Ultrasound-assisted bony landmark palpation in untrained palpators.

CONTEXT: Medical students with no previous experience may find it difficult to identify and palpate bony landmarks while learning physical examination skills. In a study of 168 medical schools, 72.6 % have indicated that they are utilizing ultrasound in their curriculum. Although the integration of ultrasound curriculum has become more widespread, the depth of instruction is inconsistent. Ultrasound is not commonly taught in conjunction with palpation of bony landmarks in osteopathic structural examination. OBJECTIVES: The objective of this analysis was to identify whether utilizing ultrasound assistance in teaching palpation of specific thoracic vertebral bony landmarks would improve palpation accuracy in first-year medical students with no previous palpatory experience. METHODS: First-year medical students were given video instructions to palpate and identify a thoracic vertebral transverse process and to mark it with invisible ink. The participants were then taught and instructed to utilize ultrasound to identify the same landmark and mark it with a different color. The accuracy of palpation was measured with digital calipers. RESULTS: A test of the overall hypothesis that participants will show improved accuracy utilizing ultrasound compared with hand palpation was not significant (F=0.76, p>0.05). When separating students into groups according to patient body mass index (BMI), however, there was a trend toward significance (F=2.90, p=0.071) for an interaction effect between patient BMI and the repeated measures variable of palpation/ultrasound. When looking specifically at only those participants working with a normal BMI patient, there was a significant improvement in their accuracy with the use of ultrasound (F=7.92, p=0.017). CONCLUSIONS: The analysis found increased accuracy in bony landmark identification in untrained palpators utilizing ultrasound vs. palpation alone in a normal BMI model, but not in obese or overweight BMI models. This study shows promise to the value that ultrasound may have in medical education, especially with respect to early palpation training and landmark identification.

DNA-crosslinked alginate and layered microspheres to modulate the release of encapsulated FITC-dextran.

Alginate can be gently crosslinked by calcium into hydrogels and microspheres for the encapsulation and release of proteins and drugs. However, the release is often over short periods unless alginate is also covalently modified or crosslinked. This research aims to sustain the release of encapsulated model drug FITC-dextran by covalently crosslinking alginate with short oligomers DNA because evidence suggests that DNA may also interact with alginate to further increase effective crosslinking. Furthermore, modulating the release of drugs from alginate in response to specific proteins could tailor release profiles to improve patient treatment. This research develops a DNA-crosslinked alginate hydrogel and layered alginate microspheres to encapsulate and then sustain the release FITC-dextran (model drug). An aptamer sequence to hen egg-white lysozyme is included in one DNA strand to allow for the disruption of the crosslinks by interactions with human lysozyme. Alginate was covalently modified with complementary strands of DNA to crosslink the alginate into hydrogels, which had increased crosslinking density when re-swollen (in comparison to controls crosslinked with PEG) and could sustained the release of encapsulated FITC-dextran. When an aptamer sequence for hen lysozyme was included in the DNA crosslinks, the hydrogels decrosslinked when incubated in human lysozyme for 60 days. In addition, calcium alginate microspheres were coated with 3 alternating layers of poly-Lysine, DNA-crosslinked alginate, and poly-L-lysine. FITC-dextran loaded into the microspheres released in a sustained manner past 30 days (into PBS at 37 °C) and would likely continue to release for far longer had the studies continued. When incubated with 3 µM of human lysozyme, a burst release of FITC-dextran occurred from both the hydrogels and microspheres, with no changes in the controls. The increased release was in bursts followed by similar sustained release rates suggesting that the human lysozyme temporarily disrupted the DNA crosslinks which were then re-established or were influenced by interactions between DNA and alginate. Importantly, covalently bound complementary strands of DNA could crosslink the alginate and additional interactions appeared to further sustain the release of encapsulated therapeutics.

Completeness of Intervention Reporting of Clinical Trials Published in Highly Ranked Obesity Journals.

OBJECTIVE: Randomized controlled trials (RCTs) play a crucial role in the research and advancement of medical treatment. A cross-sectional study design was utilized to analyze the completeness of intervention reporting using the Template for Intervention Description and Replication (TIDieR) checklist and to evaluate factors associated with intervention reporting. A comparison of the completeness of intervention reporting before and after the publication of TIDieR was sought. METHODS: PubMed was searched for RCTs in the top 10 obesity journals per the Google h5-index. After excluding non-RCTs, 300 articles were randomly sampled. After assessing each publication for eligibility, two authors (SLR and DT) extracted data related to intervention reporting from records in an independent, masked fashion. Data were then verified and analyzed. RESULTS: The analysis revealed that the quality of intervention reporting is quite variable. Overall, no statistically significant difference in the quality of intervention reporting before and after the release of TIDieR guidelines was found. In general, obesity research has good intervention reporting in areas such as the mode of delivery, material lists for intervention, and procedure lists. However, four main areas in which obesity researchers can improve reporting quality were determined. These include providing the expertise and background of intervention providers and providing statements regarding the assessment of fidelity of the intervention. CONCLUSIONS: Urgent intervention is warranted to improve the quality of research reporting in obesity research, which is a fundamental component of obesity management. This will likely require a unified approach from researchers, journals, and funding sources.

Evaluation of articles in metabolism research on the basis of their citations.

INTRODUCTION: The number of research papers and journals each year is increasing and millions of dollars are spent. Despite this there is evidence to suggest that many publications do not impact clinical practice. We used citation analysis to measure the influence of metabolism publications from 2003-2013. Those papers with lower citation rates are likely to be of the least value and high rates of such publications may be a marker of research waste. MATERIALS AND METHODS: We analysed 67 journals with 81,954 articles related to metabolism indexed on the Scopus station database from 2003-2013. We identified those articles with less than 5 citations within 5 years from publication date as poorly cited. Journals were ranked by the percentage of articles that were poorly cited or uncited. RESULTS: Over the 10-year period, the number of total articles increased by 127%. We found that 24% of articles were poorly cited within 5 years of publication. Journals in the bottom 25% and top 25% of rankings by citation rates accounted for a similar proportion of poorly cited articles. Most of the open access journals were ranked in the top 25% for citation rates. CONCLUSIONS: Our analysis contradicts concerns over increasing amounts of publications with little impact. The proportion of poorly cited articles are low, with little change in the trend over 10 years. The top and bottom ranked journals produced similar proportions of poorly cited articles. These findings suggest the necessity of pursuing further research to study waste in metabolism research.

Evaluation of the NCCN guidelines using the RIGHT Statement and AGREE-II instrument: a cross-sectional review.

INTRODUCTION: Robust, clearly reported clinical practice guidelines (CPGs) are essential for evidence-based clinical practice. The Reporting Items for practice Guidelines in HealThcare (RIGHT) Statement and Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument were published to improve the methodological and reporting quality in healthcare CPGs. METHODS: We applied the RIGHT Statement checklist and AGREE-II instrument to 48 National Comprehensive Cancer Network (NCCN) guidelines. Our primary objective was to assess the adherence to RIGHT and AGREE-II items. Since neither RIGHT nor AGREE-II can judge the clinical usefulness of a guideline, our study is designed to only focus on the methodological and reporting quality of each guideline. RESULTS: The NCCN guidelines demonstrated notable strengths and weaknesses. For example, RIGHT Statement items 19 (conflicts of interest), 7b (description of subgroups) and 13a (clear, precise recommendations) were fully reported in all guidelines. However, the guidelines inconsistently incorporated patient values and preferences and cost. Regarding the AGREE-II instrument, the NCCN guidelines scored highly on the domains 4 (clear, precise recommendations) and 6 (handling of conflicts of interest), but lowest on domain 2 (inclusion of all relevant stakeholders). CONCLUSIONS: In this investigation, we found that NCCN CPGs demonstrate key strengths and weaknesses with respect to the reporting of key items essential to CPGs. We recommend the continued use of NCCN guidelines and improvements to weaknesses in reporting and methods. Doing so serves to improve the evidence delivered to healthcare providers, thus potentially improving patient care.