IntroductionHistorically, testing medical students’ skills using a handheld ophthalmoscope has been difficult to do objectively. Many programs train students using plastic models of the eye which are a very limited fidelity simulator of a real human eye. This makes it difficult to be sure that actual proficiency is attained given the differences between the various models and actual patients. The purpose of this article is to introduce a method of testing where a medical student must match a patient with his/her fundus photo, ensuring objective evaluation as well as developing skills on real patients which are more likely to transfer into clinical practice directly.Presentation of caseFundus photos from standardized patients (SPs) were obtained using a retinal camera and placed into a grid using proprietary software. Medical students were then asked to examine a SP and attempt to match the patient to his/her fundus photo in the grid.ResultsOf the 33 medical students tested, only 10 were able to match the SP’s eye to the correct photo in the grid. The average time to correct selection was 175 seconds, and the successful students rated their confidence level at 27.5% (average). The incorrect selection took less time, averaging 118 seconds, yet yielded a higher student-reported confidence level at 34.8% (average). The only noteworthy predictor of success (p<0.05) was the student’s age (p=0.02).ConclusionIt may be determined that there is an apparent gap in the ophthalmoscopy training of the students tested. It may also be of concern that students who selected the incorrect photo were more confident in their selections than students who chose the correct photo. More training may be necessary to close this gap, and future studies should attempt to establish continuing protocols in multiple centers.
BackgroundThis study quantified the effects of heat, cold, and pressure on the median nerve and transverse carpal ligament in subjects without carpal tunnel syndrome.Material/MethodsSubjects were individuals ages 20–50 who had no symptoms of carpal tunnel disease. Imaging ultrasound was used to measure the clearance around the median nerve, transverse ligament elasticity, nerve conduction velocity, thickness of the carpal ligament, and area of the median nerve. Pressure was applied to the carpal ligament to assess the effects of increasing pressure on these structures. On 3 separate days, 10 subjects had ThermaCare heat or cold packs applied, for either 60 or 120 minutes for heat or 20 minutes for cold, to the palmer surface of the hand.ResultsTissue changes were recorded as a response to pressure applied at 0, 5, 10, and 20 N. The size of the nerve and ligaments were not significantly altered by pressure with the hand at room temperature and after cold exposure. After heat, the nerve, ligaments, and tendons showed significantly more elasticity.ConclusionsApplication of cold to the hand may reduce compression of the carpal ligament and nerve.
Background: Training healthcare practitioners on cultural competence and increasing the cultural diversity of healthcare professionals, may help to alleviate barriers and improve patient outcomes. The American Physical Therapy Association (APTA) has implemented goals and guidelines for the training of culturally competent physical therapists. The goal of this study was to evaluate whether an association exists between physical therapy directors' self-reports of the implementation of the APTA goals and guidelines and the cultural competence of those directors, and also to examine whether there are racial/ethnic differences in the implementation of these goals and guidelines and cultural competency among the directors. Methods: The study design was a cross sectional. The survey was sent to 225 physical therapy directors who were required to provide information about the implementation of the APTA goals and guidelines, cultural competency, and demographic characteristics. Linear regression was used to test the association between the implementation of APTA goals and guidelines and the cultural competence of the physical therapy directors. Independent sample t-tests were used to examine whether there were racial/ethnic differences in the implementation of these goals and guidelines and the cultural competence of the directors. Results: A total of 47 physical therapy directors responded to the survey. There was no significant relationship between the implementation of APTA goals and guidelines and the cultural competence of the physical therapy directors or significant racial/ethnic differences in the implementation of the goals and guidelines and cultural competence among the directors. Conclusions: Recommendations for practicing cultural competency in the field of physical therapy will need to be supported by further research into other populations. Other frameworks for understanding cultural competence among physical therapists should be explored.
Background and purpose: It is still inconclusive which method of iontophoresis delivers the most medication deepest through the skin, and therefore most effective in treating lateral epicondylitis. The purpose of this systematic review is to analyze the efficacy of treatments for lateral epicondylitis using iontophoresis. Method:The review included articles from peer-reviewed journals with sufficient data related to the purpose and focus of the study. Inclusion criteria included randomized control trials, cohort studies, case studies, systematic reviews, meta-analyses, and pilot studies published since 2000. Results:Fourteen relevant studies were identified. Twelve were experimental in vivo studies, two were review studies. All studies were published 2002 through 2015, providing a robust overview of treatments over the last 15 years. Discussion and conclusion: Among studies in this systemic review, pooled data from RCTs pointed to minimal intermediate-to long-term clinical benefit for the nonsurgical treatment of lateral epicondylitis. Of drug treatments, the most frequently used in iontophoresis are dexamethasone and lidocaine. Studies of iontophoresis with dexamethasone show evidence that the combination of treatments may be effective in reducing pain; there is evidence supporting the iontophoretic administration of dexamethasone as an alternative to other medication and oral therapy. Based on this review, it is not conclusive that iontophoresis be recommended as a treatment approach for the management of epicondylitis, however iontophoresis should not be ruled out in treating epicondylitis as it is a dose-response modality. More research and review of research is needed on the use of iontophoresis in managing epicondylitis.
Background: In 2018, President Donald J. Trump announced that his administration would place restrictions on international students seeking to pursue higher education degrees in the United States. American institutions of higher education protested these policy changes, because international students represent a significant social and cultural contribution to their system and provide a source of revenue. The restrictions on international students were not overwhelming, primarily consisting of increased visa fees and threats stating that misbehavior in the country would result in immediate deportation. Although these demands do not typically deter international students, some individuals view these restrictions as part of an overall trend of anti-immigrant sentiment in the United States. The goal of this study was to investigate the impact of these new restrictions on the education of international students in the United States. Methods: The population, intervention, comparison, and outcome (PICO) question format was used to formulate the research question, centered on international students seeking to complete their higher education in the United States. The databases used for this study were ProQuest, JSTOR, LexisNexis, and Google Scholar. Results: The movement to place restrictions on international students in the United States is a recent development, and no statistically significant effects can presently be determined. Government funding for public universities, who market their programs to international students, has been reduced. Conclusions: This research demonstrates that international student attendance at American universities was declining before the immigration restrictions were implemented. Based on current data, it is too early to determine how immigration restrictions will impact American universities, and more time will be needed to evaluate the impact of President Trump's policies.
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