Objective Clinical Examination Research Articles

THE PILOMATRICOMA: A CASE REPORT OF PALPEBRAL LOCALIZATION

Pilomatricoma, formerly called calcified epithelioma of Malherbe, is a rare and benign skin tumor occurring during the first two decades of life, generally located in the upper part of the body (neck and head). In its typical form, it manifests clinically as a small, solitary, asymptomatic, sometimes painful subcutaneous nodule. The usual size is less than 3 cm. The diagnosis is made clinically and requires histological confirmation. The prognosis is generally good. Carcinomatous transformation remains controversial. Healing without recurrence is the rule after surgical excision. Ocular or palpebral localization is exceptional. We report the case of Mrs. G.E, 26 years old, without any notable pathological history, who consulted for a mass on the right eyelid that had been developing for 1 year. Objective clinical examination: a polylobed mass, well defined, 3 cm long axis, hard, painless and mobile in relation to the deep plane. The surrounding skin is normal in appearance. In addition, motor skills and ocular mobility remain preserved. A total surgical excision is performed. Histological study of the biopsy specimen reveals the presence of basaloid cells covering layers of mummified cells with eosinophilic cytoplasm, suggestive of a Malherbe Pilomatricoma. No recurrence was detected after a 12-month follow-up.

Vertebromedullary hydatidosis: a case report.

This article presents the case of a 12-year-old child with no particular pathological antecedent, who presents a spinal cord compression syndrome evolving gradually for 2 weeks whose objective clinical examination found a 2/5 paraparesis with a sharp pyramidal syndrome and subxiphoid sensory level. Medullary MRI has objectified an aspect of hydatid cysts at the level of D8 D9 and D10 compressing the spinal cord. Management was surgical by decompression by laminectomy of stage D8, D9, and D10 under general anesthesia and put on albendazole, the diagnosis was confirmed by histopathological examination, the evolution was marked by a partial recovery of deficit. Clinical symptomatology is vague with a gradually inescapable movement towards spinal or root pressure.

Development and operationalisation of a mixed reality interactive virtual patient application for online nursing Objective Clinical Examinations

During the 2020 iteration of a Bachelor of Nursing Clinical Health Assessment skills course delivered in Singapore, the sudden cancellation of all face-to-face classes due to the COVID-19 pandemic resulted in innovative strategies being required and quickly created to enable students to successfully complete clinical skills laboratories and Objective Structured Clinical Examinations (OSCEs) online. However, the realism of the experience was rudimentary. At the end of the 2020 teaching semester, and the possibility that the next iteration of the course would also need to be online, it was decided to explore technologies to provide a more realistic and interactive user experience for the 2022 iteration of the Clinical Health Assessment skills course and particularly for the OSCEs. A research project was initiated in 2021, to develop and test the use of virtual or mixed reality applications for online simulated learning and clinical skills assessment. This paper discusses the development and operationalisation phases of a mixed reality interactive virtual patient application used for online OSCEs in a Clinical Health Assessment skills course.

Perspectives and experiences of newly registered nurses surrounding the objective structured clinical examination in an obstetrics and gynecology hospital: A qualitative study in Shanghai, China

ObjectivesNewly registered nurses in China are required to attend two years of standardized training programs after graduation, and an evaluation of the training program's effectiveness is critical. The objective structured clinical examination is a relatively new and objective approach to exploring the effectiveness of training programs and is increasingly being encouraged and used in clinics. However, the perspectives and experiences of newly registered nurses in obstetrics and gynecology regarding the objective structured clinical examination are unclear. Therefore, the objective of this study was to investigate newly registered nurses' perspectives and experiences of the objective structured clinical examination in an obstetrics and gynecology hospital. DesignThis qualitative study was conducted using a phenomenological approach. Data sourcesTwenty-four newly registered nurses taking the objective structured clinical examination in a third-level obstetrics and gynecology hospital in Shanghai, China. Review methodsSemi-structured face-to-face interviews were conducted between July and August 2021. The Colaizzi seven-step framework was applied for data analysis. ResultsThree main themes and six sub-themes emerged: 1) high satisfaction with the objective structured clinical examination; 2) gaining experience and growing as nurses; and 3) high pressure. ConclusionThe objective clinical structured examination can be used to assess the competence of newly registered nurses after training in an obstetrics and gynecology hospital. The examination not only enables an objective and comprehensive evaluation of others and self-evaluation but also leads to positive psychological experiences in newly registered nurses. However, interventions are needed to relieve examination pressure and to provide effective support for participants. The objective clinical structured examination can be incorporated into the training assessment system; this study provides a basis for improving training programs and the training of newly registered nurses.

Anxiety and performance in a structured objective clinical examination of undergraduate physical therapy students

Anxiety and performance in a structured objective clinical examination of undergraduate physical therapy students

Apport et limites des « ECOS », « examen clinique au lit du malade » et « appréciation globale de stage » comme modalité d’évaluation de fin de stage. Expérience de deux services de médecine interne

IntroductionDuring placements, there is an opportunity to learn clinical skills and to assess their application. However, it represents two different goals. The validity of an end-of-placement assessment is questionable, as the medical competency is contextual. We decided to evaluate the contribution and limits of different assessment modalities as an end-of-placement assessment. Material and methodsInternal medicine clerks were assessed using the Mini-Cex grid by a structured objective clinical examination (OSCE), a long-case clinical examination (LCE) and a global end-of-placement marking (GEPM). Following these evaluations, students and teachers fulfilled an open questionnaire. ResultsIn 2021, 41 students and 16 teachers participated in the study. Physical examination was evaluated in 0%, 97% et 76% of cases during OSCE, LCE and GEPM, respectively; teaching skills were assessed for 100, 42 et 49% of students in OSCE, LCE and GEPM, respectively. As compared to OSCE, there was a perceived superiority of LCE regarding its formative value (P=0.07 and P=0.03) and its summative value (P=0.0007 and P=0.02), for students and teachers, respectively. Qualitative analysis highlights the breadth of clinical skills that could be assessed during OSCE stations. Integration into a team was an additional skill that could specifically be assessed during GEPM. GEPM could also take into account the progress made during placement. ConclusionDespite its subjectivity, LCE seemed to be the preferred modality for an end-of-rotation assessment.

Differences of Anxiety and Depression in Dry Eye Disease Patients According to Age Groups.

This study aimed to investigate the association between dry eye disease (DED) and DED-related anxiety and depression tendencies, as well as the risk factors for anxiety and depression in patients with DED of different age groups. This was a cross-sectional study involving 160 patients with DED and 80 healthy individuals aged 20–65 years. All participants completed the investigation of the demographic characteristics, the Hospital Anxiety Depression Scale (HADS), the Ocular Surface Disease Index (OSDI) questionnaire, the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, and underwent objective clinical eye examinations. In patients aged 20–40 years, anxiety and depression scores were correlated with OSDI, sleep disorders, and Best Corrected Visual Acuity (BCVA). In patients with DED aged 41−65 years, anxiety scores were correlated with sleep disorders, the level of DED impact on life and work, and the severity of DED. Depression scores were correlated with sleep disorders and the severity of DED. The results indicated that the tendency for anxiety and depression was closely associated with DED and sleep disorders. Moreover, the factors affecting anxiety and depression in patients varied with age.

COVID-19 infection and liver damage in children. Clinical case study.

Introduction. COVID-19 is currently considered a systemic disease affecting the immune system, primarily, lungs, heart, central nervous system, kidneys, intestines, liver and spleen. Impaired liver function and the presence of biochemical changes in liver can be found in approximately 14-53% of adults infected with SARS-CoV-2. Impaired liver function in patients infected with COVID-19 may occur due to a direct effect of the virus on hepatocytes, as well as being secondary to factors such as a systemic inflammatory response of the infected host, the onset of hypoxia (associated with lung damage), multiple organ failure, or due to abusive treatment using overlapping and hepatotoxic drugs. The purpose of this article is to describe a clinical case study regarding the clinical and paraclinical manifestations of liver damage in a 12-year-old child infected with SARSCoV-2, hospitalized at the Municipal Children’s Clinical Hospital „Valentin Ignatenco”, Republic of Moldova. Material and methods. The epidemiological, clinical and paraclinical data were used to highlight this study, followed by the conclusions of multidisciplinary specialists, retrieved from the inpatient medical records of the 12-yearold child with moderate COVID-19 infection, who was admitted for emergency treatment. Results. A 12-year-old patient F. was admitted to the „Covid-19” subunit, complaining of severe general malaise, fever up to 39°C, cough, rhinorrhea. The objective clinical examination revealed hepatomegaly and lack of splenomegaly. Laboratory findings determined leukocytosis 15.88 x109 /l, neutrophilia 72.2%, lymphopenia 26.1%, increased ESR (Erythrocyte Sedimentation rate) – 20 mm/h, increased CRP (C-reactive protein) >12.0 mg/l, increased ALT (alanine aminotransferase) by 16 (50.9-487-764 U/l) values compared to the normal reference and a 3-fold increase in AST (aspartate aminotransferase) that is higher than the normal range (55.8 - 113 - 181 U/l), an increased fibrinogen - 5.3 g/l, increased ferritin - 2834 pmol/l and D-dimer levels - 762 ng/ml. Hepatomegaly was detected on abdominal ultrasound. Covid-19 infection was confirmed by a rapid test of nasopharyngeal exudate for SARS-CoV-2 antigens. Conclusions. Patients with the novel coronavirus (COVID-19) show varying degrees of liver dysfunction, especially those with increased levels of AST and ALT. A question arises within the clinical practice, as whether the liver damage occurred due to direct viral hepatotoxicity or due to the drugs used in COVID-19 treatment.

Colonic diverticulosis - diagnostic and therapeutic difficulties

Objectives. The objectives of this study are to highlight the diagnostic and therapeutic difficulties in patients with complicated acute colonic diverticulosis. Methods. The study group comprised 40 patients hospitalized to the Second Surgical Clinic of the Emergency County Hospital in Craiova, Romania, through the emergency service between 2015 and 2021. Regarding the sex distribution of the patients with colonic diverticular disease studied, there was a predominance of males. The distribution of patients was as follows: 22 patients with acute colonic diverticulitis, out of whom 21 patients suffered from left acute colonic diverticulitis and 1 patient suffered from right acute colonic diverticulitis. Results. The diagnosis of acute colonic diverticulitis was made by corroborating the data obtained on the objective clinical examination with the data obtained by exploring the abdomen by means of computed tomography, which revealed a thickening of the colon wall (acute sigmoid diverticulitis predominated). The treatment applied to patients with acute diverticulitis was conservative and in patients with acute perforated colonic diverticulitis, the treatment of choice was the surgical one. Mortality was 7.5% of all the cases. Conclusions. In patients with perforated colonic diverticular disease, the administered treatment consisted in Hartmann segmental colectomy, wound care, peritoneal drainage. The reintegration of the colon in the digestive transit was performed after 3-6 months.

Vasomotor menopausal disorders as a possible result of dysfunction of the microbiota-intestine-brain axis.

The study involved clinical and laboratory examination of 54 women with vasomotor menopausal disorders divided into 3 subgroups depending on the duration of symptoms (not more than 12 months, about 3 years, from 5 to 7 years). The control group included 21 patients without vasomotor disorders during the menopausal period. Data from the general and obstetric-gynecological anamnesis and the results of objective and general clinical examinations were analyzed. To assess the state of intestinal microbiocenosis in patients, a bacteriological study of feces was used according to modern methods. In women with menopausal vasomotor disorders, chronic arterial hypertension, overweight, diabetes mellitus, chronic enterocolitis, and chronic pyelonephritis prevailed among somatic diseases. The study also revealed that these patients had a pronounced imbalance of the intensive microbiota, which was characterized by a significant decrease in the main representatives of the obligate microflora (Bifidobacterium, Lactobacillus) and an increase in the number of opportunistic strains (Klebsiella and Clostridiodes difficile). Considering modern concepts, a change in the microbial composition of the intestine may be one of the possible trigger factors for the occurrence of vasomotor menopausal disorders. Further research will clarify the influence of the microbiome on the formation of the pathological menopausal symptom complex and improve the preventive and therapeutic measures in this category of women.

КЛИНИКО-МОРФОЛОГИЧЕСКИЕ ПАРАЛЛЕЛИ ПРИ ГИПОТОНИЧЕСКОМ И ИНФЕКЦИОННОМ ВАРИАНТАХ ПОСЛЕРОДОВОГО ЭНДОМЕТРИТА

A survey was carried out of 186 puerperas (average age 25.1 ± 2.3), the following groups: 1st — 87 puerperas with hypotonic postnatal endometritis (HPE); 2-th — 68 puerperas with infectious variants of postnatal endometritis (IPE). The subjects were given an individual card, in which the data of the anamnesis, objective clinical examination, the results of laboratory and instrumental studies were noted. The control group consisted of 31 puerperas with physiological period (average age 25.4 ± 2.8). Histological examination of endo- myometrial scrapings in puerperas with hypotonic and infectious variants of postpartum endometritis showed a difference in their morphological picture, indicating the separation of the pathogenetic mechanisms of the formation of HPE and IPE.

Development of an Embodied Avatar-Agent Communication System to Support Communication Education for Clinical Engineer Students

Currently, there are few opportunities to develop communication skills in clinical engineering training schools in Japan. Therefore, we developed a system to interact with an agent equipped with a rule-based chatbot, which was created with reference to the objective clinical competence examination (OSCE). In a previous study, a virtual hospital room system was developed for nursing students to interact with the rule-based chatbot agent. In this study, we added an avatar that reflects the user's embodied movements to the system. In the virtual space created, the agent playing the patient, equipped with a rule-based chatbot, responds to the user's voice, and the avatar uses a webcam to project the user's body movements in real time. This system allows for repetitive learning, which is difficult with face-to-face training. In addition, the avatar, which reflects the user's body movements, exists in the same space as the agent, allowing the user to view his or her own body movements objectively.

Dental Students' Oral Health-Related Quality of Life and Temporomandibular Dysfunction-Self-Rating versus Clinical Assessment.

The aim of this study was to compare dental students’ self-perception of oral health with the results of a clinical examination of the masticatory system. Seventy-four dental students (38 (51.4%) females and 36 (48.6%) males) completed the Oral Health Impact Profile questionnaire (OHIP-G-14) and underwent a clinical examination according to the Graz Dysfunction Index (GDI). Data were analyzed with descriptive and comparative statistics. Median OHIP-G-14 scores were 3 (IQR 0–6) in the total collective, 4 (1–11) in females, and 2 (0–4) in males (p = 0.072). A score of 0 was found in 29.7% of the sample. The results of the GDI were 50% “normal function”, 43.2% “adaptation”, 5.4% “compensation”, and 1.4% “dysfunction”. The comparison of OHIP-G-14 scores and DGI groups showed a significant difference (p = 0.031). Based on the questionnaire, less than one third of the sample indicated maximum oral health-related quality of life. In contrast, the GDI revealed “normal function” or “adaptation” in 93.2%. Dental students underappreciated their oral health condition. Health assessments should not be solely questionnaire-based, especially in health professionals (-to-be). To establish a valid diagnosis of the state of health, self-assessment must be complemented by an objective clinical examination, e.g., GDI.

Скринінг бронхіальної астми як ефективний метод вчасного її виявлення у дітей шкільного віку

Проведене епідеміологічне дослідження бронхіальної астми шляхом анкетування батьків і дітей міської та сільської місцевості Тернопільської області з метою вивчення поширеності, визначення та репрезентації основних маркерів захворюваності серед дітей старшого та середнього шкільного віку. Дітям проводилися детальний збір анамнезу, анкетне опитування, розроблене згідно з методологією ISAAC, та об’єктивне клінічне обстеження. Даний фрагмент епідеміологічних досліджень засвідчив, що показники поширення бронхообструктивних захворювань у регіоні (5,62 %) суттєво відрізняються від показників офіційної статистики (1,7 %).

Diagnostic Criteria for Breast Cancer-Related Lymphedema of the Upper Extremity: The Need for Universal Agreement.

With advances in breast cancer treatments and resultant increased survival rates, emphasis has been placed on post-treatment complications such as breast cancer-related lymphedema (BCRL), a chronic, negative sequela of breast cancer treatment. Accurate BCRL diagnosis necessitates longitudinal screening beginning at preoperative baseline. Prospective screening programs incorporating symptoms, objective measurements and clinical examination allow for early detection, early intervention, and improved BCRL prognosis. Currently, varied diagnostic criteria for BCRL exist, and this lack of consensus leads to variation in diagnostic and screening practices across institutions. This review outlines current diagnostic tools, including subjective and objective measurement methods and clinical examination. The merits of different criteria are evaluated and recommendations are made regarding measurement tools and diagnostic criteria for BCRL. Ultimately, the BCRL diagnostic process should be universalized and combine objective measurements, clinical evaluation, and symptoms assessment, and adhere to the best practices of the measurement tools used.

Фактори ризику розвитку стеатозу печінки в дітей

Неалкогольна жирова хвороба печінки є найбільш частою причиною захворювань печінки в дітей у всьому світі. Мета: визначити фактори ризику стеатозу печінки в дітей. Методи дослідження. Під нашим спостереженням були 32 дитини з розладами шлунково-кишкового тракту. Визначення наявності й ступеня стеатозу печінки проводили з використанням апарата FibroScan® 502 touch із визначенням контрольованого параметра ультразвукового затухання (CAP). За показниками CAP діти були розподілені на 2 групи: 1-ша група (основна) — 13 дітей із стеатозом (40,6 %), 2-га група (контрольна) — 19 дітей без стеатозу (59,4 %). Для визначення факторів ризику ми проаналізували історію життя й захворювання, дані об’єктивного клінічного й лабораторного обстеження хворих. Результати. Аналіз вікового розподілу показав, що в основній групі переважають діти віком понад 10 років (відносний ризик (RR) 3,3; відношення шансів (OR) 4,0; р = 0,1). Ожиріння було виявлене у 12 (92,3 %) дітей у групі хворих із стеатозом і в 9 (47 %) дітей, які не мали стеатозу. Збільшення окружності талії понад 95-й перцентиль спостерігалося у 12 (92,3 %) дітей в основній групі і 8 (42,1 %) дітей контрольної групи (RR 7,2; OR 16,5; р < 0,05). Було встановлено, що наявність пубертатного гіпоталамічного синдрому пов’язана з ризиком розвитку стеатозу печінки в дітей (RR 30,6; OR 4,8; р < 0,05). Обговорення. Як провідний фактор ризику розвитку стеатозу печінки в дітей слід розглядати абдомінальний тип ожиріння в поєднанні із захворюваннями ендокринної системи, а саме гіпоталамічним синдромом.

Active and non-active stations as an adaptive method for Objective Structured and Clinical Examination during the COVID-19 pandemic

Objective: The COVID-19 pandemic caused by the SARS-CoV-2 infection is of global concern. In mid-March 2020 all learning activities in Indonesia were carried out online. The biggest challenge in measuring the competency of graduates during this pandemic time was to test skills online. The aim of this study was to develop adaptation of the online Objective Structured and Clinical Examinations (OSCE) model at the Apothecary programme, Universitas Padjadjaran, Indonesia. Methods: The OSCE online method is designed using two systems, namely active stations and non-active stations with competencies tested based on the OSCE blueprint, and with the application of virtual facilities such as Google meet, Google forms, etc. Results: The results showed that this method can be used for lab skills exams so that candidates and examiners can still take the exam comfortably without being disturbed. The methods can evaluate competence using the Global Rating and Actual Mark Score, and the examiner does not find it difficult to assess the competency being tested.

APLICABILIDADE DO OSCE (OBJECTIVE STRUCTURED CLINICAL EXAMINATION) COMO MÉTODO AVALIATIVO

Learning based on the development of competencies has an important applicability in education nowadays, mainly aiming at the training of professionals who experience real scenarios since the beginning of training. In this sense, the structured objective clinical examination (OSCE), which is not only restricted to knowledge, but to capacitate and practice based on clinical reasoning, considers skills-based learning, enabling the application in health courses. The objective of this work was to report the experience and applicability of the OSCE as a tool for monitoring the learning scenarios in the Nursing and Medicine courses of the Sao Carlos Metropolitan College – FAMESC, in the municipality of Bom Jesus do Itabapoana, RJ. The OSCE evaluates the student's performance in delimited situations, based on a structured script predefined by the teacher in charge, where there is interaction of the student with a simulated patient or didactic resources through evaluation stations. In this study, it was verified that most students recognize the OSCE as an evaluation tool that allows the student to reflect and fix the content through the simulations in stations, which are like the real scenarios present in the health units. Most students perceive the technique as important in the content fixation process, but some students reported being a stressful activity. Analyzing all the steps of the OSCE is fundamental to ensure its proper functioning and especially for its validity, so studies that assess students' perceptions of the methods of evaluating learning processes are important for the improvement of professional practice.

Instrumented Objective Clinical Examination of Cerebellar Ataxia: the Upper and Lower Limb—a Review

Cerebellar dysfunction results in impairments in co-ordination or 'ataxia'. Bedside examination of cerebellar function has changed little since the early nineteenth century with the exception being the oculomotor examination which has become instrumented. Otherwise, competence and confidence in performing the clinical assessment relies heavily on the skill and experience of the clinician. Potentially, instrumented objective measurement will more accurately assess the severity of ataxia and the changes brought about by advancing therapies in pharmaceutical trials and in rehabilitation intervention. This study describes instrumented versions of several bedside tests of cerebellar function, including rhythmic tapping of the hand (RTH), finger-nose test (FNT), dysdiadochokinesia (DDK), ramp tracking (RMT), ballistic tracking (BT), rhythmic tapping of the foot (RTF) and the heel shin (HST) examination which were validated against scores from Ataxia Rating Scales (ARS) such as the Scale of Assessment and Rating of Ataxia (SARA). While all of the instrumented tests accurately distinguished between ataxic subjects and controls, there was a difference in performance, with the best four performing upper limb tests being RTH, FNT, DDK and BT. A combination of BT plus RTH provided the best correlation with the SARA and outperformed a combination of all the bedside tests (Spearman 0.8; p < 0.001 compared to 0.68; p < 0.001 for the combined set) in identifying the presence and severity of ataxia. This indicates that there is redundancy in the information provided by the bedside tests and that adding other tests to BT plus RTH does not add accuracy to the assessment of ataxia. This analysis highlighted the need for metrics that could be generalised to each of the assessments of ataxia, so, in turn, domains of stability, timing, accuracy and rhythmicity (STAR domains) were developed and compared to the SARA. The STAR criteria could potentially influence the future of instrumented assessment in CA and pave the way for further research into the objective measurement of the cerebellar examination.

Macroscopic Changes in Oral Mucosa and Hygiene Indicators in Smokers.

Smoking is the most important factor affecting the oral cavity by components born in the tobacco combustion process and acting directly on the oral mucous membranes, dental arch and indirectly on the teeth support. Recent studies show the tobacco action on the oral cavity, manifestations in the form of gingivitis, bacterial plaque, dental plaque, papillary bleeding at drilling, periodontitis. Purpose of the study. In this study, we have set out to assess the macroscopic modifications of oral cavity on smokers. Materials and Methods. The participants in the study were divided into two groups, the first group of smokers with a smoking period over 5 years and the control group of nonsmokers. The patients in the two groups underwent a physical examination and an objective clinical examination, the resulting data being compared with the control group. Results. For the bacterial plaque indicatorin the smoker group there was obtained a mean value of 35.68±12.45, compared to a mean value of 16.32±6.61 for the nonsmoker group, the dental plaque indicatorfor the smoker group had a mean value of 2.24±1.02, higher than the one in the nonsmoker group, namely 0.94±0.68, and for the drilling bleeding indicator we obtained a mean value of 19.54±7.89 in the nonsmoker group, which is lower than that in the smoker group, namely 42.86±14.93. Conclusions. Smoking is a cause that maintains and aggravates the periodontal disease, including the risk of periodontitis, allowing the aggravation of gingivitis, considered a reversible surface inflammation of the gum mucosa which, by accumulation of dental plaque, the dental plaque accompanied by incorrect oral hygiene, favors the progression to periodontitis.