Effects of using an abdominal simulator to develop palpatory competencies in 3rd year medical students

BACKGROUND

Medical school faculty are hard pressed to provide clerkship students with sufficient opportunity to develop and practice their capacity to perform a competent clinical examination, including the palpatory examination of the abdomen. We evaluated the impact of training with an abdominal simulator, AbSim, designed to monitor the depth, location, and thoroughness of their palpation and to provide concurrent and summative feedback regarding their performance.

METHODS

All third-year medical students were given the opportunity to develop their palpatory skills with the AbSim simulator during the family medicine rotation. The performance of those who studied with the simulator was measured by its sensors, before and after a training session that included visual feedback regarding the depth and coverage of the student's manual pressure. Additionally, all students reported their confidence in their evolving abdominal palpation skills at the beginning and end of the rotation.

RESULTS

119 (86.9%) of 137 students filled out the initial questionnaire, and 73 (61.3%) studied with the abdominal simulator. The training produced a highly significant improvement in their overall performance (4 measures, p's < 0.001). Pre-training performance (depth calibration and thoroughness of coverage) was not related to the number of months of previous clinical rotations nor to previous internal medicine or surgery rotations. There was little relation between students' confidence in their abdominal examination skills and objective measures of their palpatory performance; however, students who chose the training started with less confidence, and became more confident after training.

CONCLUSIONS

Guided abdominal simulator practice increased medical students' capacity to perform an abdominal examination with more appropriate depth and thoroughness of palpation. Interpretation of changes in confidence are uncertain, because confidence was unrelated to objectively measured performance. However, students with low initial confidence in their abdominal examination seemed to be more likely to choose to study with the abdominal simulator.

Multiple idiopathic left ventricular aneurysms in a Japanese woman

Idiopathic aneurysms of the left ventricle (LV) are uncommon in Western society. Multiple idiopathic LV aneurysms are distinctly unusual and are rarely reported. As with aneurysms of atherosclerotic origin, these entities may be associated with chest discomfort, congestive heart failure, cardiac dysrhythmias, and thromboembolic phenomena. We present the case of a Japanese woman living in the United States with chest discomfort, ventricular arrhythmias, and a previous transient ischemic attack who demonstrated four discrete LV aneurysms on ventriculography. Extensive evaluation demonstrated no clear cause for these aneurysms. The patient was treated conservatively with medical therapy and has continued to do well without adverse clinical sequelae.

Placement of peripherally inserted central catheters in the cardiac catheterization laboratory

This report describes our experiences with three patients requiring several weeks of central venous access for various intravenous therapies. These particular patients posed a considerable challenge for bedside placement of a peripherally inserted central catheter, so the catheters were placed in the cardiac catheterization laboratory by the cardiology team involved using a different technique for each patient.

Nothing new under the sun

As Ecclesiastes tells us: 'There is nothing new under the sun.'

Dissent and resentment

Referring to the clinical grading structure which has been hailed as the all embracing answer to nurses' pay, its anomalies and discrepancies are set to produce dissension and resentment in nursing in the years to come. (Witness the arguments and discussion going on at the moment right to the highest levels.).

Phosphorylation in crested wheatgrass seeds at low water potentials

Crested wheatgrass seeds [Agropyron desertorum (Fisch. ex Link) Schult.] were tested for their ability to carry on phosphorylation reactions at low water potentials. Seeds were treated with (32)P labeled sodium phosphate and incubated in air having different controlled relative humidities. Ion exchange chromatography and radioassay of phosphate esters indicated that some phosphorylation occurred at a water potential of -880 atmospheres. Seeds did not incorporate (32)P in nicotinamide adenine dinucleotide, adenosine triphosphate, and uridine diphosphate hexose until they were moistened to a water potential of -130 atmospheres.

Hexose-, inositol-, and nucleoside phosphate esters in germinating seeds of crested wheatgrass

Net synthesis of phosphate esters was measured in crested wheatgrass seeds [Agropyron desertorum (Fisch.) Schult.] to learn what phosphorylating reactions occur in early stages of germination. Phosphate esters were separated on ion exchange columns and identified by cochromatography and chemical analyses. Synthesis of adenosine triphosphate and UDP-hexose was detected 6 hours after the beginning of water absorption. This synthesis occurred during the period of rapid increase in water potential. Synthesis of hexose phosphate and uridine triphosphate was detected 12 hours after the beginning of water absorption. The concentrations of these esters increased during 48 hours. Increases in concentration of inositol di-, tri-, and tetraphosphate suggested that hydrolysis of inositol hexaphosphate began after 12 hours.