On line clinical reasoning assessment with Script Concordance test in urology: results of a French pilot study

BACKGROUND: The Script Concordance test (SC) test is an assessment tool that measures the capacity to solve ill-defined problems, that is, reasoning in a context of uncertainty. This study assesses the feasibility, reliability and validity of the SC test made available on the Web to French urologists. METHODS: A 97 items SC test was developed based on major educational objectives of French urology training programmes. A secure Web site was created with two sequential modules: a) The first one for the reference panel to elaborate the scoring system; b) The second for candidates with different levels of experience in urology: Board certified urologists, chief-residents, residents, medical students. All participants were recruited on a voluntary basis. Statistical analysis included descriptive statistics of the participants' scores and factorial analysis of variance (ANOVA) to study differences between groups' means. Reliability was evaluated with Cronbach's alpha coefficient. RESULTS: The on line SC test has been operational since June 2004. Twenty-six faculty members constituted the reference panel. During the following 10 months, 207 participants took the test online (124 urologists, 29 chief-residents, 38 residents, 16 students). No technical problem was encountered. Forty-five percent of the participants completed the test partially only. Differences between the means scores for the 4 groups were statistically significant (P = 0.0123). The Bonferroni post-hoc correction indicated that significant differences were present between students and chief-residents, between students and urologists. There were no differences between chief-residents and urologists. Reliability coefficient was 0.734 for the total group of participants. CONCLUSION: Feasibility of Web-based SC test was proved successful by the large number of participants who participated in a few months. This Web site has permitted to quickly confirm reliability of the SC test and develop strategy to improve construct validity of the test when applied in the field of urology. Nevertheless, optimisation of the SC test content, with a smaller number of items will be necessary. Virtual medical education initiative such as this SC test delivered on the Internet warrants consideration in the current context of national pre-residency certification examination in France

Decim v2

The original publication is available at www.springerlink.comIn this paper, we present Decimv2, a stream cipher hardware- oriented selected for the phase 3 of the ECRYPT stream cipher project eSTREAM. As required by the initial call for hardware-oriented stream cipher contribution, Decimv2 manages 80-bit secret keys and 64-bit public initialization vectors. The design of Decimv2 combines two filtering mechanisms: a nonlinear Boolean filter over a LFSR, followed by an irregular decimation mechanism called the ABSG. Since designers have been invited to demonstrate flexibility of their design by proposing vari-ants that take 128-bit keys, we also present a 128-bit security version of Decim called Decim-128

Online clinical reasoning assessment with the Script Concordance test: a feasibility study

BACKGROUND: The script concordance (SC) test is an assessment tool that measures capacity to solve ill-defined problems, that is, reasoning in context of uncertainty. This tool has been used up to now mainly in medicine. The purpose of this pilot study is to assess the feasibility of the test delivered on the Web to French urologists. METHODS: The principle of SC test construction and the development of the Web site are described. A secure Web site was created with two sequential modules: (a) The first one for the reference panel (n = 26) with two sub-tasks: to validate the content of the test and to elaborate the scoring system; (b) The second for candidates with different levels of experience in Urology: Board certified urologists, residents, medical students (5 or 6(th )year). Minimum expected number of participants is 150 for urologists, 100 for residents and 50 for medical students. Each candidate is provided with an individual access code to this Web site. He/she may complete the Script Concordance test several times during his/her curriculum. RESULTS: The Web site has been operational since April 2004. The reference panel validated the test in June of the same year during the annual seminar of the French Society of Urology. The Web site is available for the candidates since September 2004. In six months, 80% of the target figure for the urologists, 68% of the target figure for the residents and 20% of the target figure for the student passed the test online. During these six months, no technical problem was encountered. CONCLUSION: The feasibility of the web-based SC test is successful as two-thirds of the expected number of participants was included within six months. Psychometric properties (validity, reliability) of the test will be evaluated on a large scale (N = 300). If positive, educational impact of this assessment tool will be useful to help urologists during their curriculum for the acquisition of clinical reasoning skills, which is crucial for professional competence

Focal non granulomatous orchitis in a patient with Crohn’s disease

Crohn’s disease is a systemic disease and sometimes involves the testicle, usually leading to granulomatous lesions. We report herein a case of focal non-granulomatous orchitis in a 21-year-old patient with active Crohn’s disease treated by an anti-tumor necrosis factor monoclonal antibody. This circumscribed testicular lesion mimicked a tumor, leading to orchiectomy. Pre-operative blood tests (i.e. alpha-fetoprotein, lactate dehydrogenase and human chorionic gonadotrophin) were strictly normal Pathological examination of the testicle revealed a focal inflammatory infiltrate predominantly composed of lymphocytes accompanied by few plasma cells, lacking giant cells or granulomas. Importantly, intratubular germ cell neoplasia, atrophy or lithiasis were not observed. After discussing and excluding other plausible causes (burnt-out /regressed germ cell tumor, infection, vascular or traumatic lesions, iatrogenic effects), we concluded that this particular case of orchitis was most likely an extra-digestive manifestation of inflammatory bowel disease. To our knowledge, this is the first described case of focal non-granulomatous orchitis associated with Crohn’s disease. Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/211774728416011

Birth‐weight differences at term are explained by placental dysfunction and not by maternal ethnicity

Objective To investigate the influence of ethnicity, fetal gender and placental dysfunction on birth weight (BW) in term fetuses of South Asian and Caucasian origin. Methods This was a retrospective study of 627 term pregnancies assessed at two public tertiary hospitals in Spain and Sri Lanka. All fetuses underwent biometry and Doppler examinations within 2 weeks of delivery. The influences of fetal gender and ethnicity, gestational age (GA) at delivery, cerebroplacental ratio (CPR) and maternal age, height, weight and parity on BW were evaluated by multivariable regression analysis. Results Fetuses born in Sri Lanka were smaller than those born in Spain (mean BW = 3026 ± 449 g vs 3295 ± 444 g; P < 0.001). Multivariable regression analysis demonstrated that GA at delivery, maternal weight, CPR, maternal height and fetal gender (estimates = 0.168, P < 0.001; 0.006, P < 0.001; 0.092, P = 0.003; 0.009, P = 0.002; 0.081, P = 0.01, respectively) were associated significantly with BW. Conversely, no significant association was noted for maternal ethnicity, age or parity (estimates = −0.010, P = 0.831; 0.005, P = 0.127; 0.035, P = 0.086, respectively). The findings were unchanged when the analysis was repeated using INTERGROWTH‐21st fetal weight centiles instead of BW (log odds, −0.175, P = 0.170 and 0.321, P < 0.001, respectively for ethnicity and CPR). Conclusion Fetal BW variation at term is less dependent on ethnic origin and better explained by placental dysfunction. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd

Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis

<p>Abstract</p> <p>Background</p> <p>There is currently a lack of consensus for the diagnosis, investigations and treatments of acute bacterial prostatitis (AP).</p> <p>Methods</p> <p>The symptoms, investigations and treatments of 371 inpatients diagnosed with AP were analyzed through a retrospective study conducted in four departments – Urology (U), Infectious Diseases (ID), Internal Medicine (IM), Geriatrics (G) – of two French university hospitals.</p> <p>Results</p> <p>The cause of admission, symptoms, investigations and treatments depended markedly on the department of admission but not on the hospital. In U, patients commonly presented with a bladder outlet obstruction, they had a large imaging and functional check-up, and received alpha-blockers and anti-inflammatory drugs. In ID, patients were febrile and received longer and more appropriate antibiotic treatments. In G, patients presented with cognitive disorders and commonly had post-void urine volume measurements. In IM, patients presented with a wide range of symptoms, and had very diverse investigations and antibiotic regimen.</p> <p>Overall, a 3:1 ratio of community-acquired AP (CA-AP) to nosocomial AP (N-AP) was observed. Urine culture isolated mainly <it>E. coli </it>(58% of AP, 68% of CA-AP), with venereal agents constituting less than 1%. The probabilistic antibiotic treatments were similar for N-AP and CA-AP (58% bi-therapy; 63% fluoroquinolone-based regimen). For N-AP, these treatments were more likely to be inadequate (42% <it>vs. </it>8%, p < 0.001) and had a higher rate of bacteriological failure (48% <it>vs. </it>19%, p < 0.001).</p> <p>Clinical failure at follow-up was more common than bacteriological failure (75% versus 24%, p < 0.001). Patients older than 49 had more underlying urinary tract disorders and a higher rate of clinical failure (30% versus 10%, p < 0.0001).</p> <p>Conclusion</p> <p>This study highlights the difficulties encountered on a daily basis by the physicians regarding the diagnosis and management of acute prostatitis.</p

Test de concordance de script et développement professionnel continu (DPC) : un mariage qui ne peut être que réussi !

International audienceCrohn's disease is a systemic disease and sometimes involves the testicle, usually leading to granulomatous lesions. We report herein a case of focal non-granulomatous orchitis in a 21-year-old patient with active Crohn's disease treated by an anti-tumor necrosis factor monoclonal antibody. This circumscribed testicular lesion mimicked a tumor, leading to orchiectomy. Pre-operative blood tests (i.e. alpha-fetoprotein, lactate dehydrogenase and human chorionic gonadotrophin) were strictly normal Pathological examination of the testicle revealed a focal inflammatory infiltrate predominantly composed of lymphocytes accompanied by few plasma cells, lacking giant cells or granulomas. Importantly, intratubular germ cell neoplasia, atrophy or lithiasis were not observed.After discussing and excluding other plausible causes (burnt-out /regressed germ cell tumor, infection, vascular or traumatic lesions, iatrogenic effects), we concluded that this particular case of orchitis was most likely an extra-digestive manifestation of inflammatory bowel disease. To our knowledge, this is the first described case of focal non-granulomatous orchitis associated with Crohn's disease. Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2117747284160112

Etude de l'estradiol et de la testostérone dans le sang spermatique chez les patients avec azoospermie non obstructive en fonction de la présence ou non de spermatozoïdes testiculaires

But : Comparaison des hormones sexuelles (testostérone, estradiol) dans le sang du cordon spermatique et dans le sang périphérique, en fonction du résultat de l'extraction de spermatozoïdes testiculaires dans une population de patients présentant une azoospermie non obstructive (ANO). Méthode : Etude prospective comparative (CHU promoteur, avec accord du CCPRB) de 30 patients présentant une ANO. Pour chaque patient a été réalisés simultanément des dosages plasmatiques de testostérone et d'estradiol (E2) dans le sang périphérique (Tp et E2p) et au niveau de la veine spermatique (Ts et E2s), au moment de l'extraction chirurgicale. L'analyse comparative des résultats hormonaux et de l'extraction a été réalisée à l'aide du test de Mann-Whitney et du test de corrélation de Spearmann, et analyse de variances uni et multivariées (p< 0,005). Conclusion : Le rapport E2s/Ts apparaît significativement augmenté en cas d'extraction négative (p = 0,018), traduisant une activité aromatase plus importante en cas d'absence de cellules germinales haploïdes. Des études avec d'autres marqueurs, en particulier tisssulaires (activité aromatase, expression du gène CYP 19), sont nécessaires pour confirmer le rôle physiologique de l'E2 dans la spermatogenèse et pour mettre en évidence des critères de sélection des biopsies testiculaires chez les patients présentant une ANO.ROUEN-BU Médecine-Pharmacie (765402102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Etude prospective de traitement des sténoses urétérales localisées par prothèse grillagée métallique

But : évaluation de l'efficacité des prothèses grillagées métalliques Mémotherm® BARD® dans le traitement des sténoses urétérales. Matériel et méthodes : étude pilote, prospective évaluant la fréquence des récidives sténotiques après traitrement par prothèses métalliques. Douze patients ayant une sténose urétérale étagée d'étiologie variable (9 néoplasiques, 3 bénignes) ont été inclus sur une période de quatre ans. Le suivi a été assuré par ASP, échographie ou UIV à 1, 3, 6, 12, 18 et 24 mois. Résultats : le suivi moyen est de 14 mois et 14 jours. Le taux de récidive des sténoses urétérales est de 41,6% (5 patients). Le taux d'échec est de 33,3% (4 patients). L'âge moyen est de 68 ans (47-91), on note une nette prédominance féminine (75%), l'étiologie est principalement néoplasique (75%). Aucun problème technique lors de la pose n'a été constaté. La tolérance s'est avérée excellente ( de 75 à 100% des patients restants asymptomatiques). La morbidité de cette technique est faible (une seule néphrectomie pour rein détruit). Nous n'avons pas constaté d'incrustation, d'infection ou de migration de prothèse. Plus de la moitié des patients sont décédés (58,3%), en effet la meilleur indication du traitement est palliative dans les sténoses extrinsèques néoplasiques. La plupart des récidives sténotiques s'expliquent par l'envahissement tumoral. Conclusion : Nous avons constaté un taux important de récidives mais il est comparable à celui du traitement de référence (sonde urétérale JJ), par contre la tolérance et la morbidité se sont avérées satisfaisantes, avec un bon confort de vie, chez les patients survivants. Ce type de matérel, sous réserve d'amélioration technique, a sa place dans la stratégie thérapeutique de prise en charge des sténoses urétérales chez les patients fragiles.ROUEN-BU Médecine-Pharmacie (765402102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF