Comparison of performance 2 years after the old and new (interactive) ATLS courses.

BACKGROUND: We previously (1997) demonstrated superior clinical but similar cognitive performance after the new interactive compared to the old ATLS course. The present study is aimed at determining whether this difference was short term or maintained over time (2 years). MATERIALS AND METHODS: Two groups of 13 physicians out of the original 32 physicians were available for the study which compared performance in a 40-item MCQ examination on trauma topics and clinical performance in 4 trauma OSCE stations consisting of simulated trauma patients. Paired and unpaired t tests were used for within- and between-group comparisons, respectively, with P < 0.05 being considered statistically significant. Overall OSCE scores (maximum standard 20), adherence to priority scores (Priority, scale 1 to 7), and overall approach (Approach, scale 1 to 5) scores were analyzed. RESULTS: Values are means +/- SD; (+)-P < 0.05 compared to 1999; *P < 0.05 compared to old group [table in text]. CONCLUSIONS: Although knowledge base decreases similarly with time after both courses, the new interactive course participants maintained a consistently higher clinical skill performance level at 2 years.

Papillary thyroid adenocarcinoma arising in a thyroglossal tract remnant following excision of a thyroglossal cyst: the importance of the Sistrunk procedure.

Carcinoma of the thyroglossal tract is a rarity--over the past 85 years only 160 cases have been reported. We report the first case of carcinoma arising in a thyroglossal tract remnant 10 years after simple excision of a thyroglossal cyst. This case highlights the importance of the Sistrunk procedure, (the removal of the entire thyroglossal tract) for preventing not only cyst recurrence, sinus and fistula formation, but also the occurrence of carcinoma.

Comparison of performance of interns completing the old (1993) and new interactive (1997) Advanced Trauma Life Support courses.

BACKGROUND: The 1997 edition of the Advanced Trauma Life Support (ATLS) course emphasized interactivity as its major change. The impact of this change is assessed in this study. METHODS: We compared two matched groups of 16 interns completing either the old (group I) or new (group II) ATLS course. Cognitive skills (40 standard ATLS questions plus 10 additional questions on airway and shock) and clinical trauma management skills (four trauma objective structured clinical examinations [OSCEs] on simulated trauma patients) were tested. OSCE station scores (standardized to a maximum of 20), priority scores (graded 1-7), organized approach global passing grades (graded 1-5), and initial assessment test station scores (graded 1-5) were compared. RESULTS: Using ATLS criteria, three interns failed in each group. Post-ATLS examination question scores were similar (84.5+/-6.9 for group I, 85.9+/-7.1 for group II); scores for the airway and shock questions were higher but not different between the two groups. The four OSCE station mean scores varied between 13.9+/-2.0 and 15.4+/-2.1 for group I and were higher (p < 0.05) for group II (17.9+/-1.6 to 19.1+/-1.0). Priority scores were similar (group I, 6.3+/-1.1; group II, 6.4+/-1.2), but approach scores (3.9+/-0.1 for group I and 4.9+/-0.8 for group II) were lower in group I, as were the initial assessment test scores (2.9+/-0.2 for group I and 4.9+/-0.8 for group II). There were 8 honors grades in group I and 40 (p < 0.05) in group II. Interactive teaching, adult education principles, opportunities for discussion, provision of feedback, and stimulation of self-learning were rated more highly in the new course. CONCLUSION: Using standard ATLS pass criteria, performance after the new and old ATLS courses was similar. Superior performances were measured using OSCE methodology for clinical trauma management skills after the new compared with the old ATLS course in this population of interns.

Effect of basic prehospital trauma life support program on cognitive and trauma management skills.

We tested the effectiveness of a basic prehospital trauma life support (PHTLS) program by assessing cognitive performance and trauma management skills among prehospital trauma personnel. Fourteen subjects who completed a standard PHTLS course (group I) were compared to a matched group not completing a PHTLS program (group II). Cognitive performance was assessed on 50-item multiple choice examinations, and trauma skills management was assessed with four simulated trauma patients. Pre-PHTLS multiple choice questionnaire scores were similar (45.8 +/- 9.4% vs. 48.8 +/- 8.9% for groups I and II, respectively), but the post-PHTLS scores were higher in group I (80.4 +/- 5.9%) than in group II (52.6 +/- 4.9%). Pre-PHTLS simulated trauma patient performance scores (standardized to a maximum total of 20 for each station) were similar at all four stations for both groups, ranging from 7.9 to 10.4. The post-PHTLS scores were statistically significantly higher at all four stations for group I (range 16.0-19.0) compared to those for group II (range 8.0-11.1). The overall mean pre-PHTLS score for all four stations was 8.3 +/- 2.1 for group I and 8.8 +/- 2.0 (NS) for group II; the group I post-PHTLS mean score for the four stations was 17.1 +/- 2.7 (p < 0.05) compared to 9.1 +/- 2.3 for group II. Pre-PHTLS Adherence to Priority scores on a scale of 1 to 7 were similar (1.1 +/- 0.9 for group I and 1.2 +/- 1.0 for group II). Post-PHTLS group I Priority scores increased to 5.9 +/- 1.1. Group II (1.1 +/- 1.0) did not improve their post-PHTLS scores. The pre-PHTLS Organized Approach scores in the simulated trauma patients on a scale of 1 to 5 were 2.1 +/- 1.0 for group I and 1.9 +/- 1.2 for group II (NS) compared to 4.2 +/- 0.9 (p < 0.05) in group I and 2.0 +/- 0.8 in group II after PHTLS. This study demonstrates improved cognitive and trauma management skills performance among prehospital paramedical personnel who complete the basic PHTLS program.

Effects of sympathetic activation on heart rate variability in Chagas' patients.

To assess the alterations present in neural control of heart rate in patients with signs of Chagas' disease we studied the spectral components of heart rate variability in 10 Chagas' patients, without cardiac failure, and in 10 control subjects during supine and standing position. Chagas' patients during standing did not present the changes in the spectral components of heart rate variability which normally accompany sympathetic activation and vagal withdrawal.

Distinctive abnormal responses to tilting test in chronic Chagas' disease.

The purpose of this study was to investigate the sympathetic nervous system function in 34 patients with chronic Chagas' disease. The tilting test was selected as an appropriate means to assess the adrenergic system function. Our results demonstrate that (a) all chagasics respond with a significantly smaller rise in diastolic blood pressure (0-3.8 mmHg) than normal subjects (9-12 mmHg), when submitted to the tilting test and (b) chagasic patients with heart failure have a significantly lower heart rate than normal subjects and nonchagasic heart failure patients (P < 0.05 and 0.001, respectively). With these results we may speculate that the damage in chronic Chagas' disease should be located in the sympathetic pathway. Therefore, the faulty orthostatic mechanism would be the consequence of a diminished adrenergic activity, with a defective arteriolar vasoconstriction and a decreased basal heart rate. At the same time we note that our results differ from the results of similar tests performed on the same kind of chagasic patients in Brazil, where a predominantly decreased parasymphathetic activity has been demonstrated.