Background: Standardised patients (SPs) have been widely used to assess physicians' clinical competence. However, in paediatrics, the use of children in such a way has long been questioned with regard to ethics and the examination quality (in terms of validity, reliability, and feasibility). Aims: To summarise the current state of the use of child SPs, and to highlight the difficulties inherent in the use of children for this purpose. Methods: Nineteen articles dealing with the use of child SPs for clinical assessment were reviewed. Results: Child SPs, ranging in age from infancy to adolescence, were present in varied proportions of paediatric objective structured clinical examination stations (12-27%). In most of these reports, there were several children with cases who could substitute for one another. Child SPs successfully portrayed various roles, although only older children had to learn a scenario. In general, clinical examinations using child SPs were found to be valid and generated reliable scores. Child SPs also provided effective feedback. The experience tended to be considered negative for younger children but was quite positive for a number of older children. The use of young SPs should be avoided for ethical reasons, and the use of child SPs should be limited to assessments that cannot be satisfactorily measured by other methods. Conclusion: Through meticulous attention to detail and careful planning, a clinical examination using children as SPs can be practical, valid, and reliable.

Introduction:We assessed whether a strategy using dynamic, internet-mediated, team-based case management could reduce the number of subsequent emergency department (ED) visits by frequent ED users. Methods: Patients who attended the ED three or more times within 72 hours in June 2010 were identified. These cases were divided into the pain management or chronic disease group according to their chief complaint. Patients were assessed by expert panels, and initial care plans were developed and posted on an internal website. Thereafter, each emergency physician could follow or adjust the care plans dynamically via the internal website according to the patient's condition and use the website to communicate results. Care plans were revised by the team according to the patient's clinical situation as it changed. Patient ED visits over the subsequent six months were monitored. Results: Fourteen cases were enrolled in the study, seven in each group. The mean number of visits per patient per month in the pain management and chronic disease groups decreased from 14.9 to 5.79 (p=0.031) and 6.1 to 2.9 (p<0.001) visits per month after the intervention, respectively. The overall mean number of visits per patient per month decreased from 10.5 to 4.36 (p=0.004), a decrease of 6.14 visits (58.27%). Conclusions: Dynamic internet-mediated team-based case management may help to reduce subsequent visits in patients who frequently visit the ED. (Hong Kong j.emerg.med.

With a carefully designed rating instrument and simulation operation, the manikin-based simulation examination was shown to be reliable and valid. However, a further refinement of the test instrument will be required for higher stake examinations.

Tamoxifen enhanced the cytotoxicity of chemotherapeutic agents largely through its toxic effects on the bladder cancer cells. The mode of action of tamoxifen was not through the regulation of TGF beta-1 or the function of mdr-1. Although cytotoxic levels of tamoxifen (> 50 microM) can be achieved easily in the intravesical model, further study is necessary before tamoxifen can be used clinically in intravesical chemotherapy.

The effect of body tilting on physiological functions was studied in 32 healthy, full-term neonates at 2 and 24 h of age. The neonates were placed in the supine position and the physiological functions were measured in the sequence of -30 degrees (head-down), 0 degree and 30 degrees (head-up) tilts. Arterial oxygen saturation and respiratory rate were comparable in the vaginal delivery and caesarean section groups. The baroreceptor responses were similar in the neonates delivered vaginally and by caesarean section. Mean heart rate increased on 30 degrees up tilting and the responses tended to be larger at 24 h compared with those at 2 h of age, but these differences were not significant. At 2 h of age, mean systolic and diastolic blood pressures decreased on 30 degrees up tilting. At 24 h of age, mean systolic and diastolic pressures decreased on up tilting (from -30 degrees to 0 degree) and the values were sustained on further up tilting (from -0 degree to 30 degrees). The present results indicate that baroreceptor reflexes are present from birth and the responses tend to be less developed at 2 h than those at 24 h of age.