Early use of magnetic endoscopic imaging by novice colonoscopists: improved performance without increase in workload.

BACKGROUND: Magnetic endoscopic imaging represents a recent advance in colonoscopy training. This technique provides adjunct information to the endoscopist, specifically with regard to colonoscope loop formation. OBJECTIVE: To examine the effect of a magnetic endoscopic imager on novice performance and workload in colonoscopy. METHODS: Twenty complete novices received an introductory teaching session followed by the completion of two procedures on a colonoscopy model. One-half of the participants performed their first procedure with the imager, and the second procedure without, while the other one-half were trained with the inverse sequence. Two main outcome measures were recorded: distance achieved and total workload as measured by the National Aeronautics and Space Administration task load index tool. RESULTS: A significant improvement was noted between the first and second colonoscopies, with the best performance recorded for participants who performed their first procedure with the imager, and their second without. The imager did not significantly change the total workload.  DISCUSSION: The study participants paid attention to the magnetic endoscopic imager; however, this did not translate into a measurable increase in novice workload. A delayed learning benefit was conferred to the group exposed to the imager on their first colonoscopy, suggesting that, even at an early training stage, the additional imager information entered working memory and was processed in a useful fashion. The introductory teaching strategy used in the present study was successful as judged by the overall distance achieved and performance improvement seen in all study participants.

Disappearance of trachoma from Western Nepal.

We assessed how much of the observed decline in the prevalence of trachoma in a district of Western Nepal was due to an antibiotic treatment program and how much to an underlying secular trend outside of the program. Although antibiotic treatments clearly have an effect at 6 months, we were unable to show that this effect persisted at 12 months; in fact, long-term gains may be due to a secular trend in the area.

Logistics of community smallpox control through contact tracing and ring vaccination: a stochastic network model.

BACKGROUND: Previous smallpox ring vaccination models based on contact tracing over a network suggest that ring vaccination would be effective, but have not explicitly included response logistics and limited numbers of vaccinators. METHODS: We developed a continuous-time stochastic simulation of smallpox transmission, including network structure, post-exposure vaccination, vaccination of contacts of contacts, limited response capacity, heterogeneity in symptoms and infectiousness, vaccination prior to the discontinuation of routine vaccination, more rapid diagnosis due to public awareness, surveillance of asymptomatic contacts, and isolation of cases. RESULTS: We found that even in cases of very rapidly spreading smallpox, ring vaccination (when coupled with surveillance) is sufficient in most cases to eliminate smallpox quickly, assuming that 95% of household contacts are traced, 80% of workplace or social contacts are traced, and no casual contacts are traced, and that in most cases the ability to trace 1-5 individuals per day per index case is sufficient. If smallpox is assumed to be transmitted very quickly to contacts, it may at times escape containment by ring vaccination, but could be controlled in these circumstances by mass vaccination. CONCLUSIONS: Small introductions of smallpox are likely to be easily contained by ring vaccination, provided contact tracing is feasible. Uncertainties in the nature of bioterrorist smallpox (infectiousness, vaccine efficacy) support continued planning for ring vaccination as well as mass vaccination. If initiated, ring vaccination should be conducted without delays in vaccination, should include contacts of contacts (whenever there is sufficient capacity) and should be accompanied by increased public awareness and surveillance.

UNDERSTANDING THE HIGH COST OF SUCCESS IN UNIVERSITY RESEARCH.

In light of new transparency in budgeting and expenditures expected of central research administration and reductions in the amount of indirect cost revenues distributed to colleges, departments, and faculty, universities must present a more accurate perspective on the "real costs" of research, costs that extend well beyond support for the central research office. The purpose of this article is to illuminate the significant gap between the real costs of research within universities and the funding that is available to support them.

Novel presenilin-1 Y159F sequence variant associated with early-onset Alzheimer's disease.

BACKGROUND: Mutations in the gene for presenilin-1 cause familial, early-onset Alzheimer's disease. METHODS: We report the case of a 43-year-old woman presenting with progressive cognitive decline and a family history of early-onset dementia. Her workup included cerebrospinal fluid amyloid-beta, tau, and phospho-tau levels, as well as genetic sequencing of genes implicated in familial Alzheimer's disease. RESULTS: Cerebrospinal fluid biomarkers were consistent with a diagnosis of Alzheimer's disease. A novel nucleotide sequence variant (A476T) was discovered in one allele for presenilin-1, corresponding to a missense tyrosine-to-phenylalanine change at codon 159 (Y159F). An affected maternal uncle carried the same allele. The sequence variant occurs in a conserved region of the gene near other previously reported mutations. CONCLUSIONS: This novel presenilin-1 sequence variant cosegregated with early onset dementia in the proband and at least one other affected family member, and likely represents a mutation causing familial, early-onset Alzheimer's disease.

A triangulation study of the clinician and patient experiences of the use of the immunosuppressant drugs azathioprine and 6-mercaptopurine for the management of inflammatory bowel disease.

AIM: The aim of this study was to explore the service for patients with inflammatory bowel disease taking or having taken azathioprine or 6-mercaptopurine in the last three years, at two District General Hospitals within the same Trust. BACKGROUND: Published data confirm that the use of azathioprine and 6-mercaptopurine is effective in the control of inflammatory bowel disease. However, there are inconsistencies in dosing regimes, blood monitoring and duration of therapy. Regimes used have been largely based on clinicians' personal preference leading to inconsistencies in practice. METHODS: A questionnaire, designed to elicit the experience of treatment regimes, blood monitoring and access to information was sent to 130 patients taking or having taken azathioprine or 6-mercaptopurine in the last three years. A further questionnaire was sent to 94 general practitioners and interviews were conducted with 10 hospital doctors initiating treatment. RESULTS: The study demonstrated lack of clarity in the prescribing methods, the monitoring regimes being offered, variation in information given to patients and consequent patient knowledge. CONCLUSION: Azathioprine and 6-mercaptopurine are increasingly being used successfully in inflammatory bowel disease, sparing the use of steroids and maintaining remission over a longer period. A review of the current literature has informed and made possible a suggested blood-monitoring regime. RELEVANCE TO CLINICAL PRACTICE: The adoption of a protocol-led service, managed by the nurse specialist, incorporating guided self-management by patients should be considered. A shared-care approach with the patient and general practitioner with rapid access to secondary care would provide a robust system.