Learning through multiple lenses: analysis of self, peer, near-peer, and faculty assessments of a clinical history-taking task in Australia / 보건의료교육평가

PURPOSE: Peer assessment provides a framework for developing expected skills and receiving feedback appropriate to the learner's level. Near-peer (NP) assessment may elevate expectations and motivate learning. Feedback from peers and NPs may be a sustainable way to enhance student assessment feedback. This study analysed relationships among self, peer, NP, and faculty marking of an assessment and students' attitudes towards marking by those various groups. METHODS: A cross-sectional study design was used. Year 2 osteopathy students (n=86) were invited to perform self and peer assessments of a clinical history-taking and communication skills assessment. NPs and faculty also marked the assessment. Year 2 students also completed a questionnaire on their attitudes to peer/NP marking. Descriptive statistics and the Spearman rho coefficient were used to evaluate relationships across marker groups. RESULTS: Year 2 students (n=9), NPs (n=3), and faculty (n=5) were recruited. Correlations between self and peer (r=0.38) and self and faculty (r=0.43) marks were moderate. A weak correlation was observed between self and NP marks (r=0.25). Perceptions of peer and NP marking varied, with over half of the cohort suggesting that peer or NP assessments should not contribute to their grade. CONCLUSION: Framing peer and NP assessment as another feedback source may offer a sustainable method for enhancing feedback without overloading faculty resources. Multiple sources of feedback may assist in developing assessment literacy and calibrating students' self-assessment capability. The small number of students recruited suggests some acceptability of peer and NP assessment; however, further work is required to increase its acceptability.

Reliability of a viva assessment of clinical reasoning in an Australian pre-professional osteopathy program assessed using generalizability theory / 보건의료교육평가

Clinical reasoning is situation-dependent and case-specific; therefore, assessments incorporating different patient presentations are warranted. The present study aimed to determine the reliability of a multi-station case-based viva assessment of clinical reasoning in an Australian pre-registration osteopathy program using generalizability theory. Students (from years 4 and 5) and examiners were recruited from the osteopathy program at Southern Cross University, Lismore, Australia. The study took place on a single day in the student teaching clinic. Examiners were trained before the examination. Students were allocated to 1 of 3 rounds consisting of 5 10-minute stations in an objective structured clinical examination-style. Generalizability analysis was used to explore the reliability of the examination. Fifteen students and 5 faculty members participated in the study. The examination produced a generalizability coefficient of 0.53, with 18 stations required to achieve a generalizability coefficient of 0.80. The reliability estimations were acceptable and the psychometric findings related to the marking rubric and overall scores were acceptable; however, further work is required in examiner training and ensuring consistent case difficulty to improve the reliability of the examination.

Expression and clinical significance of bone marrow sclerostin in patients with multiple myeloma / 重庆医学

Objective To investigate the bone marrow supernatant expression of sclerostin in the patients with multiple myeloma (MM) and to clarify its clinical signification .Methods The sclerostin level was quantified by using ELISA ,and the gene expression of sclerostin was determined by RT-PCR .Results The sclerostin level was (0 .54 ± 0 .21)pg/mL in the MM group ,which was sig-nificantly higher than (0 .31 ± 0 .06)pg/mL in the control group (t=5 .67 ,P<0 .01) .The sclerostin level was (0 .65 ± 0 .17) pg/mL in the recurrent and refractory MM group ,which was significantly higher than (0 .47 ± 0 .21) pg/mL in the control group and the newly diagnosed group (t=8 .44 ,3 .27 ,P<0 .01) ,RT-PCR verified that the BMMNC of most patients expressed sclerostin gene .The expression of sclerostin in the MM group was negatively correlated with alkaline phosphatase (ALP)(r= -0 .379 ,P=0 .005) ,and positively related with the correction blood calcium ,bone loss points ,serum β2-micro globulin(β2-GM ) ,proportion of serum M protein and clinical International Staging System (ISS) stages .The median follow-up periods were 29(6-65) months ,the low sclerostin group had the median survival period of 48(6-65) months and the high sclerostin group had the median survival pe-riod of 24(6-52) months ,the difference between them had statistical significance (χ2 = 12 .74 ,P< 0 .01) .Conclusion Its level may reflect the bone destruction ,osteogenesis inhibition degree and myeloma burden ,and reflect the median survival period of MM patients to some extent .

Intervenção osteopática em idosos e o impacto na qualidade de vida / Osteopathic intervention in the elderly and its impact on quality of life

INTRODUÇÃO: O envelhecimento evidencia a necessidade do idoso do controle das doenças e do bem-estar físico, psíquico e social. OBJETIVO: Avaliar o impacto da intervenção osteopática na qualidade de vida de idosos. MATERIAIS E MÉTODOS: Vinte e um indivíduos (72,1 ± 4,7 anos, 18 mulheres) completaram este estudo. Foi aplicado o questionário de qualidade de vida WHOQOL-bref no primeiro e sexto atendimentos no intervalo de 48 [39; 66] dias. A avaliação e o tratamento das disfunções somáticas encontradas foram feitos em todas as sessões e as técnicas de domínio osteopático foram utilizadas. Os dados foram analisados por meio do teste de Wilcoxon com significância em p < 0,05. RESULTADOS: Foi encontrada diferença significativa no domínio físico (pré-tratamento: 58,67 ± 12,91 por cento; pós-tratamento: 64,64 ± 13,75 por cento; p < 0,05). Não foram encontradas diferenças significativas nos domínios: psicológico (pré-tratamento: 63,10 ± 15,38 por cento; pós-tratamento: 64,38 ± 11,67 por cento; p = 0,846), relações sociais (pré-tratamento: 62,30 ± 14,34 por cento; pós-tratamento: 62,50 ± 12,82 por cento; p = 1,000) e meio ambiente (pré-tratamento: 52,08 ± 11,91 por cento; pós-tratamento: 52,19 ± 11,02 por cento; p = 0,806). O nível de escolaridade apresentou associação significativa com a pontuação total do questionário antes (r = 0,457; p = 0,019) e após (r = 0,380; p = 0,049) a intervenção. CONCLUSÃO: A medicina osteopática, com sua ampla abordagem, interferiu positivamente no domínio físico da qualidade de vida. Outros domínios (meio ambiente, psicológico e relações pessoais) não foram modificados pela intervenção osteopática, contribuindo para a manutenção da qualidade de vida geral.

INTRODUCTION: The aging process evidence the need to provide to the elderly either disease control and physical, psychological, and social well-being. OBJECTIVE: To evaluate the osteopathic intervention and its impact in quality of life of aged people. MATERIALS AND METHODS: Twenty-one subjects (72.1 ± 4.7 years, 18 women) were enrolled in and completed this study. The WHOQOL-bref questionnaire was applied at first and sixth session with an average time interval of 48 [39; 66] days. At each session, screening tests and treatment were performed for somatic dysfunctions; treatment techniques were selected among osteopathic domain. Data from questionnaire were analyzed with Wilcoxon test with significance established at p < 0.05. RESULTS: Significant difference was found in the physical domain (before: 58.67 ± 12.91 percent; after: 64.64 ± 13.75 percent; p < 0.05). No significant difference was found in psychological domain (before: 63.10 ± 15.38 percent; after: 64.38 ± 11.67 percent; p = 0.846), social relations (before: 62.30 ± 14.34 percent; after: 62.50 ± 12.82 percent; p = 1.000) and environment (before: 52.08 ± 11.91 percent; after: 52.19 ± 11.02 percent; p = 0.806). Educational level presented significant association with total scoring of the questionnaire before (r = 0.457; p = 0.019) and after (r = 0,380; p = 0,049) osteopathic intervention. CONCLUSION: Osteopathic medicine, in a broad approach, positively contributed to the physical domain of quality of life. Other domains (environmental, psychological, and social relations) were not modified by osteopathic intervention, resulting in unchanged overall quality of life.

Progression of targeted therapy of multiple myeloma bone disease / 白血病·淋巴瘤

Multiple myeloma (MM) is a hematological malignancy. Osteolytic lesion is the commonest complication in patients with MM. Skeletal-related events severely affect the survival quantity and prognosis. Current therapeutic approach for the treatment of myeloma bone disease (MBD) is based on the use of bisphosphonates. AS the recent advance in the pathogenesis and therapeutics of MBD,more factors related to this disease are found. In this article important factors related to the pathogenes of MBD and the cytokine targeted therapies are reviewed.

Diagnosis and treatment of bone disease of multiple myeloma / 白血病·淋巴瘤

Up to 90 % of multiple myeloma patients can develop to osteolytic lesions. Although the conventional X radiography can only demonstrate the lytic bone disease when 30 % of the trabecular bone loss, it still remains the gold standard of the staging procedure of newly diagnosed myeloma patients. CT scans are more sensitive than X radiography for detecting small lytic lesions. MRI or CT is the choice of diagnosis to assess suspected cord compression. Technicium-99m bone scan in patients with myeloma usually underestimate the extent of bone damage. Treatments of myeloma bone disease include bisphosphonate therapy, novel targeted agents, surgical intervention and radiation therapy.

Long-term efficacy of calcitonin and bisphosphonates on renal osteopathy in maintenance hemodialysis patients / 中华肾脏病杂志

Objective To observe the efficacy of ealcitonin and bisphosphonates on renal osteopathy of maintenance hemodialysis (MHD)patients. Methods Forty-three MHD patients were raindomly divided into two groups: A group and B group. All the patients were routinely received oral calcium carbonate 1.0 g tid and calcitriol 0.25 μg qd. Calcitonin (20U) hypodermic injection was given three times a week additionally during hemodialysis in A group. Patients in B group received bisphosphonates 70 mg once a week based on the therapy of A group. Serum levels of intact parathyroid hormone (iPTH), calcium, phosphorus, alkaline phosphatase (AKP), bone mass density (BMD) of lumbar spine and femoral neck, and the degree of bone ache (visual analogue scale, VAS) were assessed before the therapy and 3, 6 and 12 months after treatment. The adverse reactions were recorded during treatment. Results The levels of AKP and iPTH in both two groups decreased significantly after treatment. The above values of pre-treatment and 12 months after treatment were as follows: AKP(U/L)of A group 244.05±41.99 and 148.35±27.71,of B group 245.60±40.86 and 143.40±28.03;PTH(ng/L) of A group 697.5±119.7 and 267.4±45.9,of B group 708.2±120.3 and 277.6±41.9 (all P<0.05). While the levels of calcium and phosphorus did not change obviously during treatment (P>0.05). BMD was not improved at 3, 6 mouths and became better at 12 mouths after treatment. As compared to pre-treatment, BMD of lumbar spine(g/cm2) in A group was 1.062±0.223 vs 1.202±0.251 ,in B group 1.033±0.152 vs 1.189±0.225; BMD of femoral neck (g/cm2)in A group was 0.993±0.108 vs 1.067±0.095,in B group 0.947±0.083 vs 1.018 ±0.217 (all P<0.05). The scores of VAS also decreased significantly at 3, 6, 12 months after treatment(P<0.05). No severe adverse reaction was found during the treatment. Conclusions Utilization of calcitonin and combination with bisphosphonates during bemodialysis can effectively preserve the BMD and prevent bone loss in MHD patients and is well tolerated. No significant difference of therapeutic effect is observed between using ealcitonin or combination with bisphosphonates.

The clinical and the X-ray diagnosis of the bone yaws disease / 中华放射学杂志

Objective To study the clinical and the X-ray characteristics of the yaws disease in bone.Methods The clinical features and X-ray imaging appearances of 12 cases with bone yaws were analyzed and summarized,and discussed with related cultural heritage.Results Nine patients were period Ⅱ yaws,whose skin of all extremities were detected multiple symmetry or no-symmetry papulas and nodes,with systematic toxic symptom.There patients were period Ⅲ yaws,with multiple brown abscess in and under the skin of all extremities,multiple bayberrylike nodes up and down surrounding the ulcer.In the(9 patients) with period Ⅱ yaws,the bone lesions were predominantly periosteal proliferation and hyperostosis.In the 3 patients with period Ⅲ yaws,the bone lesions were hyperostosis with destruction of bone.Conclusion The X-ray characteristics of bone yaws are:(1) multiple bones are involved;(2)the pathological change is mainly located in the long bone diaphysis;(3) local irregular periosteal proliferation and cortical hyperplassia,medullary canal blurring or disappearing;(4)diffusing long bone sclerosis with cortical bone destruction and cancellated bone erosion;(5)the bones involved has no sequestra.