Medical problem-solving: a critique of the literature.
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Biomedical subjects
Publications and source records attributed to C McGuire.
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A patient with severe seropositive rheumatoid arthritis and hepatic cirrhosis developed septic arthritis of his knees. Plesiomonas shigelloides was isolated from joint fluid, blood, and also from the gut. The patient's joint symptoms responded to treatment with oral trimethoprim-sulphamethoxazole, but he died of uncontrolled gastrointestinal bleeding five days later.
A three-year study was designed to assess general reading and writing skills of 231 entering medical students and to compare these scores with those of clinically oriented reading and writing skills in the same cohort of students three years later. Standardized reading and writing tests were administered to all entering freshmen in the class of 1982. Clinical reading and writing examinations were developed by the authors and members of the faculty. The reading test consisted of 16 multiple-choice questions in response to three short discussions in medical journals. Clinical writing was assessed through scoring each student's latter of referral to another physician after he read a "mock" chart of a patient's hospital care. The results showed that entry-level reading comprehension and clinical reading had a significant association as did entry-level English composition and clinical writing. Regression analysis showed that the entry-level reading and writing scores were better predictors of clinical reading and writing skills than any other prematriculation variables. The implications of these findings for medical education are discussed.
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Conventional hardcopy images from 266 body CT studies were compared with those provided at a commercially available picture archiving communication system (PACS) workstation. Unprocessed PACS images were larger but otherwise precisely duplicated hardcopy images. The PACS images were evaluated before and after application of various image processing/display features. Approximately three-quarters of the cases were depicted equally well with PACS and hardcopy, but in one quarter of the cases, diagnostic features were judged to be shown more clearly at the PACS workstation. When PACS images were viewed first, change in diagnosis after subsequent hardcopy inspection was infrequent (confidence change: 4%; different findings: 2%). Conversely, when hardcopy images were viewed first, change in diagnosis after subsequent PACS inspection was more frequent (confidence change: 19%; different findings: 8%). Specialized image manipulation available on PACS was critical for its performance. Review of cases with new findings discovered during the second inspection showed the majority of them to be clinically significant, true-positives discovered by PACS. We conclude that PACS is a useful modality for interpretation of body CT images.
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