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Background: The exponential growth of image-based diagnostic and minimally invasive interventions requires a detailed three-dimensional anatomical knowledge and increases the demand towards the undergraduate anatomical curriculum. This randomized controlled trial investigates whether musculoskeletal ultrasound (MSUS) or arthroscopic methods can increase the anatomical knowledge uptake.
Methods: Second-year medical students were randomly allocated to three groups. In addition to the compulsory dissection course, the ultrasound group (MSUS) was taught by eight, didactically and professionally trained, experienced student-teachers and the arthroscopy group (ASK) was taught by eight experienced physicians. The control group (CON) acquired the anatomical knowledge only via the dissection course. Exposure (MSUS and ASK) took place in two separate lessons (75 minutes each, shoulder and knee joint) and introduced standard scan planes using a 10-MHz ultrasound system as well as arthroscopy tutorials at a simulator combined with video tutorials. The theoretical anatomic learning outcomes were tested using a multiple-choice questionnaire (MCQ), and after cross-over an objective structured clinical examination (OSCE). Differences in student's perceptions were evaluated using Likert scale-based items.
Results: The ASK-group (n = 70, age 23.4 (20--36) yrs.) performed moderately better in the anatomical MC exam in comparison to the MSUS-group (n = 84, age 24.2 (20--53) yrs.) and the CON-group (n = 88, 22.8 (20--33) yrs.; p = 0.019). After an additional arthroscopy teaching 1 % of students failed the MC exam, in contrast to 10 % in the MSUS- or CON-group, respectively. The benefit of the ASK module was limited to the shoulder area (p < 0.001). The final examination (OSCE) showed no significant differences between any of the groups with good overall performances. In the evaluation, the students certified the arthroscopic tutorial a greater advantage concerning anatomical skills with higher spatial imagination in comparison to the ultrasound tutorial (p = 0.002; p < 0.001).
Conclusions: The additional implementation of arthroscopy tutorials to the dissection course during the undergraduate anatomy training is profitable and attractive to students with respect to complex joint anatomy. Simultaneous teaching of basic-skills in musculoskeletal ultrasound should be performed by medical experts, but seems to be inferior to the arthroscopic 2D-3D-transformation, and is regarded by students as more difficult to learn. Although arthroscopy and ultrasound teaching do not have a major effect on learning joint anatomy, they have the potency to raise the interest in surgery.
A review of biological control efforts against Diptera of medical and veterinary importance includes pertinent literature of major dipterous taxonomic groups where some success has been achieved or where work is currently being conducted on species breeding in aquatic (e.g., mosquitoes, blackflies, tabanids) and terrestrial habitats (muscids, tsetse, etc.). Most effort has been directed against aquatic Diptera because of the human and animal disease agents they transmit. Research has established that the natural enemy component frequently is responsible for significant population reduction and indispensable to integrated control which seeks to maintain populations below annoyance or disease transmission levels. The manipulation of natural enemies through introduction and/or augmentation has in some cases provided satisfactory control, and sustained releases of natural enemies over several years may overcome the relative high cost of massive release rates. Ultimately, to guarantee the existence and maximum expression of resident natural enemies has become almost universally accepted, and challenging, to sound control practices. Indeed, chemical industry recognizing this, has sought to manufacture products such as Bacillus toxins, juvenile hormones, and baits that are minimally disruptive to existing natural controls. Although such easily applied products have been widely adopted, their cost continues to become prohibitive with developing resistance, as was observed earlier with many organophosphate and chlorinated hydrocarbon insecticides. Further advancements in the control ofthese Diptera should continue to embrace a sound appreciation for the natural control component and nurture ways to allow its maximum expression. Keyword Index: Biological Control, Diptera, Medical, Veterinary.