Objective Clinical Evaluation Research Articles

A Mini-Workshop to Train Medical Students to Use a Patient-Centered Approach to Smoking Cessation

Leaders in preventive medicine and medical education have called for more attention to preventive medicine in medical education curricula. This study describes the implementation of a training program designed to introduce preventive medicine skills into the medical school curriculum. The specific issue addressed was smoking cessation. A two-hour workshop on the patient-centered approach to smoking intervention was presented to medical students during the family medicine rotation of the second-year clinical medicine course sequence. Two of the four student groups in the family medicine clinical rotation received the training and were afforded practice opportunity with at least one smoking patient at the clinical site. The other two groups went through the usual rotation with no special instruction or clinical emphasis on preventive interventions. Second-year medical students expressed positive perceptions of preventive medicine as assessed by self-rating on attributes important to successful preventive practice. These positive perceptions were retained by both groups after the clinical experience. Students with the workshop training were more confident in their smoking intervention skills and performed better overall on an objective clinical evaluation of intervention skills.

Clinical diagnosis from digital displays: Preliminary findings of the St Mary's evaluation project

Image quality is a fundamental issue in the introduction of picture archiving and communications systems (PACS), and one that has hitherto been eclipsed by other aspects of the considerable technological challenge facing scientists and manufacturers involved in its development. We conducted a formal evaluation of clinical radiological diagnosis from a commercially available PACS viewing station, using subperiosteal resorbtion in renal osteodystrophy as the test pathological diagnosis, with receiver operating characteristic (ROC) analysis of the results. We conclude that the displayed, digitised images were inferior to film using the apparatus tested and believe that careful, objective clinical evaluation of such systems is of paramount important.

Late treatment of scaphoid fractures by bone grafting and compression staple osteosynthesis

Scaphoid nonunions and delayed unions still offer a difficult challenge. In 15 of 16 cases it was possible to achieve a secure and lasting union by using a compression staple and a bone graft. The subjective and objective clinical evaluation also showed similar favorable results. This modification of the Russe operation is recommended as a relatively simple procedure with good results and minimal need for immobilization.

Objective clinical evaluation of function. Gait analysis.

Automated gait analysis allows us to document and quantify objectively normal gait, functional deficits, and patient response to therapeutic intervention. Instrumentation for this analysis at the Mayo Clinic Gait Laboratory includes three-dimensional electrogoniometers for measurement of relative joint rotation at the hip, knee, and ankle; footswitches that record foot-floor contact sequences; instrumented mats that measure step length and width; piezoelectric force plates for measurement of floor reaction forces; and two walkways that simulate a variety of ground conditions. We use a DEC-PDP 11/34 computer for acquisition, storage, and analysis of data and for generation of a gait report form that displays a patient's results relative to normal and previous evaluations. Applications of these techniques include assessment of function preoperative and postoperative total joint arthroplasty, quantification of gait faults, and documentation of effectiveness of exercise and gait training techniques. We have demonstrated the reliability of the techniques, accumulated a sizeable normal data bank, and developed a concise, effective data summary for communication with referring practitioners.

An index for assessment of oral health in the edentulous population.

SUMMARYSuccess or failure of prosthodontic treatment, in terms of comfort and function, is linked to tissue health. To date, no baseline indication of inflammatory status hzs been available to objectively evaluate preprosthetic tissue preparation. The Prosthodontic Tissue Index (PTI) was developed in a manner similar to periodontal indexes, to provide objective clinical evaluation of basal supporting tissueS. At the University of Michigan, 150 patients who were edentulous in one or both arches were examined and asked a series of questions relating to their prosthetic history. The inflammatory status of basal seat tissues was scored according t o defined observable inflammatory changes.Inflammation status was charted on a grid delineated by major areas of denture support for each arch. In 97% of patients examined, inflammatory changes requiring some degree of preprosthetic management were found. Tissue abnormalities other than inflammation that required specific management were noted in 62% of the patientS. Although nearly all patients registered problems relative t o their prostheses, most were not aware of the extent of their tis‐sue changes.Dental care should be concerned with the preservation of health and function in the middle and older ageS. Principal epidemiological characteristics of the edentulous population showed that: most patients with complete dentures have pathologic tissue changes that require treatment; and tissue changes have little relation t o a patient's perception of denture success or personal oral health status.

FOREFOOT ARTHROPLASTY IN RHEUMATOID ARTHRITIS: CLINICAL APPRAISAL AND FORCE PLATE ANALYSIS

Nineteen metatarsal head resections are evaluated at an average followup of 18 months. A subjective patient questionnaire and objective clinical evaluation reveal that in the rheumatoid patient with severe foot involvement, this operation is quite successful. The cholesterol-crystal force plate is shown to be helpful in pre- and postoperative evaluation of these patients.

The Present Status of Spinal Fusion in the Treatment of Lumbar Intervertebral Joint Disorders

Every type of fusion has its enthusiastic supporters. Unfortunately, the literature includes comparative analyses of various fusion procedures. Much of the effort spent in the clinical assessment of spinal fusion must be reinvested; neither the indications for diskectomy nor spinal fusion have been sufficiently clear-cut and accurately recorded. Moreover, spinal fusions often have not been applied to treat the disorder or to correct the deformity. It is essential at the outset to establish the mechanical fault; this is achieved only by a thorough understanding of the underlying pathologic lesion. Diagnosis follows a careful history and physical examination assisted by plain radiographs, lateral radiographs in flexion and extension, radiographs (anteroposterior in left and right lateral bending), and by information obtained from the CAT scan. We have designed a protocol for a prospective investigation wherein a specific fault with a specific etiology and pathologic anatomy is identified and submitted to a surgical procedure in a specified sequence. In future reviews, emphasis must be paid to selection of patients, the individual joint requiring stabilization and the type of fusion performed. Only then can we put this theoretically effective procedure to the acid test of objective clinical evaluation.

A comparison of clindamycin and penicillin V in the treatment of oral infections

To evaluate the long-term clinical and radiographic outcomes of trapeziectomy with abductor pollicis longus tendon interposition arthroplasty for moderate to severe osteoarthritis of the thumb carpometacarpal joint (Eaton stages III-IV).We evaluated 13 patients (15 thumbs) who underwent trapeziectomy and abductor pollicis longus tendon interposition arthroplasty for end-stage osteoarthritis of the thumb carpometacarpal joint, at an average follow-up of 15 years. Subjective clinical outcomes evaluated included visual analogue scale scores and disability of arm shoulder and hand score questionnaires. Objective clinical evaluation included lateral pinch and grip tests, and a range of active and passive thumb movements. All patients underwent a radiological assessment by two independent senior radiologists. Wherever possible, results obtained from the operated thumbs were compared to the non-operated side.At a mean of 15 years post operation (range 15–17 years), there was no statistical difference between the operated and non-operated hands with regards to grip and pinch strength. In all cases CMC and MCPJ range of motion in the operative hand was either equal to or greater than non-operative counterparts. Mean visual analogue scale score was 2.13 and mean DASH score was 16.85. Mean carpal height was 0.52 and mean trapezial space ratio was 0.163. There were no early or late complications recorded and no revision surgery was required.It is the opinion of these authors that abductor pollicis longus tendon interposition arthroplasty is able to provide high-quality long-term results for patients who suffer from moderate to severe osteoarthritis of the thumb carpometacarpal joint.Therapeutic Level IV.

Objective scoring vs. clinical evaluation of the Bender-Gestalt.

Journal of Clinical PsychologyVolume 15, Issue 1 p. 39-41 Diagnostic Processes: The Rating of Adjustment Objective scoring vs. Clinical evaluation of the Bender-Gestalt Eugene B. Nadler, Eugene B. Nadler Highland View Hospital, Cleveland 22, OhioSearch for more papers by this authorSteven L. Fink, Steven L. Fink Highland View Hospital, Cleveland 22, OhioSearch for more papers by this authorFranklin C. Shontz, Franklin C. Shontz Highland View Hospital, Cleveland 22, OhioSearch for more papers by this authorRobert W. Brink, Robert W. Brink Highland View Hospital, Cleveland 22, OhioSearch for more papers by this author Eugene B. Nadler, Eugene B. Nadler Highland View Hospital, Cleveland 22, OhioSearch for more papers by this authorSteven L. Fink, Steven L. Fink Highland View Hospital, Cleveland 22, OhioSearch for more papers by this authorFranklin C. Shontz, Franklin C. Shontz Highland View Hospital, Cleveland 22, OhioSearch for more papers by this authorRobert W. Brink, Robert W. Brink Highland View Hospital, Cleveland 22, OhioSearch for more papers by this author First published: January 1959 https://doi.org/10.1002/1097-4679(195901)15:1<39::AID-JCLP2270150107>3.0.CO;2-ACitations: 7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume15, Issue1January 1959Pages 39-41 RelatedInformation

Preliminary progress report of a clinical study of the effect of C.V.P. on gingival hemorrhage

Summaryo1.Twenty-five patients were divided into three groups: (A) nine patients received six C.V.P. capsules daily, (B) eight patients received six placebo capsules daily, and (C) eight patients received no capsules and acted as controls. All patients were examined biweekly for at least three months.2.Salutary response was noted in eight out of nine patients receiving six capsules of C.V.P. daily in that the bleeding tendency was diminished. This was in contrast to five out of eight patients receiving six placebo capsules daily who showed no improvement, as well as five out of eight patients in the control group who showed no improvement.3.The results noted in this experiment in no way imply that a lack of ascorbic acid and/or bioflavonoids is the only factor involved in hemorrhagic gingivitis. There is a need for a more objective clinical evaluation, other than those criteria used in this preliminary experiment. There is also a need for testing a larger group with a more equable distribution as to age and sex.4.The results of this study indicate that the use of ascorbic acid with bioflavonoids may be of some supportive value in cases of gingival hemorrhage. Scaling, curettage, oral physiotherapy, occlusal equilibration, and the removal of any or all known local as well as systemic factors which may be implicated must not be overlooked in order to successfully conclude and prevent early recurrence of periodontal disease of which gingival hemorrhage may be only one of the clinical symptoms. Twenty-five patients were divided into three groups: (A) nine patients received six C.V.P. capsules daily, (B) eight patients received six placebo capsules daily, and (C) eight patients received no capsules and acted as controls. All patients were examined biweekly for at least three months. Salutary response was noted in eight out of nine patients receiving six capsules of C.V.P. daily in that the bleeding tendency was diminished. This was in contrast to five out of eight patients receiving six placebo capsules daily who showed no improvement, as well as five out of eight patients in the control group who showed no improvement. The results noted in this experiment in no way imply that a lack of ascorbic acid and/or bioflavonoids is the only factor involved in hemorrhagic gingivitis. There is a need for a more objective clinical evaluation, other than those criteria used in this preliminary experiment. There is also a need for testing a larger group with a more equable distribution as to age and sex. The results of this study indicate that the use of ascorbic acid with bioflavonoids may be of some supportive value in cases of gingival hemorrhage. Scaling, curettage, oral physiotherapy, occlusal equilibration, and the removal of any or all known local as well as systemic factors which may be implicated must not be overlooked in order to successfully conclude and prevent early recurrence of periodontal disease of which gingival hemorrhage may be only one of the clinical symptoms.

Clinical experience with transfusions of platelets separated from normal blood.

The development of a method for separating and concentrating platelets from normal blood1has facilitated the use of platelet transfusions for prevention or control of bleeding in thrombocytopenic purpura. Fifty-seven platelet concentrates, most of which were processed from five pints of blood each, have been prepared in the Lenox Hill Hospital's Laboratory for Experimental Cytology and given to 28 patients with thrombocytopenic purpura. To obtain an objective clinical evaluation of these transfusions, the observations and impressions of the 24 physicians attending these patients have been reviewed. This report is a summary of their experience. CLINICAL MATERIAL The 28 patients studied were divided, according to prognosis, into two groups of 14 each. Group A consisted of patients who might be expected to have a good prognosis, provided the hemorrhagic diathesis could be temporarily controlled. Ten patients in group A had idiopathic thrombocytopenic purpura, and four had thrombocytopenia secondary to severe