[The use of video as preparation for the objective structured clinical examination in medicine and surgery]. / Anvendelse af video som forberedelse til stationsbaseret eksamen i medicin og kirurgi.

The objective structured clinical examination (OSCE) is a tool for measuring the dimensions of clinical competences. OSCE differs from traditional oral or written examination and results should not be influenced by lack of knowledge of the testing type. We prepared a video describing the practical aspects. On a Likert scale from 1 to 7 our video was rated 4 (interquartile range (IQR): 4-6). An informatory lecture was rated 4 (IQR: 3-5) and a rehearsal OSCE was rated 6 (IQR: 5-7). Video use peaked in the days up to OSCE. Accessibility should be improved by reaching out using the appropriate tools. We encourage the use of video for preparation to new examination types.

[Medical students gain from a practical course in clinical ultrasound]. / Medicinstuderende har udbytte af praktisk kursus i klinisk ultralydundersøgelse.

Ultrasound scanning (US) is a new universal medical tool that may be compared to the stethoscope. Both are highly operator-dependent examinations used for screening, and both should be followed by more conclusive examinations. Clinical ultrasound can be seen as an extension of the clinical examination. Since 2009, 1,141 medical students have participated in a training course in basic US at the University of Copenhagen. The evaluation of the course has been good with the average score of 5.21 on a 7-point Likert scale. Students' feedback on the questionnaire reveal that the clinical departments are not capable of supervising the further training. A description of the training in US, an evaluation of the course and a discussion on how to implement the outcome of the course in clinical pratice is summarised.

[Gender differences among medical students in the approach to simulation]. / Forskelle i mandlige og kvindelige medicinstuderendes tilgang til simulation.

INTRODUCTION: Simulation-based training is gaining ground as a replacement for the "apprenticeship" model of training. For this reason, it is useful to know if men and women have the same prerequisites and assumptions prior to training. The purpose of the study was to investigate whether male and female medical students performed differently whilst training in a bronchoscope simulator. MATERIALS AND METHODS: At a medical conference in Copenhagen, 62 medical students took part in a simulator experiment (number of male students: 33, number of female students: 29). Data collection was obtained from the bronchoscope simulator. The participant's task was to identify and visualise as many orifices as possible during five minutes, without impinging on the mucous membranes. RESULTS: The male participants visualised a significantly higher amount of segments (p = 0,045) than the female participants, however there were also significantly more incidences of impingement on nearby mucous membranes in the male group of students (p = 0,045). At Copenhagen Medical School, there are almost twice as many female students as male students. Thus, gender distribution among the participants in this study does not reflect the gender distribution at a Danish medical school. This implies that men's interest in simulation is higher than the one of women's, and the results suggest a gender difference in the approach to simulation based training. CONCLUSION: Gender differences should be taken into consideration, when planning and organising medical education and assessment in simulation training.

[Lack of correlation between performances in a simulator and in reality]. / Manglende sammenhaeng mellem praestationer i et virtuelt og i et virkeligt miljø.

INTRODUCTION: Simulation-based training provides obvious benefits for patients and doctors in education. Frequently, virtual reality simulators are expensive and evidence for their efficacy is poor, particularly as a result of studies with poor methodology and few test participants. In medical simulated training- and evaluation programmes it is always a question of transfer to the real clinical world. To illustrate this problem a study comparing the test performance of persons on a bowling simulator with their performance in a real bowling alley was conducted. MATERIAL AND METHODS: Twenty-five test subjects played two rounds of bowling on a Nintendo Wii and 25 days later on a real bowling alley. Correlations of the scores in the first and second round (test-retest-reliability) and of the scores on the simulator and in reality (criterion validation) were studied and there was tested for any difference between female and male performance. RESULTS: The intraclass correlation coefficient equalled 0.76, i.e. the simulator fairly accurately measured participant performance. In contrast to this there was absolutely no correlation between participants' real bowling abilities and their scores on the simulator (Pearson's r = 0.06). There was no significant difference between female and male abilities. CONCLUSION: Simulation-based testing and training must be based on evidence. More studies are needed to include an adequate number of subjects. Bowling competence should not be based on Nintendo Wii measurements. Simulated training- and evaluation programmes should be validated before introduction, to ensure consistency with the real world.

Epidemiology of chronic wound patients and relation to serum levels of mannan-binding lectin.

The aim of this study was to describe the epidemiology of chronic wounds in a large cohort of patients from a tertiary hospital out-patient clinic, and examine the significance of serum mannan-binding lectin for the occurrence and clinical presentation of such wounds. The study comprised 489 consecutive patients with chronic foot and leg ulcers. A clinical classification of wound- aetiology was performed, and mannan-binding lectin was measured in the sera of patients and healthy controls. The patients presented with 639 wounds altogether; diabetic foot ulcers (309), venous leg ulcers (188), arterial ulcers (109), and vasculitis (33). The mannan-binding lectin levels of patients with venous leg ulcer, alone or in combination with other types of wounds, differed significantly from the control group, and the frequency of values < 100 ng/ml was significantly higher. In diabetic and arterial ulcer patients the frequency of values >or= 3000 ng/ml was significantly higher than that of the control group. This suggests a role for the innate immunity in the pathology of venous leg ulcers, and indicates different roles for mannan-binding lectin in the development of ulcers with different aetiologies; it further suggests that mannan-binding lectin substitution should be tested in a controlled clinical trial.

Prevalence of toe nail onychomycosis in diabetic patients.

Onychomycosis among diabetic patients has been reported in some studies to be of high prevalence. This study aimed to investigate the prevalence of onychomycosis among diabetic patients at a Danish University Hospital. Clinical and mycological examinations were performed on type 1 and 2 diabetic patients from in- and out-patient clinics. A total of 271 patients were enrolled, 72% males, mean age 61.3 years, 26% of the patients had diabetes type 1. The prevalence of toe nail onychomycosis (positive culture and/or microscopy) was 22% (n = 59) of which 55 cases were caused by dermatophytes (93%) and 4 cases by yeasts (7%). A correlation was found between onychomycosis and age (p =0.02) and severity of nail changes (p <0.001), respectively. However, no significant correlation was found to gender, type of diabetes, lower extremity arterial disease, neuropathy, toe amputation or oedema. Onychomycosis occurred with a high prevalence in diabetic patients, especially among older patients and those with severe nail changes.

Standardised method of surgical treatment of chronic leg ulcers.

Healing and recurrence rates were compared in leg ulcers of different aetiology in 385 patients with 406 chronic leg ulcers. Standard treatment was excision of the ulcer followed by meshed split-skin grafting and correction of superficial venous insufficiency in the area. The median age of the patients was 75 years (range 16-95). After one year 345 patients with 357 leg ulcers were alive. Overall healing rate was 64% (227 in 357 legs) after one year. The best results were achieved in traumatic ulcers (31 in 36 ulcers) and worst for the arterial ulcers (4 in 20 ulcers). Recurrence rate in venous and venous/ischaemic ulcers was 14% (33 in 235 legs) and 8% (n=3) in the traumatic ulcers. Vasculitic ulcers tend to recur 59% (n=10), but the graft does relieve pain.

Achilles tendon lengthening, the panacea for plantar forefoot ulceration?

BACKGROUND: Recent reports on Achilles tendon lengthening (ATL) have documented rapid healing of chronic plantar neuropathic forefoot ulcers. METHODS: Sixty-eight patients with 75 ulcerated neuropathic feet (63 patients with diabetes with 69 ulcerated feet) underwent ATL and were retrospectively studied for chronic plantar ulceration in the forefoot and reduced dorsiflexion range of motion at the ankle. Median duration of ulcers was 48 months (range 11-84 months) in 16 forefoot amputation stumps and 11 months (range 3-84 months) for the rest of the patients. RESULTS: Healing of the ulcers was obtained in 68/75 feet (91%). At a median follow-up of 12 months (3-26 months), 4 had never healed, 5/10 recurrent ulcers and 6/11 transfer ulcers (localized to the heel) had not healed, that is, a healing rate of 60/75 (80%). Acute transfer ulcers to the heel occurred in 47% of patients with complete anaesthesia of the heel pad. Late heel ulceration occurred in 14% of those with extreme ankle dorsiflexion (>15 degrees). Failure to heal or ulcer recurrence occurred more frequently at dorsiflexion <10 degrees (33%). Rupture of the Achilles tendon occurred in 7 feet (10%). Charcot event was experienced in 3 (4%). CONCLUSION: Lengthening of the Achilles tendon is effective in healing plantar neuropathic ulceration. Patients with complete anaesthesia of the heel pad should not undergo this procedure and extreme dorsiflexion should be avoided because of the risk of heel ulceration. Moreover, the procedure should be performed only in a multidisciplinary setting for immediate dealing with complications and for surveillance and treatment of future ulceration.