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During the past 40 years a series of instruments has been developed in the MRC Social Psychiatry Unit to measure various components of social disablement. Their conceptual basis is discussed and a brief description is provided of those that are still in use or often quoted. A bibliography is also appended.
OBJECTIVE: A marked increase in the number of computer programs for computer-assisted instruction in the medical sciences has occurred over the past 10 years. The quality of both the programs and the literature that describe these programs has varied considerably. The purposes of this study were to evaluate the published literature that described computer-assisted instruction in medical education and to assess the quality of evidence for its implementation, with particular emphasis on obstetrics and gynecology. STUDY DESIGN: Reports published between 1988 and 2000 on computer-assisted instruction in medical education were identified through a search of MEDLINE and Educational Resource Identification Center and a review of the bibliographies of the articles that were identified. Studies were selected if they included a description of computer-assisted instruction in medical education, regardless of the type of computer program. Data were extracted with a content analysis of 210 reports. The reports were categorized according to study design (comparative, prospective, descriptive, review, or editorial), type of computer-assisted instruction, medical specialty, and measures of effectiveness. RESULTS: Computer-assisted instruction programs included online technologies, CD-ROMs, video laser disks, multimedia work stations, virtual reality, and simulation testing. Studies were identified in all medical specialties, with a preponderance in internal medicine, general surgery, radiology, obstetrics and gynecology, pediatrics, and pathology. Ninety-six percent of the articles described a favorable impact of computer-assisted instruction in medical education, regardless of the quality of the evidence. Of the 210 reports that were identified, 60% were noncomparative, descriptive reports of new techniques in computer-assisted instruction, and 15% and 14% were reviews and editorials, respectively, of existing technology. Eleven percent of studies were comparative and included some form of assessment of the effectiveness of the computer program. These assessments included pre- and posttesting and questionnaires to score program quality, perceptions of the medical students and/or residents regarding the program, and impact on learning. In one half of these comparative studies, computer-assisted instruction was compared with traditional modes of teaching, such as text and lectures. Six studies compared performance before and after the computer-assisted instruction. Improvements were shown in 5 of the studies. In the remainder of the studies, computer-assisted instruction appeared to result in similar test performance. Despite study design or outcome, most articles described enthusiastic endorsement of the programs by the participants, including medical students, residents, and practicing physicians. Only 1 study included cost analysis. Thirteen of the articles were in obstetrics and gynecology. CONCLUSION: Computer-assisted instruction has assumed to have an increasing role in medical education. In spite of enthusiastic endorsement and continued improvements in software, few studies of good design clearly demonstrate improvement in medical education over traditional modalities. There are no comparative studies in obstetrics and gynecology that demonstrate a clear-cut advantage. Future studies of computer-assisted instruction that include comparisons and cost assessments to gauge their effectiveness over traditional methods may better define their precise role.
Thirty hemi-faces of fresh cadavers and two centuries of bibliographies have been studied. Both packed fat and organ fat linked to the mastication, the Corpus Adiposum Buccae (CAB-Bichat's fat ball) is an anatomic structure which involves the entire hemi-face. The CAB stretches from the temporal region to the cheek, passing through the zygomatico-malar tunnel and the pterygomandibular fossa. It is completely enclosed within a partitioned capsule of varying thickness which allows to recognise it. From its main part, the Body, the CAB has ten extensions. Size, volume and aspect are different from one subject to another and one side to another. Its cheek extensions are inconsistent or disappear with age. However, its outline remains characteristic. This is not a ball one except in the case of the foetus and new born and for the most sloping extension, buccal, which gives its name to CAB. The CAB is always found under the SMAS plane which keeps it apart from superficial fat. Where fronto-facial liftings are more extensive and deeper, the CAB becomes an important surgical reference. It is possible to use the CAB as a local flap for filling in the cheek area. Local partial amputations have been put forward as an aesthetic goal. In the light of the present study, the author suggests a discussion with regards to the validity of these surgical manipulations.
In the first chapter, the initial studies using immuno-histochemical methods for the cytological analysis of the adenohypophysis are presented; the different trends of the actual groups of research workers are summarized. In the second chapter are described, with details utillsation, some ser viceable techniques for experimental or anatomo-pathological studies of the pituitary gland; immunization of animals against hypophysial hormones, application to the study of the hypophysis (conditions of fixation, analysis of the subsequent times of histological techniques, immunohistochemical reactions [immuno-fluorescence and immuno-enzymatic reactions], controls of these reactions, applications on semi-thin and ultra-thin sections). In the third charpter are studied the results of this immunohistochemical analysis of the mammalian hypophysis: description of different cell types first in the anterior lobe then in the intermediate lobe; these observations are discussed. A special subdivision concerns the study of the human pituitary gland in normal and pathological conditions, in adults and foetuses. In the fourth chapter the results obtained in the study of the adenohypophysis of non mammalian Vertebrates: Fish, Amphibians, Reptiles, and Birds, are grouped. An extensive bibliography concludes this review (references until 1977). Illustrations, furnished by several french workers, are adapted to the different descriptions.
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PURPOSE: To ascertain the activity of intravenous immunoglobulin in a wide range of diseases. DATA IDENTIFICATION: English-language literature search using MEDLINE (1982 to 89), review of meeting reports, and extensive hand searching of bibliographies of identified articles. STUDY SELECTION: All identified articles. DATA EXTRACTION: Study quality and specific descriptive information concerning population, intervention, and outcome measurements were assessed. RESULTS OF DATA SYNTHESIS: There have been few controlled, randomized trials of intravenous immunoglobulin. Available data suggest efficacy in persons with primary immune deficiency, premature infants at risk for group B streptococcus infection, patients with Kawasaki disease, transplant recipients at risk for cytomegalovirus infection, patients with idiopathic thrombocytopenic purpura, and selected patients with chronic lymphocytic leukemia. Data are also favorable concerning the use of intravenous immunoglobulin in some other autoimmune disorders, but randomized trials are needed. Interesting areas for future study include the acquired immunodeficiency syndrome (AIDS), multiple myeloma, and lymphomas. Risks of intravenous immunoglobulin are minimal. CONCLUSION: Intravenous immunoglobulin is safe and effective in treating several human diseases. Additional randomized trials are needed.
BACKGROUND: Rituximab, a monoclonal anti-CD20 antibody, is increasingly used to treat idiopathic thrombocytopenic purpura (ITP). PURPOSE: To systematically review the literature on the efficacy and safety of rituximab for the treatment of adults with ITP. DATA SOURCES: MEDLINE, EMBASE, the Cochrane Library, abstracts from the American Societies of Hematology and Clinical Oncology annual meetings, and bibliographies of relevant articles and reviews were searched in duplicate until April 2006. STUDY SELECTION: Descriptive and comparative studies in any language that met predefined inclusion criteria were eligible. Efficacy analysis was restricted to studies enrolling 5 or more patients. DATA EXTRACTION: Platelet count response, toxicities, dose, previous treatments, baseline platelet count, duration of ITP, study design, and sources of funding were extracted in duplicate. DATA SYNTHESIS: We identified 19 eligible reports on efficacy (313 patients) and 29 on safety (306 patients). Weighted means for complete response (platelet count > 150 x 10(9) cells/L) and overall response (platelet count > 50 x 10(9) cells/L) with rituximab were 43.6% (95% CI, 29.5% to 57.7%) and 62.5% (CI, 52.6% to 72.5%), respectively. Responses lasted from 2 to 48 months. Nearly all patients had received corticosteroids, and 53.8% had undergone splenectomy. Nine patients (2.9%) died. LIMITATIONS: There were no controlled studies, and no studies met all criteria for study quality. Reported deaths could not necessarily be attributed to rituximab. Overall, the number of rituximab-treated patients with ITP reported in the literature is small. CONCLUSIONS: Rituximab resulted in an overall platelet count response in 62.5% of adults with ITP. However, this finding derives from uncontrolled studies that also reported significant toxicities, including death in 2.9% of cases. These data suggest that providers should avoid indiscriminate use of rituximab and that randomized, controlled trials of rituximab for ITP are urgently needed.
OBJECTIVE: Vulvar vestibulitis syndrome (VVS) is thought to be the most frequent cause of dyspareunia in premenopausal women and is one of the major subtypes of vulvodynia. Vulvar vestibulitis is a chronic, persistent clinical syndrome characterized by severe pain on vestibular touch or attempted vaginal entry, exquisite tenderness to a cotton-swab palpation of the vestibular area, and physical findings confined to vestibular erythema. The purpose of this paper is to critically review the descriptive, diagnostic, etiologic, and treatment studies on VVS. Methodological problems are highlighted, and future guidelines for research are proposed. DATA SOURCES: References were obtained from a MEDLINE search covering the period from January 1984 until June 1995. The indexing term "vulvar vestibulitis" was used, and the search was constrained to English-language articles. References from other relevant sources, such as texts and bibliographies, were also included. STUDY SELECTION: All articles pertaining to VVS were reviewed. DATA EXTRACTION: All data relevant to the descriptive, diagnostic, etiologic, and treatment aspects of VVS were included. DATA SYNTHESIS: Pain symptomatology tends to be underemphasized in the current descriptive studies. The trend in etiological research is to focus on biomedical factors such as candidiasis and human papillomavirus (HPV). Only a few studies adopt a nonreductionnist approach. Surgery is the treatment option with the highest reported success rate. Medical management is underinvestigated, considering its widespread use. Pain management techniques such as biofeedback and behavior therapy show promising results. CONCLUSIONS: A pain syndrome conceptualization is suggested as the most useful approach for solving current empirical and clinical problems.
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In light of the overwhelming response to the previous publication in Neuroscience and Biobehavioral Reviews (1993, 17, 21-41) regarding trends in place conditioning (either preference or aversion), the present work constitutes a five-year follow-up to review the empirical research in this behavioral paradigm from 1992 to 1996, inclusively. The behavioral technique has grown as indicated by the number of publications over the last five years which equals those authored over the 35 years covered by our last survey. The previous work used descriptive statistics to explore topical issues, whereas the present work discusses trends since that time and hopes to provide an exhaustive bibliography of the CPP literature, including articles, published abstracts, book chapters and reviews, as well as providing a cross-index of identified key words/drugs tested.
OBJECTIVE: This review discusses the latest developments in selected clinical features and catheter-based therapy of mitral stenosis. DATA SOURCES: English-language journal articles and reviews in the clinical and epidemiological literature as related to mitral valve stenosis from 1965 through March 1993, identified by bibliography review and expert consultation. STUDY SELECTION: Selected studies included clinical trials with adequate patient population description and short- and long-term (5 years) follow-up for topics related to mitral valve stenosis in the clinical literature. DATA EXTRACTION: Two reviewers participated in extracting the data with the aim of presenting a balanced and comprehensive review of the subject. DATA SYNTHESIS AND CONCLUSIONS: The main conclusions are (1) mitral stenosis should no longer be viewed as a largely "geriatric disease" in the United States due to a recent inflow many young immigrants from countries where rheumatic fever continues partially or wholly unabated; (2) clinical and anatomical features of mitral stenosis are age-dependent; when clinical presentation occurs at 30 vs 70 years of age, for example, the degree of valve obstruction may be similar but differences exist in the frequency of atrial fibrillation, the magnitude of reduction in cardiac output, the degree of valve deformity and calcification, and the frequency of coexistent coronary artery disease; and (3) mitral stenosis therapy has undergone a reorientation with the introduction of percutaneous mitral balloon valvotomy, which has proven to be safe, cost-effective, and to provide short- and long-term improvements in symptomatic and hemodynamic status in selected patients.
The present last part of the study on morphology and development of the cranium of Felis silvestris f. catus provides a detailed description and discussion of the development of the visceral skeleton and the membrane bones. Finally, there is given a summary with conclusions of the whole investigation. In Felis 2, the Cartilago Meckeli is still in homocontinuous connection with the Malleus. Probably, only the rostral part of the Cartilago will ossify enchondrally, while the caudal part shows some beginning resorption. In this 95 mm Embryo, the Cartilago Reicherti still remains cartilaginous. A small cartilaginous Spence's cartilage lies in dorsolateral position towards the Chorda tympani. All membrane bones of the adult cranium are present in Felis 1. The following development of the osseous skull towards the stage of Felis 2 is characterized by covering the wide fissures of the side wall and by resorption of certain primordial supporting constructions. The interparietal develops from a paired anlage. In Felis 1 and 2, the cartilago within the pterygoid probably serves as a gliding surface for the M. tensor veli palatini. The dental bone contains some largely extended particles of secondary cartilage.
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This article reviews the development of glucose monitoring techniques and approaches during the last decade. The predominance of the electrochemical measuring principles reported in the literature makes them a focus of this work. Biosensors are still in the main stream of the research interest of most teams due to their high selectivity for glucose determination. Systematization and classification of the glucose monitoring principles and types of glucose sensors is shown. The review gives a brief description of the basic operational principles of the most popular types of glucose biosensors, providing an enhanced bibliography of the original works of the main groups in establishing or significantly contributing to the development of the particular type of glucose biosensor. Different design approaches are overviewed including needle-type sensors, sensors for chronical implantation and the combination of the glucose biosensors with microdialysis sampling technique. The authors approach for replacing of the spent enzyme and thus recharging the sensor in situ while implanted is widely discussed. This approach provides a way to increase the lifespan of the system and ultimately, it could lead to rare transcutaneous interventions for refilling of the implanted sensor.
OBJECTIVE: To ascertain patients' views on the benefits of and possible memory loss from electroconvulsive therapy. DESIGN: Descriptive systematic review. DATA SOURCES: Psychinfo, Medline, Web of Science, and Social Science Citation Index databases, and bibliographies. STUDY SELECTION: Articles with patients' views after treatment with electroconvulsive therapy. DATA EXTRACTION: 26 studies carried out by clinicians and nine reports of work undertaken by patients or with the collaboration of patients were identified; 16 studies investigated the perceived benefit of electroconvulsive therapy and seven met criteria for investigating memory loss. DATA SYNTHESIS: The studies showed heterogeneity. The methods used were associated with levels of perceived benefit. At least one third of patients reported persistent memory loss. CONCLUSIONS: The current statement for patients from the Royal College of Psychiatrists that over 80% of patients are satisfied with electroconvulsive therapy and that memory loss is not clinically important is unfounded.
When children with disabilities have difficulty with written communication, members of their educational teams, including occupational therapists and physical therapists, often recommend use of a word processor. This annotated bibliography summarizes a variety of articles that describe the use of word processing technology with school-aged children. The articles include research reports, descriptions of special features used with word processing programs, and guidelines for using word processing with students. Implications for occupational therapists and physical therapists working with students who have written communication problems are discussed.
A curriculum developed for pediatric orthopaedic residency training is described. The curriculum is practice based, emphasizing those components thought to be necessary for orthopaedic practice. Highly technical or esoteric topics are deemphasized, because they are not relevant to practice capabilities at the end of residency training. The curriculum is designed to serve as a guide for educational direction in pediatric orthopaedic residency training, and not as a description of competency. Resource materials are being developed to provide the educator with relevant clinical material, objectives, and bibliography. The advantages of a practice based curriculum warrant further development of this model for other orthopaedic subspecialties.