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Kinds of Examiners Terms modified by Examiners Selected AbstractsAmbient temperature and risk of death from accidental drug overdose in New York City, 1990,2006ADDICTION, Issue 6 2010Amy S. B. Bohnert ABSTRACT Background Mortality increases as ambient temperature increases. Because cocaine affects core body temperature, ambient temperature may play a role in cocaine-related mortality in particular. The present study examined the association between ambient temperature and fatal overdoses over time in New York City. Methods Mortality data were obtained from the Office of the Chief Medical Examiner for 1990 to 2006, and temperature data from the National Oceanic and Atmospheric Association. We used generalized additive models to test the relationship between weekly average temperatures and counts of accidental overdose deaths in New York City, controlling for year and average length of daylight hours. Results We found a significant relation between ambient temperature and accidental overdose fatality for all models where the overdoses were due in whole or in part to cocaine (all P < 0.05), but not for non-cocaine overdoses. Risk of accidental overdose deaths increased for weeks when the average temperature was above 24°Celsius. Conclusions These results suggest a strong relation between temperature and accidental overdose mortality that is driven by cocaine-related overdoses rising at temperatures above 24°Celsius; this is a substantially lower temperature than prior estimates. To put this into perspective, approximately 7 weeks a year between 1990 and 2006 had an average weekly temperature of 24 or above in New York City. Heat-related mortality presents a considerable public health concern, and cocaine users constitute a high-risk group. [source] External Examiners and Immediate Post Qualification Clinical Dental Training in EuropeEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 2 2004G. H. Moody Background: A conversation at the ADEE Conference in Bern, 2001, revealed an apparent diversity in the use and role of External Examiners in dental undergraduate examinations in ADEE-associated schools. There also appeared to be considerable variation in the amount of post-graduate supervised clinical training. Aims: (i) To elicit information on the use of External Examiners in dental undergraduate examinations. (ii) To acquire information about immediate post-qualifying supervised clinical experience and training. Method: Questionnaire to the 205 Dental Schools listed in the ADEE Directory in 35 European countries. Results: Eighty-two (40%) completed questionnaires were returned. Of these 82 schools, 43 (52.4%) did not use External Examiners. The remaining 39 (47.6%) used an External Examiner at least once during the under-graduate course. All 39 used an External Examiner in ,Finals', 34 in all clinical examinations and 30 in pre-clinical examinations. Thirty out of 39 allowed external examiners to scrutinize papers before the examination. Although 31/39 were asked to advise on problems during examinations, only 26/39 were consulted about the fate of ,failed' candidates and 23/39 asked to adjudicate in such instances. Following qualification, graduates from 38/82 schools experienced some form of supervised further clinical training ranging from 3 months to 2 years. The majority (21/38) were trained for 1 year and 13 for 2 years. However, 30/82 (36.5%) schools produced graduates who qualified without any external assessment and without the benefit of any post-qualifying supervised training. Conclusions: Although the questionnaire response rate is low, it is clear that there are disparities in practice with regard to the use of external examiners and post-graduate training, which need to be evaluated if dental undergraduate standards in Europe are to converge. [source] A participatory evaluation project to measure SANE nursing practice and adult sexual assault patients' psychological well-beingJOURNAL OF FORENSIC NURSING, Issue 1 2008Rebecca Campbell Ph.D. Abstract This paper describes a collaborative project between a team of researcher-evaluators and a Sexual Assault Nurse Examiner (SANE) program to develop an evaluation survey of SANE nursing practice and patient psychological well-being. Using a participatory evaluation model, we followed a six-step process to plan and conduct an evaluation of adult sexual assault patients treated in one Midwestern SANE program. Our collaborative team developed a logic model of "empowering care," which we defined as providing healthcare, support, and resources; treating survivors with dignity and respect; believing their stories; helping them re-instate control and choice; and respecting patients' decisions. We created a corresponding survey that can be administered to patients following exam procedures and tested it with N= 52 sexual assault victims. Results indicated that nursing practice was consistent with this empowering care philosophy as the overwhelming majority of patients reported positive psychological well-being outcomes. Implications for evaluating forensic nursing practice are discussed. [source] Review of: Cause of Death: Forensic Files of a Medical ExaminerJOURNAL OF FORENSIC SCIENCES, Issue 5 2007Haskell M. Pitluck J.D. No abstract is available for this article. [source] Responding to sexual assault victims' medical and emotional needs: A national study of the services provided by SANE programsRESEARCH IN NURSING & HEALTH, Issue 5 2006Rebecca Campbell Abstract We measured the consistency with which a national random sample of 110 Sexual Assault Nurse Examiner (SANE) programs provided 17 services to sexual assault victims. SANE programs consistently offered forensic evidence collection, sexually transmitted infection (STI) prophylaxis, information on HIV, information on pregnancy risk, and referrals to community resources. Reasons programs did not routinely offer particular services (e.g., STI cultures, HIV testing/prophylaxis, emergency contraception (EC)) included financial constraints, difficulties balancing medical care with legal prosecution, and affiliations with Catholic hospitals. © 2006 Wiley Periodicals, Inc. Res Nurs Health 29: 384,398, 2006 [source] External Examiners and Immediate Post Qualification Clinical Dental Training in EuropeEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 2 2004G. H. Moody Background: A conversation at the ADEE Conference in Bern, 2001, revealed an apparent diversity in the use and role of External Examiners in dental undergraduate examinations in ADEE-associated schools. There also appeared to be considerable variation in the amount of post-graduate supervised clinical training. Aims: (i) To elicit information on the use of External Examiners in dental undergraduate examinations. (ii) To acquire information about immediate post-qualifying supervised clinical experience and training. Method: Questionnaire to the 205 Dental Schools listed in the ADEE Directory in 35 European countries. Results: Eighty-two (40%) completed questionnaires were returned. Of these 82 schools, 43 (52.4%) did not use External Examiners. The remaining 39 (47.6%) used an External Examiner at least once during the under-graduate course. All 39 used an External Examiner in ,Finals', 34 in all clinical examinations and 30 in pre-clinical examinations. Thirty out of 39 allowed external examiners to scrutinize papers before the examination. Although 31/39 were asked to advise on problems during examinations, only 26/39 were consulted about the fate of ,failed' candidates and 23/39 asked to adjudicate in such instances. Following qualification, graduates from 38/82 schools experienced some form of supervised further clinical training ranging from 3 months to 2 years. The majority (21/38) were trained for 1 year and 13 for 2 years. However, 30/82 (36.5%) schools produced graduates who qualified without any external assessment and without the benefit of any post-qualifying supervised training. Conclusions: Although the questionnaire response rate is low, it is clear that there are disparities in practice with regard to the use of external examiners and post-graduate training, which need to be evaluated if dental undergraduate standards in Europe are to converge. [source] The CFE: Another Weapon for Fighting FraudJOURNAL OF CORPORATE ACCOUNTING & FINANCE, Issue 4 2001Anthony M. Lendez Certified Fraud Examiners (CFEs) belong to the world's largest antifraud SWAT team. And one day, you may need their help. © 2001 John Wiley & Sons, Inc. [source] Nightguard Vital Bleaching of Tetracycline-Stained Teeth: 90 Months Post TreatmentJOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 3 2003RALPH H. LEONARD JR DDS ABSTRACT Purpose: The purpose of this longitudinal whitening study was to determine the stability, post-treatment side effects, and patient satisfaction at 90 months post treatment after 6 months of active treatment of tetracycline-stained teeth with 10% carbamide peroxide. Materials and Methods: Fifteen of 21 participants enrolled in the study (71%) were contacted and asked to participate in a survey concerning their whitening experience. Participants were asked whether there had been any change in the shade of their teeth after treatment and if they had experienced any side effects that they believed were treatment related. Eight of the 15 participated in a clinical examination. Results: Nine participants (60%) reported no obvious shade change or only a slight darkening not noticed by others. None reported darkening back to the original shade; however, four had re-treated their teeth. Examiners were in agreement with the participants' perception of shade change upon comparing pretreatment and post-treatment photographs and Vita® shade (Vita Zahnfabrik D-79713, Bad Sackingen, Germany) values. The degree of improvement over the pretreatment shade was significant for the 90-month post-treatment shade (p < .01). All respondents (n = 15) denied having to have a crown or root canal or tooth sensitivity that they believed was treatment related. CLINICAL SIGNIFICANCE The results of this study of nightguard vital bleaching indicate that tetracycline-stained teeth can be whitened successfully using extended treatment time and that shade stability may last at least 90 months post treatment (range 84,100 mo). Patients participating in this study were over-whelmingly positive about the procedure in terms of shade retention and lack of post-treatment side effects. [source] The challenges forensic nurses face when their patient is comatose: Addressing the needs of our most vulnerable patient populationJOURNAL OF FORENSIC NURSING, Issue 3 2008Jennifer Pierce-Weeks RN, SANE-A, SANE-P Abstract Since 1996, the American Nurses Association has recognized forensic nursing as a formal specialty. Despite this recognition, Sexual Assault Nurse Examiners and Emergency Department nurses struggle with incorporating evidence collection into the care they give the unconscious or comatose patient they suspect has been sexually assaulted. Through case example, this article provides an abbreviated review of the circumstances under which these patients present for care, current challenges, and barriers in upholding the standard of forensic nursing care, as well as proposed interventions for the practicing forensic nurse. [source] The Bar Examination and the Dream Deferred: A Critical Analysis of the MBE, Social Closure, and Racial and Ethnic StratificationLAW & SOCIAL INQUIRY, Issue 3 2004William C. Kidder In this article, the author applies social closure theory to help explain why more than a dozen states have recently enacted more stringent bar exam passing standards and why others are considering similar changes. While higher standards are usually advocated as a way to protect the public from lower student "quality," the author applies social closure theory and argues that changes in passing standards are a response to a perceived oversupply of lawyers, especially among solo practitioners. In the 1990s, crowding among solo practitioners reached record levels, and real earnings eroded substantially. The author then links this labor market analysis to a critical examination of the knowledge claims that justify the bar exam to the legal profession and the public at large. The article's conclusion is that the psychometric research sponsored by the National Conference of Bar Examiners consistently minimizes and obscures the disparate impact and unfairness of the bar exam for people of color. [source] Use of a structured interview to assess portfolio-based learningMEDICAL EDUCATION, Issue 9 2008Vanessa C Burch Context, Portfolio-based learning is a popular educational tool usually examined by document review which is sometimes accompanied by an oral examination. This labour-intensive assessment method prohibits its use in the resource-constrained settings typical of developing countries. Objectives, We aimed to determine the feasibility and internal consistency of a portfolio-based structured interview and its impact on student learning behaviour. Methods, Year 4 medical students (n = 181) recorded 25 patient encounters during a 14-week medical clerkship. Portfolios were examined in a 30-minute, single-examiner interview in which four randomly selected cases were discussed. Six standard questions were used to guide examiners in determining the ability of candidates to interpret and synthesise clinical data gathered during patient encounters. Examiners were trained to score responses using a global rating scale. Pearson's correlation co-efficient, Cronbach's , coefficient and the standard error of measurement (SEM) of the assessment tool were determined. The number of students completing more than the required number of portfolio entries was also recorded. Results, The mean (± standard deviation [SD], 95% confidence interval [CI]) interview score was 67.5% (SD ± 10.5, 95% CI 66.0,69.1). The correlation coefficients for the interview compared with other component examinations of the assessment process were: multiple-choice question (MCQ) examination 0.42; clinical case-based examination 0.37; in-course global rating 0.08, and overall final score 0.54. Cronbach's , coefficient was 0.88 and the SEM was 3.6. Of 181 students, 45.3% completed more than 25 portfolio entries. Conclusions, Portfolio assessment using a 30-minute structured interview is a feasible, internally consistent assessment method that requires less examination time per candidate relative to methods described in published work and which may encourage desirable student learning behaviour. [source] Structured assessment using multiple patient scenarios by videoconference in rural settingsMEDICAL EDUCATION, Issue 5 2008Tim J Wilkinson Context, The assessment blueprint of the Australian College of Rural and Remote Medicine postgraduate curriculum highlighted a need to assess clinical reasoning. We describe the development, reliability, feasibility, validity and educational impact of an 8-station assessment tool, StAMPS (structured assessment using multiple patient scenarios), conducted by videoconference. Methods, StAMPS asks each candidate to be examined at each of 8 stations on issues relating to patient diagnosis or management. Each candidate remains located in a rural site but is examined in turn by 8 examiners who are located at a central site. Examiners were rotated through the candidates by either walking between videoconference rooms or by connecting and disconnecting the links. Reliability was evaluated using generalisability theory. Validity and educational impact were evaluated with qualitative interviews. Results, Fourteen candidates were assessed on 82 scenarios with a reliability of G = 0.76. There was a reasonable correlation with level of candidate expertise (, = 0.57). The videoconference links were acceptable to candidates and examiners but the walking rotation system was more reliable. Qualitative comments confirmed relevance and acceptability of the assessment tool and suggest it is likely to have a desirable educational impact. Conclusions, StAMPS not only reflects the content of rural and remote practice but also reflects the process of that work in that it is delivered from a distance and assesses resourcefulness and flexibility in thinking. The reliability and feasibility of this type of assessment has implications for people running any distance-based course, but the assessment could also be used in a face-to-face setting. [source] The effect of candidate familiarity on examiner OSCE scoresMEDICAL EDUCATION, Issue 9 2007Ann Jefferies Context, Although examiners are a large source of variability in the objective structured clinical examination (OSCE), the exact causes of examiner variance remain understudied. Objective, This study aimed to determine whether examiner familiarity with candidates influences candidate scores. Methods, A total of 24 candidates from 4 neonatal-perinatal training programmes participated in a 10-station OSCE. Sixteen trainees and 7 examiners came from a single centre (site A) and 8 candidates and 5 examiners came from the other 3 centres. Examiners completed station-specific binary checklists and an overall global rating; standardised patients (SPs) and standardised health professionals (SHPs) completed 4 process ratings and the overall rating. A fixed-effect, 2-way analysis of variance was performed to ascertain whether there was interaction between examiner site and candidate site. Results, Interstation Cronbach's , was 0.80 for the examiner checklist, 0.88 for the examiner global rating and 0.88 for the SP or SHP global rating. Although the checklist scores awarded by site A examiners were significantly higher than those awarded by non-site A examiners, there was no significant interaction between examiner and candidate site (P = 0.124). Similarly, the interaction between examiner and candidate site for the global rating was not significant (P = 0.207). Global ratings awarded by SPs and SHPs were also higher in stations where site A faculty examined site A candidates, suggesting the observed differences may have been related to performance. Conclusions, Results from this small dataset suggest that examiner familiarity with candidates does not influence how examiners score candidates, confirming the objective nature of the OSCE. Confirmation with a larger study is required. [source] Achieving acceptable reliability in oral examinations: an analysis of the Royal College of General Practitioners membership examination's oral componentMEDICAL EDUCATION, Issue 2 2003Val Wass Background, The membership examination of the Royal College of General Practitioners (RCGP) uses structured oral examinations to assess candidates' decision making skills and professional values. Aim, To estimate three indices of reliability for these oral examinations. Methods, In summer 1998, a revised system was introduced for the oral examinations. Candidates took two 20-minute (five topic) oral examinations with two examiner pairs. Areas for oral topics had been identified. Examiners set their own topics in three competency areas (communication, professional values and personal development) and four contexts (patient, teamwork, personal, society). They worked in two pairs (a quartet) to preplan questions on 10 topics. The results were analysed in detail. Generalisability theory was used to estimate three indices of reliability: (A) intercase (B) pass/fail decision and (C) standard error of measurement (SEM). For each index, a benchmark requirement was preset at (A) 0·8 (B) 0·9 and (C) 0·5. Results, There were 896 candidates in total. Of these, 87 candidates (9·7%) failed. Total score variance was attributed to: 41% candidates, 32% oral content, 27% examiners and general error. Reliability coefficients were: (A) intercase 0·65; (B) pass/fail 0·85. The SEM was 0·52 (i.e. precise enough to distinguish within one unit on the rating scale). Extending testing time to four 20-minute oral examinations, each with two examiners, or five orals, each with one examiner, would improve intercase and pass/fail reliabilities to 0·78 and 0·94, respectively. Conclusion, Structured oral examinations can achieve reliabilities appropriate to high stakes examinations if sufficient resources are available. [source] Standard setting in an objective structured clinical examination: use of global ratings of borderline performance to determine the passing scoreMEDICAL EDUCATION, Issue 11 2001Tim J Wilkinson Background Objective structured clinical examination (OSCE) standard-setting procedures are not well developed and are often time-consuming and complex. We report an evaluation of a simple ,contrasting groups' method, applied to an OSCE conducted simultaneously in three separate schools. Subjects Medical students undertaking an end-of-fifth year multidisciplinary OSCE. Methods Using structured marking sheets, pairs of examiners independently scored student performance at each OSCE station. Examiners also provided a global rating of overall performance. The actual scores of any borderline candidates at each station were averaged to provide a passing score for each station. The passing scores for all stations were combined to become the passing score for the whole exam. Validity was determined by making comparisons with performance on other fifth-year assessments. Reliability measures comprised interschool agreement, interexaminer agreement and interstation variability. Results The approach was simple and had face validity. There was a stronger association between the performance of borderline candidates on the OSCE and their in-course assessments than with their performance on the written exam, giving a weak measure of construct validity in the absence of a better ,gold standard'. There was good agreement between examiners in identifying borderline candidates. There were significant differences between schools in the borderline score for some stations, which disappeared when more than three stations were aggregated. Conclusion This practical method provided a valid and reliable competence-based pass mark. Combining marks from all stations before determining the pass mark was more reliable than making decisions based on individual stations. [source] Book review: Comparative Skeletal Anatomy: A Photographic Atlas for Medical Examiners, Coroners, Forensic Anthropologists, and ArchaeologistsAMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue 3 2009Joseph T. Hefner No abstract is available for this article. [source] Prevalence and causes of fractured permanent incisors in 12-year-old suburban Nigerian schoolchildrenDENTAL TRAUMATOLOGY, Issue 3 2009Comfort A. Adekoya-Sofowora A dental trauma cross-sectional survey was carried out through clinical examination of upper and lower permanent incisors and interviews with 415 (212 boys, 203 girls) 12-year-old children attending private and public secondary schools in lle-Ife, in 2004/2005 by one calibrated examiner. Garcia-Godoy's classification was used. The prevalence of traumatic dental injuries was 12.8%. There was no statistical difference in the prevalence between boys and girls P > 0.05. The most common cause of injuries was falls (49.1%), followed by traffic accidents (13.2%), collision against objects or people (11.3%) and misuse of teeth 9.4%. The commonest type of injury was enamel fracture alone (9.9%), followed by enamel-dentine fracture (4.8%). Majority of the accidents occurred at home (60.4%), followed by school (26.4%). The prevalence of traumatic dental injuries was on the increase among suburban Nigerian children in Ile-Ife and it has a potential to be considered an emerging public health problem. [source] Prevalence of dental trauma in 5,6- and 12,14-year-old boys in Riyadh, Saudi ArabiaDENTAL TRAUMATOLOGY, Issue 4 2001Ibrahim Al-Majed Abstract , This study involved 354 boys aged 5,6 years and 862 boys aged 12,14 years, attending 40 schools in Riyadh. All children were examined at school by a single dental examiner, using criteria similar to those employed in the survey of children's dental health in the United Kingdom. The prevalence of dental trauma in 354 Saudi boys aged 5,6 years was 33%. The most common type of dental trauma was fracture of enamel (71%) followed by loss of tooth due to trauma (13%), fracture into enamel and dentine (7%), discolouration (5%), pulp involvement (4%). No relationship between the degree of overjet and the occurrence of dental trauma in the primary dentition was observed. The prevalence of dental trauma in 862 12,14-year-old boys was 34%. The commonest dental trauma was fracture of enamel (74%) followed by fracture into enamel and dentine (15%), fracture into enamel-dentine and pulp (5%), loss of tooth due to trauma (3%), and discolouration (0.4%). A significant relationship (P=0.02) between the increased overjet (, 6 mm) and the occurrence of dental trauma in the permanent dentition was reported. The present study found no evidence of dental care provided for traumatised primary incisors in 5,6-year-old boys. The treatment of dental trauma in 12,14-year-old boys was negligible (2.4%). The present Saudi Arabian study showed higher prevalence of dental trauma in 5,6- and 12,14-year-old boys than the reported results of the United Kingdom Children's Dental Health Survey of the same age groups. [source] Treatment of Striae Rubra and Striae Alba With the 585-nm Pulsed-Dye LaserDERMATOLOGIC SURGERY, Issue 4 2003Gloria P. Jimeénez MD BACKGROUND The treatment of striae distensae has recently been reported with various lasers such as the 585-nm pulsed dye laser. At lower fluences (2.0 to 4.0 J/cm2), this laser has been purported to increase the amount of collagen in the extracellular matrix. OBJECTIVE To determine whether the 585-nm pulsed dye laser is effective in both striae rubra and striae alba after two treatments and, in addition, to determine whether there is a net effect on collagen density in treated samples. METHODS Twenty patients (skin types II to VI) with either striae rubra (9) or striae alba (11) were treated at baseline and at week 6. The total length of the study was 12 weeks. Untreated striae on the same patient were used as control subjects. Striae clinical parameters such as color and area were measured before the first and after the last treatment by an independent examiner using a visual analog scale. A hydroxyproline assay was used to measure collagen changes in two of the striae quantitatively. RESULTS The 585 nm had a moderate beneficial effect in reducing the degree of erythema in striae rubra. There was no apparent clinical change on striae alba. Total collagen per gram of dry weight of sampled tissue increased in striae treated with pulsed dye laser versus control subjects. CONCLUSION We recommend the use of the 585-nm pulsed dye laser for striae rubra in patients skin types II to IV. Extreme caution or avoidance should be observed in pulsed dye laser treatments for patients with phototypes V to VI even with the use of low fluences. Tissue collagen changes measured may be an early change, which precedes significant clinical improvement. [source] 585-nm Pulsed Dye Laser in the Treatment of Surgical Scars Starting on the Suture Removal DayDERMATOLOGIC SURGERY, Issue 1 2003Keyvan Nouri MD Background The optimal time frame to improve the quality and cosmetic appearance of scars by laser therapy has not been clearly elucidated by prior controlled clinical trials. Objective To determine the efficacy of the 585-nm pulsed dye laser (PDL) in the treatment of surgical scars starting on the day of suture removal. Methods Eleven patients (skin types I,IV) with 12 postoperative linear scars that were greater than 2 cm were treated three times on monthly intervals with the 585-nm PDL (450 ,s, 10-mm spot size, 3.5 J/cm2 with 10% overlap) on one scar half, whereas the other half received no treatment. Scars were later evaluated by a blinded examiner using the Vancouver Scar Scale (VSS) for pigmentation, vascularity, pliability, and height. Scars were then blindly examined for cosmetic appearance using a visual analog scale. Results One month after the last treatment, final scar analysis by the blinded examiner revealed a significant difference between treated and untreated sites, with the treated halves scoring better in all scar parameters in the VSS and in cosmetic appearance. The treated halves demonstrated an overall average improvement in the VSS between the first treatment score and the final score of 54% versus 10% in the controls (P=0.0002). The cosmetic appearance score (0=worst; 10=best) at final assessment was significantly better for the treated scars, scoring 7.3 versus the averaged control score of 5.2 (P=0.016). Conclusion The 585-nm PDL is effective and safe in improving the quality and cosmetic appearance of surgical scars in skin types I,IV starting on the day of suture removal. [source] Neurological recovery in obstetric brachial plexus injuries: an historical cohort studyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2 2004Agnes F Hoeksma MD An historical cohort study was conducted to investigate the rate and extent of neurological recovery in obstetric brachial plexus injury (OBPI) and to identify possible prognostic factors in a cohort of children with OBPI from birth to 7 years. All children (n=56; 31 females, 25 males) with OBPI were evaluated at fixed time intervals by one examiner. They underwent a final neurological examination at a mean age of 3 years 10 months (range 1 to 7 years). Neurological outcome was not as favourable as is often reported: complete neurological recovery occurred in 37 out of 56 children (66%). In half of these there was delayed recovery, in which case complete neurological recovery was assessed from 1.5 to 16 months of age (median age 6.5 months, SD 4.2 months). External rotation and supination were the last to recover and recovered the least. Although biceps function at three months was considered to be the best indicator for operative treatment, external rotation and supination were found to be better in predicting eventual complete recovery. Initial symptoms directly post partum were not found to be prognostic. Functional outcome was mainly reported to be good. [source] Incremental Value of Live/Real Time Three-Dimensional Transthoracic Echocardiography in the Assessment of Right Ventricular MassesECHOCARDIOGRAPHY, Issue 5 2009Venkataramana K. Reddy M.D. This case series demonstrates the incremental value of three-dimensional transthoracic echocardiography (3D TTE) over two-dimensional transthoracic echocardiography (2D TTE) in the assessment of 11 patients with right ventricular (RV) masses or mass-like lesions (three cases of RV thrombus, one myxoma, one fibroma, one lipoma, one chordoma, and one sarcoma and three cases of RV noncompaction, which are considered to be mass-like in nature). 3D TTE was of incremental value in the assessment of these masses in that 3D TTE has the capacity to section the mass and view it from multiple angles, giving the examiner a more comprehensive assessment of the mass. This was particularly helpful in the cases of thrombi, as the presence of echolucencies indicated clot lysis. In addition, certainty in the number of thrombi present was an advantage of 3D TTE. Also, sectioning of cardiac tumors allowed more confidence in narrowing the differential diagnosis of the etiology of the mass. In addition, 3D TTE allowed us to identify precise location of the attachments of the masses as well as to determine whether there were mobile components to the mass. Another noteworthy advantage of 3D TTE was that the volumes of the masses could be calculated. Additionally, the findings by 3D TTE correlated well with pathologic examination of RV tumors, and some of the masses measured larger by 3D TTE than by 2D TTE, which was also validated in one case by surgery. As in the case of RV fibroma, another advantage was that 3D TTE actually identified more masses than 2D TTE. RV noncompaction was also well studied, and the assessment with 3D TTE helped to give a more definitive diagnosis in these patients. [source] The Effect of Noise in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 7 2005Leslie S. Zun MD Abstract Background: It is hypothesized that high ambient noise in the emergency department (ED) adversely affects the ability of the examiner to hear heart and lung sounds. Objective: To determine the ability of various examiners to hear heart tones and lung sounds at the high end of loudness typically found in the ED setting. Methods: The study was divided into two parts. First, sound levels in the ED were measured over various times during the months of January through June 2001, using a sound level monitor. The second part of the study was the determination of the ability to hear heart and lung sounds on a young healthy volunteer using the same Littmann lightweight stethoscope at a predetermined ambient noise level of 90 dB. The results were entered into a database and analyzed using SPSS version 10 (Chicago, IL). Descriptive statistics, analysis of variance, frequencies, and correlation were calculated using this program. Results: Two hundred five sound measurements were taken in the ED during the study period in three locations at various hours. The mean noise level at the nursing station was 57.60 dB, with a minimum of 45.00 dB and a maximum of 70.00 dB. Four of the 104 test subjects (3.8%) were unable to hear the heart tones, and nine of the 104 (8.7%) were unable to hear the lung sounds. Fifty percent (27 of 54) of the test subjects reported diminished lung sounds and eight of 15 (53.3%) reported diminished heart sounds. No significant difference was found between hearing heart sounds and years of experience, age, professional position, and quality of the sound. Significant differences were found between hearing lung sounds and years of experience and professional position, but not with age, gender, and sound quality. Conclusions: This study demonstrated that most of the tested examiners have the ability to hear heart and lung sounds at the extreme of loudness found in one ED. [source] Original article: Assessment of changes in oral health-related quality of life among patients with complete denture before and 1 month post-insertion using Geriatric Oral Health Assessment IndexGERODONTOLOGY, Issue 3 2010Kamal Shigli doi:10.1111/j.1741-2358.2009.00323.x Assessment of changes in oral health-related quality of life among patients with complete denture before and 1 month post-insertion using Geriatric Oral Health Assessment Index Objective:, Geriatric Oral Health Assessment Index (GOHAI) is a 12-item measure of "patient-reported oral functional problems" intended for use in the assessment of the effectiveness of dental treatment. Design and Setting:, As there is scanty literature available on GOHAI in the Indian population, the present study was undertaken to assess the changes in GOHAI before and 1 month after placement of dentures in completely edentulous patients reporting to a dental hospital at Indore, India. Measurements:, The GOHAI questionnaire was completed by the examiner who interviewed the patients (n = 35) before placement of complete dentures and 1 month later. Mean, median values were calculated and the data were analysed using Wilcoxon signed-rank test. Results:, When overall mean was considered, the GOHAI scores increased from 27.48 to 30.19 (p = 0.002; highly significant). Conclusion:, Patients reported improvement in functional changes after placement of complete dentures. [source] A comparison between clearing and radiographic techniques in the study of the root-canal anatomy of maxillary first and second molarsINTERNATIONAL ENDODONTIC JOURNAL, Issue 5 2004O. E. Omer Abstract Aim, To compare a clearing technique with conventional radiography in studying certain features of the root-canal system of maxillary right first and second molars. A secondary aim was to assess interexaminer agreement for these features using radiographs. Methodology, Eighty-three recently extracted permanent maxillary right first molars and 40 recently extracted maxillary right second molars from an Irish population were included. Standard periapical radiographs were taken from a buccolingual and mesiodistal direction. The specimens were then decoronated, demineralized in 10% hydrochloric acid for 8 days and then cleared using methyl salicylate. The cleared teeth were examined using a dissecting microscope (×20), and data relating to number of roots, canal type following Vertucci's classification, presence of lateral canals, presence of transverse anastomoses and position/number of apical foramina were collected. The radiographs were examined by two independent trained endodontists using an X-ray viewer and a magnifying lens (×2) in a dark room for the same features studied using the clearing technique. Results, The Kappa values for the agreement between the radiographic examiners A and B and the clearing technique and between the two examiners for the number of roots were 0.60, 0.64 and 0.53; for the root-canal type, 0.37, 0.41 and 0.42; for the number of roots with lateral canals, 0.21, 0.18 and 0.14; and for the transverse anastomoses, 0.29 for radiographic Examiner A. Radiographic Examiner B did not feel capable of accurately recognizing transverse anastomoses from the radiographs. For the position/number of apical foramina, the Kappa values were 0.33 and 0.24, respectively. In general, the Kappa values were low to modest for all comparisons. Conclusions, It is concluded that the agreement between the two radiographic examiners and the agreement between either radiographic examiner and the clearing technique were poor to moderate, indicating the limited value of radiographs alone when studying certain aspects of the root-canal system. [source] Apical inflammatory root resorption: a correlative radiographic and histological assessmentINTERNATIONAL ENDODONTIC JOURNAL, Issue 6 2000M. Laux Abstract Aim To assess the reliability of routine single radiographs in the diagnosis of inflammatory apical root resorption by correlating the radiographic and histological findings. Methodology The material comprised serial and step serial sections of plastic-embedded root-apices with attached apical periodontitis lesions that were prepared for a previous study and the diagnostic radiographs. The histological sections of 114 specimens were analysed by light microscopy and categorized into three groups: (i) those without any resorption (0); (ii) those with moderate resorption (+); and (iii) those with severe resorption (+ +). The radiographs were examined by a separate examiner and graded with a similar categorization of no resorption (0); moderate (+); and severe (+ +) apical resorption. Results Radiographically, 19% of the teeth were diagnosed as having apical inflammatory root resorption, whereas histologically, 81% of the teeth revealed apical inflammatory root resorption. A correlative radiographic and histological assessment (n = 104) revealed a coincidence of diagnosis in 7% of the specimens and noncoincidence of diagnosis in 76% of the specimens. Conclusions The results indicate that routine single radiographs are not sufficiently accurate or sensitive to consistently diagnose apical root resorptive defects developing as a consequence of apical periodontitis. [source] Vehicle effects on skin sensitizing potency of four chemicals: assessment using the local lymph node assayINTERNATIONAL JOURNAL OF COSMETIC SCIENCE, Issue 2 2001Z M Wright Synopsis The murine local lymph node assay (LLNA) can be used to determine the relative skin sensitizing potency of chemicals via interpolation of the quantitative dose response data generated. Using this approach we have demonstrated previously that the vehicle matrix in which a chemical allergen is encountered on the skin can have a significant influence on sensitizing potency. Estimates of relative potency are calculated from LLNA dose responses as a function of the mathematically derived EC3 value, this being the concentration estimated to induce a stimulation index (SI) of 3. To investigate further the influence of application vehicle on sensitizing potency, the LLNA has been used to examine the activity of four recognized human contact allergens: isoeugenol and cinnamic aldehyde, two fragrance chemicals; 3-dimethylaminopropylamine (a sensitizing impurity of cocamidopropyl betaine, a surfactant used in shower gel) and dibromodicyanobutane (the sensitizing component of Euxyl K 400, a preservative used in cosmetics). The four chemicals were applied in each of seven different vehicles (acetone: olive oil [4 : 1]; dimethylsulphoxide; methylethylketone; dimethyl formamide; propylene glycol; and both 50 : 50 and 90 : 10 mixtures of ethanol and water). It was found that the vehicle in which a chemical is presented to the epidermis can have a marked effect on sensitizing activity. EC3 values ranged from 0.9 to 4.9% for isoeugenol, from 0.5 to 1.7% for cinnamic aldehyde, from 1.7 to > 10% for dimethylaminopropylamine and from 0.4 to 6.4% for dibromodicyanobutane. These data confirm that the vehicle in which a chemical is encountered on the skin has an important influence on the relative skin sensitizing potency of chemicals and may have a significant impact on the acquisition of allergic contact dermatitis. The data also demonstrate the utility of the LLNA as a method for the prediction of these effects and thus for the development of more accurate risk assessments. Résumé Le test local des ganglions lymphatiques murins (LLNA) peut être utilisé pour déterminer le potentiel relatif de sensibilisation de la peau de produits chimiques, par interpolation des données quantitatives de dose/réponse obtenues. En utilisant cette approche, nous avions démontré précédemment que la matrice vecteur par laquelle un allergène chimique est mis en contact avec la peau peut avoir une influence significative sur le potentiel de sensibilisation. Des estimations d'activité relative sont calculées à partir des doses/réponses de LLNA en fonction de la valeur EC3 dérivée mathématiquement, celle-ci étant la concentration estimée comme induisant un indice de stimulation (IS) de 3. Pour examiner plus avant l'influence du vecteur d'application sur l'activité de sensibilisation, on a utilisé le LLNA pour déterminer l'activité de quatre allergènes de contact humains reconnus: isoeugénol et aldéhyde cinnamique, deux substances chimiques de parfumerie; la 3-diméthylaminopropylamine (une impureté sensibilisante de la cocamidopropyl bétaïne, un tensioactif utilisé dans les gels douches) et le dibromodicyanobutane (le composant sensibilisant de Euxyl K 400, un conservateur utilisé dans les cosmétiques). Les quatre produits chimiques ont été appliqués dans chacun de sept vecteurs différents (acétone: huile d'olive [4: 1]; diméthylsulfoxyde; méthyléthylcétone; diméthylformamide; propy- lène glycol; et deux mélanges 50: 50 et 90: 10 d'éthanol et d'eau). On observe que le vecteur dans lequel le produit chimique est présentéà l'épiderme peut avoir un effet marqué sur l'activité sensibilisatrice. Les valeurs EC3 vont de 0,9 à 4,9 % pour l'isoeugénol, de 0,5 à 1,7 % pour l'aldéhyde cinnamique, de 1,7 à > 10 % pour la diméthylaminopropylamine et de 0,4 à 6,4 % pour le dibromodicyanobutane. Ces données confirment que le vecteur dans lequel un produit chimique est mis en contact avec la peau a une influence importante sur le potentiel relatif de sensibilisation de la peau des produits chimiques, et peut avoir un impact significatif sur l'apparition de dermatite allergique par contact. Les données démontrent aussi l'utilité du LLNA comme méthode de prévision de ces effets et donc pour le développement d'évaluations plus précises des risques. [source] Patient versus informant reported quality of life in the earliest phases of Alzheimer's diseaseINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2006Asmus Vogel Abstract Objectives The study investigated if patient and informant reported Quality of Life (QoL) differed in early Alzheimer's disease (AD). In addition, we examined whether anosognosia had an impact on the agreement between patient and informant ratings of QoL and whether anosognosia, dementia severity, depression and behavioural symptoms were significantly correlated to QoL in early AD. Methods From a prospective research program including newly referred patients (age >60 years and MMSE,,,20), 48 patients with very early AD were included. QoL was assessed using the QoL-AD and EQ-5D scales. Anosognosia was rated on a categorical scale by an examiner. MMSE, Geriatric Depression Scale, Danish Adult Reading Test and Frontal Behavioural Inventory were also administered. Results On most QoL measures patients rated their QoL higher than their informants. Anosognosia was not associated with QoL but significantly with an inverse impact on the agreement between patient and informant ratings of QoL. Self-reported QoL was significantly correlated to depression but not to age, dementia severity, behavioural symptoms or memory impairment. Informant ratings of QoL were significantly correlated to behavioural symptoms and informant ratings on the EQ-5D Visual Analogue Scale were significantly correlated to patient reported depression. Conclusion Patients with early AD generally reported higher QoL than their informants. This disagreement was associated with the presence of anosognosia. Self-reported QoL did not correlate with the MMSE score. Behavioural changes and depressive symptoms may be associated with low QoL. Copyright © 2006 John Wiley & Sons, Ltd. [source] Detection of in vitro demineralization of primary teeth using quantitative light-induced fluorescence (QLF)INTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 3 2002I. A. Pretty Summary. Introduction. With the advent of remineralizing therapies and the new, conservative approach to restoration placement, interest in detecting and monitoring subclinical, precavitated lesions has increased. The increased understanding of clinicians about the processes of primary and secondary prevention and the detection of lesions to which these therapies may be applied, is one of the current goals in caries management. Quantitative light-induced fluorescence (QLF) is a new method for the detection of very early caries. Objectives. To determine the ability of QLF to detect and longitudinally monitor in vitro enamel demineralization. To present the device to the paediatric community and present future in vivo uses of the device. Design. An in vitro study with combined in vivo pilot. Sample and methods. Twelve previously extracted, caries free, primary molars were selected and prepared. Two teeth were randomly selected as controls. Teeth were prepared by gentle pumicing and coating in an acid-resistant nail-varnish, except for an exposed window on the buccal surface. QLF baseline images were taken and the teeth then exposed to a demineralizing solution. Teeth were removed at regular intervals (24, 48, 72, 96, 120, and 144 h), air-dried and QLF images taken. QLF images were analysed by a single, blinded examiner (to control, to length of exposure). Mineral loss, as measured by ,Q, was recorded. Results. Demineralization was noted in all experimental teeth by 48 h, and within 24 h in six teeth. The QLF successfully monitored the increase in mineral loss over time (P < 0·05). The detected lesions were not visible clinically until 144 h and then in only the most severe lesions. No demineralization was detected by QLF in control teeth. The device was user- and patient-friendly in vivo, detecting subclinical lesions. Conclusion. Detection of very early mineral loss and subsequent monitoring of this loss is possible in primary teeth using QLF. The device is well suited to use in paediatric dentistry and offers applications for both clinicians and researchers. The determination of the status of carious lesions (active/inactive) will be possible with readings taken at recall appointments. [source] Usefulness of PSA screening in outpatients with bladder cancer: Preliminary resultsINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2002Kohei Kurokawa Abstract Background: We performed prostate-specific antigen (PSA) screening and evaluated its usefulness in outpatients with bladder cancer who may have an elevated risk for prostate cancer. Methods: Sixty-one new or followed-up outpatients with bladder cancer were examined between September 1999 and December 2000 in the Department of Urology, Gunma University Hospital, Japan. PSA was measured after informed consent was obtained, and patients in whom the PSA level was 4.1 ng/mL or higher were selected for thorough examination. In the examination, one examiner performed DRE (digital rectal examination) and, based on DRE and TRUS (transrectal ultrasonography) findings, determined whether prostate biopsy was indicated. Results: The average age of the 61 cases was 69.1 ± 8.6 years, and the average PSA level was 3.5 ± 5.8 ng/mL. The PSA level was 4.1 ng/mL or higher in 11 (18.0%) patients, nine of whom underwent six-sextant biopsy under TRUS guidance. Of these nine cases, four (6.6%) were diagnosed as having prostate cancer. The Gleason score was 7 in three cases and 9 in one case. The clinical stage was T2N0M0 in three cases and T3N0M0 in one case. Conclusions: On PSA screening in patients with bladder cancer and patients with a history of transurethral resection of the bladder tumor (TUR-BT), prostate cancer was found in 6.6%. This rate is higher than in the general population. These cancers were classified into intermediate to high-risk groups, and the prognosis of prostate cancers could be more important than those of the bladder cancers in two cases (50%). We conclude that PSA screening for inpatients with bladder cancer may be useful. [source] | |||||||||||||||||||||||||||||||