BackgroundLimited data are available on the frequency of IgE mediated food sensitization and food allergy (FA) in adults with atopic dermatitis (AD).ObjectiveWe investigated the pattern of food sensitization in adults with AD in relation to AD severity using multiplexed allergen microarray.Methods211 adult patients referred between January 2010-July 2011 for evaluation of AD were unselectively included. Severity of AD was determined by therapy intensity, SASSAD-skin-score and sTARC levels. Allergen specific sIgE levels were measured by ImmunoCAP ISAC® microarray. FA was defined as convincing history taken by physician and sensitization to the corresponding allergen.ResultsSensitization to food was found in 74.4% of the AD patients, 54% had a positive history of FA and 20.4% asymptomatic sensitization. There was no association between severity of AD and frequency of food sensitization or history of FA.Sensitization to PR-10 related food allergens occurred most frequently (63.5%) and was independent from AD severity. Correspondingly, pollen-food syndrome accounted for most of the FA, being also independent from AD severity. Of all plant food allergens only sensitization to nAra h 1 was significantly more frequent in patients with severe AD. In the total group 75 (35.5%) patients with AD showed sensitization to any animal food allergen. The percentage was significantly higher in patients with severe AD (51.4%) compared to patients with mild/moderate AD (27.7%). Sensitization to cow’s milk allergens, in particular to nBos d lactoferrin, was more frequent in severe AD patients.ConclusionAD was frequently associated with food sensitization. The percentage of sensitization to animal food allergens was significantly higher in severe AD patients.
Receiving feedback on daily clinical activities, in whatever form, is crucial for the development of clinical proficiency. Multisource or 360-degree feedback procedures have been recommended to include various co-workers as sources of feedback. In 2008, a web-based multisource feedback (MSF) tool for medical residents was developed at the University Medical Center Utrecht and launched nationally in the Netherlands and has been widely used since then. In 2012, an evaluation was carried out to collect opinions on its use, on the quality of the instrument and on its experienced effectiveness. We approached 408 residents and 59 residency programme directors with an anonymous online survey.Completed surveys were received from 108 residents (26 %) and 22 programme directors (37 %). The tool was well received among the respondents and proved to be a simple, efficient and effective instrument to prepare for information-rich progress interviews of programme directors with their residents. Despite a relatively low response rate, indications were found for the effectiveness of MSF use at four levels of Kirkpatrick’s hierarchy based on user impressions: reaction, learning, behaviour change, and impact. This MSF tool, designed for effective formative feedback, was found to meet its purpose and was well received.
BackgroundThe overuse of laboratory tests and radiology imaging and their possible hazards to patients and the health care system is observed with growing concern in the medical community. With this study the authors wished to determine whether ordering patterns for laboratory and radiology tests by medical students close to their graduation are related to undergraduate training.MethodsWe developed an assessment for near graduates in the setting of a resident’s daily routine including a consultation hour with five simulated patients, three hours for patient work up with simulated distracting tasks, and thirty minutes for reporting of patient management to a supervisor. In 2011, 60 students participated in this assessment: 30 from a vertically integrated (VI) curriculum (Utrecht, The Netherlands) and 30 from a traditional, non-VI curriculum (Hamburg, Germany). We assessed and compared the number of laboratory and radiology requests and correlated the results with the scores participants received from their supervisors for the facet of competence “scientifically and empirically grounded method of working”.ResultsStudents from a VI curriculum used significantly (p < .01) less total laboratory requests (N = 283 versus N = 466) which correlated with their scores for a “scientifically and empirically grounded method of working” (Pearson’s r = .572). A significantly (p < .01) higher number of radiology imaging was ordered with a large effect size (V = .618) by near graduates from a non-VI curriculum (N = 156 versus N = 97) even when this was not supporting the diagnostic process.ConclusionThe focused ordering patterns from VI students might be a result of their early exposure to the clinical environment and a different approach to clinical decision making during their undergraduate education which further studies should address in greater detail.
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