Simulated versus traditional therapeutic radiography placements: A randomised controlled trial.

INTRODUCTION: Clinical placements provide rich learning environments for health professional pre-registration education but add significant workload pressure to clinical departments. Advances in simulation approaches mean that many aspects of students' clinical learning can be undertaken in the academic environment. There is, however, little data identifying specific pedagogical gains afforded by simulation compared to clinical placement. This study measured the impact of a comprehensive integrated simulation placement on student clinical skill acquisition. METHODS: A virtual department was developed using a range of simulation equipment and software, with actors and service users providing a range of patients for students to engage with. A cohort of 29 first-year undergraduate therapeutic radiography students were randomly assigned to either simulated or conventional clinical placement. Clinical skills assessment scores provided by a blinded assessor were then compared. RESULTS: Mean overall assessment scores for each cohort were within 3% of each other. The simulation cohort had over 10% higher "communication" scores than the traditional group (p = 0.028). The ability to gain both technical and interpersonal skills simultaneously improved learning compared to clinical placement. Students valued the structured approach of the simulated placement and the opportunity to practice techniques in a safe unpressured environment. CONCLUSION: An integrated simulated placement can help students to achieve clinical learning outcomes and lead to improved interpersonal skills. IMPLICATIONS FOR PRACTICE: Use of blended simulation resources can enable students to acquire technical, procedural and interpersonal skills which in turn may enable reduction of overall clinical placement time and departmental training burden.

An evaluation of techniques used in superficial radiotherapy for non-melanoma skin cancer to replicate the planned treatment area: A prospective study.

INTRODUCTION: Accuracy of superficial radiotherapy for non-melanoma skin cancer is dependent on replicating the original clinical mark-up. Responses from 18 UK Radiotherapy centres identified the four most common replication techniques; the accuracy and time-efficiency of each was evaluated, as well as participant preference and confidence. METHODS: A 2.0  cm × 2.5  cm ellipse field was drawn around the nasal ala of a surrogate patient. Templates for each replication method (1-4) were created, and skin marks removed. Twenty-five therapeutic radiographers used each method to replicate the mark-up. Measurements were recorded for lateral and longitudinal displacement, ellipse diameter and time taken. A post-study questionnaire recorded participant preference and perceived confidence. RESULTS: Comparison of the mean ellipse areas for methods 1-4 identified no statistically significant differences (ANOVA test; p = 0.579 to p = 0.999). Lateral and longitudinal displacements for method 1-4 showed a statistically significant difference between method 3 and each of methods 1, 2, 4 for lateral and longitudinal respectively (ANOVA; lateral: p = 0.008, p = 0.002, p = 0.05; longitudinal: p = 0.036, p = 0.000, and p = 0.000). Mean time taken was longest for method 3, and was compared using a Friedman test (p = 0.000) identifying a statistically significant difference. Twenty-two participants completed the questionnaire. 48% favoured method 2, 41% method 4. Method 3 was least favourite. A Likert scale (1-10) measured confidence. Participants had most confidence in methods 2 and 4. CONCLUSION: In this study, method 3 was least accurate, most time consuming, and was least favoured by users. The clinical significance of these results will depend on the margins used in local practise.

Mood changes during captopril therapy for hypertension. A double-blind pilot study.

A small double-blind pilot study was carried out to assess whether captopril treatment in hypertension has a euphoriant effect. Eight patients were maintained on constant therapy of atenolol and bendrofluazide for at least 4 weeks before and throughout the study. Captopril 25 mg three times daily or matching placebo was administered double-blind for 6 weeks, with crossover to placebo or captopril from Weeks 7 to 12. Psychiatric assessment was made at Weeks 3, 6, 9, and 12. During the captopril phase, blood pressure was reduced, plasma angiotensin II lowered, and plasma renin raised. Mood was slightly, but significantly, lower during captopril administration; thus, there was no evidence of an euphoriant effect of captopril. This pilot trial also indicates the feasibility of the approach, and such studies of hypertensives under therapy should be usefully extended and refined.

Comparison of enalapril and atenolol in mild to moderate hypertension.

PURPOSE: Short-term therapy with angiotensin converting enzyme (ACE) inhibitors for hypertension is effective and well tolerated, and compared with beta blockers, may cause fewer adverse reactions. Furthermore, enalapril has been observed to have a greater effect on systolic blood pressure than beta blockers. We therefore decided to compare the ACE inhibitor enalapril and the beta blocker atenolol as monotherapy in a double-blind study of patients with mild to moderate hypertension. PATIENTS AND METHODS: After a four-week placebo run-in period, 162 patients were allocated randomly to receive atenolol (50 to 100 mg daily) or enalapril (20 to 40 mg daily) for 12 weeks. To assess the influence of these drugs on quality of life, a series of psychologic tests was performed, and a subset of patients also underwent treadmill exercise and pulmonary function tests. RESULTS: In 147 patients who completed the study, enalapril reduced supine blood pressure by 19/12 mm Hg, compared with 9/7 mm Hg for atenolol (p less than 0.001/p less than 0.005). The modest blood pressure response to atenolol was not due to poor compliance. A target blood pressure of 140/90 mm Hg or less was achieved by 35 percent of enalapril-treated atenolol (p less than 0.01). The frequency and severity of adverse effects with the two drugs were similar, and few important differences emerged from the quality-of-life assessments. CONCLUSION: At the doses used, enalapril induced a greater short-term blood pressure response than atenolol; long-term studies of its safety and efficacy are required.

Thrombocytopenia in leptospirosis: the absence of evidence for disseminated intravascular coagulation.

In a prospective study of human leptospirosis, thrombocytopenia was demonstrated in 54% of 24 cases. The only additional laboratory evidence suggestive of disseminated intravascular coagulation lay in a mild elevation of fibrinogen degradation products, but this occurred with equal frequency in nonthrombocytopenic patients. There is therefore no causal relationship between disseminated intravascular coagulation and the thrombocytopenia of human leptospirosis.

Penicillin therapy in icteric leptospirosis.

A prospective, controlled randomized study of penicillin therapy in icteric human leptospirosis was carried out between 1 October 1983 and 31 December 1986. Thirty-eight patients received intravenous crystalline penicillin for 5 days, while 41 assigned to a control group received intravenous fluids only. A comparison of the results of laboratory tests made on the day of admission revealed no significant differences between the 2 groups. There was no significant difference in time for defervescence, return of biochemical parameters to normal, incidence of iritis, or mortality in the 2 groups. Three patients (7.3%) in the control group and 1 patient (2.6%) in the treatment group died. The overall mortality rate was 5.9%. Leptospira were recovered from urine cultures in 6 control patients but from none of the treated patients' post-treatment cultures. We conclude that penicillin has little effect on clinical outcome in icteric leptospirosis.

Psychosis de novo following temporal lobectomy.

A case report of a 61 year-old male with a long history of complex partial seizures is presented. Multiple psychotic symptomatology developed post-operatively. It is argued that these reflect continuing right temporal epileptogenic activity.

Death by suicide in Grampian 1991-1999: comparison with a previous study.

OBJECTIVES: To review the changes in suicide and undetermined death rates in Grampian between 1991-1999 and to make comparisons with a previous study on the same population. DESIGN: All suicide and undetermined deaths in Grampian recorded by the General Register Office for Scotland were included and linked with the psychiatric case records from Grampian Health Board. RESULTS: The high suicide and undetermined death rates in Grampian are accounted for by the excess of deaths in males. In males there has been a change in the method used to commit suicide with hanging now being the commonest method used. Firearm deaths have reduced dramatically since legislation was introduced in 1997 (RR = 021,95% CI [0.05,0.91). For those with previous psychiatric contact, a greater proportion were drug users than in 1974-1990 (OR = 3.75,95%CI [2.7, 5.2]). A higher percentage of suicides have a history of more than one previous attempt at suicide than in 1974-990. In Grampian there is a lower percentage of inpatient suicide than the rest of Scotland. CONCLUSION: There have been changes in suicide trends in Grampian and these are similar to elsewhere in Scotland Strategies to address this are discussed.

Urinary diagnostic indices in the management of leptospirosis. Selection of patients for dialysis therapy.

Cases of leptospirosis admitted to the Queen Elizabeth Hospital (QEH), Barbados, were assessed for the presence of "pre-renal azotaemia" (NON-ARF) as opposed to "acute renal failure" (ARF). Distinction between the two diagnoses was made on the basis of clinical course. Peritoneal dialysis was inappropriately utilised in 26% of patients receiving such therapy. This study evaluates diagnostic tests for pre-renal azotaemia, and acute renal failure in leptospirosis, and indicates guidelines for the management of azotaemia in such patients. U/P urea and osmolar ratios show high sensitivity and specificity in diagnosing pre-renal azotaemia. While "early" dialysis is essential for patients with acute leptospiral renal failure, in those with plasma creatinines less than 600 mumol/litre on entry and indices indicating NON-ARF, decisions regarding dialysis can safely be delayed for 48-72 hours while the effect of rehydration is assessed.

Leptospirosis in Barbados. A clinical study.

A 39-month clinical study of leptospirosis was undertaken at the Queen Elizabeth Hospital, Barbados. Eighty-eight patients had a confirmed diagnosis of the disease during the period. The major serogroups identified were autumnalis (including a new serovar bim), icterohaemorrhagiae, ballum and canicola. The majority of patients presented with jaundice (95%,) anorexia and headaches (85%), fever (76%) and conjunctival suffusion (54%). While abnormal creatinine levels were seen in 49% of patients on admission, only 16% were judged to have had renal failure. The urine to plasma urea ratio showed high sensitivity and specificity in the diagnosis of pre-renal azotemia. Cardiac arrhythmias and myocarditis occurred in 18% of patients and pericarditis in 6%. An elevated serum amylase was found in 65% of cases. The bilirubin level took 5.5 weeks to return to normal. Thrombocytopenia was shown not to be due to a disseminated intravascular coagulation, and a randomised trial of high dose penicillin did not reveal any benefit to jaundiced patients. The overall mortality during the study was 5.7%.

The efficacy of acarbose in type 2 diabetes mellitus in Jamaica.

The efficacy and tolerability of acarbose was studied in type 2 diabetic patients eating a typical Jamaican diet. The study was an open label parallel group study without placebo control. Of the 51 subjects recruited, five (9.8%) did not complete the study and were excluded from further analysis. Six (13%) of the remaining 46 had adverse side effects and did not complete the protocol. Of the remaining 40 (Gp A), acarbose was added to their previous regime of diet alone (n = 15), [Gp B], oral hypoglycaemic agents, OHAs (n = 17), [Gp C], or insulin (n = 8), Gp D]. In addition, during the run-in period all subjects had one session each with a dietitian and a diabetes educator. Over a 3-month period, significant reductions in average glucose (mmol) were observed in Gp B 10.5 +/- 1.1 to 8.4 +/- 0.9 (p < 0.027) and, from 11.0 +/- 1.0 to 8.7 +/- 0.7 (p < 0.01) in Gp C. Similarly, total glycosylated haemoglobin fell from 14.8 +/- 1.1% to 12.2 +/- 1.0% (p < 0.016) in Gp B, from 14.9 +/- 1.1 to 11.9 +/- 1.1% (p < 0.002) in Gp C, and from 14.1 +/- 1.4 to 11.8 +/- 1.4 (p < 0.02) in Gp D. Twenty-three per cent (23%) of the patients experienced flatulence; 7.5%, changes in bowel habits and 5%, abdominal cramps and discomfort. Acarbose is effective as monotherapy and as combination therapy with oral hypoglycaemic agents or insulin. Side effects were common, but tolerable.

Analysis of transcriptional activity mediated by Drosophila melanogaster ecdysone receptor isoforms in a heterologous cell culture system.

Ecdysteroid regulation of gene transcription in Drosophila melanogaster and other insects is mediated by a heterodimer comprised of Ultraspiracle (USP) and one of three ecdysone receptor (EcR) isoforms (A, B1 and B2). This study revealed that the EcR/USP heterodimer displays isoform-specific capabilities. EcRB1 is normally induced with a form of USP that is missing its DNA-binding domain (DBD), although potentiation by juvenile hormone (JH) III is reduced. The EcRA and B2 isoforms, however, display almost no response to ecdysteroids with the DBD(-) USP. A mutation, K497E, in the shared ligand-binding domain of the EcR isoforms caused elevated EcRB2-specific affinity for a canonical ecdysone response element. The effects of directed modification and mutagenesis offer a strategy for developing hypotheses and considerations for studying in vivo function.

Non-progressive familial idiopathic intracranial calcification: a family report.

The clinical features and long term outcome of familial idiopathic intracranial calcification in three members of one family are described. The illness presented as psychiatric disorder in all patients, and in one patient, epilepsy and intellectual deterioration were later manifestations. Skull radiographs and CT were performed sequentially, in one patient, over a 22 year period and, in another, CT was carried out eight years apart. In neither patient was there any evidence of progression of calcification.

Ethics and aims in psychotherapy: a contribution from Kant.

Psychotherapy is an activity which takes many forms and which has many aims. The present paper argues that it can be viewed as a form of moral suasion. Kant's concepts of free will and ethics are described and these are then applied to the processes and outcome of psychotherapy. It is argued that his ideas, by linking rationality, free will and ethics into a single philosophical system, offer a valuable theoretical framework for thinking about aims and ethical issues in psychotherapy.

Exposure assessment of consumer products: human body weights and total body surface areas to use, and sources of data for specific products.

A thorough understanding of the routes and magnitudes of chemical exposures that consumers experience during the use of a household product is needed as part of a well-founded risk assessment for that product and its components. This review describes some sources of generic consumer data (eg, relevant body weight or total body surface area for a given human age), and exposure-related data (eg, task frequency and duration) for specific product types needed for exposure assessments. The review also contains a discussion of the importance of statistical characterization of the consumer data (eg, does its range follow a normal, log-normal, or other type of distribution?). The importance of examining these data for correlative interactions is emphasized.