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PubMed1998

Learning style influences student examination performance.

BACKGROUND: The Kolb Learning Style Inventory (LSI) measures preference for each of four learning orientations: abstract conceptualization, concrete experience, active experimentation, and reflective observation. These orientations define four learning styles: convergence, divergence, assimilation, and accommodation. METHODS: To determine if learning style correlates with objective multiple-choice and clinical measures of performance, the learning styles of third-year medical students (n = 227) were evaluated using the LSI. Performance was assessed using the United States Medical Licensing Examination step 1 (USMLE 1), the National Board of Medical Examiners (NBME) multiple-choice surgical subject examination (MCQ), and NBME computer-based case simulations (CBX). RESULTS: The data showed a significant (P < or = 0.05) relationship between learning style and performance on the USMLE 1. There was a significant (P < or = 0.05) and direct correlation between an abstract orientation and performance on the USMLE 1 (r = 0.33) and MCQ (r = 0.20). There was no relationship between learning style and clinical performance measured using the CBX. CONCLUSIONS: These data demonstrate that performance on objective measures of academic achievement is influenced by learning style, while application of that knowledge in the management of clinical situations may require additional skills beyond those measured.

Education, Medical, Undergraduate↗
PubMed1999

The MACE procedure: experience in the United Kingdom.

BACKGROUND/PURPOSE: The Malone Antegrade Continence enema (MACE) procedure has become commonplace in the treatment of patients with faecal incontinence and constipation. To ascertain its place in paediatric practice, the authors surveyed members of the British Association of Paediatric Surgeons (BAPS) to see if they have performed a MACE and continue to do so. The authors also assessed their indications, success rate, and complications. METHODS: Members were asked to give the diagnosis of the patients submitted for surgery before September 1996, the procedure used to constructthe MACE, the rate of failure, and complications encountered. RESULTS: A total of 300 MACE were reported, and the mean follow-up was 2.4 years. The diagnosis of 273 patients was known: spina bifida, 108; anorectal anomaly, 90; Hirschsprung's disease, 22; constipation, 23; other, 30. The most popular procedure was appendix disconnection and reimplantation. The overall success rate for all diagnoses was 79%. The main complication was stomal stenosis, 30%. CONCLUSIONS: These figures confirm that MACE is a useful operation. Improved patient selection, improvement in techniques, and increasing knowledge regarding continued management should lead to improving results across the country.

Adolescent↗
PubMed1990

Sleep disorders in psychiatric practice.

Sleep disorders medicine and psychiatry interface in numerous ways. Most psychiatric patients have a complaint about sleep, and regardless of the theoretical orientation of a psychiatrist, understanding of a patient's sleep function is an important part of assessment. The success or failure of treatment will be strongly influenced by the effect of that treatment on the patient's sleep disorder. The psychiatrist can provide expertise in treating patients with primary sleep disorders, offering pharmacologic consultations, and recommending psychotherapy or behavioral management. Conversely, a knowledge of primary sleep disorders should make the psychiatrist a more effective practitioner.

Humans↗
PubMed1983

Diagnosis and management of strabismus and amblyopia.

Strabismus and amblyopia are among the most common eye problems encountered in children. Proper assessment and management require a knowledge of the various types, methods of detection, and principles of treatment. The role of the pediatrician is emphasized because of the importance of early detection.

Abducens Nerve↗
PubMed2001

Intra-amniotic infection in patients with preterm prelabor rupture of membranes. Pathophysiology, detection, and management.

The recent increase in knowledge about infection and preterm delivery has engendered many new questions and should make us rethink our long held beliefs and management strategies. Although this article focused primarily on infection as an important factor in the pathogenesis of PPROM, multiple other causes do exist. The various serologic and amniotic fluid assays that can identify activation of the host immune and inflammatory responses as a consequence of the microbial invasion of the amniotic cavity detailed in the preceding paragraphs are very promising but not yet available for clinical use. These tests identify the fetus in the early stages of an infectious process, before the full clinical manifestations of chorioamnionitis. Should such fetuses be treated with antibiotics in an effort to sterilize the amniotic cavity? Should patients with documented microbial invasion be delivered immediately or is there room for a more conservative management with aggressive antibiotic in utero treatment, altering the natural course of PPROM, avoiding extremely preterm deliveries? Certainly many questions remain unanswered. Continuing the search for information on the relationship between infection and PPROM can only add hope to one day finding an option for prevention, because many and probably most cases of PPROM are apparently caused by infection, and the opportunity for preventing this problem most probably lies here.

Amniocentesis↗
PubMed1990

Life-threatening hemorrhage from placement of a dental implant.

This report focuses on a potentially fatal hemorrhage arising from dental implant placement in the mandible. Anatomic considerations of the lingual artery and its divisions in the floor of the mouth are discussed. In addition, various methods of controlling bleeding from the floor of the mouth are reviewed. The case presented is unusual in that intraoral ligation of the transected vessel was possible despite the presence of massive sublingual, submental, and submandibular hematomas as well as severely distorted anatomy. This case represents a severe complication resulting from a seemingly minor oral surgical procedure. Those performing endosteal implant placement should be knowledgeable in the management of such complications.

Arteries↗
PubMed1999

Development of a decision support system for trypanocidal drug control of bovine trypanosomosis in Africa.

During this century livestock production has increased massively through the improved ability to diagnose, treat, control and prevent certain diseases. Despite these advances, disease remains a major constraint to livestock production and welfare throughout the world. In many instances, this is a result of failure to properly apply methods that are already available. TrypsChemo is an expert system that attempts to aid the application of veterinary knowledge to disease management. It has been designed to maximise the effectiveness and cost efficiency of the different trypanocidal drug regimens currently available for prophylaxis and treatment of tsetse-transmitted bovine trypanosomosis in Africa. This paper describes the design of TrypsChemo, the properties of the system, and illustrates how it can be used to support decision making for trypanocidal drug control. The system is currently undergoing a structured evaluation by potential users in Africa.

Africa↗
PubMed1992

Construction of the knowledge file for an image understanding system.

To enable an image understanding system to provide an automated interpretation of diagnostic imagery it must have access to all of the concepts, procedures and methods used by human experts. The paper describes information elicitation from experts of different domains and the construction of a knowledge file. Uncertainty management is based on Bayesian belief network methods.

Bayes Theorem↗
PubMed1993

Factors affecting fertility with artificial insemination.

Man's intervention in the natural processes of reproduction with the use of AI has allowed rapid genetic improvement in beef and dairy herds and has resulted in a marked increase in livestock productivity. In today's tough economic climate, high reproductive efficiency is of utmost importance for livestock enterprises to remain viable. Many factors affect the success of AI programs; of particular importance are the health and nutritional management of the herd and accurate, efficient heat detection. Good management combined with knowledge, technical expertise and careful attention to detail in the timing of insemination in relation to the period of estrus, semen handling, and correct semen placement in the uterus ensure the successful use of AI.

Animals↗
PubMed2003

Prevention and treatment of adverse effects related to chemotherapy for recurrent ovarian cancer.

OBJECTIVES: To review the side effects frequently observed with ovarian cancer, focusing on the development of interventions to assess, prevent, and treat these events. DATA SOURCES: Research articles and textbooks. CONCLUSION: Treatment-related side effects impact the quality of life of patients with recurrent ovarian cancer. Simple tools for assessment of side effects are needed to identify their development and resolution. IMPLICATIONS FOR NURSING PRACTICE: Careful assessment of patients undergoing chemotherapy for ovarian cancer promotes immediate attention to a patient's concerns and empowers women to take an active part in managing their disease. Knowledge of side effects and their dose/schedule relationships enables the oncology nurse to institute proactive interventions that may limit side effect progression.

Alopecia↗
PubMed2003

[Cerebral oedema in children compared to cerebral oedema in adults].

About 50% of deaths, in the pediatric population between 1-15 years of age, are due to trauma. This high mortality rate, associated with the frequent sequelae, leading sometimes to severe handicaps, constitutes a major problem for public health in the developed countries. Pediatric trauma has some particularities, due to anatomic and physiologic differences, and to specific injury mechanisms. In a busy traumatology center, a child will be admitted daily in the emergency department with head trauma injury. The anaesthesiologist must have a complete understanding of the pathophysiology involved in this clinical presentation if one wishes to develop a practical knowledge of initial management of such patients. Traumatic brain injury may have intracranial and systemic effects that combine to give global cerebral ischaemia.

Adult↗
PubMed2000

[From the macroscopic lesion to cellular ischemia].

Traumatic brain injury (TBI) constitutes a major health and economic problem for developed countries, being one of the main causes of mortality and morbidity in children and young adults. Because of the immense importance and future consequences of TBI, the physician who sees a patient soon after brain injury must have a complete understanding of the pathophysiology and develop a practical knowledge of initial management of such patients. TBI may have intracranial and systemic effects that combine to give overall cerebral ischaemia. Injury to the nervous system is characterised by a stereotypic pattern, irrespective of the primary injury. The primary injury initiates a multitude of inflammatory cascades resulting in secondary brain injury, the effect of which is as important as the primary injury. This period of brain inflammation can last up to three weeks and renders the brain more susceptible to the effects of systemic insults such as hypotension, hypoxia and/or pyrexia. It has been shown in postmortem examination of patients dying from severe TBI that more than 90% had evidence of secondary ischaemic damage. The concept of 'cerebral protection' has been extended to encompass pretreatment of secondary injury. Preventing and treating cerebral ischaemia is the main goal of initial management of head-injured patients. Initial care focuses on achieving oxygenation, airway control and treatment of arterial hypotension.

Adult↗
PubMed2000

Clinical economics: calculating the cost of acute postoperative pain medication.

Few data are available that address the cost of postoperative pain management, although such knowledge would enhance our understanding of caregiver choices related to direct medical costs, such as type, frequency, and route of medication. This article describes the cost of postoperative pain medications before and after an educational program provided to nurses, pharmacists, and physicians in six community hospitals. Medication costs were calculated by averaging across all brands the average wholesale price of the most common dose administered in the sample for each medication. The median cost of postoperative pain medication across all days, all surgeries, was $9.46. Calculating the cost of acute postoperative pain medication suggested that cost over stay is highly influenced by the use of a few expensive medications. The relationship of medication cost to length of stay (LOS), function, and pain intensity is discussed.

Acute Disease↗
PubMed2003

New treatments for perioperative cardiac arrhythmias.

Cardiac arrhythmias remain a major source of morbidity, mortality, and prolonged postoperative hospital stay in surgical patients. Recent studies in patients experiencing out-of-hospital cardiac arrest have expanded our knowledge in the management of cardiac arrhythmias. Future advances require additional studies focused on the unique proarrhythmic substrates in surgical patients, to provide a clear rationale for antiarrhythmic drug therapy in the perioperative period.

Anti-Arrhythmia Agents↗
PubMed2000

Pathologic diagnosis of acute lymphocytic leukemia.

With present knowledge, the optimal management of individual patients with acute leukemia requires that every case be studied by morphology, cytochemistry, cytogenetic, immunologic and molecular techniques. An algorithm for diagnostic evaluation and classification of ALL is provided in Fig. 11. Other techniques, such as DNA or cDNA [figure: see text] microarray, are at present important research tools but have not yet had a major effect on patient care. More detailed studies of individual patients need to be conducted at specialized cancer centers, where preservation of cells, DNA, RNA, or protein is possible. Such investigations will yield important information on the clinical importance of the expression of various markers, the prevalence and relevance of bilineage and biphenotypic leukemias, and above all will reveal the mechanisms of leukemogenesis and of disease evolution. Such insights will further aid clinicians in treating ALL and in preventing refractory disease.

Adult↗
PubMed1991

Prevention of macrosomia.

In summary, appropriate assignment of patients to treatment modality utilizing verified blood glucose determination and targeting mean blood glucose level throughout pregnancy to 5.3 mmol/l (similar to normal nondiabetic blood glucose levels) will result in neonatal size comparable to the general population. Today, we have the knowledge and the technology not only to strive for the target but also, more importantly, to achieve the goal of pregnancy outcome in the diabetic comparable to the non-diabetic population. To return to our original research question: Is it glucose or insufficient knowledge of the management approach that maintains macrosomia levels? It is evident that glucose is the prime cause of macrosomia, although other nutrients have a secondary role. Proper management of glucose abnormality will result in a significant decrease in the rate of macrosomia.

Blood Glucose↗
PubMed1994

Musculoskeletal problems of performing artists.

We have reviewed the frequency and variety of rheumatic problems among performing artists. For instrumentalists, injuries are related to the type of instrument played, the technique used and the effort expended in the quest for excellence. For dancers, musculoskeletal problems too reflect technique and effort. We should not be surprised at the frequency of these problems. Rheumatologists, as well as orthopaedic surgeons, physiotherapists, neurologists and other physicians, encounter performing artists as patients. We should be familiar with their problems and be able to knowledgeably diagnose and manage them. This may include observing the artist during actual performances. How is the instrument being held? What is the posture of the artist? What are the comments of the coach or teacher. What type of shoes does the ballerina wear? What movements in particular cause discomfort? These and similar observations will have direct bearing on the musculoskeletal problems of these artists. Published studies have related the variety, frequency and disabling nature of performance-related musculoskeletal problems. Unfortunately few if any of these are controlled, blinded or prospective. We need more and better information. We will want clear information about prevalence of problems, better definition of the musculoskeletal ailments, classification of the relationship of problems with performance and individual biomechanical features, information about response of specific problems to interventions, and data about the long-term consequences, if any, of these rheumatic problems to the musculoskeletal system. Artists as patients are unique. Minor problems can become potentially career-ending disabilities. Making music or performing dance may provide us with delightful entertainment but represents a source of livelihood to artists. Understanding their medical needs and enabling them to continue to perform is the challenge before us.

Adult↗