Basic echocardiography for undergraduate students: a comparison of different peer-teaching approaches.

BACKGROUND: The aim of this study was to assess the impact of different teaching interventions in a peer-teaching environment on basic echocardiography skills and to examine the influence of gender on learning outcomes. METHODS: We randomly assigned 79 s year medical students (55 women, 24 men) to one of four groups: peer teaching (PT), peer teaching using Peyton's four-step approach (PPT), team based learning (TBL) and video-based learning (VBL). All groups received theoretical and practical hands-on training according to the different approaches. Using a pre-post-design we assessed differences in theoretical knowledge [multiple choice (MC) exam], practical skills (Objective Structured Practical Examination, OSPE) and evaluation results with respect to gender. RESULTS: There was a significant gain in theoretical knowledge for all students. There were no relevant differences between the four groups regarding the MC exam and OSPE results. The majority of students achieved good or very good results. Acceptance of the peer-teaching concept was moderate and all students preferred medical experts to peer tutors even though the overall rating of the instructors was fairly good. Students in the Video group would have preferred a different training method. There was no significant effect of gender on evaluation results. CONCLUSIONS: Using different peer-teaching concepts proved to be effective in teaching basic echocardiography. Gender does not seem to have an impact on effectiveness of the instructional approach. Qualitative analysis revealed limited acceptance of peer teaching and especially of video-based instruction.

Role of milk protein-based products in some quality attributes of goat milk yogurt.

Goat milk yogurts were manufactured with the fortification of 2% (wt/vol) skim goat milk powder (SGMP), sodium caseinate (NaCn), whey protein concentrate (WPC), whey protein isolate (WPI), or yogurt texture improver (YTI). Yogurts were characterized based on compositional, microbiological, and textural properties; volatile flavor components (with gas chromatography); and sensory analyses during storage (21d at 5 °C). Compared with goat milk yogurt made by using SGMP, the other goat milk yogurt variants had higher protein content and lower acidity values. Goat milk yogurts with NaCn and WPC, in particular, had better physical characteristics. Using WPI caused the hardest structure in yogurt, leading to higher syneresis values. Acetaldehyde and ethanol formation increased with the incorporation of WPI, WPC, or YTI to yogurt milk. The tyrosine value especially was higher in the samples with NaCn and YTI than in the samples with WPC and WPI. Counts of Streptococcus thermophilus were higher than the counts of Lactobacillus delbrueckii ssp. bulgaricus, possibly due to a stimulatory effect of milk protein-based ingredients other than SGMP on the growth of S. thermophilus. Yogurt with NaCn was the best accepted among the yogurts. For the parameters used, milk protein-based products such as NaCn or WPC have promising features as suitable ingredients for goat milk yogurt manufacture.

Long term effects of palatal implant method in adult patients with simple snoring and obstructive sleep-apnea syndrome.

OBJECTIVE: To investigate the long term effect and reliability of palatal implant surgery, which is a minimally invasive technique, used in simple snoring and obstructive sleep-apnea syndrome types based on objective and subjective data. MATERIALS AND METHODS: Seventy-eight patients were included prospectively in this study. It has been possible to obtain preoperative and postoperative polysomnography results in 59 patients. The cases were followed-up for 8 months on average. Considering the apnea index and AHI values, the patients were divided into 5 groups, namely simple snoring (n=13), mild OSAS (n=21), moderate OSAS (n=17), severe OSAS (n=8), and the group on which polysomnography could not be performed, the no-polysomnography group (n=19). The cases were evaluated based on polysomnography and the Epworth Sleepiness Scale and visual analog scale filled by relatives or friends of the patients. RESULTS: The AHI of 46 patients diagnosed with OSAS decreased from 14.9 to 10.14 (31% decline) (p=0.279). The AHI of 13 patients with simple snoring diagnosis reduced from 3.09 to 2.02 (p=0.033). A 40% improvement was observed in VAS of all cases. Implant rejection occurred in 7 of our cases and 3 patients experienced ecchymosis. CONCLUSIONS: It is concluded that palatal implant procedure is a good option for appropriate cases, it is equivalent to other methods in terms of treatment efficacy and that is more advantageous than other techniques in that it can be applied in office settings with low morbidity, is minimally invasive and brings about higher patient compliance.

[Evaluation of septoplasty patients with health status scale, rhinomanometry and computed tomography]. / Septoplasti hastalarinin yasam kalitesi ölçegi, rinomanometri ve bilgisayarli tomografi ile degerlendirilmesi.

OBJECTIVES: We evaluated disease-specific health status prior to and after septoplasty in patients with nasal septal deviation (NSD), and sought correlation between diagnosis and laboratory findings (anterior rhinomanometry and computed tomography). PATIENTS AND METHODS: The study included 39 patients (8 females, 31 males; mean age 41 years; range 18 to 59 years) with a diagnosis of NSD. Prior to septoplasty, all patients were evaluated by coronal paranasal sinus computed tomography (CT), anterior rhinomanometry and the Nasal Obstruction Symptom Evaluation (NOSE) scale. Rhinomanometry and the NOSE scale were repeated three months after septoplasty. RESULTS: Compared to the preoperative values, the patients exhibited a significant decrease in NOSE scores, and in rhinomanometry, significantly increased nasal airflow and decreased total nasal airway resistance (p<0.05). No relationship was found between pre-and postoperative NOSE scores and total nasal airway resistance, and between preoperative NOSE scores and the severity of NSD assessed by CT (p>0.05). CONCLUSION: The NOSE scale is a reliable tool to assess health status of patients with nasal obstruction symptoms. The diagnosis of NSD does not require rhinomanometry or computed tomography.

[The results of specific immunotherapy for house dust mites in patients with allergic rhinitis]. / Alerjik rinitli hastalarda ev tozu akarlarina karsi uygulanan spesifik immünterapi sonuçlari.

OBJECTIVES: We evaluated three-year clinical and laboratory results of specific immunotherapy (SIT) for allergenic house dust mite species, Dermatophagoides pteronyssinus and D. farinae. PATIENTS AND METHODS: The study included 26 patients (6 males, 20 females; mean age 28 years; range 17-56 years) who had allergic rhinitis and were found to be sensitive to D. pteronyssinus and D. farinae. Due to unresponsiveness to other treatment modalities, the patients received subcutaneous SIT for three years. Symptoms (nasal stuffiness, rhinorrhea, itching, sneezing, headache, eye symptoms, and smelling) were graded before and at the end of SIT, and blood eosinophilia, total IgE and specific IgE levels were determined. RESULTS: At the end of three years, the number of patients that showed strong positivity to D. pteronyssinus and D. farinae decreased from 26 (100%) to 3 (11.5%) (p=0.0001) and from 18 (69.3%) to 4 (15.4%) (p<0.005), respectively. There were significant decreases in blood eosinophilia, total IgE and specific IgE levels, and in the severity of all symptoms related to the nose, head, and eye. CONCLUSION: Specific immunotherapy reduces symptoms in patients with allergic rhinitis. It is an effective treatment method for allergic rhinitis if performed by trained physicians in carefully selected patients.

[Cardiac penetration wounds: three years Adana Numune Hospital experience]. / Kalbe penetran yaralanmalar: üç yillik Adana Numune Hastanesi deneyimi.

BACKGROUND: Cardiac penetration wounds have high mortality which need a rapid diagnosis and surgical intervention. METHODS: Between May 1999 to May 2002, 196 thoracic penetration cases who were admitted to emergency department were examined and in 12 (6.1%) of them cardiac penetration was diagnosed. In this retrospective study, the cardiac penetration cases were evaluated. RESULTS: All the cases were male, 11 of them were injured by stab wounds, and one case by a gunshot wound. We performed left anterolateral thoracotomy in nine of the cases, right anterolateral thoracotomy in two cases and a median sternotomy in one case. Two of the cases died. CONCLUSION: The survival chance of the cases can be increased with rapid diagnosis and surgical intervention.

Caloric vestibular test in the weightless phase of parabolic flight.

Twenty-four caloric vestibular tests were conducted in 20 test subjects during parabolic flight, in which weightless periods of about 10 seconds were elicited. The caloric nystagmus disappeared completely in all experiments in weightlessness, whereas in the higher G-periods the speed of the nystagmus increased. With regard to the modes of response during the periods with increased G-values prior to and following the weightlessness, four different types could be distinguished. In mode I the speed of the slow nystagmus phase increased in the higher G-periods, the nystagmus showed a prolonged duration, while in weightlessness it faded out completely. A reversed nystagmus appeared when the primary caloric nystagmus had disappeared. In modes II, III and IV the direction of the nystagmus reversed during weightlessness. In modes II and III this reversed nystagmus appeared even when the primary caloric nystagmus had disappeared. In mode III the nystagmus resembled the type of mode II, with the difference that it faded away much earlier than could be expected. In mode IV the primary nystagmus lasted rather briefly, while the reversed nystagmus during weightlessness was also much shorter. The experiments produced two remarkable facts: the appearance of a nystagmus reversal, a 'secondary nystagmus', in all experiments in weightlessness, and furthermore great differences in findings between the individuals as well as between experiments in the same person. The only explanation for the inconsistency in the findings is the assumption that effects on other canals, otoliths and vestibular nuclei are continuously changing and therefore interfere with the only endproduct measured, the horizontal nystagmus.(ABSTRACT TRUNCATED AT 250 WORDS)

Vestibular caloric test and local anaesthesia: a nystagmographical study on pigeons.

The caloric test was conducted on pigeons before and after the application of infiltration anaesthesia around the investigated ear. After irrigation with the same amount of water at the same temperature, it was observed that following local anaesthesia the caloric response was intensified. This result suggests that the nerve supply and blood supply of the external ear may be one of the factors responsible for the large variability of caloric responses found in routine caloric investigations.

Post-caloric secondary phase nystagmus.

Spontaneous direction reversal of a peripherally induced nystagmus, known as secondary phase nystagmus, can be found following a thermal stimulus. In 120 patients with various vestibular symptoms, post-caloric secondary phase nystagmus has been examined and its diagnostic value is discussed. Although the mechanism responsible for the post-caloric secondary phase nystagmus is not clear, there seem to be three factors that play a role in its occurrence: a the intensity of the stimulus; b the sensitivity of the vestibular and optokinetic systems; c the anatomical features of the external and middle ear. Because of these multiple factors, it is difficult to define the diagnostic value of the secondary phase nystagmus. However, we assume that secondary phase nystagmus is due to the adaptation of the organism to the peripheral vestibular stimulus, and factors mentioned above may induce or suppress its occurrence.

Internal and external vestibular caloric tests in pigeons. A nystagmographic study.

The caloric test was conducted on pigeons in two different ways: 'external calorization', stimulation by irrigation of the external ear canal, and 'internal calorization', stimulation through a coil winded around one horizontal semicircular canal. Different temperatures and amounts of irrigation water were tried out to obtain caloric responses. Internal calorization proved to be more effective than external calorization in a wide range of temperature levels. The experiments proved that a kind of modifying effect of the external ear canal sensory innervation exists on the vestibular caloric test.