Competency assessment of primary care physicians as part of a peer review program

OBJECTIVE

To design and test a program that assesses clinical competence as a second stage in a peer review process and to determine the program's reliability.

DESIGN AND SETTING

A three-cohort study of Ontario primary care physicians.

PARTICIPANTS

Reference physicians (n = 26) randomly drawn from the Hamilton, Ontario, area; volunteer, self-referred physicians (n = 20); and physicians referred by the licensing body (n = 37) as a result of a disciplinary hearing or peer review.

MAIN OUTCOME MEASURES

Standardized patients, structured oral examinations, chart-stimulated recall, objective structured clinical examination, and multiple-choice examination.

RESULTS

Test reliability was high, ranging from 0.73 to 0.91, and all tests discriminated among subgroups. Demographic variables relating to the final category were age, Canadian or foreign graduates, and whether or not participants were certified in family medicine.

CONCLUSIONS

The study demonstrated the feasibility, reliability, and validity of a multicomponent examination in the peer review process.

Peer Imitation by Toddlers in Laboratory, Home, and Day-Care Contexts: Implications for Social Learning and Memory

Three experiments examined peer imitation with 14- to 18-month-old infants. In Experiment 1, infants saw a trained 14-month-old ("expert peer") perform specific actions on 5 objects. Imitation from memory was tested after a 5-min delay. In Experiment 2, the infants observed an expert peer in the laboratory, and retention and imitation were tested in the home (change of context) after a 2-day delay. In Experiment 3, a peer demonstrated target acts at a day care, and after a 2-day delay infants were tested in their homes. Results from all 3 experiments showed significant imitation compared with controls. The experiments demonstrate social learning from peers during infancy and also provide the first evidence for infant imitation from memory across a change in context.

Laser welding of fascial grafts and its potential application in tympanoplasty: an animal model

This study evaluates the welding effect of argon laser on fascial grafts and its potential application in tympanoplasty. An animal model was designed so that surgically induced perforations of the lumbar fascia of the animals were grafted in an underlay fashion. Each graft was "spot welded" around the circumference of the perforation using a hand-held argon laser. Various lasing parameters were used on different grafts. Control perforations were grafted but not welded. A total of 96 perforations was studied. Weld sites were evaluated both histologically and by tensile strength measurement at the end of surgery, and at 7, 14, and 21 days postoperatively. Comparison with controls showed a higher tensile strength for welded grafts, which was most significant in the early postoperative period (p < 0.001). Histologically, it seems that the basic mechanism of fascial welding involves liquification and denaturation of extravasated proteins at the weld sites. Correlation between the extent of thermal damage on the tissues and the various lasing parameters is described. Based on the well-documented safety of argon laser in otologic surgery, and the successful welding of fascial grafts in this study, argon laser may prove beneficial in welding temporalis fascia grafts in tympanoplasty.

Sex discrimination: how do we tell the difference between male and female faces?

People are remarkably accurate (approaching ceiling) at deciding whether faces are male or female, even when cues from hair style, makeup, and facial hair are minimised. Experiments designed to explore the perceptual basis of our ability to categorise the sex of faces are reported. Subjects were considerably less accurate when asked to judge the sex of three-dimensional (3-D) representations of faces obtained by laser-scanning, compared with a condition where photographs were taken with hair concealed and eyes closed. This suggests that cues from features such as eyebrows, and skin texture, play an important role in decision-making. Performance with the laser-scanned heads remained quite high with 3/4-view faces, where the 3-D shape of the face should be easiest to see, suggesting that the 3-D structure of the face is a further source of information contributing to the classification of its sex. Performance at judging the sex from photographs (with hair concealed) was disrupted if the photographs were inverted, which implies that the superficial cues contributing to the decision are not processed in a purely 'local' way. Performance was also disrupted if the faces were shown in photographic negatives, which is consistent with the use of 3-D information, since negation probably operates by disrupting the computation of shape from shading. In 3-D, the 'average' male face differs from the 'average' female face by having a more protuberant nose/brow and more prominent chin/jaw. The effects of manipulating the shapes of the noses and chins of the laser-scanned heads were assessed and significant effects of such manipulations on the apparent masculinity or femininity of the heads were revealed. It appears that our ability to make this most basic of facial categorisations may be multiply determined by a combination of 2-D, 3-D, and textural cues and their interrelationships.

Dying to be equal: women, alcohol, and cardiovascular disease

This data note explores the relationship of gender, alcohol consumption and premature death from cardiovascular disease (MCVD). Data on the 8164 deaths attributed to MCVD from the National Mortality Followback Study (NMFS) were analyzed controlling for gender and consumption. Women who are heavy drinkers die young at a rate equal to that of men who drink heavily. In light of this, we recommend that future research and preventive efforts in this area include females as subjects and alcohol as a major risk factor.

T cell lines mediating experimental autoimmune uveoretinitis (EAU) in the rat

Long-term S-antigen (S-Ag)-specific T lymphocyte lines were derived from the lymph nodes of immunized Lewis rats that had been pretreated with low-dose cyclophosphamide. The protocol consisted of functional selection by alternating cycles of stimulation with S-Ag presented on syngeneic accessory cells and proliferation in IL 2-containing spleen-conditioned medium, coupled with early phenotypic selection for cells bearing the helper/inducer membrane marker (W3/25), by panning on antibody-coated plastic dishes. This protocol consistently resulted in the rapid generation of in vivo functional cell lines capable of mediating experimental autoimmune uveoretinitis (EAU) when transferred into naive rats at 5 to 10 X 10(6) cells/rat systemically or 1 to 2 X 10(6) cells/rat intravitreally. The disease appeared within 6 to 8 days, usually with minimal anterior chamber involvement, and was often unilateral. Pathologic changes resembled those seen in EAU induced by active immunization. The disease could be transferred without concomitant formation of serum antibodies. The uveitogenic line cells were negative for Ia antigen and positive for the W3/25 membrane marker, which appeared to be stable in long-term culture. They proliferated vigorously in vitro and produced IL 2 in response to S-Ag or Con A, but not to unrelated antigens. The establishment of uveitogenic T helper lymphocyte lines will permit the analysis of the cellular mechanisms involved in EAU in a more defined system than has been available.

T cell lines mediating experimental autoimmune uveoretinitis (EAU) in the rat

Long-term S-antigen (S-Ag)-specific T lymphocyte lines were derived from the lymph nodes of immunized Lewis rats that had been pretreated with low-dose cyclophosphamide. The protocol consisted of functional selection by alternating cycles of stimulation with S-Ag presented on syngeneic accessory cells and proliferation in IL 2-containing spleen-conditioned medium, coupled with early phenotypic selection for cells bearing the helper/inducer membrane marker (W3/25), by panning on antibody-coated plastic dishes. This protocol consistently resulted in the rapid generation of in vivo functional cell lines capable of mediating experimental autoimmune uveoretinitis (EAU) when transferred into naive rats at 5 to 10 X 10(6) cells/rat systemically or 1 to 2 X 10(6) cells/rat intravitreally. The disease appeared within 6 to 8 days, usually with minimal anterior chamber involvement, and was often unilateral. Pathologic changes resembled those seen in EAU induced by active immunization. The disease could be transferred without concomitant formation of serum antibodies. The uveitogenic line cells were negative for Ia antigen and positive for the W3/25 membrane marker, which appeared to be stable in long-term culture. They proliferated vigorously in vitro and produced IL 2 in response to S-Ag or Con A, but not to unrelated antigens. The establishment of uveitogenic T helper lymphocyte lines will permit the analysis of the cellular mechanisms involved in EAU in a more defined system than has been available.

Attitudes toward problem drinkers. A critical factor in treatment recommendations

Problem drinkers who labeled themselves alcoholics tended to be assigned to a special Alcohol Team, whereas those who did not were referred for regular psychiatric treatment.