[Students' perceptions comparing standardized and non-standardized oral exams in internal medicine]. / Percepción de examen oral estandarizado vs no estandarizado en el internado de medicina interna.

BACKGROUND: Oral examinations are a useful tool to appraise certain medical skills compared to other examinations. However, they have some disadvantages that might be reduced with standardization. AIM: To compare students' perception comparing a standardized oral exam (SOE) versus a traditional, non-standardized oral exam (NSOE). MATERIAL AND METHODS: During the first semester of 2013 a NSOE was applied to internal medicine undergraduate students. During the second semester, a SOE was applied. An anonymous and voluntary perception questionnaire, consisting in 10 questions based on a 5-level Likert scale, was answered by these students. Statistical analysis was done using the Mann-Whitney U test. RESULTS: Among the 118 students, 50.8% were evaluated using NSOE and 49.2% using SOE. Questionnaire response rate was 84%. Among respondents, 52% took the SOE and 48%, the NSOE. Students evaluated using SOE perceived that the degree of complexity of clinical cases was similar for all examinees (p < 0.05), that exam duration was standardized (p < 0.05), and that grades obtained were less influenced by the clinical site where the exam was taken (p < 0.05). However, anxiety level remained high in both groups, as well as the overall satisfaction experience. CONCLUSIONS: Standardization of an oral examination improves the perception of medical students about levels of difficulty, duration and external influences on the final grade.

Percepción de examen oral estandarizado vs no estandarizado en el internado de medicina interna / Students’ perceptions comparing standardized and non-standardized oral exams in internal medicine

Background: Oral examinations are a useful tool to appraise certain medical skills compared to other examinations. However, they have some disadvantages that might be reduced with standardization. Aim: To compare students’ perception comparing a standardized oral exam (SOE) versus a traditional, non-standardized oral exam (NSOE). Material and Methods: During the first semester of 2013 a NSOE was applied to internal medicine undergraduate students. During the second semester, a SOE was applied. An anonymous and voluntary perception questionnaire, consisting in 10 questions based on a 5-level Likert scale, was answered by these students. Statistical analysis was done using the Mann-Whitney U test. Results: Among the 118 students, 50.8% were evaluated using NSOE and 49.2% using SOE. Questionnaire response rate was 84%. Among respondents, 52% took the SOE and 48%, the NSOE. Students evaluated using SOE perceived that the degree of complexity of clinical cases was similar for all examinees (p < 0.05), that exam duration was standardized (p < 0.05), and that grades obtained were less influenced by the clinical site where the exam was taken (p < 0.05). However, anxiety level remained high in both groups, as well as the overall satisfaction experience. Conclusions: Standardization of an oral examination improves the perception of medical students about levels of difficulty, duration and external influences on the final grade.

Osteomalacia hipofosfatémica secundaria a sarcoma de muslo: caso clínico / Hypophosphatemic osteomalacia secondary to a sarcoma: report of one case

Tumor induced osteomalacia is uncommon and is characterized by an isolated and not PTH dependent reduction in tubular phosphate reabsorption. This alteration is produced by phosphaturic factors, such as fibroblast growth factor-23 (FGF-23) that are secreted by tumors. We report a 41 years old female presenting with joint pain and progressive loss of muscle strength in the lower limbs. Initial laboratory assessment showed hypophosphatemia, elevated alkaline phosphatases, normal intact parathormone levels, low levels of 25 hydroxy vitamin D and an elevated 24 h phosphaturia. Bone mineral density showed spine and femoral neck osteopenia. A positron emission tomography (PET) revealed a right thigh tumor with lung metastases. Its biopsy disclosed a fibrosarcoma. FGF-23 levels, measured by ELISA were markedly elevated. The patient was discharged with palliative measures.

Effects of normal and perturbed social play on the duration and amplitude of different types of infant smiles.

Different types of smiling varying in amplitude of lip corner retraction were investigated during 2 mother-infant games--peekaboo and tickle--at 6 and 12 months and during normally occurring and perturbed games. Using Facial Action Coding System (FACS), infant smiles were coded as simple (lip corner retraction only), Duchenne (simple plus cheek raising), play (simple plus jaw drop), and duplay (Duchenne plus jaw drop). In addition, again using FACS, the amplitude of lip corner retraction was coded on a 5-point scale. Rather than a single smile expression that differs only in amplitude, the authors found a complex family of different smile expressions differing in their duration and amplitude as a function of game, setup versus climax of the game, and perturbation. Both type of smiling and amplitude of smiling appear to be controlled independently by the infant in relation to the context. These findings reveal systematic and context-specific nuances in infant smiles in the 2nd half of the first year.

Desenvolvimento da vida emocional durante o segundo ano de vida: narrativas e sistemas dinamicos

Tradicionalmente, a emocao tem sido concebida como um estado interno e preexistente manifestado na face. Assim, a emocao tem sido analisada atraves do estudo detalhado da face. O presente trabalho propoe uma perspectiva alternativa, defendendo a utilidade teorica e metodologica dos conceitos de narrativas e sistemas dinamicos para o estudo da emocao. Partindo desta perspectiva, a emocao e concebida enquanto emergente da interacao do individuo com seu meio. Em nossas investigacoes, enfatizamos, simultaneamente, as acoes corporais, vocais, e faciais de ambos parceiros bem como os contextos comunicativos construidos durante a interacao. Utilizamos o metodo de analise de narrativas aplicado a dados longitudinais de uma diade mae-bebe durante o segundo ano de vida. Procuramos ilustrar como o desenvolvimento das emocoes emerge das sutis transformacoes que ocorrem no relacionamento social entre o bebe e sua mae.

Influence of blood storage after in vitro exposure on the yield of micronuclei observed in human lymphocytes.

In a cooperative study, four laboratories evaluated the micronucleus test in irradiated and non-irradiated lymphocytes with respect to time of storage, the difference between X-ray and gamma exposure and inter-observer variance. The results were compared with parallel studies on dicentric aberrations. No significant differences between laboratories, with respect to storage time or between gamma and X-irradiation were observed for micronuclei and dicentrics using analysis of variance. However, micronuclei are not suitable for an assessment of exposure inhomogeneity because of a significant overdispersion already in controls and homogeneously irradiated samples.