Analysis of Web-based learning methods in emergency medicine: randomized controlled trial.

INTRODUCTION: In medical education, Web-based learning is increasingly used as a complement to practical classes. The objective of the study was to perform a comparative analysis of three different forms of e-learning course on emergency medicine in terms of an indicator of knowledge growth and students' satisfaction. MATERIAL AND METHODS: For the purpose of the study, we developed and implemented a tool in the form of an online course: A - non-animated presentation, B - video, C - interactive video. The participants were undergraduate students of emergency medicine and nursing (n = 106). A pre-test and a post-test were carried out, and the resulting data were analyzed using parametric tests (t-test, ANOVA, post-hoc). Final questionnaires assessing six parameters of satisfaction were also evaluated. RESULTS: A significant increase in knowledge in the experimental group which used an interactive video was observed (p = 0.04). Moreover, the number of replays of learning material was the highest in group C (2.09 ±2.48). The level of post-course satisfaction turned out to be comparable in all three groups (p = 0.62). CONCLUSIONS: The study allowed the interactive course to be identified as the most effective method of distance learning among selected ones. Due to the limitations of the study, we conclude that there is a need for further studies on the effectiveness of e-learning in emergency medicine.

[Evaluation of the risk of developing lymphoedema of the upper limb in women subjected to motor rehabilitation after radical mastectomy]. / Ocena ryzyka rozwoju obrzeku limfatycznego konczyny górnej u kobiet poddanych rehabilitacji ruchowej po radykalnej mastektomii.

The analysis included 86 women in whom lymphoedema occurred in the upper limn (ULL) after radical mastectomy. The analysis were carried out in this group of patients, as well as in a control group (patients without ULL) 14 somatic parameters were examined. These parameters were evaluated before the intervention. It was established that among the anthropometric traits examined, only the body mass, hip width, hip-shoulder index, Chest flattening index, BMI index, WHR index, Quetelet's index, Rohrer's index, Pignet-Verwaeck's index assume average values in women with ULL in the preoperative period (statistically significantly different from those which occur in women without this complication(. It was shown that the dispensary group of women ill with breast cancer with a statistically significantly high risk of developing ULL was made up of patients with a large mass (>69.2 kg), WHR (>0.94), Quetele's (>448.7), Rohrer's (>1.76) and Pignet-Verwaeck's (107.7). A slim body build and low indexe values appear to be a factor protecting from this occurrence of the complication.

[An attempt to precise indications for treatment with systemic cryotherapy of patients with rheumatoid arthritis]. / Próba sprecyzowania wskazan dla leczenia krioterapia ogólnoustrojowa chorych na reumatoidalne zapalenie stawów.

The prospective studies included 178 patients (43 men and 135 women) aged 30 to 68 years, treated because of rheumatoid arthritis (R.A.). All of them were subjected to systemic cryotherapy, considerin the total antioxidant states in the serum registered before and after the cryotherapic treatment. Fluctuations of serum antioxidants were referred to selected clinical factors such as: sex, age, duration and progression of the disease. It was confirmed that among patients with R.A., the most beneficial clinical effects obtained through systemic cryotherapy may be expected in women aged up to 49 years, in whom the disease lasted no longer than 3 years and is in the Ist of IInd period (phase).

Influence of some anthropometric parameters on the risk of development of distal complications after mastectomy carried out because of breast carcinoma.

The analysis included 46 women after radical breast amputation because of cancer with which lymphoedema occurred in the upper limb, as well as 51 women in whom no lymphoedema occurred during the period of the observation. Both groups were subjected to a comparative analysis as for height, body mass, and weight-height indexes: BMI, Quetelet, Rohrer, and Pignet-Verwaeck. The results show that women with high body mass, obesity (BMI > 30.0), and high values of the Quetelet (>370), Rohrer (>1.59), and Pignet-Verwaeck (>93.1) indexes are threatened to a significant degree with lymphoedema of the upper limbs after cancer-related mastectomy. On the other hand, slim body build and low index values appear to be a factor protecting from the occurrence of lymphoedema of the upper limb.

The disturbances of the zinc concentration in the blood in selected neoplasms.

A study was carried out on 92 patients (58 males and 34 females) aged 42-76 treated for malignant neoplasm of the gastrointestinal tract (54 patients with colorectal carcinoma, 38 with gastric carcinoma). In all patients, the zinc serum concentration was measured and the results obtained were referred to some epidemiological-clinical factors (sex, age, primary cause of cancer, the stage of clinical progression, and histological type). The results showed that the most pronounced hypozincemia occurred in male patients with mucous membrane carcinoma of the stomach.

[The chronic DIC associated with the neoplastic disease in patients of an advanced age]. / Przewlekly DIC towarzyszacy chorobie nowotworowej u chorych w starszym wieku.

The analysis included 80 patients (48 men and 32 women) aged 65 to 87 years, treated because of cancer of the stomach (34 causes) or of the large bowel (46 causes). In all the patients as well as in a control group made up of persons who were treated because of non-neoplastic diseases of the gastrointestinal tract the determinations were conducted of selected coagulological parameters: fibrinogen and D-dimer concentration, antithrombin III (AT III) activity, kaolin-cephalin index (APTT), prothrombin (PT), thrombin time (TT) and number of thrombocytes in the blood. The analysis of the results obtained showed that hemostasis disturbances of a chronic DIC character occur in 82.5% of persons of an advanced age ill with a cancer of the stomach or of the large bowel.

[The efficacy of the Helicobacter pylori eradication in people of an advanced age]. / Skutecznosc eradykacji zakazenia Helicobacter pylori u ludzi w starszym wieku.

In a group of 112 patients aged 65 to 72 years with chronic gastritis (48 persons), a peptic ulcer (30 persons), a duodenal ulcer (34 persons) bacteriological examinations were conducted aiming at determining the sensitivity to antibiotics of Helicobacter pylori (H. pylori) strains isolated from the month (gingival pockets), the stomach or duodenal mucous, from stool samples and from the skin of the hands. The sensitivity to antibiotics was tested with the diffusive-disc method taking into consideration 23 chemotherapeutic agents. It was shown that with the use of single antibiotics the chance of efficiently elimination the H. pylori infection from the area of the whole alimentary canal (month, stomach, duodenum, large bowel) amounted to 14.3-35.7% depending on the chemotherapeutics used, where with the use of a two-medicine therapy (metronidazol + amoxycillin) it increased to 42.9%. This means that in people of an advanced age the chemotherapy carried out with the aim of liquidating the infection in the stomach or duodenum mucousa creates possibilities for the H. pylori infection to persist in other parts of the alimentary canal ranging from 64.3 to 85.7%. This way the patient treated may then undergo self-infection as well as be a source of infection for other persons.

[The disturbance of the magnesium management in patients in grave clinical status]. / Zaburzenia gospodarki magnezowej u chorych w ciezkim stanie klinicznym.

The analysis included 46 patients (27 men and 19 women), aged 41 to 76 years, who required intensive medical care because of a grave clinical state. In all af them, as in a group of patients treated because of illnesses identical to those of the basic group but not requiring intensive medical care (CG), as well as in a reference group (RG)--blood donors, the determinations were conducted of the magnesium concentration in the serum with the flame atomic absorptive spectrometry method. It was confirmed that in the patients in grave clinical state the average concentration in the serum of that element was statistically significantly lower that in the other groups (CG and RG). The average magnesium concentration also differs statistically really between the CG and RG. A critical value was also determined of the magnesium concentration in the serum raising 5.78 micrograms/ml, which may be the prognosis of the metabolic disturbances leading to a grave clinical state.

The importance of determination of magnesium concentration in the serum of patients with cancer metastases to the liver.

The study was carried out on 48 patients (26 male and 22 female), aged 52-76 diagnosed as having cancer metastases to the liver. The serum level of magnesium in the studied group and also in two other groups (the first consisting of 48 blood donors and the second of 50 patients suffering from cancer of a non-disseminated nature) was measured by the flame atomic absorption spectrophotometric method. The results of the study showed that cancer metastases to the liver significantly decrease the mean level of magnesium in serum compared to the other two groups. It was shown that a magnesium level below 12.76 micrograms/ml in cancer patients increased the risk of cancer metastases to the liver.

Comparative diagnostic value of the breath test and the urine test with 14C-urea in the detection of the Helicobacter pylori infection.

Among 92 patients with chronic gastritis we conducted a synchronous diagnosis of the Helicobacter pylori (H. pylori) infection using a culture and a serological test (IFP), in conjunction with breath and urine tests involving (14)C-urea (BTU-C14 and UTU-C14). The infection was confirmed by isolation in 71 persons (77.2%), the presence of specific IgG in the blood serum was found in 75 (81.5%). In comparison, the BTU-C14 indicated a group of 77 people (83.7%) as infected, and the UTU-C14 a group of 76 (82.6%). In order to determine the diagnostic value (sensitivity, specificity and efficiency) of the latter tests, the results were compared with those of the culture and of the serological tests. It was found that the BTU-C14 test used showed a 100% sensitivity, a 89.5% specificity and a 97.9% efficiency. The UTU-C14 test showed a 100.0% sensitivity, a 94.4% specificity and a 98.9% efficiency in the detection of the H. pylori infection.