Assessing housestaff diagnostic skills using a cardiology patient simulator

Article Abstract:

The cardiovascular physical examination skills of residents in internal medicine may need to be improved. Medical residents may not be receiving adequate instruction in the physical examination skills needed to diagnose certain cardiovascular diseases. Among 60 internal medicine residents who participated in two sessions of a program to identify simulated heart valve abnormalities, 52% correctly identified mitral regurgitation, 37% correctly identified mitral stenosis and 54% correctly identified aortic regurgitation. Residents who identified mitral regurgitation correctly assessed the characteristics of a holosystolic murmur. Those who identified mitral stenosis noted an opening snap sound in the heart and correctly assessed the characteristics of a mitral area diastolic murmur. No specific observations were associated with the correct diagnosis of aortic regurgitation.

Cardiovascular diseases, Education, Study and teaching, Residents (Medicine), Physical diagnosis, Medical examination

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The role of antineutrophil cytoplasmic antibody (c-ANCA) testing in the diagnosis of Wegener granulomatosis: a literature review and meta-analysis

Article Abstract:

Antineutrophil cytoplasmic antibody (c-ANCA) tests may not be sensitive or specific enough to make a definitive diagnosis of Wegener granulomatosis. This disease causes inflammation of small blood vessels throughout the body and may be fatal unless treated. A four-stage review of the medical literature for articles on the use of c-ANCA to diagnose Wegener granulomatosis yielded 15 articles for data analysis. The percentage of patients tested with c-ANCA who were finally diagnosed with Wegener granulomatosis was 5.9%. The sensitivity, or true positive, rate for c-ANCA varied from 34% to 92%, while the specificity, or true negative, rate varied from 88% to 100%. A more accurate diagnosis of Wegener granulomatosis may be achieved by considering c-ANCA results along with the prevalence of the disease and the patient's symptoms.

Autoantibodies

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Limitations of the 1990 American College of Rheumatology classification criteria in the diagnosis of vasculitis

Article Abstract:

Vasculitis classification criteria established by the American College of Rheumatology (ACR) in 1990 are inadequate for the diagnosis of these inflammatory blood vessel conditions. The classification criteria were developed to categorize vasculitis conditions, but in practice they are often used to diagnose the diseases. Researchers audited the medical charts of 198 patients with suspected vasculitis, and found that the ACR classifications correctly predicted the final diagnosis in only 17-29% of cases referred to rheumatologists.

Standards, Evaluation, Vasculitis, Giant cell arteritis, Temporal arteritis, Nosology, American College of Rheumatology, Periarteritis nodosa, Polyarteritis nodosa

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