Regulatory assessment of the consultation competence of Family Physicians in Hong Kong

Objective: To evaluate the Consultation Skills Assessment (CSA) component of the Exit Assessment of the Higher Vocational Training Programme of the Hong Kong College of Family Physicians with particular reference to content validity and reliability. Design: An observational study in which candidates were directly observed and independently assessed by three assessors in the candidates' own practice setting during which they were expected to consult with six unselected and consecutive patients within two hours of consulting time. Subjects: Eighty-one candidates, 476 patients and 26 assessors (one external). Main outcome measures: Content validity and reliability (contributions to variance and generalisability) of the overall process. Results: Between 1997 and 2003, 81 clinical assessments were carried out. Internal assessors conducted a range of 1-19 assessments and the external assessor was present at 59 assessments (78.7%). The pass rate per CSA diet varied from 25-100%.published_or_final_versio

Complications after cryosurgery with new miniature cryoprobes in long hollow bones: An animal trial

BACKGROUND: In vitro studies show that new miniature cryoprobes are suitable for cryoablation of bone tissue. The aim of this animal trial on 24 sheep was to examine the perioperative complications, particularly the danger of embolism, of cryoablation when using miniature cryoprobes. METHODS: Cryoablations with 2 freeze-thaw cycles each were carried out in the epiphysis of the right tibia and the metaphysis of the left femur. Pulmonary artery pressure (PAP) and central venous pressure (CVP) were measured. Throughout the intra- and perioperative phase, heart rate and oxygen saturation by pulse oxymetry, blood gas and electrolytes were monitored regularly. Postoperative complications were examined up to 24 weeks postoperativ. RESULTS: As result, no significant increase of PAP, CVP or heart rate were observed. Blood gases were unremarkable, with pO(2 )and pCO(2 )remaining constant throughout the operation. Regarding pH, standard bicarbonate and base excess, only a non-significant shift towards a slight acidosis was seen. There was a mean hemoglobin decrease of 0.5 g/dl. One animal showed postoperative wound infection and wound edge necrosis. No major peri- and postoperative complications associated with cryosurgery of bone were observed, especially regarding clinically relevant pulmonary embolism. CONCLUSION: Surgery with new types of miniature cryoprobes appears to be a safe alternative to or a complement to conventional resection of abnormal bone tissue

Comparing [C II], H I, and CO dynamics of nearby galaxies

The HI and CO components of the interstellar medium (ISM) are usually used to derive the dynamical mass M-dyn of nearby galaxies. Both components become too faint to be used as a tracer in observations of high-redshift galaxies. In those cases, the 158 mu m line of atomic carbon ([CII]) may be the only way to derive M-dyn. As the distribution and kinematics of the ISM tracer affects the determination of M-dyn, it is important to quantify the relative distributions of HI, CO, and [CII]. HI and CO are well-characterized observationally, however, for [CII] only very few measurements exist. Here we compare observations of CO, HI, and [CII] emission of a sample of nearby galaxies, drawn from the HERACLES, THINGS, and KINGFISH surveys. We find that within R-25, the average [CII] exponential radial profile is slightly shallower than that of the CO, but much steeper than the HI distribution. This is also reflected in the integrated spectrum ("global profile"), where the [CII] spectrum looks more like that of the CO than that of the HI. For one galaxy, a spectrally resolved comparison of integrated spectra was possible; other comparisons were limited by the intrinsic line-widths of the galaxies and the coarse velocity resolution of the [CII] data. Using high-spectral-resolution SOFIA [CII] data of a number of star forming regions in two nearby galaxies, we find that their [CII] linewidths agree better with those of the CO than the HI. As the radial extent of a given ISM tracer is a key input in deriving M-dyn from spatially unresolved data, we conclude that the relevant length-scale to use in determining M-dyn based on [CII] data, is that of the well-characterized CO distribution. This length scale is similar to that of the optical disk

Self-referring patients at the emergency department: appropriateness of ED use and motives for self-referral

© 2014, van der Linden et al.; licensee Springer. Background: Nearly all Dutch citizens have a general practitioner (GP), acting as a gatekeeper to secondary care. Some patients bypass the GP and present to the emergency department (ED). To make best use of existing emergency care, Dutch health policy makers and insurance companies have proposed the integration of EDs and GP cooperatives (GPCs) into one facility. In this study, we examined ED use and assessed the characteristics of self-referrals and non-self-referrals, their need for hospital emergency care and self-referrals' motives for presenting at the ED. Methods: A descriptive cohort study was conducted in a Dutch level 1 trauma centre. Differences in patient characteristics, time of presentation and need for hospital emergency care were analysed using χ2 tests and t tests. A patient was considered to need hospital emergency care when he/she was admitted to the hospital, had an extremity fracture and/or when diagnostic tests were performed. Main determinants of self-referral were identified via logistic regression. Results: Of the 5,003 consecutive ED patients registering within the 5-week study period, 3,028 (60.5%) were self-referrals. Thirty-nine percent of the self-referrals had urgent acuity levels, as opposed to 65% of the non-self-referrals. Self-referrals more often suffered from injuries (49 vs. 20%). One third of the self-referrals presented during office hours. Of all self-referrals, 51% needed hospital emergency care. Younger age; non-urgent acuity level; chest pain, ear, nose or throat problems; and injuries were independent predictors for self-referral. Most cited motives for self-referring were ‘accessibility and convenience’ and perceived ‘medical necessity’. Conclusions: A substantial part of the self-referrals needed hospital emergency care. The 49% self-referrals who were eligible for GP care presented during out-of-hours as well as during office hours. This calls for an integrative approach to this health care problem

Zoning of mucosal phenotype, dysplasia, and telomerase activity measured by telomerase repeat assay protocol in Barrett's esophagus

Glandular dysplasia in Barrett's esophagus may regress spontaneously but can also progress to cancer. The human telomerase RNA template and the human telomerase reverse transcriptase enzyme which do not, of themselves, correlate strongly with telomerase activity, are too often overexpressed in Barrett's dysplasia to predict individual cancer risk. This study relates telomerase activity, mucosal phenotype, and dysplasia in Barrett's esophagus. Biopsies (n = 256) from squamous esophagus, columnar-lined esophagus every 2 cm, esophago-gastric junction, gastric body, and antrum from 32 patients with long-segment Barrett's esophagus were evaluated by telomerase repeat assay protocol (TRAP). Three biopsies for histology (n = 794) were simultaneously taken at each anatomical level. These and all prior and subsequent biopsies (n = 1917) were reviewed for mucosal phenotypes and dysplasia severity. Intestinal-type Barrett's mucosa was present at all levels in Barrett's esophagus. At least one Barrett's biopsy was TRAP(+) in 22 of 32 patients. TRAP positivity of intestinal-type Barrett's mucosa increased distally, possibly as a consequence of mucosal exposure to acid or bile reflux. Native gastric mucosa was rarely TRAP(+) (1/31 corpus, 2/32 antrum), whereas native squamous mucosa usually was TRAP(+) (31/32). Dysplasia almost always involved intestinal-type Barrett's mucosa (85/87; P</p

H_2 emission arises outside photodissociation regions in ultra-luminous infrared galaxies

Ultra-luminous infrared galaxies are among the most luminous objects in the local universe and are thought to be powered by intense star formation. It has been shown that in these objects the rotational spectral lines of molecular hydrogen observed at mid-infrared wavelengths are not affected by dust obscuration, leaving unresolved the source of excitation of this emission. Here I report an analysis of archival Spitzer Space Telescope data on ultra-luminous infrared galaxies and demonstrate that star formation regions are buried inside optically thick clouds of gas and dust, so that dust obscuration affects star-formation indicators but not molecular hydrogen. I thereby establish that the emission of H_2 is not co-spatial with the buried starburst activity and originates outside the obscured regions. This is rather surprising in light of the standard view that H_2 emission is directly associated with star-formation activity. Instead, I propose that H_2 emission in these objects traces shocks in the surrounding material, which are in turn excited by interactions with nearby galaxies, and that powerful large-scale shocks cooling by means of H_2 emission may be much more common than previously thought. In the early universe, a boost in H_2 emission by this process may speed up the cooling of matter as it collapsed to form the first stars and galaxies and would make these first structures more readily observable.Comment: Main text and supplemental information, 21 pages including 6 figures, 2 table