Design, implementation and prospective evaluation of a new interactive musculoskeletal module for medical students in Ireland.

BACKGROUND: We designed, implemented and assessed an interactive musculoskeletal teaching module for fourth-year medical students. Over a 2-week period, students followed a programme of alternating lectures, interactive tutorials, case discussions, clinical examination and 'how to do' sessions using patients and clinical models. METHODS: Over a 4-month period, 140 fourth-year medical students rotated for 2 weeks through a new interactive musculoskeletal teaching module in an elective orthopaedic hospital. To assess the impact of our module, a basic-competency examination in musculoskeletal medicine was developed and validated. Each student completed the examination on the first and last days of the module. We also assessed musculoskeletal basic knowledge in students from a different medical school, receiving a classic lecturing programme. RESULTS: In the pre-course assessment, only 20 % of students achieved an overall pass rate. The pass rate increased to 85 % in post-course examination. Students found particularly beneficial the interactive tutorial approach, with 48 % finding this to be the single most effective teaching method. When compared with students who completed a classic lecturing programme, students attending our interactive module scored higher in all aspects of musculoskeletal knowledge. SIGNIFICANCE: This study highlights the benefits and need for more interactive teaching of musculoskeletal medicine in medical schools.

18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Management of Aggressive Non-Hodgkin's B-Cell Lymphoma.

18-Fluorodeoxyglucose (FDG-PET/CT) is an established imaging modality that has been proven to be of benefit in the management of aggressive B-cell non-Hodgkin's lymphoma, such as diffuse large B-cell lymphoma and advanced stage follicular lymphoma. The combination of anatomic and functional imaging afforded by FDG-PET/CT has led to superior sensitivity and specificity in the primary staging, restaging, and assessment of response to treatment of hematological malignancies when compared to FDG-PET and CT alone. The use of FDG-PET/CT for posttreatment surveillance imaging remains controversial, and further study is needed to ascertain whether this modality is cost effective and appropriate for use in this setting.

Injectable corticosteroid preparations: an embolic risk assessment by static and dynamic microscopic analysis.

BACKGROUND AND PURPOSE: Transforaminal CS injections have been associated with severe adverse CNS events, including brain and spinal cord infarction. Our purpose was to describe the static and dynamic microscopic appearances of CS preparations, with an emphasis on their potential to cause adverse central nervous system events by embolic mechanisms during transforaminal injection. MATERIALS AND METHODS: Pharmaceutical preparations of nondilute injectable CSs were used after appropriate mixing: MPA (40 mg/mL), TA (40 mg/mL), and DSP (8 mg/2 mL). For dynamic imaging, a novel methodology was devised to replicate the flow of crystals within spinal cord arterioles. In addition, CS preparations were mixed with plasma to assess for changes in crystal size, morphology, and tendency to aggregate. RESULTS: The CS preparations MPA and TA are composed of crystals of varying sizes. MPA crystal size range was 0.4-26 µm (mean, 6.94 µm), TA crystal size range 0.5-110 µm (mean, 17.4 µm), and DSP did not contain any significant crystals or particles. There was no change in the crystal morphology or propensity to aggregate after mixing with local anesthetic. After mixing with plasma, the crystals also were unchanged; however, there was a significant reduction in the size of aggregates. On dynamic imaging, these aggregates were proved to maintain their integrity and to act as potential embolization agents. CONCLUSIONS: MPA and TA have a substantial risk of causing infarction by embolization if inadvertently injected intra-arterially at the time of TFESI. DSP is completely soluble and microscopically has no potential to obstruct arterioles. When performing cervical TFESI procedures, the administration of insoluble CSs should be avoided.

Meticillin-resistant Staphylococcus aureus (MRSA) environmental contamination in a radiology department.

AIM: To explore the potential risk to patients and healthcare workers of acquiring meticillin-resistant Staphylococcus aureus (MRSA) in clinical and non-clinical areas within a radiology department. MATERIALS AND METHODS: High-risk sites in clinical and non-clinical areas within the Department of Radiology were identified and 125 environmental swabs were obtained by an infection control nurse specialist. Decontamination methods and protocols were reviewed and compared against international decontamination best practice. RESULTS: One of 125 samples was culture positive for MRSA. The positive sample was isolated from the surface of the bore of the magnetic resonance imaging (MRI) unit. A hypochlorite cleaning agent was applied using a long-handled brush to clean the bore of the MRI unit. A repeat environmental screen found the MRI unit to be culture negative for MRSA. CONCLUSION: This study has demonstrated that standard decontamination measures are adequate to prevent environmental contamination with MRSA in a radiology department. However, the MRI unit requires special attention because of its long bore and difficult access.

Metastatic adenocarcinoma of the lung mimicking mucoid degeneration of the anterior cruciate ligament.

We report a case of a 63-year-old male with known adenocarcinoma of the lung who presented with knee pain which was initially diagnosed as mucoid degeneration of the anterior cruciate ligament (ACL) on magnetic resonance imaging (MRI). Due to persistent knee pain an interval MRI was performed, followed by image guided biopsy which showed metastatic adenocarcinoma of the lung infiltrating the ACL. This is the first reported case in the literature of an intra-articular metastasis mimicking mucoid degeneration of the ACL.

Deficiencies in the education of musculoskeletal medicine in Ireland.

BACKGROUND: Basic competency in musculoskeletal medicine is essential for many specialties being particularly relevant to primary care. AIM: The purpose of this study was to objectively assess the adequacy of musculoskeletal education at multiple levels of medical training from undergraduate level to primary care. METHODS: A previously validated musculoskeletal examination was administered to 303 volunteers consisting of medical students, orthopaedic specialist registrars, general practice trainees and general practitioners. RESULTS: Forty (71%) general practitioners and 74 (71.8%) general practice trainees failed to obtain the passing score of 70. Sixty-three (87.5%) medical students who had completed an intensive 1-week long course in musculoskeletal medicine failed the examination. The pass rate improved significantly for general practitioners who had completed a postgraduate rotation in musculoskeletal medicine (47.8 vs 18.1%, P < 0.01). CONCLUSIONS: These findings suggest that training in musculoskeletal medicine is inadequate at multiple levels of medical education with reform urgently required.

Spinal injuries in Irish rugby: a ten-year review.

This study assessed the frequency of acute injury to the spinal cord in Irish Rugby over a period of ten years, between 1995 and 2004. There were 12 such injuries; 11 were cervical and one was thoracic. Ten occurred in adults and two in schoolboys. All were males playing Rugby Union and the mean age at injury was 21.6 years (16 to 36). The most common mechanism of injury was hyperflexion of the cervical spine and the players injured most frequently were playing at full back, hooker or on the wing. Most injuries were sustained during the tackle phase of play. Six players felt their injury was preventable. Eight are permanently disabled as a result of their injury.