Regular Exams Research Articles

Pregnancy aspects related to intracranial hemorrhage in newborns of very low weight in South Brazil

To analyze the relationship between route of delivery and other aspects of pregnancy and the occurrence of intracranial hemorrhage in newborns of very low weight at a teaching hospital in South Brazil. A case-control study was conducted. Medical records of all patients who were born weighing ≤ 1,500 g and who were submitted to transfontanellar ultrasonography were analyzed from January 2011 to September 2014. The cases were newborns with diagnosis of intracranial hemorrhage, while newborns with regular exams were used as controls. Differences between groups were analyzed by the Student t test and by χ2 or Fisher exact tests, and association was determined using the odds ratio with a 95% confidence interval and α = 5%. A total of 222 newborns with birth weight ≤ 1,500 g were recorded; of these, 113 were submitted to transfontanellar ultrasonography and were included in the study. Sixty-nine (61.1%) newborns were diagnosed with intracranial hemorrhage (cases) and 44 (38.9%) showed no abnormal results (controls). Most cases had grade I hemorrhage (96.8%) originating from the germinative matrix (95.7%). The predominant route of delivery was caesarean section (81.2% of the cases and 72.7% of the controls). Five deaths were recorded (3 cases and 2 controls). Gestational age ranged from 24 to 37 weeks. Median birth weight was 1,205 g (range: 675-1,500 g). The median time of hospitalization was 52 days, ranging from 5 to 163 days. Grade I intracranial hemorrhage from the germinative matrix was the most frequent. No differences were found between cases and controls for the variables studied. The small number of infants submitted to transfontanellar ultrasonography limited the sample size and the results of the study.

Development of Modified Questionnaire for Screening Purposes for Obstructive Sleep Apnea in Pediatric Population

Development of Modified Questionnaire for Screening Purposes for Obstructive Sleep Apnea in Pediatric Population Objective: To assess the relationship between the clinical complaints in pediatric population, suspected with obstructive sleep apnea (OSA), and the gravity of polysomnographic criteria, a modified protocol for screening purposes has been developed. Material and Methods: For a period of one year, during regular otorhinolaryngologic exam, five pediatric patients, aged between 4, 5 and 9 years with potential obstructive sleep disordered breathing have been identified. Subsequently, their parents fill out the modified questionnaire to evaluate the necessity of further polysomnographic examination. Results: All five patients underwent split-night polysomnography and have been diagnosed with OSA, one with REM-dependent OSA. Conclusion: Based on our clinical experience, we believe that the developed protocol for screening purposes is a valuable and effective tool for early detection of pediatric OSA, while the exact diagnosis requires an overnight polysomnography as a golden standard.

Pannus Is the New Prepuce? Penile Cancer in a Buried Phallus.

Two males presented to our urology department with complaints of bleeding and malodor from buried phallus within a suprapubic fat pad. Although both men had neonatal circumcisions, advanced penile carcinoma was found in both men. Formal penectomies showed high grade, poorly differentiated squamous cell carcinoma invading the corporal bodies and urethra. Buried penis represents a difficulty in early detection of suspicious lesions but may also provide an environment susceptible to poor hygiene and subsequent chronic inflammation. Patients with buried penis may be at a higher risk for development of invasive penile cancer and may benefit from regular and thorough genital exams.

Osteoradionecrosis of Jaw in Head and Neck Cancer Patient Treated with Free Iliac Bone and Umbilical Fat Pad Graft

Osteoradionecrosis is one of the most serious complications of patients receiving radiation therapy. It is characterized by hypovascularity, hypocellularity, and hypoxia-inducing necrosis of bone and soft tissue following delayed healing. In this case, a 72-year-old man was referred to the Department of Oral and Maxillofacial Surgery complaining of trismus following extraction three months before first visit. He had a history of right tonsillectomy, radical neck dissection and radiotherapy performed due to right tonsillar cancer seven years prior. After the diagnosis of osteoradionecrosis on right mandibular body and angle, conservative antibiotic therapy was used first, but an orocutaneous fistula gradually formed, and extensive bony destruction and sequestrum were observed. Sequestrectomy, free particulated iliac bone and umbilical fat pad graft were performed via a submandibular approach under general anesthesia. Preoperative regular exams and delicate wound care led to secondary healing of the wound without vascularized free flap reconstruction.

Human papillomavirus 18 as a poor prognostic factor in stage I-IIA cervical cancer following primary surgical treatment.

ObjectiveThis study evaluates the effect of the specific human papillomavirus (HPV) genotype as a prognostic factor in stage I-IIA cervical cancer patients following primary surgical treatment.MethodsThe medical records of 116 cervical cancer patients treated with primary surgical treatment were reviewed. The HPV genotypes were categorized into following groups: negative and unclassified, HPV 16, HPV 18, and other high risk (HPV 31, 33, 35, 45, 51, 52, 56, and 58).ResultsAmong the HPV genotypes, HPV 16 predominated (40.52%), followed by intermediate risk and unclassified (25%), HPV 18, 45, and 56 (17.24%) and negative (17.24%). In univariate analysis, HPV genotypes (P=0.03), parametrial spread (P=0.02), depth of invasion (DOI) (P<0.01) and lymph-vascular space invasion (P=0.02) were significantly associated with progression free survival (PFS). In multivariate analysis, HPV 18 (hazard ratio [HR], 5.2; 95% confidence interval [CI], 1.29 to 20.90; P=0.02) and ≥one half of DOI (HR, 5.4; 95% CI, 1.08 to 27.31; P=0.04) were significantly associated with PFS. HPV genotypes are not significantly associated with overall survival.ConclusionHPV 18 was a poor prognostic factor for the PFS in stage I-IIA cervical cancer patients following primary surgical treatment. Careful long-term observation and regular exams are recommended for cervical cancer patients with HPV 18 compared to those with other HPV genotypes.

Prospects and limitations for cervical and breast cancer prevention: the experience of the Guarus Health Center users, in Campos dos Goytacazes, RJ

This article analyzes the factors that prevent women from seeking gynecological care and, therefore, taking regular exams concerning the prevention of cervical and breast cancer. This study is a qualitative and quantitative research based on interviews, through individual questionnaires, applied to clients of the Guarus Health Center Gynecology Service, in Campos dos Goytacazes, State of Rio de Janeiro, adopting as parameters the National Women’s Health Assistance Policy settings, as well as related bibliography. Results indicate that the coverage of annual mammogram and Pap smear tests fail to respond to the National Women’s Health Assistance Policy and Pact for Health 2010-2011 guidelines, and that performing gynecology exams is limited by socioeconomic, subjective, cultural and institutional factors – the latter being predominant; differing from the related literature, in which subjective and cultural aspects stand out above the others.

Variations in breast cancer awareness among urban Tanzanian women.

e12561 Background: Nearly 70% of the 7.6 million cancer deaths occur annually in developing countries like Tanzania, with breast cancer being among the most common causes of cancer mortality. Although data are incomplete, late-stage disease is believed to limit breast cancer control in Tanzania, with delayed diagnosis linked to low levels of breast cancer awareness among women. The goal of this study was to explore awareness of this disease among low-income women accessing routine medical care from three district hospitals in Dar es Salaam, Tanzania. Methods: This survey-based study examined participants' knowledge, attitudes, and beliefs regarding breast cancer causes, risk factors, symptoms, early detection measures, treatment, and preferred education sources. Sociodemographic variations in knowledge of breast cancer risk factors, symptoms, and treatments were assessed. Results: Two hundred and twenty-five women, ages 18-55 years, participated. Over half (52%) reported a primary school education or less; 69.9% were married; 26.2% were unemployed. The average monthly household income was just below the Dar es Salaam mean. Ninety-eight percent were aware of breast cancer; 22% knew someone with a history of breast cancer. Among the 126 women who heard of breast self exam, 25% and 34% practiced it regularly and occasionally, respectively; 41% never practiced it. Only 6.2% had regular clinical breast exams. A minority knew of mammography (32%); &lt;2% had undergone a mammogram. Of the items listed, respondents correctly identified symptoms (51%), risk factors (31%), and treatments (51%). Data reflecting sociodemographic variations in knowledge will be shown. Preferred sources of breast cancer educational materials included group sessions, television or radio programs, and meetings with breast cancer survivors. Conclusions: This work provides valuable insight into preferred sources of breast cancer education among Tanzanian women.

The Relationship between Epistemic Beliefs and Academic Performance: Are Better Students always More Mature?

This study investigates the relationship between epistemic beliefs and academic performance among a group of high school students in United Arab Emirates (UAE). Despite some contradictions, the general trend in the literature is that more mature students usually outperform students with naïve epistemic beliefs. We hypothesized that this relationship is reciprocal and learning strategies and task demands play a key role in building the schemas of epistemic beliefs. Accordingly, the requirements of traditional teaching and assessment methods might lead students to adopt less advanced epistemic beliefs that might be consistent with traditional learning strategies and task demands. To test this hypothesis, we compared the epistemic beliefs of high, average, and low level students (n = 165) in the traditional, developing educational system in UAE. Students were classified according to their performance on two formats of assessment; the regular exams and the continuous evaluation, using Arabic, standardized version of Epistemic beliefs Inventory prepared by Schraw et al, (2002). For the two assessment formats, the results were inconsistent with the traditional findings in the literature as advanced and medium students got higher scores (immature beliefs) than low level students on most epistemic beliefs, with the exception of the beliefs in Innate Ability (IA), where weak students got higher epistemic beliefs than advanced or medium level students. The results were discussed as an indication that academically better students were more able to adapt to the system requirement by adopting naïve epistemic beliefs. Also, the results were discussed within the Arab/Emirati cultural context.

Learning through role-playing games: an approach for active learning and teaching

This study evaluates the use of role-playing games (RPGs) as a methodological approach for teaching cellular biology, assessing student satisfaction, learning outcomes, and retention of acquired knowledge. First-year undergraduate medical students at two Brazilian public universities attended either an RPG-based class (RPG group) or a lecture (lecture-based group) on topics related to cellular biology. Pre- and post-RPG-based class questionnaires were compared to scores in regular exams and in an unannounced test one year later to assess students' attitudes and learning. From the 230 students that attended the RPG classes, 78.4% responded that the RPG-based classes were an effective tool for learning; 55.4% thought that such classes were better than lectures but did not replace them; and 81% responded that they would use this method. The lecture-based group achieved a higher grade in 1 of 14 regular exam questions. In the medium-term evaluation (one year later), the RPG group scored higher in 2 of 12 questions. RPG classes are thus quantitatively as effective as formal lectures, are well accepted by students, and may serve as educational tools, giving students the chance to learn actively and potentially retain the acquired knowledge more efficiently.

Abstract 5510: Assessing the level of breast cancer awareness among recently diagnosed patients in Ain Shams University Hospital

Abstract Introduction: 97% of Egyptian breast cancer patients are diagnosed at advanced stage, 70.6% possess positive lymph node metastasis on diagnosis while only 29.4% are free of metastasis reflecting late presentation of Egyptian patients. PURPOSE: Assess the level of knowledge about breast cancer among recently diagnosed breast cancer patients at Ain Shams University Hospitals. METHODS: In a cross-sectional, analytical observational study, we randomly enrolled 289 breast cancer patients with 45 of them who were recently diagnosed at Ain Shams University Hospitals meeting our inclusion criteria.Recurring patients or those unaware of diagnosis were excluded. Patients were interviewed using a specially designed questionnaire -of 75 questions over 60 minutes. Questionnaire gathered socio-demographic information, maternity history and tested knowledge of risk factors, signs and symptoms, screening options, management and prognosis of breast cancer was tested. Data was correlated to TNM staging. RESULTS: Patients’ age ranged between 30-72 years (mean 48±10.19). 40% were illiterate and only 15.6% finished higher education with 6-month average delay in seeking medical attention. Among the 45, TNM staging was assessed in 19 patients. Although 93% knew painless mass was symptom of breast cancer, 69% presented with painless mass and 47% knew someone with breast cancer prior to diagnosis, yet 24% thought they might have breast cancer. Regarding regular clinical breast exam 58% agreed to have it but 60% didn't know what was mammography, 56% didn't hear about breast self-exam and only 22% knew breast cancer had risk factors. Moreover, 58% thought treatment caused patients to be very ill, 29% thought breast cancer had good survival, yet 75% thought breast cancer is curable. Total breast cancer knowledge scores were low, with a median of 13 (out of 35) and mean of 12.64 ±5.12. CONCLUSIONS: Patients had acceptable awareness about breast cancer symptoms yet displayed gross ignorance about risk factors and poor awareness about screening, management and prognosis, correlating with their advanced TNM score. Therefore, raising breast cancer awareness and promoting education and early detection among our community is important. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5510. doi:1538-7445.AM2012-5510

Predicting academic success in higher education: what’s more important than being smart?

This study investigated the combined predictive validity of intelligence and personality factors on multiple measures of academic achievement. Students in a college of higher education in the Netherlands (N = 137) completed a survey that measured intelligence, the Big Five personality traits, motivation, and four specific personality traits. Student performance was measured with grade point average (GPA) and time to graduation, as well as with five specific performance measures: regular exams, skills training, team projects, internships, and a written thesis. Results show that 33% of the variance in GPA and 30% of the variance in time to graduation can be explained by combining intelligence, personality, and motivational predictors. Conscientiousness is the best predictor across a broad spectrum of academic achievement measures and explains five times as much variance in GPA as does intelligence. The practical implications are that institutes of higher education should collect personality data on students at the outset and then help students accordingly. Highly conscientious students who are organized and internally motivated might potentially be offered more challenging honours programs with corresponding special commendations on their diplomas, whereas students who score low on conscientious would receive more structure through student study groups, frequent deadlines, shorter assignments, group assignments, clearly defined learning goals, and less second chances for passing examinations.

Nurse practitioner knowledge of child sexual abuse in children with cognitive disabilities

The purpose of this study was to describe the knowledge level of nurse practitioners regarding symptoms of child sexual abuse in children with cognitive disabilities. A total sample of 43 nurse practitioners from two professional nurse practitioner organizations was surveyed to assess child sexual abuse symptoms identification in intellectually disabled children using a revised edition of the Child Sexual Abuse Knowledge Survey. Data collected showed nurse practitioners have deficits in identifying various parts of prepubescent female genitalia. The majority of nurse practitioners did not check genitalia in regular physical exams, did not feel competent to perform this type of evaluation, and were not aware of their professional organizations' position regarding checking for child sexual abuse. When assessing a child with an intellectual disability, nurse practitioners must accurately assess physical symptoms and behaviors that could have resulted from sexual abuse. Examining children for sexual abuse is a required duty of the nurse practitioner as evidenced by the position statements of the various professional organizations and nurse practitioners must be aware of their required scope of practice.

Die asymptomatische Aortenstenose

In patients with symptomatic severe aortic stenosis (AS) therapeutic decision is straightforward and aortic valve replacement is strongly recommended. In asymptomatic AS patients clinical strategy is controversial and challenging. Prospective studies suggest a watchful waiting approach in the majority of patients with regular follow-up exams. Defining symptomatic status related to the disease can be particularly difficult in the elderly and patients with comorbidities. A robust measurement of AS severity is mandatory in this context. Nevertheless some patients with asymptomatic AS benefit from early valve replacement and reliable risk stratification for identification of high-risk patients is of importance. This review article will outline relevant clinical studies and guidelines on management of asymptomatic AS patients.

Self esteem, optimism and exams’ anxiety among high school students

The study aims to examine the impact of optimism and exams’ anxiety on high school students’ self esteem. 200 students from four high schools from Bucharest, Romania participated in the study, 100 facing an upcoming national examination (class 12) and 100 with only their regular exams (class 10), 82 male and 118 female, aged 15 - 19 years (M = 16,78, SD = 1,281). Data were collected with three self-rating questionnaires assessing optimism, self esteem and anxiety.The research's results could be used by school counsellors in developing programs aiming to increase their ability to maintain constant their self-esteem even in uncertain and adverse conditions.

Virtual patient simulation: what do students make of it? A focus group study

BackgroundThe learners' perspectives on Virtual Patient Simulation systems (VPS) are quintessential to their successful development and implementation. Focus group interviews were conducted in order to explore the opinions of medical students on the educational use of a VPS, the Web-based Simulation of Patients application (Web-SP).MethodsTwo focus group interviews-each with 8 undergraduate students who had used Web-SP cases for learning and/or assessment as part of their Internal Medicine curriculum in 2007-were performed at the Faculty of Medicine of Universidad el Bosque (Bogota), in January 2008. The interviews were conducted in Spanish, transcribed by the main researcher and translated into English. The resulting transcripts were independently coded by two authors, who also performed the content analysis. Each coder analyzed the data separately, arriving to categories and themes, whose final form was reached after a consensus discussion.ResultsEighteen categories were identified and clustered into five main themes: learning, teaching, assessment, authenticity and implementation. In agreement with the literature, clinical reasoning development is envisaged by students to be the main scope of VPS use; transferable skills, retention enhancement and the importance of making mistakes are other categories circumscribed to this theme. VPS should enjoy a broad use across clinical specialties and support learning of topics not seen during clinical rotations; they are thought to have a regulatory effect at individual level, helping the students to plan their learning. The participants believe that assessment with VPS should be relevant for their future clinical practice; it is deemed to be qualitatively different from regular exams and to increase student motivation. The VPS design and content, the localization of the socio-cultural context, the realism of the cases, as well as the presence and quality of feedback are intrinsic features contributing to VPS authenticity.ConclusionsFive main themes were found to be associated with successful VPS use in medical curriculum: Learning, Teaching, Assessment, Authenticity and Implementation. Medical students perceive Virtual Patients as important learning and assessment tools, fostering clinical reasoning, in preparation for the future clinical practice as young doctors. However, a number of issues regarding VPS design, authenticity and implementation need to be fulfilled, in order to reach the potential educational goals of such applications.

Environmental and Occupational Health Risks Among Agricultural Workers Living in a Rural Community Near Petroleum Refinery and Motorway in Skopje Region

To assess health risks in agricultural workers associated with environmental exposure to pollutants released from a petroleum refinery and from traffic, we performed a cross-sectional study that included 119 randomly selected subjects divided in two groups. Group 1 included 60 agricultural workers living in a rural community near the petroleum refinery and a motorway overpass, whereas Group 2 consisted of 59 agricultural workers performing similar activities and living in a rural community with no exposure to industrial and traffic pollutants. Risk assessment included a questionnaire, blood pressure measurement, spirometry, laboratory tests, and toxicological analysis. The groups showed a similar prevalence of health problems, with exception of muscle pain in the extremities, headache, and fatigue, which were significantly more common in Group 1. Diastolic blood pressure was higher in Group 1, but not significantly (p=0.057). The same is true for blood carbon monoxide. Significantly higher in Group 1 were blood haemoglobin (p=0.001) and blood lead (p<0.001). Serum cholinesterase activity was similar in both groups. Our findings indicate the need of regular medical exams, ambient monitoring and environmental impact assessment in agricultural population in order to detect individuals at risk and to institute adequate preventive measures.

Abstract PL05-04: From basic science to public health: The Canadian approach to oral leukoplakia

Abstract PL05-04: From basic science to public health: The Canadian approach to oral leukoplakia

Virtual patient simulation for learning and assessment: Superior results in comparison with regular course exams

Background: Our study aimed to observe the differences in assessment results between virtual patient simulation (VPS) and regular course exams in an Internal Medicine course for undergraduate medical students.Methods: Four cohorts of students (n = 216) used: a VPS or lectures for learning (terms 1 and 2); VPS and lectures or only lectures (term 3); and a paired set-up with both VPS and lectures (term 4). The assessment results, measured with both a VPS-based exam and a paper-based exam, were compared. A scoring rubric (0–6), developed and validated for the purpose of the trial, was applied to both types of assessment. Mean score differences of the results were compared for the four cohorts.Results: Both VPS and regular examination results were significantly higher in the VPS group compared to regular exam group (p < 0.001) in terms 1, 2 and 3. The paired mean difference in term 4 was 0.66 (95% confidence interval (CI) 0.50, 0.83; p < 0.001) for haematology and 0.57 (95% CI 0.45, 0.69; p < 0.001) for cardiology.Conclusion: Our findings suggest that using VPS both for learning and for assessment supports learning. VPS are better than traditional assessment methods when the virtual application is used for both learning and evaluation.

Virtual patient simulation: Knowledge gain or knowledge loss?

Background: Virtual patients (VPs), high-fidelity simulators and standardized patients are powerful educational interventions leading to effective learning and supporting knowledge retention.Aim: This study explored the variations in retention with VP versus regular learning activities.Method: We conducted a randomized controlled study on early and delayed assessment results of 49 students using VP for learning and examination of haematology and cardiology topics in an Internal Medicine course, by means of a 0–10 scoring rubric.Results: The mean difference for early assessment with VP (study – control mean score) was 1.43 (95% confidence interval (CI) 0.96, 1.91; p < 0.001) for haematology and 1.34 (95% CI 0.93, 1.76; p < 0.001) for cardiology. In regular exams, the mean score difference was 2.21 (95% CI 1.3, 3.1; p < 0.001) and 1.52 (95% CI 0.76, 2.28; p < 0.001), respectively. With delayed assessments, the difference in mean score for Web-SP was 1.48 (95% CI 1.09, 1.86; p < 0.001), haematology and 1.16 (95% CI 0.74, 1.58; p < 0.001), cardiology; for regular exams the figures were 1.96 (95% CI 0.93, 2.98; p < 0.001) and 1.74 (95% CI 0.89, 2.58; p < 0.001). The effect size ranged from 0.5 to 0.8.Conclusion: Our results indicate better retention with VP than with traditional learning methods.

Metastasen eines malignen Melanoms als ausgedehnte Raumforderung in der Trachea

We report the case of a 71-year-old man, who was transferred to our clinic with rapidly increasing dyspnea. On examination by flexible bronchoscopy the trachea was found to be almost completely obstructed by metastatic masses of a malignant melanoma. After endoscopic removal of the obstruction, we inserted a covered nitinol stent which led to instantaneous relief of symptoms. Chemotherapy and local radiotherapy were instituted. During the next 9 months there were no signs of recurrence of the tumour in regular pneumological control exams.