A cross-sectional study of aggression levels in physicians and orthopaedic surgeons: impact on specialty selection and training?

OBJECTIVES: To determine if current validated psychometric evaluations could determine a difference in basic behavioural characteristics between surgical and medical specialties. DESIGN: Cross-sectional study. SETTING: Two district general hospitals and one University teaching hospital in England, UK. PARTICIPANTS: Internal medicine (16) and trauma and orthopaedic (20) consultants. MAIN OUTCOME MEASURES: Aggression levels as assessed by the Buss and Warren questionnaire. The self-administered questionnaire assesses aggression in terms of physical, verbal, anger, hostility, indirect hostility and an overall assessment of aggression. RESULTS: All participants had aggression scores below the population average. We found a significant difference (P < 0.01) in total level of aggression, with orthopaedic consultants scoring a mean of 61.1 (standard deviation [SD] 9.2) and physicians 51.3 (SD 9.5). When analysis of the five different subtypes of aggression was carried out, orthopaedic surgeons scored significantly higher in terms of verbal aggression (P = 0.005), hostility (P = 0.002) and indirect hostility (P = 0.03). CONCLUSION: This study joins a growing evidence base for aspects of behaviour indicative of a given specialty. Aggression is a relatively stable behavioural characteristic from adolescence, and as such this is the first study of its type to suggest that the differences in behavioural characteristics seen between specialties are inherent, rather than learned. It is unclear if the differences observed represent an attraction of that specialty to the personality type or is required for success within the given specialty. Whether this can be used in terms of selection into higher specialty training, or influence training within specialties, requires further work.

Sarcina-like bacteria associated with bloat in young lambs and calves.

Sarcina species are fastidious Gram-positive anaerobic bacteria that occur in cubical packets of eight or more cells. In 2006 to 2007, they were associated with cases of acute abomasal bloat in young lambs and calves. Two incidents were in lambs aged three to six weeks that were found dead, with one or two cases in each of a group of 15 and 100 lambs. Three incidents were recorded in small groups of calves up to 10 days of age, two cases in each incident, with the calves found dead or dying after a short illness characterised by bloat. Their gross lesions included emphysema and oedema of the abomasal wall, mucosal hyperaemia and haemorrhage, and rupture of the abomasum. Histological lesions included abomasitis with congestion, haemorrhage, emphysema and oedema. Bacteria characteristic of Sarcina species were observed in sections associated with the superficial mucosa of these cases, but the bacteria were not detected in cultures.

Development of a structured clinical operative test (SCOT) in the assessment of practical ability in the oral surgery undergraduate curriculum.

Competence in undergraduate oral surgery involves assessment of the students' knowledge, practical skill and attitude. The assessment of practical skills can be achieved using a formative assessment method such as the structured clinical operative test (SCOT) which uses a checklist for the assessment of a clinical task. The aim of this study was primarily to determine whether SCOTs could be integrated into the oral surgery undergraduate course, and secondarily to collect feedback from both the students and the staff on this assessment. A validated checklist was used by trained examiners to assess the performance of 49 students in their second clinical year undertaking simple exodontia. Feedback was collected from the students by questionnaire and from the staff by interview. The SCOT was well received by both students and staff. The main problem highlighted by the students was the perceived inter-examiner variability and by the staff, the disruptive effect on the clinics. The checklist must be objective enough to prevent misinterpretation. Despite these limitations, the SCOT provides a more objective assessment and serves to highlight weaker students, allowing them to be targeted for closer supervision and instruction as well as providing the students with a tool to measure their progress in oral surgery. The use of peer assessment by students may alleviate the burden on the staff.

Dose response and safety of cizolirtine citrate (E-4018) in patients with pain following extraction of third molars.

The objectives of this study were to determine the dose response and safety of the oral analgesic cizolirtine citrate (E-4018) in patients with postoperative pain after third molar extraction. This was a placebo-controlled, double-blind, randomised, parallel-group study. Doses of E-4018 were 50 mg, 100 mg, or 150 mg. The primary outcome measure of efficacy was patient assessment of pain severity, determined from serial visual analogue scales (VAS) over a four-hour investigation period. Other efficacy measures included the number of patients taking escape analgesic and the time before it was taken, and an overall assessment of pain relief on a four-point categorical scale. There was no significant difference between any of the E-4018 treatment groups and placebo in terms of the AUC for VAS pain scores over time. The percentages of patients who took paracetamol within five hours of their dose were 100%, 95%, 78% and 82% for the placebo, 50 mg, 100 mg and 150 mg E-4018 groups, respectively. The time to first use of paracetamol was significantly different for the 100 mg and 150 mg E-4018 groups compared to placebo. There were 17 adverse events, of which five were possibly related to the study medication (one in the placebo group and four in the 150 mg E-4018 group). We conclude that there was a dose-related trend in the percentage of patients requiring paracetamol within five hours of their study medication, and in the percentage of patients that recorded the treatment as providing good or excellent treatment of pain. There was, however, no firm evidence of a dose-related analgesic effect over the dose range of Cizolirtine chosen for this study. E-4018 was well tolerated in all patients.

Quantitative oral exfoliative cytology. Effect of alcohol on normal buccal mucosa.

OBJECTIVE: To assess the effect of chronic alcohol intake on the DNA distribution and cell area of normal oral mucosal cells. STUDY DESIGN: Smears were taken from clinically normal buccal mucosa of 50 patients attending an alcohol-problem service (i.e., chronic alcohol use) and average alcohol units per week recorded. DNA distribution histograms and total cell area values were then compared to those obtained from smears taken from a control group (which included social drinkers) of patients attending for routine dental treatment. Nuclear DNA content was assessed on 100 randomly selected, Feulgen-stained nuclei using a Seescan TV image analysis system, and total cell area was assessed on 50 Papanicolaou-stained cells using the Vids V image analysis system. RESULTS: The DNA distribution histograms were essentially diploid in appearance for the alcohol group, although there was an increase in nuclear DNA content in the occasional nucleus. A highly significant reduction in total cell area was found for the alcohol group when compared to the controls. CONCLUSION: The chronic ingestion of alcohol is associated with a reduction in total cell area but appears to have little effect on nuclear DNA content. Our previous research using the same technique showed that oral cancers are frequently nondiploid. Thus, a nondiploid DNA distribution histogram for smears taken from a clinically suspicious lesion in someone who consumes excessive amounts of alcohol is unlikely to be due to alcohol use alone and should indicate biopsy.

Effect of alcohol on the oral mucosa assessed by quantitative cytomorphometry.

The effect of alcohol on the oral mucosa was assessed using quantitative cytomorphology applied to smears taken from clinically normal oral mucosa of patients attending an alcohol problem unit and results were compared to a control group (consisting of social and non-drinkers) attending a hospital for routine dental care. Smears were stained using the Papanicolaou method and the nuclear and cell boundaries of 50 randomly selected cells traced and mean areas (NA and CA, respectively) calculated. The average number of units of alcohol consumed were recorded for each group together with relevant blood tests. The alcohol group was further subdivided into "binge" and "regular" drinkers. No significant differences were found between mean NA and mean CA values for these two types of alcohol drinkers, despite a marked difference in weekly units consumed. However, a statistically significant reduction in mean cytoplasmic area (P < 0.001) and mean nuclear area (P < 0.01) was found for the alcohol group when compared to controls. In conclusion, excess alcohol intake may influence results for quantitative oral cytomorphology. Further research is indicated on the relative effects of alcohol (both topical and systemic).

Aetiology of oral cancer: alcohol.

The effect of alcohol alone on the oral mucosa and its association with the development of oral cancer is difficult to establish, principally because alcohol consumption histories are difficult to verify, alter over time, both with respect to beverage type and quantity, and are frequently confounded by tobacco use. This review considers the various pathways by which alcohol may exert such an influence. Namely, due to topical exposure (e.g. direct effect on cell membranes, altered cell permeability, variation in enzymes that metabolise alcohol) and/or systemic effects (e.g. nutritional deficiency, immunological deficiency, disturbed liver function). Finally, the numerous papers that have sought to establish the relative risk for oral cancer in association with alcohol intake are reviewed.

Possible mechanisms by which alcohol may influence the development of oral cancer--a review.

Although pure ethanol has never been shown to be carcinogenic in laboratory experiments, alcoholic beverages are now recognised as being important aetiological factors in the development of oral cancer. Despite this, the exact mechanism by which alcohol may exert an influence upon the oral mucosa has received less attention. An overview of the association of alcohol and oral cancer, both in combination with tobacco and without, is provided and consideration given to some of the pathways by which alcohol exerts its effect upon the oral mucosa.

Oral exfoliative cytology: review of methods of assessment.

The use of oral exfoliative cytology in clinical practice declined due to the subjective nature of its interpretation and because there may be only a small number of abnormal cells identifiable in a smear. The more recent application of quantitative techniques, together with advances in immunocytochemistry, have refined the potential role of cytology, stimulating a reappraisal of its value in the diagnosis of oral cancer. This review considers the influence of the quantitative analysis of cytomorphology, DNA analysis and other tumour markers applied to oral exfoliative cytological samples. These studies indicate that oral cytology may provide an important adjunct in the assessment of the patient with a potentially cancerous oral lesion.

Mucus hypersecretion and viscoelasticity changes in cigarette-smoking dogs.

Chronic cigarette smoke exposure is well known to cause mucus hypersecretion in experimental animals, but the alterations in mucus rheology have not been described. We studied mucus hypersecretion and viscoelasticity changes in nine tracheostomized beagle dogs exposed to cigarette smoke. The dogs were trained to stand quietly in a harness, and smoke was delivered via a cuffed tracheostomy tube. A 35-cm3 bolus was introduced to the inspiratory line each 20 s, using unfiltered 70-mm cigarettes (20 mg tar, 1.2 mg nicotine). Each dog smoked 10 cigarettes per day over 2.5 h, 5 days per week. Two dogs were exposed for 6 months; 7 dogs were exposed for 10 months. Five dogs served as sham-smoking controls. Mucus was collected twice weekly without drugs by resting a cytology brush on the lower trachea for 2-5 min. The rheological properties of the mucus samples were determined by magnetic rheometry, which yields elasticity and viscosity as a function of frequency. The mucus was also weighed, and the galactose content was determined by phenolsulfuric acid assay. The mucus collection rate served as an index of tracheal mucus flux, and the galactose assay as a marker of mucous glycoprotein content. The tracheal mucus linear velocity (TMV) was determined periodically under xylazine analgesia by observing charcoal particle transport bronchoscopically. Eight of 9 smoking dogs developed mucus hypersecretion (flux greater than 2 X control) versus 1 of 5 controls (p less than .01). TMV did not change significantly in 10 months of exposure. In the first 2-4 months of smoking, the elasticity and viscosity of the mucus both decreased (mean at 4 months = 42% control, p less than .001), as did the galactose content (mean at 4 months = 48% control, p less than .01). At this stage, according to model studies, the mucus should have been more easily clearable by ciliary action. After 6 months, the viscoelasticity returned toward the initial control level, while the galactose content remained low, suggesting an alteration in the nature of the mucous glycoprotein.

Development and testing of self-instruction programs in nutrition for dental students.

A study was undertaken to test the hypothesis that self-instructional programs in nutrition and dentistry are as effective a teaching method as traditional lectures. Five programmed self-instructional manuals accompanied by 191 slides were developed and evaluated for effectiveness, as compared to six lectures containing the same information. The study population of 83 freshmen dental students was randomly assigned to a control (lecture) group and an experimental (self-instruction) group. Cognitive tests, performance criteria for diet counseling, and an attitudinal questionnaire were used to compare the two groups. The results of the analysis demonstrated that there was no significant difference in the test scores in the lecture and self-instruction groups.