Optical coherence tomography and confocal laser scanning microscopy as non-invasive tools in the diagnosis of sinonasal inverted papilloma: a pilot study

Abstract

Optical coherence tomography (OCT) and confocal laser scanning microscopy (CLSM) are light-based imaging techniques that allow for a visualization of microscopic tissue properties in vivo. Our study was to examine whether they allow for differentiation of inverted papilloma (IP) from nasal polyps (NP). Five cases of IP and NP, respectively, were investigated intraoperatively with OCT and CLSM. Biopsies were taken of the investigated area and were analyzed ex vivo with OCT and CLSM and then underwent HE-staining for standard light microscopy. On OCT images, IP showed the characteristic inverted character of the epithelium, that was thicker with a high degree of variability of thickness compared to the thin and homogenous epithelium of NP. In addition, the characteristic stromal edema of NP could be visualized. On CLSM images, the typical epithelial invaginations of IP appeared as crypts, while in NP the highly organized cylindric epithelium could be visualized. In vivo, OCT acquired images of sufficient quality to visualize these characteristics, while CLSM did not. Our study demonstrates that OCT and CLSM can distinguish IP from NP. Further technical development is required to apply the techniques clinically to guide intranasal biopsies or even to make them dispensable.

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Asynchronous Unsupervised Video-Enhanced Feedback As Effective As Direct Expert Feedback in the Long-Term Retention of Practical Clinical Skills: Randomised Trial Comparing 2 Feedback Methods in a Cohort of Novice Medical Students

Publication date: Available online 7 May 2018
Source:Journal of Surgical Education
Author(s): James Rammell, Joanna Matthan, Matthew Gray, Lucy R. Bookless, Craig I. Nesbitt, Paul Rodham, John Moss, Gerard Stansby, Alexander W. Phillips
ObjectivesTo determine the degree of practical clinical skills' retention over a 7-week period after receiving either video-enhanced direct expert feedback (DEF) or asynchronous unsupervised video-enhanced feedback (UVF).DesignA prospective single-blinded randomized trial was conducted over a 7-week period with novice medical students. Following a generic introduction, PowerPoint presentation and live demonstration of intravenous cannulation was given by an expert, and candidates performed the same task in isolation while being recorded and were randomized to receive either DEF or UVF. Further, 20 students were randomized to receive UVF and 22 to receive DEF. Candidates returned to repeat the video-recorded task at week 1, 4, and 7, with no further feedback provision on these occasions. Performances were fully anonymized and independently marked by 2 expert assessors.SettingNewcastle University, Medical School, England, United Kingdom.ParticipantsA total of 42 novice medical students from the preclinical years were selected, with no prior experience of intravenous cannulation.ResultsNo significant difference existed between demographics of either cohort. Good between-assessor score correlation was noted, with an intraclass correlation coefficient (ICC) of 0.89. The DEF arm significantly improved from their prefeedback performance at Day 1 on repeating the skill a week later (p < 0.0001); this improved score was maintained throughout the duration of the study. The UVF arm showed a nonsignificant improvement; however, there was no significant difference in the scores between the UVF and the DEF groups at any point in the trial.ConclusionsVideo-technology may play a significant role in the provision of feedback for practical skills. The ability for experts to provide remotely delivered but individualized feedback can be an efficient use of valuable resources, while students being able to self-assess their own performance alongside an expert video have the potential to provide students with an excellent opportunity to learn clinical skills without requiring intensive educator involvement.



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Female Surgeons as Counter Stereotype: The Impact of Gender Perceptions on Trainee Evaluations of Physician Faculty

Publication date: Available online 7 May 2018
Source:Journal of Surgical Education
Author(s): Magali Fassiotto, Jie Li, Yvonne Maldonado, Nishita Kothary
ObjectiveSimilar to women in Science, Technology, Engineering and Mathematics disciplines, women in medicine are subject to negative stereotyping when they do not adhere to their sex-role expectations. These biases may vary by specialty, largely dependent on the gender's representation in that specialty. Thus, females in male-dominated surgical specialties are especially at risk of stereotype threat. Herein, we present the role of gender expectations using trainee evaluations of physician faculty at a single academic center, over a 5-year period (2010-2014).DesignUsing Graduate Medical Education evaluation data of physician faculty from MedHub, we examined the differences in evaluation scores for male and female physicians within specialties that have traditionally had low female representation (e.g., surgical fields) compared to those with average or high female representation (e.g., pediatrics).SettingStanford Medicine residents and fellows' MedHub ratings of their physician faculty from 2010 to 2014.ParticipantsA total of 3648 evaluations across 1066 physician faculty.ResultsOverall, female physicians received lower median scores than their male counterparts across all specialties. When using regression analyses controlling for race, age, rank, and specialty-specific characteristics, the negative effect persists only for female physicians in specialties with low female representation.ConclusionsThis finding suggests that female physicians in traditionally male-dominated specialties may face different criteria based on sex-role expectations when being evaluated by trainees. As trainee evaluations play an important role in career advancement decisions, dictate perceptions of quality within academic medical centers and affect overall job satisfaction, we propose that these differences in evaluations based merely on gender stereotypes could account, in part, for the narrowing pipeline of women promoted to higher ranks in academic medicine.



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Bell’s Palsy-Tertiary Ischemia: An Etiological Factor in Residual Facial Palsy

Abstract

The facial nerve is unique among the motor nerves. It has long and tortuous course through the temporal bone and within the Fallopian canal. Because of this it is more prone to paralysis than any other nerve in the body. The most frequent type of facial palsy is Bell's palsy. This is an acute idiopathic lower motor neuron palsy of the facial nerve which does not normally progress and which is most usually unilateral and self limiting,: the majority of cases remit within 4–6 months and nearly always remission is complete by 1 year. In those cases that do not recover it is my contention that this is caused by Either the progression, or after effects, of secondary ischemia: tertiary ischemia. In turn this causes thickening of the facial nerve sheath with a fibrous band or bands forming with resultant strangulation and compression of the nerve, which hampers its recovery. In such cases facial nerve decompression with slitting of the sheath and cutting of any fibrous bands would be the preferred management when allied with aggressive medical therapy.

https://ift.tt/2jGKkBS

Characterization of friction and moisture of porcine lingual tissue in vitro in response to artificial saliva and mouthwash solutions

Skin Research and Technology, EarlyView.


https://ift.tt/2IiWNd4

The early effect of microdermabrasion on hydration and sebum level

Skin Research and Technology, EarlyView.


https://ift.tt/2wl3S86

Mögliche psychosoziale Langzeitfolgen onkologischer Behandlung

Zusammenfassung

Hintergrund

Das Überleben einer Krebserkrankung durch die onkologische Behandlung geht oft mit physischen und psychosozialen Langzeitfolgen einher, die besonderer Berücksichtigung bedürfen.

Ziel der Arbeit

Der Übersichtsartikel soll die wesentlichen psychosozialen Langzeitfolgen beschreiben und Ansätze zu ihrer Vorbeugung und Behandlung aufzeigen.

Material und Methoden

Sichtung bestehender relevanter wissenschaftlicher und fachlicher Beiträge im psychoonkologischen Kontext und Darstellung psychoonkologischer Erfahrungen.

Ergebnisse

Sowohl sozial als auch psychologisch bestehen potenziell stark belastende Einschränkungen für Menschen nach einer Krebserkrankung durch Arbeitsplatzkonflikte, finanzielle Einschränkungen, soziale Konflikte, eine Fatiguesymptomatik oder Ängste und depressive Symptome. Es bestehen psychoonkologische Angebote für Krebspatienten und ihre Angehörigen sowie vereinzelt spezifische Angebote für Langzeitüberlebende einer Krebserkrankung.

Diskussion

Es bedarf einer interdisziplinären Aufmerksamkeit für die psychosozialen Langzeitfolgen einer Krebserkrankung und ihrer Behandlung und noch mehr spezifischer Angebote.

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