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PubMed2004

Gynecologic oncology specialty.

In general, the gynaecologic oncologists should be fully equipped to manage primary treatment and most complications related to the care of patients with gynaecologic neoplasms. During the subspecialty trianing program the fellow in trianing should learn to understand and perform radical pelvic surgery, including intestinal and urology procedures, and in addition a deep knowledge of chemotherapy and radiation therapy is important for the complete treatment of gynaecologic neoplasms. The subspecialty of gynaecologic oncology has made many advances over the last few decades; there have been several changes to the management of gynaecologic cancers, which have led to improved outcome and well-being of patients.

Female↗

PubMedDate not supplied

[Effect of acute and chronic deprivation of catecholaminergic system activity induced by 6-hydroxydopamine on the behavior of the rat].

On 202 male rats of Wistar line, a study was carried out of the effect of chronic and acute deprivations of the brain CA-systems activity resulting from administration of 6-OHDA on investigating behaviour and learning. Chronic deprivation of CA-systems activity by neonatal administration of 6-OHDA (100 mg/kg subcutaneously) and their acute deprivation by intracerebral administration of 6-OHDA to adult rats (150 mkg in each lateral ventriculus) was accompanied by similar deep changes of behaviour. Both forms of deprivation reduced the investigating activity of the animals in the open field. In both cases, the above 6-OHDA dozes sharply impeded the learning of animals with emotionally negative reinforcement, with no significant influence on learning with emotionally positive reinforcement. Both forms of deprivation of CA-systems activity weakened the reaction of frustration elicited by a sharp reduction of food reinforcement.

Animals↗

PubMed1999

Non-penetrating deep sclerectomy preliminary results.

PURPOSE: To study the short term efficiency and safety of a new filtering procedure, the non-penetrating deep sclerectomy, in the treatment of open-angle glaucoma. METHODS: We conducted a retrospective study (January 1998-September 1998). Our material included a consecutive non-randomized series of 29 patients, 34 eyes in total. The mean age was 68 years. The mean follow-up period was 5.3 months (3-8). Preoperatively all eyes suffered from medically uncontrolled glaucoma. Under a fornix-based conjunctival flap, through deep sclerectomy, the external wall of Schlemms canal is removed. Ultimately, only the trabeculodescemetic membrane remains intact. At this moment one obtains a visible filtration of aqueous humour through this thin trabeculo-descemetic membrane which is responsible for the IOP-lowering mechanism of the deep sclerectomy. Peroperative and postoperative complications were noticed. Visual acuity, slitlamp examination and intraocular pressures were noticed preoperatively and at day 1, 2, 7 and each month after surgery. RESULTS: During the learning period, (micro)perforation of the anterior chamber occurred in 9 eyes (perfDS-group). In the remaining 25 eyes (nonperfDS-group) we noticed 2 IOP failures (IOP > 20 mmHg). In this nonperfDS-group the mean IOP decreased from 5.64-7.28 mmHg preoperatively to 15.31-4.28 mmHg at the end of the follow-up. Postoperative complications were rare and transient. CONCLUSIONS: Non-penetrating deep sclerectomy seems to be an efficient procedure in the treatment of open-angle glaucoma. It is a difficult technique to learn and during the learning period perforation of the anterior chamber is the main complication. It allows a progressive decrease in IOP and thus a very low rate of associated complications.

Adult↗

PubMed1992

Influences on the quality of student learning--implications for medical education.

This paper reviews recent research into the ways in which departments influence the quality of student learning. A substantial literature has developed which describes differences in the ways in which students learn and study in higher education. These differences emphasise the distinction between seeking personal understanding and reproducing information or procedures. The research indicates that certain departments, and some lecturers, are much better than others in encouraging students to look for deep levels of meaning. The quality of teaching and the methods of assessment are particularly influential, but so is the extent to which students are helped to develop effective studying and learning strategies. Some students have been shown to have major problems in the way they perceive and utilise the opportunities for learning provided by departments. While much of the research is not drawn directly from medical faculties, the relevance to medical education is pointed up and supported by specific examples of relevant research.

Attitude↗

PubMed2001

Approaches to learning in science: a longitudinal study.

BACKGROUND: Longitudinal studies of students' approaches to learning in higher education can tell us much about the impact of the tertiary experience. More information about teaching and learning practices and how students respond to these may enable educators to better assist students to gain the maximum benefit from their tertiary studies. AIMS: The study set out: (i) to monitor the change in approaches to learning over a three-year period; (ii) to evaluate the relationship between student age, sex and university entry mode on students' approaches to learning; and (iii) to evaluate the predictive validity of the SPQ scales on one mode of learning outcome, that being annual GPA. SAMPLES: The sample consisted of 200 commencing students studying in a science course at an Australian university. METHOD: The Biggs SPQ was administered in a first-year chemistry class and repeated at intervals of 4 and 8 months. This was followed by administration by post after 16 months and 30 months. RESULTS: Student approach to learning is dynamic and amenable to change as a result of the learning experience. Of the three SPQ scales, the achieving approach appears to undergo the greatest change with time, while the deep approach showed a consistent positive correlation with assessment outcomes. Student age was a major factor in both the SPQ scores and assessment outcomes but no gender effect was evident. CONCLUSIONS: Students see university study, and in particular the first year, as a survival course and adopt strategies suited to that task. Older students adopt approaches to study which differ from their younger colleagues and as a consequence they are in general more successful in the tertiary environment.

Adolescent↗

PubMed2000

The standardized-taper root canal preparation--Part 1. Concepts for variably tapered shaping instruments.

AIM: To introduce the concept of variable taper instruments for predictable and ergonomic root canal preparation, and demonstrate the design features of Greater Taper files. SUMMARY: Optimal root canal shaping is difficult to practice and teach with traditional instruments. Instrument sequences are complex, with up to 18 instruments and 63 procedural stages, providing almost limitless scope for poor results and iatrogenic error. In the first of six articles, Dr Buchanan describes the Variable Taper concept, which grew from such frustrations, and represents a new concept in file design. Milled from NiTi alloys in tapers of 0.06, 0.08, 0.10 and 0.12 mm mm-1, with accessory files for wide canals, their design embodies the key shaping features of adequate coronal enlargement, full deep shape, and predictable apical resistance form case after case. The ease and simplicity of their use is described, and enhanced cleaning and obturation outcomes discussed in relation to their unique design features. KEY LEARNING POINTS: Canal preparation is difficult to practice and teach with traditional K-files and Gates Glidden drills. Variable Taper files are designed to offer the optimal preparation features of adequate (not excessive) coronal enlargement, full deep shape, and apical resistance form in a simple instrument sequence. Variable Taper technique is simple to master, and offers predictable cleaning and obturation outcomes, even in inexperienced hands.

Dental Alloys↗

PubMed2005

Learning and cognitive styles in web-based learning: theory, evidence, and application.

Cognitive and learning styles (CLS) have long been investigated as a basis to adapt instruction and enhance learning. Web-based learning (WBL) can reach large, heterogenous audiences, and adaptation to CLS may increase its effectiveness. Adaptation is only useful if some learners (with a defined trait) do better with one method and other learners (with a complementary trait) do better with another method (aptitude-treatment interaction). A comprehensive search of health professions education literature found 12 articles on CLS in computer-assisted learning and WBL. Because so few reports were found, research from non-medical education was also included. Among all the reports, four CLS predominated. Each CLS construct was used to predict relationships between CLS and WBL. Evidence was then reviewed to support or refute these predictions. The wholist-analytic construct shows consistent aptitude-treatment interactions consonant with predictions (wholists need structure, a broad-before-deep approach, and social interaction, while analytics need less structure and a deep-before-broad approach). Limited evidence for the active-reflective construct suggests aptitude-treatment interaction, with active learners doing better with interactive learning and reflective learners doing better with methods to promote reflection. As predicted, no consistent interaction between the concrete-abstract construct and computer format was found, but one study suggests that there is interaction with instructional method. Contrary to predictions, no interaction was found for the verbal-imager construct. Teachers developing WBL activities should consider assessing and adapting to accommodate learners defined by the wholist-analytic and active-reflective constructs. Other adaptations should be considered experimental. Further WBL research could clarify the feasibility and effectiveness of assessing and adapting to CLS.

Aptitude↗

PubMed2026

Detection of antibiotic heteroresistance in clinical microbiology: current and emerging methodologies.

BACKGROUND: Antibiotic heteroresistance (HR) is characterised by the coexistence of susceptible and resistant subpopulations within an apparently isogenic bacterial isolate. Because routine antimicrobial susceptibility testing (AST) primarily assesses the dominant population, HR may escape detection, potentially leading to discrepancies between laboratory susceptibility categorisation and the underlying bacterial population structure. OBJECTIVES: To provide a critical and practice-oriented evaluation of current and emerging methodologies for HR detection and to discuss their strengths, limitations, and potential for clinical implementation. SOURCES: Narrative review based on PubMed searches, complemented by screening of key reference lists and relevant EUCAST and CLSI documents. Peer-reviewed literature was prioritised. CONTENT: Phenotypic approaches, particularly population analysis profiling, remain the reference method for HR definition, but their labour-intensive workflows, long turnaround times, and limited standardisation restrict routine implementation. Alternative strategies, including modified AST assays, metabolic assays, and single-cell platforms, offer gains in speed or throughput but require broader validation. Molecular approaches such as quantitative PCR, droplet digital PCR, targeted deep sequencing, and whole-genome sequencing improve detection of minority resistance determinants. Emerging computational frameworks, including machine learning models integrating phenotypic and genomic data, represent a promising frontier for scalable HR prediction. IMPLICATIONS: Available evidence supports the clinical relevance of HR, although its association with adverse outcomes varies across bacterial species and antibiotic classes. Harmonised methodologies and clinically validated interpretive criteria are needed to support integration of HR assessment into routine diagnostics. Prospective multicentre studies and further standardisation, including engagement with EUCAST and CLSI, will be important to advance clinical implementation.

Antimicrobial resistance↗

PubMed2001

Nonpenetrating glaucoma surgery.

OBJECTIVE: The purpose of this document is to describe nonpenetrating glaucoma surgery and to examine the available evidence to assess the efficacy and complications following the procedures. METHODS: A literature search that was conducted in February 2000 and repeated in September 2000 for the years 1968 to 2000 retrieved over 100 citations that matched the search criteria. Thirty three articles were selected as relevant to the assessment, and they were each evaluated by the panel methodologist for the quality of the evidence presented. RESULTS: One randomized controlled trial comparing nonpenetrating deep sclerectomy to trabeculectomy has been reported. The majority of the published literature contains information from case series, which are not randomized and lack a control group. The two major variations of nonpenetrating glaucoma surgery described in the literature are nonpenetrating deep sclerectomy and viscocanalostomy. The procedures are not familiar to many ophthalmologists, and reports often describe a difficult learning period. These procedures appear to lower intraocular pressure, usually to the mid to high teens, although follow-up is limited in most published reports. Postoperative complications due to overfiltration and hypotony are uncommon in the literature. There is no strong evidence indicating the mechanism of action, reports on bleb formation are lacking, and clinical correlation and gonioscopic findings have been minimal. CONCLUSIONS: Nonpenetrating glaucoma surgery has the potential to reduce intraocular pressure while minimizing the risk of postoperative relative hypotony and the complications associated with hypotony. Randomized clinical trials are needed to assess these procedures and to determine their role in the clinical management of glaucoma patients.

Conjunctiva↗

PubMed1998

Neurological and cognitive abnormalities associated with chronic petrol sniffing.

Substance abuse through the deliberate inhalation of petrol (petrol sniffing or gasoline sniffing) is prevalent in inner-urban and remote rural communities. Although acute toxic encephalopathy is a well-documented consequence of petrol sniffing, the neurological and cognitive effects of chronic petrol sniffing are unknown. A structured neurological examination and the Cambridge Neuropsychological Test Automated Battery (CANTAB) were used to assess neurological and cognitive function in 33 current-sniffers (individuals who had sniffed petrol for >6 months), 30 ex-sniffers (individuals who had sniffed petrol in the past but had abstained for 6 months) and 34 matched non-sniffers (individuals who had never sniffed petrol). No subject was, or had been, encephalopathic from petrol sniffing and all were residing in their community. Blood lead and hydrocarbon levels and information about petrol sniffing behaviour were obtained from each subject. When compared with non-sniffers, current-sniffers showed higher rates of abnormal tandem gait, rapid alternating hand movements, finger to nose movements, postural tremor, bilateral palmomental reflexes and brisk deep reflexes. Cognitive deficits occurred in the areas of visual attention, visual recognition memory and visual paired associate learning. Ex-petrol sniffers showed higher rates of abnormal tandem gait and bilateral palmomental reflexes and cognitive deficits in the areas of visual recognition memory and pattern-location paired associate learning. Blood lead levels and length of time of petrol sniffing correlated significantly with the magnitude of neurological and cognitive deficits. Blood hydrocarbon levels were not related to neurocognitive deficits, although this may have been due to methodological difficulties in obtaining hydrocarbon levels. These results suggest that subtle neurological and cognitive abnormalities do occur in individuals who abuse petrol but who do not have acute toxic encephalopathy and that the severity of these abnormalities is reduced with abstinence.

Adolescent↗

PubMed1987

Basal ganglia damage and subcortical dementia after possible insidious Coxsackie virus encephalitis.

Two patients with a chronic non-progressive illness beginning with undue sleepiness and personality change are described. Both have an atypical movement disorder, clearly distinct from Parkinson's disease. Each has an impairment of memory and learning with relative preservation of arithmetical, language and visuospatial tasks, suggesting a subcortical dementia. Both have atrophy of deep structures on their CT scans, and elevated antibodies to one of the Coxsackie viruses. It is suggested that insidious virus encephalitis (perhaps cases that would previously have been described as encephalitis lethargica) still occurs, and is among the causes of subcortical dementia.

Adult↗

PubMed1999

The cerebellum is necessary for rabbit classical eyeblink conditioning with a non-somatosensory (photic) unconditioned stimulus.

The present research investigated the acquisition of classically conditioned eyeblinks in rabbits using a light flash unconditioned stimulus (US), as well as the contribution of deep cerebellar nuclei to such an association. Two independent groups of animals experienced three phases of training: (1) pre-lesion delay conditioning using either a light- (Group 1) or an air puff-US (Group 2), (2) post-lesion testing of response performance, and (3) post-lesion acquisition to the opposite US. During the initial acquisition (720 trials), the groups did not differ with regard to their rate of learning or their overall level of responding. To assess the contribution of the cerebellum to the maintenance of responding, the interpositus nucleus was electrolytically lesioned and animals were given 8 days of additional training. Both groups exhibited a profound reduction in conditioned responding (CR) and showed no signs of recovery over the remainder of this phase (480 trials). Animals were then shifted to the opposite US (same eye) and given 12 days of training to assess the effect of interpositus lesions on the acquisition of CRs to a novel US. No learning was observed during this phase, regardless of whether animals experienced the light- or air puff-US. These results demonstrate: (1) the ability of a non-somatosensory stimulus to serve as a US during classical eyeblink conditioning; and (2) a common reliance on deep cerebellar nuclei for both somatosensory- and non-somatosensory-based reflexive motor learning. The findings are discussed in reference to the processing of conditioning stimuli within the brainstem-cerebellar circuitry that underlies eyeblink conditioning.

Acoustic Stimulation↗

PubMed2000

Erbium-YAG laser-assisted preparation of deep sclerectomy.

BACKGROUND: Deep sclerectomy and viscocanalostomy are becoming more and more popular as non-penetrating filtering procedures. The purpose of the present study was to simplify the technique of this procedure and to reduce the rate of unintended perforations during the preparation of the deep lamella. METHODS: 20 enucleated porcine eyes were used. A superficial lamellar scleral flap with an area of 5x5 mm as for trabeculectomy was surgically prepared. Using a pulsed erbium:YAG laser the deep lamella (220 +/- 40 microm) with an area of 4x3 mm was removed. Ablation was performed with an energy of 40-100 mJ, a frequency of 1-10 Hz and a spot size of 500 microm and 1 mm (divergent beam). During the procedure the intraocular pressure was kept constant by continuous infusion. Finally the eyes were analyzed histologically. RESULTS: After initial trials it was possible to ablate the remaining deep corneoscleral lamella with the erbium:YAG laser without perforating into the anterior chamber. Starting with an energy of 70-85 mJ and a reduction to 40-60 mJ when reaching deeper layers, a spot size of 500 microm and a 10 Hz repetition rate gave the highest safety and efficiency in preparation. After a learning curve it was possible to preserve Descemet's membrane and intact trabecular meshwork in 10 consecutive operations as demonstrated by histology. CONCLUSION: Erbium:YAG laser-assisted deep sclerectomy offers an alternative to microsurgical preparation of the deep scleral lamella. The thermal damage is minimal (10-40 microm) and scarring may therefore not be stimulated.

Animals↗

PubMed2004

The impact of international experience on student nurses' personal and professional development.

BACKGROUND: Many student nurses undertake international clinical experience during their education programmes, which raises the question 'How do these experiences impact on students nurses' personal and professional development?' METHOD: A case study was conducted in one School of Nursing in the United Kingdom. Student nurses participating in a new module, International Nursing and Health Care, which included clinical experience overseas, gave qualitative accounts of their international experiences and subsequent learning. Their accounts were also compared with the perceptions and expectations of the module facilitators. FINDINGS: While there were some similarities in student experience and facilitator expectations, there were also notable differences. The students believed that their international experiences had a deep impact on their personal development, helping them make the transition from student to qualified nurse. The case study raised further questions about the acquisition of cultural knowledge and the facilitation and provision of learning from experience.

Adaptation, Psychological↗

PubMed2003

[Brain and education].

Students with school phobia have two major clinical problems in common: 1) easy fatigability and 2) disturbed learning and memory functions. In the last 15 years, we studied these cases using various medical and physiological methods, by evaluating clinical autonomic nervous system functions, circadian rhythms such as hormonal secretion, deep body temperature, and sleep-wake. Most of them showed autonomic nervous system dysfunction and circadian rhythm disturbances quite similar to "jet lag". We suggest that this kind of circadian rhythm disturbances are quite prevalent among children in the world and cause memory and learning disabilities.

Adolescent↗

PubMed2002

Deep dissection plane for endoscopic-assisted comminuted malar fracture repair.

Endoscopic technique has been used in the management of comminuted malar fractures. However, the reported dissection plane is close to the frontal branch of the facial nerve, and paralysis of the frontal muscle is sometimes noted postoperatively. From January 1998 to November 2001, 42 patients underwent endoscopic-assisted zygomatic bone repair at Kaohsiung Medical University Hospital and Kaohsiung Municipal Hsiao Kang Hospital. The zygomatic arch was approached via a dissection plane beneath the deep temporal fascia, and the plate was fixed on the upper border of the arch. The advantages of this method are 1) one temporal incision is sufficient for dealing with the zygomatic arch fracture; 2) the learning curve for endoscopic technique is shortened; 3) there is less risk of injury to the frontal branch of the facial nerve; and 4) the periosteum at the anterior and inferior border of the zygomatic arch is preserved. The deep method is a safe alternative for endoscopic-assisted comminuted malar fracture repair.

Adolescent↗

PubMed2003

Acetabular labrum entrapment following traumatic posterior dislocation of the hip.

In traumatic dislocation of the hip with or without a fracture of the acetabular rim, complete anatomical reduction might be prevented by a bone fragment or infrequently by a soft tissue block, such as a torn acetabular labrum, ruptured capsule, or round ligament. We report a rare case of a tear in the acetabular labrum that prevented complete reduction of the dislocated hip. A 26-year-old man suffered posterior dislocation of the right hip, which was reduced under general anesthesia. The postreduction radiograph showed that the reduction was not complete, and a thin bony fragment was observed in the joint space in the weight-bearing area. Open reduction was performed 11 days later. We found a free bone fragment in the joint space, which was removed. The postoperative radiograph still did not show complete reduction of the hip. A large defect in the contrast medium was shown in the widened joint space by arthrography, which revealed the existence of the soft tissue interposition. We then performed a second operation and learned that the acetabular labrum was widely detached from the anterior to the posterior acetabular rim and was lying deep within the acetabulum. This detached portion of the labrum was excised, and the hip was reduced. The radiograph obtained during surgery then showed complete, concentric reduction. We missed the diagnosis clinically and radiologically at the first operation, proving how important it is to obtain an accurate radiological diagnosis in the operating room.

Acetabulum↗

PubMed2001

'Giving midwifery care: student midwives' views of their working role.

OBJECTIVE: to explore the opinions, feelings and views of student midwives of their education as they progressed through their two-year programme in Ireland, with the intention of interpreting and understanding the working and learning world of the participants so that future students might be assisted to improve their educational experiences. DESIGN: using quantitative and qualitative methods. A phenomenological approach was used to guide the qualitative section of the study reported here. SETTING: all seven midwifery schools in Southern Ireland. PARTICIPANTS: all students in the first intake of 1995 in every midwifery school in Ireland (n = 125). DATA COLLECTION: individual and group interviews, diary-keeping and questionnaires. KEY CONCLUSIONS: the findings presented here illustrate the students' views of their working role. The environment appeared to be one of work, rather than learning, and the students' status that of junior employee rather than 'learner' They perceived themselves as 'thrown in the deep end' without much support or guidance from qualified staff. They were frightened, unsure of themselves and suffered from role conflict and loss of status. There appeared to be an acute shortage of staff and the care given was seen to be the basic minimum, fulfilling women's physical needs but ignoring their emotional ones. The care given appeared to be planned according to routine and economic necessity rather than for sound midwifery, medical or social reasons. IMPLICATIONS FOR PRACTICE: the education of students needs to focus on the development of autonomous practice and the use of routines and non-research based care should be phased out. Students need to be assisted, with support from educated mentors, to plan care in a holistic way that will enable them to develop their midwifery skills in the future.

Adult↗