A review of clinical decision-making: Models and current research

Aims and objectives: The aim of this paper was to review the current literature with respect to clinical decision-making models and the educational application of models to clinical practice. This was achieved by exploring the function and related research of the three available models of clinical decision making: information processing model, the intuitive-humanist model and the clinical decision making model. Background: Clinical decision-making is a unique process that involves the interplay between knowledge of pre-existing pathological conditions, explicit patient information, nursing care and experiential learning. Historically, two models of clinical decision making are recognised from the literature; the information processing model and the intuitive-humanist model. The usefulness and application of both models has been examined in relation the provision of nursing care and care related outcomes. More recently a third model of clinical decision making has been proposed. This new multidimensional model contains elements of the information processing model but also examines patient specific elements that are necessary for cue and pattern recognition. Design: Literature review Methods: Evaluation of the literature generated from MEDLINE, CINAHL, OVID, PUBMED and EBESCO systems and the Internet from 1980 – November 2005

Polarisation dynamics of vector soliton molecules in mode locked fibre laser

Two fundamental laser physics phenomena - dissipative soliton and polarisation of light are recently merged to the concept of vector dissipative soliton (VDS), viz. train of short pulses with specific state of polarisation (SOP) and shape defined by an interplay between anisotropy, gain/loss, dispersion, and nonlinearity. Emergence of VDSs is both of the fundamental scientific interest and is also a promising technique for control of dynamic SOPs important for numerous applications from nano-optics to high capacity fibre optic communications. Using specially designed and developed fast polarimeter, we present here the first experimental results on SOP evolution of vector soliton molecules with periodic polarisation switching between two and three SOPs and superposition of polarisation switching with SOP precessing. The underlying physics presents an interplay between linear and circular birefringence of a laser cavity along with light induced anisotropy caused by polarisation hole burning

Spiral attractor created by vector solitons

Mode-locked lasers emitting a train of femtosecond pulses called dissipative solitons are an enabling technology for metrology, high-resolution spectroscopy, fibre optic communications, nano-optics and many other fields of science and applications. Recently, the vector nature of dissipative solitons has been exploited to demonstrate mode locked lasing with both locked and rapidly evolving states of polarisation. Here, for an erbium-doped fibre laser mode locked with carbon nanotubes, we demonstrate the first experimental and theoretical evidence of a new class of slowly evolving vector solitons characterized by a double-scroll chaotic polarisation attractor substantially different from Lorenz, Rössler and Ikeda strange attractors. The underlying physics comprises a long time scale coherent coupling of two polarisation modes. The observed phenomena, apart from the fundamental interest, provide a base for advances in secure communications, trapping and manipulation of atoms and nanoparticles, control of magnetisation in data storage devices and many other areas

European postgraduate curriculum in geriatric medicine developed using an international modified Delphi technique

the European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed considerably since then and it has therefore become necessary to update these recommendations.under the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators.the final recommendations include four different domains: General Considerations on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), Knowledge in patient care (36 sub-items), Additional Skills and Attitude required for a Geriatrician (9 sub-items) and a domain on Assessment of postgraduate education: which items are important for the transnational comparison process (1 item).the current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states

Evaluation of two 111In-oxinate formulations for labelling of white blood cells.

This study compares the cell labelling characteristics of two 111In-oxinate formulations. The two preparations differ by the solubilizing agent of the chelate and the total amount of oxine. White blood cell suspensions were obtained by standard separation techniques and were labelled with either of these formulations. The labelling efficiency was higher for 111In-oxinate in aqueous solution (compound B) compared to the preparation where an organic solubilizer was added (compound A) (79.2 +/- 7.7 vs 68.6 +/- 17.6%, respectively, P = 0.03). Red blood cells contaminating the cell suspensions incorporated a higher fraction of 111In if the cells were incubated with the aqueous 111In-oxinate preparation (22.6 +/- 4.6 vs 4.8 +/- 4.6%, respectively, P less than 0.0001). The uptake of activity by polymorphonuclear cells was reduced with compound B (46.1 +/- 12.8 vs 63.8 +/- 15.8%, respectively, P = 0.0002) whereas the fraction retained by mononuclear cells and platelets was similar (31.3 +/- 13.9 vs 31.4 +/- 15.0%, respectively). The recovery from the vial was higher for 111In-oxinate in an organic solution (86.6 +/- 1.82 vs 60.3 +/- 14.3%, respectively, P less than 0.0001). Twenty four hours after administration of the labelled cells, the vascular compartment was less frequently visualized if cells were labelled with compound A (8% of the scintigrams vs 62.5% respectively, P less than 0.0001). High quality images were more often recorded after the administration of cells labelled with compound A (60.0% of the images vs 23.5%, respectively, P less than 0.02). The image quality of scintigrams was not related to any of the other cell labelling parameters.(ABSTRACT TRUNCATED AT 250 WORDS