Purpose: Patients receive multiple bolus trials during a videofluoroscopic swallowing study (VFSS) to assess swallow function, inclusive of narrowing within the pharyngoesophageal segment (PES). While differences in the narrowest and widest segments are visualized, the ratio of distention across boluses is not well understood. Method: A…

At the examination of a patient, a doctor evaluates clinical picture of the disease that manifests itself by a great number of various general and local symptoms caused by an etiological factor and pathogenesis changes of the different organs and systems of the organism. A purpose of the surgical patient examination is making of early, correct and…

The purpose of this study was to examine the effectiveness of using a Competency-based Achievement System (CBAS) (a formative tool) in the practice ready assessment (PRA) of internationally-trained physicians seeking licensure to practice in Canada (summative assessment). The study was a retrospective analysis of over 5,000 FieldNotes completed…

A study examined the effectiveness of a method designed to increase active patient involvement in the health care context. Subjects, 38 patients visiting a three-physician dermatology practice one randomly selected morning, were asked to fill out a survey at the end of their visit. Half of the subjects were asked to read a "communication…

Assessment of clinical performance is intended to make generalizations about a physicians competence. Performance assessments involve three interacting components: the candidate, the cases, and the raters. Confidence in generalizations depends on reliability of the measurements and whether the cases represent the competence domains of interest.…

Summarizes a discussion by ten leaders in the field of child sexual abuse concerning the medical consequences of child sexual abuse. (DB)

Hyponatremia (severe sodium depletion) has symptoms similar to heat exhaustion and heat stroke and can easily be misdiagnosed. The number of wilderness users and extreme adventure activities has increased in recent years, and more cases are being diagnosed. Given that a 1993 study found that 1 in 10 cases of heat-related illnesses were…

This commentary on a paper (EC 619 273) about the appearance of acute, healing, and healed anogenital injuries in children who have been sexually abused urges the development of guidelines to interpret the physical findings found in children. Limitations of current practice and clinical studies are noted. A research procedure for the development…

This study compared the degree to which young children were placated during a standard medical evaluation by the presence of their mother, blanket, mother plus blanket, or no supportive agent. Participating were 64 three-year-olds who underwent 4 routine medical procedures. Children were rated by their mothers as attached or nonattached to…

This paper on the appearance of acute, healing, and healed anogenital trauma in children who have been sexually abused summarizes what is known, and identifies remaining questions, offers suggestions for ways to obtain answers, and identifies barriers to such research (such as the necessity of using children as subjects). (DB)

Summarizes highlights of a discussion by eight leaders in the field of child sexual abuse concerning the appearance of acute, healing, and healed anogenital trauma in children who have been sexually abused. (DB)

Five case studies illustrate evacuation decision making in a wilderness setting. The cases describe medical problems encountered during wilderness trips: (1) a hiker suffering from hypothermia; (2) a 49-year-old man with chest pains; (3) a 19-year-old woman with abdominal pain; (4) a young woman in anaphylactic shock; and (5) a teenager hit on the…

Summarizes highlights of a discussion by 12 leaders in the field of child sexual abuse concerning the technical conduct of the child-sexual-abuse medical examination. (DB)

Summarizes highlights of a discussion by 13 leaders in the field of child sexual abuse concerning normal anogenital anatomy in relation to medical evaluation for child sexual abuse. (DB)

This paper discusses two methods used in training allied health students to clarify patients' problems and develop treatment plans to resolve them. The traditional problem solving approach is presented as a means to introduce students to patient evaluation and treatment planning, while clinical reasoning is seen as a more expert way to approach…