Extracorporeal Shock Wave Therapy as Regenerative Medicine in Knee Osteoarthritis: Pre-Experiment for Matrix Metalloproteinase-3 Evaluation.

BACKGROUND: Knee osteoarthritis (KOA) is currently treated by regenerative therapies that aim to inhibit arthritic degeneration. Extracorporeal shock wave therapy (ESWT) is one of the physical regenerative approaches used for KOA management. However, little is known regarding the impact of shock wave treatment on matrix metalloproteinase-3 (MMP-3), which is one of the enzymes mediating cartilage degradation. OBJECTIVES: To evaluate the effect of ESWT on MMP-3 levels and pain intensity in patients with KOA. METHODS: Fourteen patients diagnosed with Kellgren Lawrence, grades 2 and 3 KOA were recruited for the study. ESWT piezo shockwave was applied once a week for six weeks. MMP-3 levels in the blood were measured pre-test, mid-test (three weeks after therapy) and post-test (one week after the last session) by enzyme-linked immunosorbent assay (ELISA). The perceived pain was recorded at each session by the Wong Becker Face Scale. RESULTS: The median pre-test, mid-test and post-test MMP-3 levels were 19.92 ng/mL, 15.89 ng/mL and 18.82 ng/mL, respectively, and there were significant differences between the pre-test and mid-test, and the pre-test and post-test values (p < 0.05). The pain scores also decreased significantly over the period of intervention. CONCLUSION: MMP-3 levels decreased significantly in KOA patients after ESWT, and the decline was most obvious after 3 weeks of therapy. Therefore, EWST should be considered as a suitable treatment option for KOA.

Predicting medical graduates' clinical performance using national competency examination results in Indonesia.

BACKGROUND: Indonesia has applied a national competency exit-examination for medical graduates since 2014, called The Indonesia Medical Doctor National Competency Examination (IMDNCE). This examination is administered to ensure the competence of medical graduates from at present 83 medical schools in Indonesia. Although many studies reported their evaluation on medical licensing examinations, there are not many studies performed to evaluate the correlation of a national licensing examination to the graduates' clinical practice. AIMS: This research aimed to evaluate the performance of new medical doctors in Indonesia in their internship period after the IMDNCE completion, and whether it might become a predictive indicator for the new medical doctors' clinical performance. METHODS: An observational cross-sectional study was performed in November-December 2017 on 209 doctors who were new medical graduates. Thirty-one senior doctors from a range of regions in Indonesia who were recruited and trained previously participated in the observation. The Clinical Performance Instrument (CPI) tool was developed as an evaluation tool of the new doctors' clinical competence to be observed for three weeks. The obtained data were analysed using descriptive statistics and correlated to the IMDNCE scores. RESULTS: The mean (95% CI) of the CPI for all participants was 83.0 (80.8-85.2), with no correlation of CPI score with IMDNCE results in domains of communication, professionalism and patient safety (p > 0.05). However, the mean total of the CPI observation scores from doctors who graduated from public medical schools was higher than those graduating from private medical schools. Also, there were differences in scores related to the institution's accreditation grade (p < 0.05). CONCLUSION: There is no difference between CPI and national competency examination results. There was no statistical correlation between the clinical performance of new medical doctors during their internship to CBT and OSCE scores in the national competency examination. New doctors' performance during internship is affected by more complex factors, not only their level of competencies.

The Implementation of Peer-Reflection to Improve Retakers' Achievement in National Medical Students Examination.

INTRODUCTION: Faculty of medicine plays a role to support the students' success in passing national exit exam through mentorship. Peer-reflection evaluates the students' learning process. We aimed to analyze the impact of peer-reflection to change the students' learning attitude and improve national exam score. METHODS: Nine test-retaker students participated in mentorship program for three months. They took two parts of faculty-level examination. After the 1st and the 2nd part of faculty exam, there were peer-reflections I and II that argued about the characters, strengths and weaknesses, suggestions. Then, they did self-reflection to conduct responses about the mentorship including the impact of peers' input and finally took national exam. The examination score before and after peer-reflection were compared. We analyzed the statement of reflection by documents and content analysis. The progress of examination score was analyzed descriptively. RESULTS: The students objectively understood the strengths and weaknesses of their way of learning, and then implemented the peers' advices. Peer-reflection method provided a feeling of same purpose, then developed ways of learning that promoted them to be higher motivated. Finally, 6 of 9 students passed the exam. DISCUSSION: Suggestions given by peers would be memorable and powerfully changed motivation. Peer-reflection explored non-academic problems that determined the pattern and the way of how students learned.

Strengthening Primary Health Care: Emergency and Disaster Preparedness in Community with Multidisciplinary Approach.

The increasing number of disasters and communities affected, coupled with the threats from climate change, has drawn not only national but also international attention to the risks of disasters and what can be done about them. It is important for communities and all global partners to be more prepared by taking action before disasters occur through disaster risk reduction, including the efforts of emergency preparedness, as well as through disaster response and recovery. To meet the emergency public health needs in any population, there is no other option than strengthening the primary health care system. For this goal, practitioners from various professions can work together and share an affinity in synthesizing knowledge and bridging gaps across functional areas. These include the disaster risk assessment and preparedness involving several disciplines for limiting human and material damage. This primary health care strategy with a multidisciplinary approach is the best possible method in developing improved approaches for disaster risk reduction and emergency preparedness by improving health emergency management plans and protocols.