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Teaching residents to write a research paper.

Medical writing and publications are important in developing a scholarly basis for residency programs and in providing a learning experience for both resident and faculty mentors. Residency directors must provide the stimulus and support for both faculty and residents' varied creative activities. This support manifests itself in a commitment to scholarly activity (including a dedicated research person), the procurement of available research materials, the establishment of a process or plan for beginning a research project, and the development of a method for rewarding or recognizing faculty and residents who produce scholarly works. Some osteopathic residency programs may need to train faculty in research skills at the same time that residents are learning to write. Trained faculty are better models and coaches for residents engaged in research. Beginning with a fundamental, but disciplined, writing program, both faculty and residents may learn methods for sharing new knowledge or acquiring those skills necessary to critically analyze the medical literature.

Internship and Residency↗

Writing for publication.

Clinically based nurses have many relevant and informative experiences to share. It is often difficult, however, to find effective ways to support staff in writing about these ideas. To achieve this support, a "Writing for Publication Seminar Series" is more effective than 1-day workshops. More staff development departments are being challenged to demonstrate positive outcomes. A Writing for Publication Seminar Series is an approach that works.

Curriculum↗

[Correction of left handedness worsened mirror writing in a girl with spastic diplegia].

We experienced a 4-year-11-month old girl with right side dominant spastic diplegia caused by preterm birth and neonatal asphyxia. She tended to use the left hand but showed mirror writing on both hands, which was aggravated by correction of handedness to the right. Magnetic resonance T2-weighted imaging revealed a localized high intensity lesion in the white matter of her left parietal lobe, caused by hypoxic insult and suggested a damage of spatial orientation center. Wechsler Preschool and Primary Scale of Intelligence showed a total IQ of 76, VIQ of 86 and PIQ of 74, revealing borderline intelligence with insufficient visual perception. Frostig visual perception test revealed lower scores of position in space. Spatial confusion caused by a lesion in the left parietal lobe might have induced the mirror writing of this case. Forced correction to use the right hand with damaged left parietal lobe may aggravate spatial confusion and consequently worsen mirror writing.

Cerebral Palsy↗

Bilateral mirror writing movements (mirror dystonia) in a patient with writer's cramp: functional correlates.

A recent prospective analysis on writer's cramp showed that up to 44.6% of patients in a series of 65 presented mirror dystonia, defined as involuntary movements of the resting hand, abnormal posture, tremor, and jerks occurring while writing with the opposite hand. A clinical case is presented, with videotape evidence of right-handed writer's cramp, with mirror movements elicited while writing using either hand. Functional magnetic resonance imaging studies are compared both to those of a normal patient and to those from a patient with writer's cramp but lacking mirror dystonia. Widespread bilateral activation of cortical motor areas contralateral to the mirror movements in patients with writer's cramp and mirror movements suggests, that bilateral activation of the primary motor cortex may account for the appearance of these mirror movements. Further studies need to be conducted to determine whether mirror movements in dystonic patients appear as a result of loss of intra- and/or interhemispheric cortical inhibition or are simply a consequence of the sustained effort these patients need to exert while writing using a dystonic hand.

Dominance, Cerebral↗

Changes in cortical inhibition during task-specific contractions in primary writing tremor patients.

Primary writing tremor (PWT) is a rare disease of unknown pathophysiology. We studied changes in silent period (SP) duration, after transcranial magnetic stimulation (TMS), set at 20% above the motor threshold in 6 PWT patients and 7 healthy control subjects. SP duration was tested during a task-specific act, i.e., writing that induced tremor in all patients in the affected hand (Wr); nonspecific voluntary contraction of intensity, matching that developed during writing (VCWr); and during near maximal voluntary contraction (VCNmax). There were no differences in SP duration during Wr and VCWr contraction on the right affected side or between sides in both PWT patients and control subjects, nor between the groups. However, during VCNmax, SP significantly shortened on both sides in PWT patients, whereas there were no changes in control subjects. Although it appears that inhibitory mechanism are not directly involved in the generation of the tremulous activity, the shortening of SP indicates that central inhibitory mechanisms are affected in PWT patients. Therefore, whereas the underlying pathophysiological mechanisms in PWT and writer's cramp may share common features, the results indicate that PWT is not a variant of focal task-specific dystonia but rather a separate nosological entity.

Adult↗

A single family with writer's cramp, essential tremor, and primary writing tremor.

We studied seven members of a family who had different types of movement disorders: Two had typical essential tremor, two (twins) had typical writer's cramp, one had both essential tremor and writer's cramp, one had primary writing tremor, and one (deceased) had uncharacterized tremor. This appears to be the first report of writer's cramp in twins and in so many family members. This family links together primary writing tremor, essential tremor, and writer's cramp and may help resolve the apparent controversy about the relationship of primary writing tremor to essential tremor and writer's cramp.

Adult↗

Primary writing tremor. A form of focal dystonia?

Five patients exhibited severe tremor in the upper extremity, primarily when attempting to write or draw. Electromyography was performed to determine the patterns of muscle activity that were responsible for this tremor. Tremor was measured with an accelerometer and with a digitizing tablet. Two patients had postural tremor that was indistinguishable from mild, high-frequency essential tremor. All patients exhibited a severe 5-7-Hz tremor during the acts of writing and drawing. Muscles throughout the affected extremity exhibited rhythmic 5-7-Hz bursts of motor unit discharge, and the average level of motor unit activity was tonically increased in antagonistic muscles. This abnormal coactivation of antagonistic muscles produced subtle dystonic posturing of the affected limb that was overshadowed by severe tremor. Electromyography was useful in confirming the coexistence of tremor and dystonia in our patients. The nonspecificity of dystonia and postural tremor must be considered when discussing the nosology and pathophysiology of primary writing tremor.

Adult↗

[Central nystagmus writing during the pendular test. Findings on post-punctural symptoms after lumbar puncture (author's transl)].

The central nystagmus writing (ecriture centrale) during the pendular test is characteristically found in cerebral organic or functional lesions. Thirty patients with symptoms following lumbar puncture (L.P.) were investigated with the pendular test. In 46.6% central nystagmus writing was found 3 days after L.P. After subsiding of post L.P. troubles all the nystagmograms became normal. A control group of 30 patients without symptoms after L.P. did not show patholgic variations in the nystagmus writing during the pendular test.

Adult↗

Self-assessed and examiner-assessed writing hand posture in Swedish left-handers.

Writing hand posture was studied in 48 male and 54 female left-handed Swedish college students. Inverted posture was more common with examiner-assessment than with self-assessment and was more common in males. Examiner-assessed inversion frequency was lower than that reported from American samples but higher than that from Australian samples. Writing style was related to hand posture, printing being more common in non-inverted writers. Degree of lateral preference, presence of familial sinistrality and birth complications were not associated with writing hand posture.

Achievement↗

Hand motor patterns after the correction of left-nondominant-hand mirror writing.

In a previous report, the author studied a left-nondominant-hand mirror writer, postulating that her mirror writing resulted from the failure to reverse the right-hand writing motor patterns when transmitted from the left to the right cerebral hemisphere. In this study, the patient was asked to write in normal fashion with the left hand; the result was a mixture of handwriting motor patterns which included normal letters, letters with reversed direction tracings, letters with one or more than one loop-tracings and illegible letters. The author considers this result to be a further support for the above-proposed hypothesis.

Adult↗

Writing induces a right hemisphere linguistic advantage in dysphonetic dyslexic children: implications for attention and capacity models of laterality.

An experiment demonstrated a complete hemispheric processing reversal in 10 male, dysphonetic dyslexic children that occurred during a dichotic listening test of their verbal working memory. Requiring a written response to dichotic digits produced a right hemisphere/left ear superiority in the dysphonetic dyslexics whereas normal subjects and other dyslexics maintained a left hemisphere/right ear advantage. This reversal was unaffected by changes in task difficulty. A second experiment assessed the influence on producing the reversal of concurrent manual interference with left hemisphere verbal processing (responding orally vs. manually) and selective right hemisphere priming (Forward Writing vs. Backward Writing). The dysphonetic children reverted to a strong left hemisphere superiority when recalling the dichotic digits orally. Backward writing produced no ear advantage in either direction. The findings suggest that dysphonetic dyslexia may be related to (1) left hemisphere processing demands that exceed capacity, (2) easily activated right hemisphere processing strategies and (3) failure to coordinate linguistic processing interhemispherically. The results supported a novel hybrid conceptualization of dyslexia consisting of a synthesis of selective activation, and dual processor-limited capacity, theories.

Attention↗

Dichotic listening performance and writing posture in right- and left-handers.

Right-handers and left-handers with the inverted (IN) and noninverted (NI) writing posture were tested on a dichotic consonant-vowel listening task and on two motor tasks (hand strength and speed of tapping). The results failed to show the differences between IN and NI right-handers reported by S. M. Tapley and M. P. Bryden (1983, Neuropsychologia, 21, 129-138) and there were no significant handedness x writing posture x ear interactions. A significant interaction between dichotic listening performance and writing posture was found; NI right-handers and IN left-handers had more correct responses and fewer intrusions than IN right-handers and NI left-handers. Left-handers and right-handers were found to have a right ear advantage (REA) in the dichotic listening task but left-handers had relatively smaller left/right differences in all of the performance measures. Sample characteristics suggest that there are more IN male right-handers than IN female right-handers.

Adult↗

Evaluation of the efficacy of piracetam in treating information processing, reading and writing disorders in dyslexic children.

Piracetam, a new class of drug (nootropil) thought to enhance specific cognitive skills, was given in a 3300 mg daily dose to half of a group of fifty-five dyslexic boys aged 8-13 years, in a 12-week, double-blind, placebo-controlled study. The other half of the subjects received placebo. All subjects met the following criteria: normal intelligence, normal educational opportunities, no severe emotional problems, no neurological handicaps, good physical health, not taking other psychotropic medication, and scoring at least one and one half years below their mental age equivalent on the Gilmore Oral Reading Test. Non-verbal (auditory and visual) and verbal perceptual, and memory skills were examined, and reading, spelling, language and writing abilities were measured using standardized instruments. Compared to the placebo control group, individuals treated with Piracetam did not show statistically significant improvements above their baseline scores on measures of perception, memory, language, reading accuracy or comprehension, or writing accuracy. However, reading speed and numbers of words written in a timed period were significantly enhanced in subjects treated with Piracetam as compared to placebo. Effective reading and writing ability, taking both rate and accuracy into consideration, were also significantly improved in the Piracetam as compared to the placebo treatment group. The medication was well-tolerated and medical examinations showed no significant adverse reactions. These results encourage further study of Piracetam to determine more precisely the mechanism of action by which specific cognitive skills are affected.

Adolescent↗

Sinistrad mirror writing and reading after brain concussion in a bi-systemic (oriento-occidental) polyglot.

The problem of mirror writing and reading is discussed in the light of a clinical case, where this disturbance appeared after an apparently minor head injury. Mirror writing and reading in this polyglot individual affected only the sinistrad (Hebrew) writing and reading system, leaving the dextrad (Latin) system unimpaired. This disturbance appeared together with dyscalculia, left-right disorientation and slight temporal confusion, suggestive of parieto-occipital lobe pathology. The clinical picture also showed apparently "conversional" traits, such as are sometimes seen in incomplete parietal lobe syndromes. The relevant literature is reviewed and patho-physiological mechanisms of mirror reversal are discussed.

Brain Concussion↗

Idiopathic torsion dystonia and writing tremor within a family.

A 12-year-old boy had suffered from idiopathic torsion dystonia since the age of 8 years, which had never been relieved with pharmacologic treatment. His mother had exhibited primary tremor upon writing from the age of 10 years, but had not yet developed dystonia. Surface electromyography revealed paradoxical muscular contraction of Westphal in both patients, although the main abnormal findings in the proband and his mother were continuous tonic discharges in the arms and 4-5-Hz grouped discharges in the neck, respectively. The simultaneous occurrence of dystonia and writing tremor within one family, and the presence of the paradoxical contraction in both cases suggest that a certain type of dystonia and writing tremor may be pathogenetically linked.

Adult↗

Microperiodic structures: direct writing of three-dimensional webs.

Applications are emerging that require the creation of fine-scale structures in three dimensions--examples include scaffolds for tissue engineering, micro-fluidic devices and photonic materials that control light propagation over a range of frequencies. But writing methods such as dip-pen nanolithography and ink-jet printing are either confined to two dimensions or beset by wetting and spreading problems. Here we use concentrated polyelectrolyte inks to write three-dimensional microperiodic structures directly without using masks. Our technique enables us to write arbitrary three-dimensional patterns whose features are nearly two orders of magnitude smaller than those attained with other multilayer printing techniques.

Journal Article↗

Category specificity in reading and writing: the case of number words.

In standard models, word meanings contribute to reading words aloud and writing them to dictation. It is known that categories of knowledge and the associated word meanings can be spared or impaired selectively, but it has not been possible to demonstrate that category-specific effects apply to reading and writing. Here we report the case of a neurodegenerative patient with selectively spared numerical abilities whose brain damage left him able to read and write only number words.

Atrophy↗

Who writes guidelines, and who should?

AIM: To confirm or refute the impression that diagnostic radiology was often not represented on guideline writing committees, despite the fact that guidelines often made statements with implications for radiological practice. MATERIALS AND METHODS: We took two approaches. Firstly we examined all published Scottish Intercollegiate Guidelines Network (SIGN) guidelines and extracted the disease topic, the number of authors and peer reviewers, the number that were radiologists, and independently decided whether, given the content, radiologist input at the writing or review stage was necessary. We also searched for all guidelines on management of stroke worldwide (a single disease topic with major radiological implications) and extracted the proportion of authors that were radiologists. RESULTS: Of 47 SIGN guidelines on different diseases, 11 (23%) had a radiologist in the authorship (13/594, 2.2% total authors), and 5/47 (11%) had a radiologist specialist reviewer (10/529, 1.8% total reviewers). Independent review of the guidelines' content suggested that 76% of guidelines should have had a radiologist author and 91% a radiologist reviewer (discrepancy 53% and 80% respectively). Amongst 22 guidelines on acute stroke management in the world literature with 202 authors (where stated), there were only two radiologists (1%), both on one guideline which was specifically to do with imaging of stroke (5% of all stroke guidelines identified). CONCLUSION: Diagnostic radiology is poorly represented on guideline writing committees, although frequently guidelines have implications for radiological practice. Radiologists should try to be more involved in guideline production.

Authorship↗