Medicine Examinations Research Articles

Automated Diagnosis of Canine Gastrointestinal Parasites Using Image Analysis.

Because canine intestinal parasites are considered cosmopolitan, they carry significant zoonotic potential to public health. These etiological agents are routinely diagnosed using microscopic examination commonly used because of its low cost, simple execution, and direct evidence. However, there are reports in the literature on the poor performance of this test due to low to moderate sensitivity resulting from frequent errors, procedures and interpretation. Therefore, to improve the diagnostic efficiency of microscopic examination in veterinary medicine, we developed and evaluated a unique new protocol. This system was tested in a study involving four genera of highly prevalent canine intestinal parasites in an endemic region in São Paulo state, Brazil. Fecal samples from 104 animals were collected for this research. The new protocol had a significantly higher (p < 0.0001) number of positive cases on image data, including parasites and impurities, and was elaborate to test them with the TF-GII/Dog technique, with a moderate agreement and Kappa index of 0.7636. We concluded that the new Prototic Coproparasitological Test for Dogs (PC-Test Dog) allowed a better visualization of the parasitic structures and showed a favorable result for the diagnosis of intestinal parasites in dogs.

Abstract No. 669 Radiologic reporting of inferior vena cava filters: an analysis of 10,217 discrete patient encounters yielding an opportunity for standards improvement

To quantify the frequency and accuracy of inferior vena cava filter reporting practices on plain radiography and computed tomography examinations with attention to retrievability and device brand. Improved reporting may encourage appropriate anticoagulation or facilitate filter retrieval. All radiologic reports containing “inferior vena cava filter” or “IVC filter” were screened at a single academic institution between January 2000 and July 2019 (n = 17,833). Using an automated classification scheme followed by manual review, duplicated and linked reports were removed, yielding 15,214 (85.3%) unique patient encounters. Procedural (n = 3859), ultrasound (n = 968), magnetic resonance (n = 99), nuclear medicine (n = 39), outside interpretation (n = 24), and bone densitometry-based (n = 8) examinations were excluded, leading to a cohort of 10,217 (57.3%) radiography (n = 5970), computed tomography (n = 4161), and positron emission tomography-computed tomography (n = 86) examinations. Study cohort included 60.2% males with mean age 62.8 years (range, 21-99 years). Frequency and accuracy of reporting inferior vena cava filter retrievability and device brand were recorded. Seventeen (0.2%) encounters described inferior vena cava filter retrievability (n = 10 permanent; n = 7 retrievable). One (5.9%) report misclassified a retrievable filter as permanent. 138 (1.4%) encounters specified device brand, including 50 Gunther Tulip, 32 Greenfield, 17 G2, 13 Bird’s Nest, 11 OptEase, 10 Simon Nitinol, two TrapEase, one Denali, one Recovery, and one Crux inferior vena cava filters. Sixty-four (46.3%) reports misidentified device brands. There is poor reporting of inferior vena cava filter retrievability (0.2%) and device brand (1.4%) with frequent misidentification of brand (43.3%) on radiography and computed tomography examinations. Education and standardized reporting practices may prove beneficial to referring providers, interventionalists, and patients with respect to improving anticoagulation protocols and filter retrieval rates.

Natural Magnesium-Enriched Deep-Sea Water Improves Insulin Resistance and the Lipid Profile of Prediabetic Adults: A Randomized, Double-Blinded Crossover Trial.

Previous in vitro and in vivo studies have shown that the antidiabetic effect of balanced deep-sea water (BDSW) works through the suppression of hyperglycemia and improvement of glucose tolerance. Based on these promising results, we conducted an eight week randomized, double-blinded crossover trial of the effects of BDSW in prediabetic adults. The subjects consumed 440 mL of BDSW (hardness 4000) per day, and maintained an otherwise normal lifestyle and diet throughout. Efficacy assessments were made by measuring fasting glucose, postprandial glucose, fasting insulin, homeostasis model assessment for insulin resistance (HOMA-IR), C-peptide, glycosylated hemoglobin, lipid metabolism indicators, and physical metrics, along with safety assessments. Fasting insulin and HOMA-IR values of the BDSW group were significantly lower than those of the placebo group after eight weeks of BDSW ingestion. Total cholesterol and low-density lipoprotein–cholesterol were also significantly decreased in the BDSW group after eight weeks of BDSW ingestion compared with the placebo group. There were no statistically and clinically meaningful changes in adverse events, physical examination, laboratory medicine examination, or vital signs of the BDSW intake group. These results suggested that the intake of BDSW in prediabetic adults can improve glucose metabolism and lipid profiles and is safe for human consumption.

TEKNIK PEMERIKSAAN KEDOKTERAN NUKLIR SIDIK TIROID DI INSTALASI RADIOLOGI RSUP DR. KARIADI SEMARANG

Background: Examination of thyroid scintigraphy or thyroid gland scintigraphy is a nuclear medicine examination using radioactive substances or radiopharmaceuticals that are inserted into the body through intravenous injections which aim to obtain functional morphological imaging of the thyroid and to assess the ability of the thyroid gland to capture radioactive substances or radiopharma-ceuticals.Methods: This imaging prosedure using Tc-99m (Technisium-99m) radiopharmaceuticals as much as 2-5 mCi. To get maximum results, patients are asked to stop taking drugs that can interfere with iodine accumulation in the thyroid gland.Results: Imaging was carried out 10-15 minutes after injection of the radiopharmaceutical. Marked with the thyroid cartigalo, jugulum and surgical sutures. The scanning process lasts for 5-10 minutes.Conclusions: The imaging results of hot nodules are generally identical to autonomic thyroid nodules, about 10-30% of cold nodules are found in the thyroid malignancy process while the rest are thyroid cysts.

Full report on a survey of adverse reactions to radiopharmaceuticals from 1975 to 2017 in Japan.

This pharmacovigilance-based survey was aimed at determining the prevalence of, and association between, radiopharmaceuticals and adverse reactions to radiopharmaceuticals from 1975 to 2017 in Japan. The Subcommittee for Safety Issues of Radiopharmaceuticals of the Japan Radioisotope Association's Medical Science and Pharmaceutical Committee mailed a form for reporting adverse reactions to radiopharmaceuticals to all institutes performing nuclear medicine examinations in Japan. This investigation included adverse reactions to diagnostic radiopharmaceuticals labeled with both single-photon- and positron-emitting radionuclides and therapeutic sodium iodide labeled with 131I. Each institute returned the reporting form to the subcommittee each time an adverse reaction occurred. Replies were obtained from 75% of the institutions. In total, 1099 adverse reactions were reported from 46,645,580 radiopharmaceutical administrations, giving a prevalence of 2.4 adverse reactions per 100,000 administrations (95% confidence interval 2.2-2.5). Adverse reactions were most frequently observed for 131I-iodomethylnorcholesterol (230.1/105 administrations), followed by 131I-HSA (76.3/105 administrations), 131I-sodium iodohippurate (31.2/105 administrations), and 99mTc-DTPA (12.0/105 administrations). Comparison of adverse reactions between before and after 1997 revealed that prevalence dropped from 3.7/105 administrations (95% confidence interval 3.5-4.1) to 1.5/105 administrations (95% confidence interval 1.4-1.6). During the study period, vasovagal reactions accounted for 50.3% of adverse reactions, fever for 7.5%, allergic reactions for 25.7%, and other for 16.5%; 3.7% of all adverse reactions were considered severe but none were lethal. A definite, probable, possible, less likely, and uncertain causal relationship with radiopharmaceuticals was observed in 13.1%, 33.7%, 39.9%, 6.2%, and 7.1% of adverse reactions, respectively. These results suggest that nuclear medicine staff must be aware of the possibility of adverse reactions from radiopharmaceuticals, despite their rarity.

Occupational radiation exposure of health professionals and cancer risk assessment for Lithuanian nuclear medicine workers

BackgroundReconstruction and analysis of low doses received by the occupationally exposed medical radiation workers, especially nuclear medicine staff dealing with radioisotopes may significantly contribute to the understanding of radiation impact on individuals, assess and predict radiation related risks for the development of cancer or other specific diseases. MethodsA pool of 2059 annual effective doses corresponding to 272 job's positions occupied by nuclear medicine and radiology workers for a certain time period over 26 years in five Lithuanian hospitals was investigated in order to analyze the occupational exposure tendencies to medical staff. Requested data, measured in terms of whole body dose, personal dose equivalent Hp(10), was obtained from the National Register of Sources of Ionizing Radiation and Occupational Exposure. Considering that nuclear medicine staff is dealing with open sources/radioisotopes, doses to extremities, Hp(0.07), were measured using thermoluminescent dosimeters (TLD) of LiF:Mg, Ti type. Lifetime risk estimations for the development of specific cancer (thyroid cancer and leukemia) for exposed radiation workers were performed using risk models included in BEIR VII report (BEIR VII, 2006). The conservative assessment of the thyroid exposure was performed using RadRAT 4.1.1 tool. ResultsDoses to radiology technologists and radiology nurses were found to be highest over the years. However, their annual doses never exceeded dose limit of 20 mSv and were following the same decreasing tendency as the doses of other personnel. There was no increase of doses to nuclear medicine staff observed after installation of two new PET/CT machines, indicating increased radiation protection culture and application of relevant technical and protective measures by the staff. Measured fingertip doses were 2–3 times higher than the hand doses measured with TLD ring and were dependent on the type and frequency of the nuclear medicine examination procedure and on the type and activity of isotopes used for examination. ConclusionsFor the first time, retrospective dose evaluation for the cohort of medical radiation workers was performed in the country. It enabled estimation of lifetime attributable risk for the development of two cancer types: thyroid and leukemia cancer among occupationally exposed medical radiation staff. Projected risk was low, ~10−5, however it was found that the risk of thyroid cancer for female staff was 5.7 times higher than for the males. Obtained results will be used for the predictive assessment of possible radiation induced health effects to occupationally exposed medical radiation workers.

Patient-Reported Adverse Events of Radiopharmaceuticals: Development and Validation of a Questionnaire.

IntroductionRadiopharmaceuticals may cause adverse events. Knowledge about adverse events from a patient’s perspective could help healthcare professionals to detect, understand, and manage adverse events more efficiently when using radiopharmaceuticals. Researchers need a validated questionnaire that can be used in patients to assess adverse events with radiopharmaceuticals.ObjectiveThe aim of this study was to develop, validate the content of, and perform initial testing of a questionnaire assessing patient-reported adverse events of radiopharmaceuticals.MethodsBased on existing literature, six professionals drafted and evaluated a first version of the questionnaire. Further content validation was performed using cognitive interviews with six patients undergoing a nuclear medicine examination. After adaptations, the questionnaire was developed into a web-based questionnaire. One hundred patients undergoing nuclear examination tested this version, and the results were used to assess its acceptability and evaluate reported adverse events.ResultsQuestions and answer options were revised in the initial questionnaire to improve clarity. In addition, some questions were removed. The final version consisted of 18 questions. In the test phase, the acceptability of the questionnaire was demonstrated (e.g. 79% of the patients who received the questionnaire completed it, and the median time to complete the questionnaire was 12 min for patients who reported an adverse event). Of the 100 patients (53% men, median age 64 years), 12 reported a total of 22 adverse events. One of these adverse events had a high causal association.ConclusionAfter validation and testing, the developed questionnaire to study patient-reported adverse events of radiopharmaceuticals is a suitable and valid instrument which can be used in future research.Electronic supplementary materialThe online version of this article (10.1007/s40264-019-00895-2) contains supplementary material, which is available to authorized users.

Which is the most affected muscle in lumbar back pain – multifidus or erector spinae?

IntroductionThe purpose of this study is to evaluate the relationship between lumbar back pain, lumbar disc herniation, and erector spinae and multifidus muscle lipomatous degeneration.Material and methodsAfter receiving approval from the clinical studies Ethics Committee, magnetic resonance imaging (MRI) studies of patients who had physical examination in orthopaedic, neurology, neurosurgery, physical medicine and rehabilitation clinics were evaluated. Their pre-diagnoses were ‘herniated nucleus pulposus’ or ‘lumbar disc herniation’ or ‘back pain’ and their age range was between 18 and 64 years. Patients who had vertebral fracture, spondylitis-spondylodiscitis, tumours, structural anomalies such as spondylolisthesis, scoliosis and vertebral segmentation anomalies and previous surgery in the lumbar area were excluded. There were 205 patients in the case group who had lumbar disc herniation between L1-S1 level and there were 187 patients in the control group who had no lumbar disc herniation. In the study, patient age, sex, herniation level and erector spinae and multifidus muscle lipomatous degeneration were compared. Muscle lipomatous degeneration were evaluated with a visual scale.ResultsThere were 105 men and 100 women in the case group and 88 men and 99 women in the control group. In the case group, lumbar disc herniation was detected mostly at L4-5 and L5-S1 levels. There was no significant difference between case and control groups with regard to erector spinae and multifidus muscle lipomatous degeneration. In the case group, lipomatous degeneration of the erector spinae was higher compared to that of the multifidus muscle.ConclusionsPatients with low back pain may have fatty degeneration in erector spina and multifidus muscles with or without LDH, but LDH accelerates this process rather than being a result of it. In patients with LDH, fatty degeneration in the erector spina is more pronounced than in multifidus, and the erector spina is more affected by the LDH process.

THE PROCESS OF SCIENTIFIC KNOWLEDGE INTEGRATION IN CRIME PREVENTION AND TRENDS OF MEDICAL CRIMINALISTICS DEVELOPMENT IN UKRAINE IN XIX – EARLY XX CENTURY

The aim: To carry out a historical review of the formation and development of medical forensics in the XIX - early XX century in Ukraine, as well as to identify its trends at the present stage. Materials and methods: The article is based on the study of archival and published materials, the results of integrating expert judgments, judicial practice and regulatory acts of the Ministry of Health of Ukraine, interviewing investigators and court experts. In the course of the research a system of scientific methods has been used: historical, comparative, terminological analysis, formal-logical, sociological. Conclusions: In the XIX and early XX centuries, the foundations for the formation of medical criminalistics were laid, which facilitated the development of forensic medicine, criminalistics and forensic examination. Special medical knowledge is widely used in investigative, judicial and expert practice. The synthesis of medical and forensic knowledge enhanced the development of a method of personal identification, based on his/her genetic properties, the formation of molecular genetic examination, the study of individual objects at the modern level.

Risk factors for obstetrical brachial plexus palsy

Objective: The study was aimed to identify the risk factors for obstetrical brachial plexus palsy (OBPP). Patients and Methods: A retrospective case–control study was designed. A comparison was performed between cases of brachial plexus paralysis (n = 32), with controls without brachial plexus paralysis (n = 30) randomly selected from physical rehabilitation medicine examination. Statistical analysis was performed using the SPSS Package. Results: Independent risk factors for brachial plexus paralysis were macrosomia (birth weight 4000 g; odds ratio [OR] = 12.353; 95% confidence interval [CI] 2.510–60.802, P

Practice Predictors of Buprenorphine Prescribing by Family Physicians.

Both opioid use disorder and mortality for opioid overdoses are increasing. Family physicians (FPs) can treat opioid use disorder if they are waivered to prescribe buprenorphine. Our objective was to determine personal, practice, and community characteristics associated with FPs prescribing buprenorphine. We used data from the 2017 and 2018 American Board of Family Medicine examination registration questionnaire. The questionnaire asked about current prescribing of buprenorphine, as well as about practice size, organization, and location. Logistic regression was used to determine associations between buprenorphine treatment and individual, practice, and county characteristics. The questionnaire had a 100% response rate. After excluding FPs in noncontinuity practices and those who could not be linked to a US county, our final sample was 2726. Only 161 (5.9%) prescribed buprenorphine. Practice in a Federal Qualified Health Center (adjusted Odds Ratio [aOR] = 1.98 (95% CI, 1.08, 3.63)), in solo practice (aOR = 2.60 (1.38, 4.92)), or with a mental health professional (aOR = 2.70 (1.73, 4.22)) were positively associated with prescribing buprenorphine. Practice in a rural county or in a whole county mental health professional shortage area were not associated with buprenorphine prescribing. Few FPs prescribed buprenorphine, but those in practice settings with supporting mental health services were more likely to prescribe. With their training in the biopsychosocial model and a more even distribution across the rural continuum, FPs are perfectly situated to meet the increasing need for medication-assisted treatment. However, ensuring they have supporting mental health services will be central to having more FPs provide medication-assisted treatment.

Current state of bone scintigraphy protocols and practice in Japan.

Nuclear medicine technologists in Japan often perform additional single-photon emission computed tomography (SPECT) with or without computed tomography (CT) after whole-body imaging for bone scintigraphy. In this study, we wanted to identify the bone scanning protocols used in Japan, together with the current clinical practices. The study was conducted between October and December 2017. We created a web survey that was hosted by the Japanese Society of Radiological Technology. The questionnaire included 12 items regarding the demographics of the responders, their scan protocols, and the imaging added to, or omitted from, routine protocols. In total, 228 eligible responses were collected from participants with a mean of 11.6±8.4 years' experience in nuclear medicine examination. All responders reported using routine scan protocols that included whole-body imaging. However, only 2%, 4%, 20%, and 14% of the responders also acquired single-field SPECT, single-field SPECT/CT, multi-field SPECT, and multi-field SPECT/CT, respectively. Our survey results indicate that nuclear medicine practice in Japan is beginning to shift from planar whole-body imaging with additional spot planar images to additional SPECT or SPECT/CT. Further study is required to examine the optimal protocols for bone scintigraphy.

Introduction of basic medicine examination in Korean Medical License Examination to improve physician's science competency

Introduction of basic medicine examination in Korean Medical License Examination to improve physician's science competency

Relevant approaches to modernization of academic and material and technical process support of academic process in the field of knowledge “Health care” in terms of adapting to international assessment criteria.

One of the important tasks in modernization of Ukrainian medical education is to bring it in line with international assessment criteria, which has become especially relevant after the introduction of the International Basic Medicine Examination in 2018. The aim of this work was to identify the most significant differences between international medical exams (for example, The United States Medical Licensing Examination, USMLE) and the national system of licensed exams KROK, and based on this, determine the direction of modernization of Ukrainian medical education for its adequate adaptation to new systems of assessment. The most significant differences between the two exams are: format (on computers / on paper); presence / absence of digital files with images and audio data in tasks; thematic focus of tests within one / several subjects; different list of items by which tasks are distributed; in the case of USMLE, there is a much higher motivation to pass the exam with the highest possible result. To adapt the medical education system to such features, it is necessary: to provide students with high-quality illustrated textbooks and meaningful digital data bases for each specialized subject; to actively use images (audio, video files) from these sources during the analysis of the material and all types of control (including test ones); to establish cooperation between the fundamental and clinical departments in the process of creating test tasks, as well as the exchange of digital materials for practical classes. Of particular importance is the synchronization of methodological approaches to conducting practical classes and assessment criteria not only in theoretical but also in clinical departments, which will make the learning process more transparent and understandable. Such a set of measures will help not only to adapt students to exams at the international level, but also will increase their interest and improve the effectiveness of the educational process. The employment of digital images, audio, video files will also contribute to the adequate preparation of students for new directions in medicine, such as telemedicine and telepathology.

Radiological trends in trampoline-related paediatric injuries in a major paediatric trauma centre: a 6-year experience

AimReview of visits to the radiology department related to trampoline injuries in a major trauma centre in the UK over a 6-year period, and analysis of imaging performed, injury type, and seasonal trends in children under 18 years of age.Subject and methodsRetrospective review of the Radiology Information System (RIS) for requests and reports between January 2012 and December 2017 containing the search term “tramp*” with an age of < 18 years.ResultsA total of 1794 children (44% male, mean age 8.15) visited the radiology department 1871 times and received 2343 separate radiographic examinations, ten ultrasound examinations, 20 CT examinations, 19 MR examinations and two nuclear medicine examinations. Seven hundred and eighty-eight children (45.9% male) had injury demonstrated on radiographs (622 fractures and 183 soft-tissue injuries) during 796 visits to radiology. Positive CT, MRI, and US were seen in 55%, 47.3%, and 50% of cases respectively. Children under 7 years of age are more likely to have been injured compared to older children attending for X-rays, with the proportion of injuries seen in 6-year-old children being the highest (63.7%). Trampoline injury-related X-ray requests to radiology rose from 1.7% to 4% per year as a percentage of overall X-ray requests from the emergency department.ConclusionTrampoline injury-related visits to the radiology department and the number of injuries demonstrated on imaging studies have increased over the study period, putting greater pressure on the healthcare system. Younger children are especially prone to injury. Public health campaigns and mandatory national safety standards are needed to increase awareness of potential dangers of recreational trampoline use.

Quantitative imaging biomarkers in nuclear medicine: from SUV to image mining studies. Highlights from annals of nuclear medicine 2018.

Quantification in medical imaging is one of the main goals in research and clinical practice since it allows immediate understanding, objective communication, and comparison. Our aim was to summarize relevant investigations on quantification in nuclear medicine studies published in the volume 32 of Annals of Nuclear Medicine. In this article, we summarized the data of 14 selected papers from international research groups that were published between January and December 2018. This is a descriptive review with an inherently subjective selection of articles. We discussed the role of parameters ranging from standardized uptake value to ratios, to flow within a region of interest, to volumetric parameters and to texture indices in different clinical scenarios in oncology, cardiology, and neurology. In all the medical disciplines in which nuclear medicine examinations play a role, quantification is essential both in research and in clinical practice. Standardization and high-quality protocols are crucial for the success and reliability of imaging biomarkers.

Validating the Test Plan Specifications for the American Board of Family Medicine's Certification Examination.

To demonstrate the degree to which the American Board of Family Medicine's certification examination is representative of family physician practice with regard to frequency of diagnoses encounter and the criticality of the diagnoses. Data from 2012 National Ambulatory Medical Care Survey was used to assess the frequency of diagnoses encountered by family physicians nationally. These diagnoses were also rated by a panel of content experts for how critical it was to diagnose and treat the condition correctly and then assign the condition to 1 of the 16 content categories used on the American Board of Family Medicine examination. These ratings of frequency and criticality were used to create 7 different new schemas to compute percentages for the content categories. The content category percentages for the 7 different schemas correlated with the 2006 to 2016 test plan percentages from 0.50 to 0.90 with the frequency conditions being more highly correlated and the criticality conditions being less correlated. This study supports the continued use of the current Family Medicine Certification Examination content specifications as being representative of current family medicine practice; however, small adjustments might be warranted to permit better representation of the criticality of the topics.

The model medical degree programme "human medicine" in Oldenburg - the European Medical School Oldenburg-Groningen.

In the summer of 2012 the School of Medicine and Health Sciences at the Carl von Ossietzky University of Oldenburg became the first new medical faculty to be founded in Germany in more than 20 years. The faculty was established within the framework of the European Medical School Oldenburg Groningen, a cooperation project between the University of Oldenburg and the University of Groningen. In addition to the University of Groningen and its faculty of medical sciences (Universitair Medisch Centrum Groningen – UMCG), four hospitals in Oldenburg are involved in the programme as cooperation partners, as well as a network of general practitioner practices that provide training and academic teaching hospitals across northwest Germany. The programme itself is a model medical degree programme with a modular structure, a highly integrative approach and an early and consistent focus on practical skills and patient-centredness. In addition to the early introduction to outpatient care in the first years of study, longitudinal pathways and a strong focus on research with early integration of scientific activities into medical studies are the defining characteristics of this programme. The two faculties in Oldenburg and Groningen coordinated their respective curriculums during the founding phase and recognise each other's study modules as equivalent to their own. This has created the preconditions for students from Oldenburg to obtain Dutch qualifications (Bachelor of Human Life Sciences and/or Master of Science in Medicine) in addition to the German "Staatsexamen" (the state examination in medicine) under certain circumstances. Irrespective of whether they intend to obtain these qualifications, all students from Oldenburg must spend at least a year studying at the partner university in Groningen. In exchange, up to 40 students from Groningen have the option to complete part of their studies in Oldenburg.

Development of a medical education program with abdominal palpation simulators to support the understanding of traditional Japanese (kampo) medicine in beginners

ABSTRACTAimTraditional Japanese (kampo) medicine has recently been included in the medical education curriculum in Japan; hence, an education program in kampo physical examination for beginners is needed. The aim of the present study was to develop an education program using a simulator of kampo abdominal palpation that would enable beginners to acquire this skill, and to assess the effectiveness and usefulness of the education program.MethodsFirst, we conducted a preliminary trial. Fifteen beginners received a lecture about abdominal findings and the associated representative kampo formulas and underwent a simulator palpation test. Following this trial, we created and conducted a 1 day education program as a prospective study. The program included a general lecture on physical examination in kampo medicine, followed by a pre‐test assessment involving palpation of the simulators, a specific lecture about abdominal palpation, and finally a post‐test assessment. The pre‐ and post‐test accuracy rates were evaluated.ResultsHigh accuracy rates were obtained in the preliminary trial, but the research protocol did not enable an assessment of the effectiveness or usefulness of the trial. In the subsequent education program, 41 participants had significantly higher accuracy rates after the lecture than before the lecture, in both abdominal findings (from 78.2% to 94.4% on average, P &lt; 0.001) and in the associated representative kampo formulas (from 21.8% to 59.7% on average, P &lt; 0.001).ConclusionAn education program using simulators for kampo abdominal palpation can be effective and useful for beginners in kampo medicine.

Hypercholesterolemia and prevention of cardiovascular diseases in the light of preventive medical examinations of employees in Poland.

Long-term exposure to hypercholesterolemia is the cause of atherosclerosis, which in turn causes cardiovascular and cerebrovascular events. In developed countries, including Poland, vascular diseases are the main cause of death. They affect an ever younger part of the population, including the working population. The authors address the problem of epidemiology of cardiovascular diseases, unsatisfactory detection and treatment, economic consequences for the health care system, and the possibilities of using occupational medicine services in the prevention of this health problem. Due to the fact that the early detection of diseases caused by high blood cholesterol levels is relatively low in Poland, obligatory occupational medicine examinations seem to be a key element of the second-line prevention. Therefore, it seems natural to consider the idea of extending the scope of obligatory examinations and introducing tests that allow lipid disorders to be detected at an early stage. This can contribute to a general improvement of the health of the population, and to economic benefits, such as a decrease in the costs of treatment of the disorders that have been detected too late. Broadening the scope of occupational examinations is also important from the perspective of public health and epidemiology of cardiovascular diseases, thus being an element of prevention of civilization diseases. It means improving health and building health awareness, and it should translate into regular health examinations. The performance of these examinations should result not only from the obligation, but also from the patient's conviction about the importance of early detection of disorders, including lipid disorders, for an effective therapy. Int J Occup Med Environ Health. 2019;32(6):865-72.