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The Medical Council of Canada (MCC) administers a qualifying examination for the issuance of a license to practice medicine. To date, this examination does not test the clinical skills of history taking, physical examination, and communication. The MCC is implementing an objective structured clinical examination (OSCE) to test these skills in October 1992. A pilot examination was developed to test the feasibility, reliability, and validity of running a multisite, two-form, four-hour, 20-station OSCE for national licensure. In February 1991, 240 volunteer first- and second-year residents were tested at four sites. The candidates were randomly assigned to one of two forms of the test and one of two sites for two of the four sites. Generalizability analysis revealed that the variance due to form was 0.0 and that due to site was .16 compared with a total variance of 280.86. The reliabilities (inter-station) were .56 and .60 for the two forms. Station total-test score correlations, used to measure station validity, were significant for 38 of the 40 stations used (range .14-.60). The results of the OSCE correlated moderately with the MCC qualifying examination; these correlations were .32 and .35 for the two test forms. Content validity was assessed by postexamination questionnaires given to the physician examiners using a scale of 0 (low) to 10 (high). The physicians' mean ratings were: importance of the stations, 8.1 (SD, 1.8); success of the examination in testing core skills, 8.1 (SD, 1.6); and degree of challenge, 7.8 (SD, 2.1). The results indicate that a full-scale national administration of an OSCE for licensure is feasible using the model developed. Aspects of validity have been established and strategies to augment reliability have been developed.
BACKGROUND: This project examines whether visits of specially trained clinic clowns, as established in pediatrics, would also be useful in psychiatry. METHODS: We describe the effects of a 6-week phase with one clown visit per week in a ward for acutely ill geriatric patients. The patients and medical team were also questioned about their attitudes towards the clowns. RESULTS: We found more positive attitudes in patients after this phase. CONCLUSIONS: We interpret this result as an indication of positive effects and sufficient reason to initiate similar projects in the future.
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Ambulance services appear to be under increasing pressure to provide a full range of services to the Community. It is important, therefore, that the service is appropriately utilised by patients. Health Service Managers, however, have little readily available information which identifies 'appropriate' utilisation. A simple technique is suggested to measure 'appropriateness' of utilisation of ambulances and a pilot survey of ambulance use by patients attending Dunfermline and West Fife Hospital Out-Patient clinics is described. In each case of ambulance use a panel of health professionals evaluated the 'appropriateness' of the patient having utilised this service. In the clinics surveyed, 91% of the sample of 328 patients did not use an ambulance to travel to clinics; in only two cases was use of the ambulance considered to be 'probably inappropriate'. Misuse of the ambulance service was minimal during this study. Health Service Managers have been provided with some evidence to refute suggestions of substantial, inappropriate use of the ambulance service.
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The newly available techniques for sensitive proteome analysis and the resulting amount of data require a new bioinformatics focus on automatic methods for spectrum reprocessing and peptide/protein validation. Manual validation of results in such studies is not feasible and objective enough for quality relevant interpretation. The necessity for tools enabling an automatic quality control is, therefore, important to produce reliable and comparable data in such big consortia as the Human Proteome Organization Brain Proteome Project. Standards and well-defined processing pipelines are important for these consortia. We show a way for choosing the right database model, through collecting data, processing these with a decoy database and end up with a quality controlled protein list merged from several search engines, including a known false-positive rate.
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Drinking water surveillance includes the use of spatial data. A geographic information system (GIS) is a practicable tool for work with spatial data in the health sector as well. Co-operation between the Institute of Public Health for North Rhine Westphalia, the local health authority of the Hoexter district and the Institute for Geoinformatics of the University of Muenster started a project testing the use of GIS for drinking water surveillance. A special application was programmed. It includes functions of retrieval and classification of the measured values of drinking water wells, in order to show time trends in a diagram and to visualise the location of the wells and the analysis data in a map. The members of the Public Health Office accepted the method and started using it regularly. In addition, the collaboration between the health authority and other local authorities was strengthened. Several data sets were included in the GIS, such as wells and results of water analysis, water protection areas, land use data, and topographical maps. Basing on to the experiences with this project, the development of a standard application is planned that is supposed to be communicated to all local health authorities in North Rhine Westphalia.
A primary health care project was started two years ago by the PIH in collaboration with the health councils of ten municipalities in the region of Turnhout. The objective was to promote actions on better health that were beyond the capacity of existing regional health care facilities. The project is managed by representatives of the province and of the ten municipalities. The first subject for coordinated action was healthy eating. Three practical projects were developed: a salt concentration analysis of bread from 150 bakeries; a quality evaluation of the deep fat from 110 french fry stands and a secondary school programme entitled "Eat Healthy". A new concept of project development was proposed after the first study. 4 steps have to be considered in the future, which are: first to quantify the amount of the suspected health care problem in the region; secondly to activate an intervention strategy which tends to limit to suggest and initiate long term policy actions. Findings of the to suggest and initiate long term policy actions. Findings of the first project show that to obtain the desired results a well conceived information campaign is essential.
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