Using a Computer Module to Teach Use of the EpiPen®

Background: The medical literature suggests that patients and physicians are deficient in their ability to use a self-injectable epinephrine device (EpiPen®) for management of anaphylaxis. This study aims to determine whether a computer module is an effective tool for the instruction of a technical skill to medical trainees.Methods: We conducted a two group comparison study of 35 Post-Graduate Year 1 and 2 Family Medicine residents. Participants were instructed on use of the EpiPen® using either a written module or a computer module. Participants were evaluated on use of the EpiPen® using standardized objective outcome measures by a blinded assessor. Assessments took place prior to and following instruction, using the assigned learning modality.Results: There were 34 participants who completed the study. Both groups demonstrated significant improvement in demonstrating use of the EpiPen® following training (p <0.001 for both). A significant post-training difference favouring the computer module learners over the written module learners was observed (p = 0.035). However, only 53% and 18% of candidates (computer module and written module, respectively) were able to correctly perform all of the checklist steps.Conclusion: While our findings suggest computer modules represent an effective modality for teaching use of the EpiPen® to medical trainees, the low number of candidates who were able to perform all the checklist items regardless of modality needs to be addressed

Medicine and the Internet Computing for Cancer: the role of distributed computing in cancer research

Computers have always been used in medicine for patient management, personal research and communication. Recently, the utilization of massively parallel processing, brought about by distributed computing grids, has allowed for cancer researchers to develop drugs and test therapies at speeds never before available. The use of distributed computing in testing molecules for their cancer protein binding potential, automated tissue microarray analysis and tumour growth modeling are all currently promising research areas. Despite some inherent challenges, distributed computing may one day be used extensively in all areas of medical research. This article has been reviewed by Dr. Eric Wong and by Dr. Wayne Weston and by Dr. Victor Han. The Internet may be synonymous with browsing and email, but its utility is much greater. The Internet is often used to garner information, be it a patient searching for facts regarding a recent diagnosis, or a physician trying to find the latest published research on treatment for an obscure disease. A conceptual link which is not immediately made, however, is the applicability of computers and the Internet in producing potential breakthroughs in cancer research. Cancer research has traditionally focused on exploring epidemiology, practical experiments in molecular biology, clinical trials of potential medications or therapies and, more recently, an exploration of immunotherapy and gene therapy. It is a direct extension of cancer research’s foray into molecular biology and genetics which has ushered in the use of computers in the oncological arena. History of distributed computing Since the birth of computers over fifty years ago, the raw speed of computation has increased by a factor of over one million. 1 Despite this increase in computational power, personal computers are still considered extremely slow in terms of requirements for solving highly complex scientific problems. 1 Cancer research is one such area where the complexity of molecular and biological interactions practically precludes the use of even modern personal computers in any but the simplest experiments. One method of solving this problem emerged in the 1980’s, and involved clustering multiple individual computers to form what was termed

Nasopharyngeal Angiofibroma: A Forgotten Entity in Older Patients

Introduction: Nasopharyngeal angiofibroma (NA) characteristically affects adolescent men. Although benign, these tumors can cause local destruction and surgical resection is warranted. Objective: We present a case of a 62-year-old man with nasal congestion and epistaxis, found to be a right NA on pathology. We also present a review of the available NA staging systems. Findings: In this case of NA, imaging revealed an aggressive, hypervascular mass in the nasal cavity with involvement of the middle cranial fossa and cavernous sinus. The patient underwent complete endoscopic surgical resection following vascular embolization. Conclusion: Although it is rare, NA should not be disregarded in the elderly population

Nasopharyngeal Angiofibroma: A Forgotten Entity in Older Patients

Introduction: Nasopharyngeal angiofibroma (NA) characteristically affects adolescent men. Although benign, these tumors can cause local destruction and surgical resection is warranted. Objective: We present a case of a 62-year-old man with nasal congestion and epistaxis, found to be a right NA on pathology. We also present a review of the available NA staging systems. Findings: In this case of NA, imaging revealed an aggressive, hypervascular mass in the nasal cavity with involvement of the middle cranial fossa and cavernous sinus. The patient underwent complete endoscopic surgical resection following vascular embolization. Conclusion: Although it is rare, NA should not be disregarded in the elderly population

Nasopharyngeal Angiofibroma: A Forgotten Entity in Older Patients

Introduction: Nasopharyngeal angiofibroma (NA) characteristically affects adolescent men. Although benign, these tumors can cause local destruction and surgical resection is warranted. Objective: We present a case of a 62-year-old man with nasal congestion and epistaxis, found to be a right NA on pathology. We also present a review of the available NA staging systems. Findings: In this case of NA, imaging revealed an aggressive, hypervascular mass in the nasal cavity with involvement of the middle cranial fossa and cavernous sinus. The patient underwent complete endoscopic surgical resection following vascular embolization. Conclusions: Although it is rare, NA should not be disregarded in the elderly population

Lymphadenopathy: what defines a palpable lymph node?

BACKGROUND: The threshold size required to detect lymphadenopathy via palpation has never been formally determined. The purpose of this study was to determine the threshold, sensitivity, and error of node palpation and how this changes with experience. METHODS: Lymphadenopathy models were created using polyvinyl alcohol cryogel (PVA-C) to mimic tissue tactility. Node diameter ranged from 0.5 to 4 cm. Study subjects were medical students, otolaryngology residents, and otolaryngology consultants. Each subject provided 22 estimates of size. Primary outcomes were the sensitivity, error (true vs estimated size), and threshold of palpation. RESULTS: Thirty subjects completed the study. Sensitivity was 60%, 74%, and 86% for students, residents, and consultants, respectively (p < .01). Error was 0.88 cm, 0.61 cm, and 0.57 cm, respectively (p < .05). Palpation threshold was 1.32 cm, 0.83 cm, and 0.75 cm, respectively (p < .05). All participants detected nodes 652 cm, whereas consultants detected nodes 651 cm.Peer reviewed: YesNRC publication: Ye

Primary care specialty career choice among Canadian medical students Understanding the factors that influence their decisions Web exclusive

Abstract Objective To identify which factors influence medical students&apos; decision to choose a career in family medicine and pediatrics, and which factors influence their decision to choose careers in non-front-line specialties. Design Survey that was created based on a comprehensive literature review to determine which factors are considered important when choosing practice specialty. Setting Ontario medical school. Participants An open cohort of medical students in the graduating classes of 2008 to 2011 (inclusive). Main outcome measures The main factors that influenced participants&apos; decision to choose a career in primary care or pediatrics, and the main factors that influenced participants&apos; decision to choose a career in a non-frontline specialty. Results A total of 323 participants were included in this study. Factors that significantly influenced participants&apos; career choice in family medicine or pediatrics involved work-life balance (acceptable hours of practice [P = .005], acceptable on-call demands [P = .012], and lifestyle flexibility [P = .006]); a robust physician-patient relationship (ability to promote individual health promotion [P = .014] and the opportunity to form longterm relationships [P &lt; .001], provide comprehensive care [P = .001], and treat patients and their families [P = .006]); and duration of residency program (P = .001). The career-related factors that significantly influenced participants&apos; decision to choose a non-front-line specialty were as follows: becoming an expert (P &lt; .001), maintaining a focused scope of practice (P &lt; .001), having a procedure-focused practice (P = .001), seeing immediate results from one&apos;s actions (P &lt; .001), potentially earning a high income (P &lt; .001), and having a perceived status among colleagues (P &lt; .001). Conclusion In this study, 8 factors were found to positively influence medical students&apos; career choice in family medicine and pediatrics, and 6 factors influenced the decision to choose a career in a non-front-line specialty. Medical students can be encouraged to explore a career in family medicine or pediatrics by addressing misinformation, by encouraging realistic expectations of career outcomes in the various specialties, and by demonstrating the capacity of primary care fields to incorporate specific motivating factors. Primary care specialty career choice among Canadian medical students Understanding the factors that influence their decisions Web exclusive EDITOR&apos;S KEY POINTS • Medical students&apos; decisions regarding specialty contribute to the formation of the national physician work force. It is important to determine the main factors that lead students to choose non-front-line specialist careers in order to have insight into whether interest in front-line specialties can be enhanced through increased educational exposure, illumination of existing misinformation, or modification of current practice opportunities. • The authors surveyed medical students at the time that they were applying to the residency match to determine what factors influenced their choice of specialty. • Status was considered important by more than 40% of respondents. However, students did not view status as equal among specialties; 89% of those interested in non-front-line specialties believed it was a positive influence on their choice of specialty, whereas only 41% of those interested in primary care believed it to be a positive influence on their choice of specialty. Recherche Résumé Objectif Cerner les principaux facteurs qui influencent les étudiants en médecine à choisir une carrière en médecine familiale ou en pédiatrie et ceux qui les amènent plutôt à choisir une autre spécialité

Objective and Subjective associations in Chronic Rhinosinusitis

We sought to determine whether there existed a correlation within our population of medically recalcitrant CRS patients. Ours is the second largest study to look at this correlation Ours is the first study to use a mixed effects model for analysis Presentation: 6:4