Informed consent from each participant was obtained.Results: Dependent sample t-test revealed significant increment (p<0.0001) in post-test scores (t=63.134) & one-way repeated measure general linear model (GLM) also revealed F=29.617 (p<.0001). The “Effect Size” was classified as “Huge” (Cohen’s D=63.134/√(352)= 3.365), as was noted between pre-test and post-test scores, based on Cohen’s convention and Sawilowsky’s addition. It was further noted that even after six hour training sessions there was 27.44% knowledge gap (p<0.0001) after adjusting for Bonferroni.Conclusions: Imperativeness of training coupled with periodic refresher training has been established as a pre-requisite for successful implementation of NPCDCS.

A study to assess the effectiveness of training on first aid among students of industrial training institute in tribal area of Thane district, Maharashtra

Background: Sudden illness, injury or animal bites can often be serious unless proper care is administered promptly. First aid is immediate attention to one suffering from illness or injury. Everyone should be able to give effective assistance until an injured person can receive professional medical care. This study was undertaken with objectives of assessing the baseline knowledge among students of industrial training institute (ITI) about common health emergencies, their appropriate first aid measures and to conduct training on first aid through lecture and demonstration as well as to assess effectiveness of training on their knowledge about first aid.Methods: An Interventional study. Baseline and post-test assessment of knowledge scores was carried out after a week and 16 weeks of training sessions on first aid of all students in the institute. Data analyzed by SPSS software using descriptive statistics and appropriate statistical tests of significance.Results: Baseline knowledge about first aid in injuries and bites was higher among students than their knowledge about burns and other emergencies. Rural students and students of scheduled caste and tribe had low baseline knowledge (p=0.015 and p=0.025 respectively). Training on first aid significantly improved knowledge about all health emergencies among all students as evident from post-test scores at first week and 16 weeks (p<0.05). Gain in knowledge was significantly higher among rural students.Conclusions: Students had low baseline knowledge about first aid measures. Sessions combining knowledge and skills have brought about significant improvement in the knowledge of participants irrespective of their age, caste or urban-rural background.

Diagnostic models of the pre-test probability of stable coronary artery disease: A systematic review

A comprehensive search of PubMed and Embase was performed in January 2015 to examine the available literature on validated diagnostic models of the pre-test probability of stable coronary artery disease and to describe the characteristics of the models. Studies that were designed to develop and validate diagnostic models of pre-test probability for stable coronary artery disease were included. Data regarding baseline patient characteristics, procedural characteristics, modeling methods, metrics of model performance, risk of bias, and clinical usefulness were extracted. Ten studies involving the development of 12 models and two studies focusing on external validation were identified. Seven models were validated internally, and seven models were validated externally. Discrimination varied between studies that were validated internally (C statistic 0.66-0.81) and externally (0.49-0.87). Only one study presented reclassification indices. The majority of better performing models included sex, age, symptoms, diabetes, smoking, and hyperlipidemia as variables. Only two diagnostic models evaluated the effects on clinical decision making processes or patient outcomes. Most diagnostic models of the pre-test probability of stable coronary artery disease have had modest success, and very few present data regarding the effects of these models on clinical decision making processes or patient outcomes.

Assessment on antibody test for diagnosis performance of heparin induced thrombocytopenia / 临床检验杂志

Objective To assess the antibody test for the diagnosis performance of heparin induced thrombocytopenia(HIT).Methods 52 plasma samples of patients with HIT,126 plasma samples of heparin treated patients without HIT and 50 plasma samples of healthy individuals were collected from 2014 September to 2016 November.According to thrombosis,the patients were further divided into two groups:isolated HIT group without thrombosis (30 cases) and heparin induced thrombocytopenia with thrombosis (HITY) group (22 cases).The whole HIT antibody in plasma was assayed by using ACL-TOP 700 coagulation analyzer and reagent (HemosIL HIT-AbPF4-H).The IgG-specific HIT antibody in plasma was assayed by using ACL AcuStar chemiluminescent analyzer and reagent (HemosIL AcuStar HIT-IgGPF4-H).Results The levels of whole antibody and IgG-specific antibody in the patients of heparin control group was higher than those in healthy control (U value was 1 644.0 and 1 911.0,respectively,P ＜ 0.01).The levels of two HIT antibodies in HIT patients group were higher than those in the patients of heparin control group (U value was 550.0 and 4.7,respectively,P ＜ 0.01).ROC curve showed that the sensitivities of both whole antibody and IgG-specific antibody were 100％,and up-regulating the cut-off value could improve the specificity of both tests.The positive incidence of the whole antibody was 27.8％ in the heparin control group and 100％ in HIT patients group while the cut-off value was 1.50 U/mL.The positive incidence of IgG-specific antibody was 0 in the heparin control group and 100％ in the HIT patients group while the cut-off value was 1.51 U/mL.While the cut-off value of IgG-specific antibody was 2.32 U/mL,the diagnosis sensitivity of thrombosis assessment was 90.9％ and the specificity was 80.0％.In case the cut-off value exceeded 2.32 U/mL,the accumulating risk of HIT increased significantly in HIT patients within 15 days (Log-rank x2 =56.577,P ＜ 0.01).Conclusion The whole antibody and IgG-specific antibody could contribute to excluding diagnosis,diagnosis or risk assessment for the suspected HIT patients.

Case Based Learning in Undergraduate Pathology A Study to Assess its Efficacy and Acceptability as Teaching-Learning Tool

Background: An innovative paradigm, of teaching-learning (TL) method, like Case Based Learning (CBL) in a paraclinical subject like Pathology is considered essential, which would bring about learning of pathological and clinical features of diseases in an integrated easy manner, resulting in growing of interest in undergraduate medical students to learn pathology with better retention of knowledge. Aim: To evaluate the efficacy of CBL as a TL method in Pathology and to assess perception of students and teachers to CBL. Materials and methods: Study involved 86 students from 2 nd professional MBBS course. Two common diseases viz. microcytic hypochromic anemia and pulmonary tuberculosis were taught in two phases respectively. Students were equally divided into two large groups of 43 each – Didactic lecture (DL) and CBL groups. DL group was taught with conventional DL by Pathology-faculties and CBL group was taught with CBL tool jointly by pathology and relevant clinical faculties. Teaching method was interchanged between large groups for two diseases. Pretest and post-test were conducted before and after intervention (DL/CBL) respectively. In addition, to test for knowledge retention one late post-test was also conducted in 2nd phase. Lastly, students’ and teachers’ feedbacks on perception to CBL were obtained

Questionnaire based assessment of teaching effectiveness during a lecture series on pharmacotherapeutics.

Background: Lecture is a widely accepted method of teaching & learning. It provides more of surface learning and covers larger text in specified time. However it has a disadvantage that there is no assessment about the extent of knowledge learner receives. Hence, we designed a daily questionnaire based evaluation technique. Methods: Without disclosing the topic, second year MBBS students (mean n=23) after learning from lecture series in Pharmacology, participated voluntarily to a questionnaire based task on eight therapeutic lecture topics. They wrote answers separately in 5-10 minutes before, and after delivery of text without referring to notes i. e. pre-test & post-test. Papers were valued on score basis, data recorded, interpreted and analyzed. Results: Mean acceptability (81.4%), mean improvement (94%), mean collective maximum score (96%), mean individual maximum score (92%) were observed. 85-100% participants out of total 184 in eight therapeutic lecture topics passed in post-test (None passing in Pre-test) reflected good improvement in cognitive structure. Conclusion: Performance in such tests provides feedback on teaching effectiveness, specificity & adequacy of knowledge gained by learners.

Practice of laboratory diagnostics teaching reform / 中华医学教育探索杂志

There are many problems in the current laboratory diagnostics teaching including unreasonable structure of teaching contents and routinization of teaching methods,etc.This paper explored the laboratory diagnostics teaching reform from the textbooks,teaching subject and teaching focus,in order to better meet the needs of the development of medicine education and clinical practice.

Clinical judgment to estimate pretest probability in the diagnosis of Cushing's syndrome under a Bayesian perspective / Contribuição do julgamento clínico na estimativa da probabilidade pré-teste do diagnóstico da síndrome de Cushing sob a perspectiva Bayesiana

OBJECTIVE: To estimate the pretest probability of Cushing's syndrome (CS) diagnosis by a Bayesian approach using intuitive clinical judgment. MATERIALS AND METHODS: Physicians were requested, in seven endocrinology meetings, to answer three questions: "Based on your personal expertise, after obtaining clinical history and physical examination, without using laboratorial tests, what is your probability of diagnosing Cushing's Syndrome?"; "For how long have you been practicing Endocrinology?"; and "Where do you work?". A Bayesian beta regression, using the WinBugs software was employed. RESULTS: We obtained 294 questionnaires. The mean pretest probability of CS diagnosis was 51.6% (95%CI: 48.7-54.3). The probability was directly related to experience in endocrinology, but not with the place of work. CONCLUSION: Pretest probability of CS diagnosis was estimated using a Bayesian methodology. Although pretest likelihood can be context-dependent, experience based on years of practice may help the practitioner to diagnosis CS. Arq Bras Endocrinol Metab. 2012;56(9):633-7.

OBJETIVO: Estimar a probabilidade pré-teste do diagnóstico de síndrome de Cushing (SC) por meio de julgamento clínico utilizando abordagem Bayesiana. MATERIAIS E MÉTODOS: Médicos res­ponderam a três perguntas, em sete congressos de endocrinologia. Após obtenção da história clínica/exame físico, sem exames laboratoriais, apenas com base em sua experiência pessoal, qual a probabilidade de diagnosticar SC?; Há quanto tempo você pratica endocrinologia?; Onde você trabalha? Uma regressão beta Bayesiana, utilizando o software WinBugs, foi empregada. RESULTADOS: Foram obtidos 294 questionários. A estimativa Bayesiana da probabilidade média de diagnosticar SC foi 51,6% (IC 95%: 48,7-54,3). Houve relação direta entre probabilidade de diagnosticar SC e experiência da prática endócrina, porém não com o local de trabalho. CONCLUSÃO: A probabilidade pré-teste do diagnóstico de SC foi estimada utilizando uma metodologia Bayesiana. Embora a probabilidade pré-teste possa ser dependente do contexto, a experiência de anos de prática pode auxiliar no diagnóstico intuitivo da CS. Arq Bras Endocrinol Metab. 2012;56(9):633-7.

Pretest scores rather than posttest scores correlate with term-end examination scores in medical education / 医学教育

  Pretests and posttests in the field of preventive medicine and public health were administered to third–year medical students of Shinshu University School of Medicine. This study aimed to determine whether pretest scores or posttest scores correlated with the term–end examination scores.<br>1）Pretests and posttests were administered 7 times to 112 third–year medical students, and the term–end examination was given in the first semester of the 2010 academic year.<br>2）Correlations were determined between pretest scores, posttest scores, the difference between pretest and posttest scores, and term–end examination scores. In addition, students were divided into quartiles in accordance with the pretest scores, and the posttest and term–end examination scores were compared among these quartiles.<br>3）The pretest scores significantly correlated with the posttest and term–end examination scores. The posttest and term–end examination scores were significantly higher in the fourth quartile（the highest pretest score quartile）than in the first quartile（the lowest pretest score quartile）.<br>4）The posttest scores did not correlate with the term–end examination scores.<br>5）Thus, we concluded that the pretest score rather than the posttest score is a useful predictor of the term–end examination score.

Evaluation of “Palliative care workshop for physicians engaged in clinical practice for cancer treatment held in Kyoto”

In Kyoto, we held the first “Palliative care workshop for physicians engaged in clinical practice for cancer treatment” in Japan on June 7-8, 2008 under the directive of the Ministry of Health, Labor and Welfare. There were 163 participants in the workshop, including 56 physicians and 107 voluntarily participating healthcare professionals (77 nurses, 23 pharmacists and 7 other medical professionals). We analyzed the results of tests consisting of 25 questions classified into 7 categories based on their contents. Tests were administered before and after the workshop (pre-test and post-test), and the educational effects of our conference were evaluated by examining changes in test scores. Participants other than physicians, nurses and pharmacists were excluded from analysis of the test scores because comprehensive medical knowledge was required to solve the questions. The mean rates of correct answers on pre- and post-test were 87.9% for physicians (total 78.9%) and 94.6% for physicians (total 89.1%), respectively. The scores were markedly increased after the workshop, showing practical significance of our attempt. However, the percentage of correct answers regarding psychological symptoms was lowest for physicians as well as for other healthcare professionals on both pre- and post-test. These findings strongly suggest that the workshops produced a sufficient educational effect, but improvement in individual training systems is considered necessary, especially in fields related to psychological manifestations. Palliat Care Res 2010; 5(2): 152-161

A Study to Validate the Pretest Probability of Malignancy in Solitary Pulmonary Nodule / 결핵및호흡기질환

BACKGROUND: Solitary pulmonary nodules (SPN) are encountered incidentally in 0.2% of patients who undergo chest X-ray or chest CT. Although SPN has malignant potential, it cannot be treated surgically by biopsy in all patients. The first stage is to determine if patients with SPN require periodic observation and biopsy or resection. An important early step in the management of patients with SPN is to estimate the clinical pretest probability of a malignancy. In every patient with SPN, it is recommended that clinicians estimate the pretest probability of a malignancy either qualitatively using clinical judgment or quantitatively using a validated model. This study examined whether Bayesian analysis or multiple logistic regression analysis is more predictive of the probability of a malignancy in SPN. METHODS: From January 2005 to December 2008, this study enrolled 63 participants with SPN at the Kangnam Sacred Hospital. The accuracy of Bayesian analysis and Bayesian analysis with a FDG-PET scan, and Multiple logistic regression analysis was compared retrospectively. The accurate probability of a malignancy in a patient was compared by taking the chest CT and pathology of SPN patients with <30 mm at CXR incidentally. RESULTS: From those participated in study, 27 people (42.9%) were classified as having a malignancy, and 36 people were benign. The result of the malignant estimation by Bayesian analysis was 0.779 (95% confidence interval [CI], 0.657 to 0.874). Using Multiple logistic regression analysis, the result was 0.684 (95% CI, 0.555 to 0.796). This suggests that Bayesian analysis provides a more accurate examination than multiple logistic regression analysis. CONCLUSION: Bayesian analysis is better than multiple logistic regression analysis in predicting the probability of a malignancy in solitary pulmonary nodules but the difference was not statistically significant.

Impacto de curso de posgrado en la atención primaria de salud / Postgraduate course impact on primary health care

La certificación de las causas de muerte forma parte de los procedimientos médico-legales. Lograr una secuencia lógica de este proceso constituye un ejercicio legal, científico y administrativo de gran trascendencia. El presente estudio se realizó en el área de salud Boyeros en el mes de mayo de 2004. Se trató de una investigación transversal y experimental que tuvo como objetivo valorar la influencia de un programa de posgrado sobre la calidad de la confección del certificado de defunción en médicos de la atención primaria de la salud. La muestra quedó formada por 36 médicos, los que se dividieron en dos grupos, uno control y otro estudio o experimental con 18 médicos cada uno. A ambos se les aplicó una preprueba relacionada con las tres primeras causas de muerte en Cuba, donde se debía establecer la secuencia lógica. Al grupo estudio se le aplicó una posprueba luego de haber concluido el curso con cuadros clínicos similares y con igual nivel de complejidad. Se manifestó a través de medidas de tendencia central que ambos grupos tenían dificultades al aplicárseles la preprueba con similares porcentajes. En el grupo estudio se obtuvo un 72,2 por ciento de respuestas correctas en la posprueba, equivalente a una proporción de 6:1 con una ganancia de respuestas correctas de 22. Se demostró que el curso de superación y capacitación impartido elevó la calidad en lo referente a la certificación de las causas de muerte y procedimientos médico-legales

The certification of death causes is a part of the medicolegal procedures. To achieve a logical sequence of this process is a legal, scientific, and managerial exercise of transcendental importance. This study was undertaken in a health area of Boyeros municipality, in May 2004. It was a cross-sectional and experimental research aimed at evaluating the influence of a postgraduate program on the quality of the death certificate making among physicians at the primary health care level. The sample included 36 physicians, which were divided into two groups, a control group and a study or experimental group, with 18 physicians each. In both, a pretest was applied related to the three first causes of death in Cuba, where a logical sequence should be established. In the study group, a posttest was applied after the culmination of the course with similar clinical pictures, and the same level of complexity. Through measurements of central trend, it was demonstrated that both groups had difficulties with the pretest, and that percentages were similar. In the study group, 72.2 % of the answers were correct in the posttest, equivalent to a 6:1 ratio with a gain of right answers of 22. It was demonstrated that the upgrading and training course conducted increased the quality of the certification of the death causes and of the medicolegal procedures.

Pre-Test Likelihood, Experience of Operators and Additive Diagnostic Efficacy of Gated Attenuation-Corrected Myocardial SPECT in coronary Artery disease

BACKGROUND AND OBJECTIVES: We investigated if gated and/or attenuation-corrected SPECT improved performance of experienced or in-experienced operators in the diagnosis of coronary artery disease (CAD) or stenosed arteries in patients having intermediate or high pretest likelihood. MATERIALS AND METHODS: Rest/dipyridamole stress gated attenuation-corrected SPECT was performed in 81 patients (M:F=48:33, 62+/-8.6 years old, of high (n=38) or intermediate (n=43) pre-test likelihood for CAD, 1 vessel; 14, 2 vessel; 19, 3 vessel disease; 31, normal; 17). Two experienced and one novice physicians graded 1 (normal) to 5 (definitely abnormal) for each artery 1) by conventional rest Tl-201/stress Tc-99m-MIBI SPECT, 2) 1) plus viewing gated SPECT (+gated) and 3) 2) plus attenuation-corrected SPECT (+AC gated). Areas under curves (AUC) of receiver operating characteristic (ROC) curves were compared. RESULTS: AUC was greater in patients with high likelihood than intermediate likelihood. Novice physician performed better in diagnosing RCA stenosis (AUC: 0.53 for usual, 0.58 for +gated, and 0.66 for +AC gated) in patients with intermediate likelihood. AUC was not different for the diagnosis of CAD and LAD or LCx. Performance of experienced physicians was not different regardless of pre-test likelihood. Novice operator's specificity increased from 53% to 73% for CAD, and 62% to 89% (p<0.05) for RCA in patients with intermediate likelihood. CONCLUSION: We conclude that gated attenuation-corrected SPECT was helpful only for novice physician to diagnose RCA stenosis by increasing specificity in patients with intermediate likelihood. Even for inexperienced physician, these methods were not helpful in patients with high pre-test likelihood or for LAD or LCX.

Effects of Nutrition Education on Nutrition Knowledge, Dietary Attitudes, and Food Behavior of College Students / 대한지역사회영양학회지

The purpose of this study was to investigate the effects of nutrition education on nutrition knowledge, dietary attitudes, and food behavior of college students. The subjects of this study were 350 college students attending a university. The education group students received nutrition education three hours per week during a 4-week period offered in a 'Home Economics' course. A total of 150 students in the education group and 200 students in the non-education group completed pre-test questionaires examining nutrition knowledge, dietary attitudes, and food behaviors. Major findings were as follows : nutrition knowledge, and food behavior of the education group were improved compared to the non-education group. But significant changes were not observed in dietary attitudes in the education group. There were higher correlations between nutrition knowledge and dietary attitudes score, and between dietary attitudes and food behavior score at the posttest than those at the pretest. These results suggest that nutrition education for college students can effectively improve their nutrition knowledge and food behaviors.