Introduction of Basic Dermatologic Ultrasound in Undergraduate Medical Education.

Purpose: Teaching ultrasound procedures to undergraduates has recently been proposed to improve the quality of medical education. We address the impact of applying standardized dermatologic ultrasound teaching to our undergraduates. Materials and Methods: Medical students were offered an additional theoretical and practical seminar involving hands-on ultrasound dermatologic ultrasound during their mandatory dermatology practical training. The students' theoretical knowledge and dermatologic ultrasoud skills were tested with a multiple choice questionnaire extracted from Level 1 Spanish Society of Ultrasound Dermatologic Ultrasound accreditation exam before and after the course. After the course, the students were asked to answer a course evaluation questionnaire Results: The multiple-choice question scores after the course showed statistically significant improvement (5.82 vs. 8.71%; P<0.001). The questionnaire revealed that students were satisfied with the course, felt that it increased both their dermatologic and ultrasound knowledge, and indicated that they wanted more sonographic hands-on training in both dermatologic ultrasound and other medical fields. Conclusion: Using both objective and subjective methods, we showed that the introduction of standardized ultrasound training programs in undergraduate medical education can improve both students' understanding of the technique and the quality of medical education in dermatology.

Nutritional assessment of marginally nourished surgical patients.

BACKGROUND: Anthropometric indices are known to be good indicators of nutritional status in the long term. However, there are conflicting reports about their effectiveness in short term assessments. METHODS: In 45 patients undergoing elective operations, the mid-arm circumference, biceps and triceps skin fold thickness and arm muscle area were measured. These were compared with haematological indices of nutritional status such as serum albumin, total protein and haemoglobin. The patients were divided into two groups based on their body mass index (< or > 18.5) or weight (< or > 52 kg). In another 10 patients, anthropometric and blood indices were studied pre- and postoperatively along with changes in body composition. RESULTS: When patients were grouped according to weight or body mass index, the anthropometric indices studied showed significant differences between the two groups, i.e. weight < 52 kg v. > 52 kg (mid-arm circumference: 22 +/- 3.3 cm v. 10 +/- 1.8 cm, p < 0.01; triceps skin fold thickness: 5.6 +/- 1.4 mm v. 10 +/- 4.9 mm, p < 0.01) although there were no differences in the blood indices. The 10 patients studied longitudinally were on energy-deficient intakes in the first postoperative week and lost lean tissue and body fat (-43 g, -33 g and -19 g protein and -78 g, -88 g and -97 g fat on postoperative days 1, 4 and 8 respectively). There was a variable response in terms of weight and body water. The measured anthropometric indices, however, showed no significant differences. CONCLUSIONS: Our results suggest that anthropometric indices are useful measures of nutritional status on a cross-sectional basis, whereas blood indices are not. Weight changes and anthropometric indices are not reliable guides to the short term nutritional course after an operation.

Resting energy expenditure and nitrogen loss after surgery in chronically undernourished patients.

Chronically undernourished patients (n = 10) undergoing elective abdominal surgery were assessed with regard to their energy expenditure and urinary nitrogen loss. These measurements were made for 1 week after the surgery, and stress factors for each parameter were computed. The responses of the chronically undernourished patients were compared to those of relatively well nourished patients (n = 10) undergoing comparable surgeries. It was found that the postoperative resting energy expenditure (REE) of the chronically undernourished patients was not significantly elevated when compared to their preoperative values (mean +/- SEM): 1210.66 +/- 88.13, 1354.91 +/- 86.61, 1215.09 +/- 89.68, and 1188.23 +/- 86.61 kcal/day preoperatively and on postoperative days 1, 4, and 8, respectively. On the other hand, the postoperative REE of the controls was significantly elevated (p < 0.05) over their baseline values: 1357.18 +/- 70.81, 1574.66 +/- 100.35, 1502.89 +/- 109.44, and 1477.23 +/- 83.52; kcal/day, respectively, for the same days. The stress factors for the controls were higher than those for the undernourished (1.16 versus 1.12, 1.11 versus 1.00, and 1.09 versus 0.98 on postoperative days 1, 4, and 8, respectively). The urinary nitrogen excretion in both groups (for the 4 days) was not significantly elevated over baseline (6.23 +/- 0.87, 7.72 +/- 0.71, 8.36 +/- 0.87, and 8.04 +/- 1.56 grams/day in the undernourished; and 7.59 +/- 1.03, 9.57 +/- 1.33, 9.49 +/- 1.03, and 8.67 +/- 0.76 grams/day in the controls. The stress factors for nitrogen excretion were slightly higher in the undernourished group.(ABSTRACT TRUNCATED AT 250 WORDS)