Explaining anomalous responses to treatment in the Intensive Care Unit

The Intensive Care Unit (ICU) provides treatment to critically ill patients. When a patient does not respond as expected to such treatment it can be challenging for clinicians, especially junior clinicians, as they may not have the relevant experience to understand the patient’s anomalous response. Datasets for 10 patients from Glasgow Royal Infirmary’s ICU have been made available to us. We asked several ICU clinicians to review these datasets and to suggest sequences which include anomalous or unusual reactions to treatment. Further, we then asked two ICU clinicians if they agreed with their colleagues’ assessments, and if they did to provide possible explanations for these anomalous sequences. Subsequently we have developed a system which is able to replicate the clinicians’ explanations based on the knowledge contained in its several ontologies; further the system can suggest additional explanations which will be evaluated by the senior consultant

A pilot study of subjective well-being in colorectal cancer patients and their caregivers

Background: Traditional endpoints in oncology are based on measuring the tumor size and combining this with a time factor. Current studies with immunotherapy show that even when median survival is unaltered, a significant proportion of patients can achieve prolonged survival. Objective tumor response does not always mean “overall” improvement, especially if toxicity is harsh. Novel agents are significantly expensive, and it is therefore crucial to measure the impact on “quality” of life, in addition to “quantity”. Materials and methods: We studied the preferences and experiences of cancer patients and their caregivers, measuring subjective well-being (SWB) ratings, EQ5D descriptions and time trade-off preferences. Results: We studied 99 patients and 88 caregivers. Life satisfaction ratings were similar between the two groups, but daily mood was significantly lower in caregivers (P<0.1). Anxiety/depression affected SWB, while pain and mobility did not. Positive thoughts about health were associated with better daily moods in both groups, and stage IV cancer was associated with lower life satisfaction. Cancer in remission was associated with better daily moods, but, interestingly, not with patient life satisfaction. Patients with better daily mood and positive thoughts about family were less willing to “trade-off” life years. Conclusion: Caregivers are as anxious or depressed as patients, and report similar levels of life satisfaction but lower daily mood. A focus on SWB could provide a valid assessment of treatment benefit. Given the interesting results of this pilot study, we suggest a larger study should be conducted, measuring SWB over time

Two meta-analyses of noncontact healing studies

Reviews of empirical work on the efficacy of noncontact healing have found that interceding on behalf of patients through prayer or by adopting various practices that incorporate an intention to heal can have some positive effect upon their wellbeing. However, reviewers have also raised concerns about study quality and the diversity of healing approaches adopted, which makes the findings difficult to interpret. Some of these concerns can be addressed by adopting a standardised approach based on the double-blind randomised controlled clinical trial, and a recent review restricted to such studies has reported a combined effect size of .40 (p < .001). However, the studies in this review involve human participants for whom there can be no guarantee that control patients are not beneficiaries of healing intentions from friends, family or their own religious groups. We proposed to address this by reviewing healing studies that involved biological systems other than ‘whole’ humans (i.e. to include animal and plant work but also work involving human biological matter such as blood samples or cell cultures), which are less susceptible to placebo and expectancy effects and also allow for more circumscribed outcome measures. Secondly, doubts have been cast concerning the legitimacy of some of the work included in previous reviews so we planned to conduct an updated review that excluded that work. For phase 1, 49 non-whole human studies from 34 papers were eligible for review. The combined effect size weighted by sample size yielded a highly significant r of .258. However the effect sizes in the database were heterogeneous, and outcomes correlated with blind ratings of study quality. When restricted to studies that met minimum quality thresholds, the remaining 22 studies gave a reduced but still significant weighted r of .115. For phase 2, 57 whole human studies across 56 papers were eligible for review. When combined, these studies yielded a small effect size of r = .203 that was also significant. This database was also heterogeneous, and outcomes were correlated with methodological quality ratings. However, when restricted to studies that met threshold quality levels the weighted effect size for the 27 surviving studies increased to r = .224. Taken together these results suggest that subjects in the active condition exhibit a significant improvement in wellbeing relative to control subjects under circumstances that do not seem to be susceptible to placebo and expectancy effects. Findings with the whole human database gave a smaller mean effect size but this was still significant and suggests that the effect is not dependent upon the previous inclusion of suspect studies and is robust enough to accommodate some high profile failures to replicate. Both databases show problems with heterogeneity and with study quality and recommendations are made for necessary standards for future replication attempts

Continued Progress: Promising Evidence on Personalized Learning

The findings are grouped into four sections. The first section on student achievement finds that there were positive effects on student mathematics and reading performance and that the lowest-performing students made substantial gains relative to their peers. The second section on implementation and the perceptions of stakeholders finds that adoption of personalized learning practices varied considerably. Personalized learning practices that are direct extensions of current practice were more common, but implementation of some of the more challenging personalized learning strategies was less common. The third section relates implementation features to outcomes and identifies three elements of personalized learning that were being implemented in tandem in the schools with the largest achievement effects. Finally, the fourth section compares teachers' and students' survey responses to a national sample and finds some differences, such as teachers' greater use of practices that support competency-based learning and greater use of technology for personalization in the schools in this study with implementation data

UWOMJ Volume 81, Issue 1, Spring 2012

Schulich School of Medicine & Dentistryhttps://ir.lib.uwo.ca/uwomj/1013/thumbnail.jp

IJSAP Volume 04, Number 01

TABLE OF CONTENTS – VOL. 4(1), 1983 LETTERS EDITORIALS The LD50—The Beginning of the End – A.N. Rowan Some Rights for Animal Therapists: Better Science and Better Welfare – D.H. Murphy Occlusion of Vision in Old English Sheepdogs – M.W. Fox NEWS AND ANALYSIS Preliminary Verdict for Electro-Immobilization Enforcement Powers for Humane Societies? In a Natural Environment, Pig Behavior Resembles That of Wild Boars Egg Producers Issue Guidelines for Destroying Baby Chicks Establishing Baselines for Domestic Animal Behavior A Farmer’s Response to the “Downer” Cow Dilemma Attitudes Toward Dogs and Cats Deaths in Primate Trade Researching Research Methods Cat Population Dynamics Dart Gun Modifications Alternatives at NIH Laboratory Animal Numbers COMMENTS Vivisection and Misanthropy – G.P. Cave Thoughtful Use of Animals – H. Kitchen ORIGINAL AND REVIEW ARTICLES Abundance and Distribution of Large Mammals in the Upper Ogun Game Reserve, Oyo State, Nigeria – T.A. Afolayan, K.R.N. Milligan, and S.O. Salami Feral Dogs of the Galapagos Islands: Impact and Control – B.D. Barnett and R.L. Rudd The Effects of Ethostasis on Farm Animal Behavior: A Theoretical Overview – A.F. Fraser and M.W. Fox LEGISLATION AND REGULATION CURRENT EVENTS BOOK NEWS VOLUME 3 INDEX INSTRUCTIONS TO AUTHOR

The role of binocularity in anisometropic amblyopia

Anisometropic amblyopia is unilateral by definition and current treatment recommendations reflect that characteristic. However, recent research suggests a binocular component that deserves consideration. The aim of this review is to consider the levels of anisometropia deemed amblyogenic, and the cortical changes that occur in the presence of anisometropic amblyopia. Particular attention is given to cortical changes that impact the binocularity of these individuals. Knowledge of binocular deficits in anisometropic amblyopia has implications for current, accepted treatment regimens which are monocular in nature. Therefore, the integrity of binocular function in anisometropic amblyopia and its impact on the visual outcome will be evaluated. Given the rise in binocular treatments under clinical trial for amblyopia, this review also aims to evaluate the evidence of potentially enhanced benefits to anisometropic amblyopes from proposed new binocular therapies