General Practitioners' perceptions of the route to evidence-based medicine: a questionnaire survey

Objectives: To determine the attitude of general practitioners towards evidence based medicine and their related educational needs. Design: A questionnaire study of general practitioners. Setting: General practice in the former Wessex region, England. Subjects: Randomly selected sample of 25% of all general practitioners (452), of whom 302 replied. Main outcome measures: Respondents' attitude towards evidence based medicine, ability to access and interpret evidence, perceived barriers to practising evidence based medicine, and best method of moving from opinion based to evidence based medicine. Results: Respondents mainly welcomed evidence based medicine and agreed that its practice improves patient care. They had a low level of awareness of extracting journals, review publications, and databases (only 40% knew of the Cochrane Database of Systematic Reviews), and, even if aware, many did not use them. In their surgeries 20% had access to bibliographic databases and 17% to the world wide web. Most had some understanding of the technical terms used. The major perceived barrier to practising evidence based medicine was lack of personal time. Respondents thought the most appropriate way to move towards evidence based general practice was by using evidence based guidelines or proposals developed by colleagues. Conclusion: Promoting and improving access to summaries of evidence, rather than teaching all general practitioners literature searching and critical appraisal, would be the more appropriate method of encouraging evidence based general practice. General practitioners who are skilled in accessing and interpreting evidence should be encouraged to develop local evidence based guidelines and advice

Successful elimination of factor VIII inhibitor using cyclosporin A

No abstract available

Comparison of body temperature measurements obtained with otic digital thermometer and mercury axillary and rectal thermometers in children under the age of five

Indexación: Web of Science; ScieloIntroducción: En los últimos años han aparecido nuevos métodos para medir la temperatura en niños, como el termómetro digital ótico. Siendo este un método más rápido para medir la temperatura y por lo tanto ideal para el servicio de urgencias, es necesario conocer su confiabilidad. Objetivo: Comparar los valores de temperatura corporal que entrega el termómetro ótico digital con los termómetros de mercurio axilar y rectal. Pacientes y Método: Se efectuó la medición de la temperatura en 50 pacientes menores de 5 años elegidos al azar, que consultaron en el Servicio de Urgencia del Hospital de Niños y Cunas de Viña del Mar. Se les midió la temperatura con un termómetro digital ótico al lado izquierdo y derecho, y las temperaturas axilar derecha y rectal con termómetros de mercurio. EL análisis de los resultados se efectuó en el grupo estudiado, separado en dos grupos, menores y mayores de 6 meses. Resultados: Los resultados entre ambos subgrupos fueron los mismos. La temperatura media rectal obtenida fue 0,414°C más alta que la media ótica derecha (p < 0,001) y 0,438°C más alta que la temperatura media ótica izquierda (p < 0,001). Conclusión: El termómetro ótico digital entrega una temperatura significativamente más baja que la que entregan los termómetros de mercurio axilar y rectal.Background: In recent years, otic thermometers to measure body temperature in children have become increasingly popular as they reflect changes in body temperature sooner than other thermometers. The have become valuable assets in hospital emergency rooms; however, their accuracy and reliability need further studies. Objective: To compare corporal temperature readings between an otic thermometer and mercury axillary and rectal thermometers. Patients and Method: 50 patients under the age of 5, who were treated at the emergency room of our hospital, were randomly chosen to participate in this study. Temperature was measured on their right and left ears using an otic thermometer, and their rectal and right axillary temperature was taken using mercury thermometers. Patients were separated into 2 subgroups for comparison, children under and over 6 months old. Results: The results between the 2 subgroups were very similar. The average temperature obtained by rectal thermometers was 0.414°C higher than the average right-ear temperature (p < 0.001) and 0.438°c higher than the average left-ear temperature (p < 0.001). Conclusion: The otic thermometer's reading is significantly lower than the one obtained using mercury rectal and axillary thermometers.http://ref.scielo.org/72p3g

MALDI Imaging Mass Spectrometry (MALDI-IMS)—Application of Spatial Proteomics for Ovarian Cancer Classification and Diagnosis

MALDI imaging mass spectrometry (MALDI-IMS) allows acquisition of mass data for metabolites, lipids, peptides and proteins directly from tissue sections. IMS is typically performed either as a multiple spot profiling experiment to generate tissue specific mass profiles, or a high resolution imaging experiment where relative spatial abundance for potentially hundreds of analytes across virtually any tissue section can be measured. Crucially, imaging can be achieved without prior knowledge of tissue composition and without the use of antibodies. In effect MALDI-IMS allows generation of molecular data which complement and expand upon the information provided by histology including immuno-histochemistry, making its application valuable to both cancer biomarker research and diagnostics. The current state of MALDI-IMS, key biological applications to ovarian cancer research and practical considerations for analysis of peptides and proteins on ovarian tissue are presented in this review

Copper vapor laser machining of polyimide and polymethylmethacrylate in atmospheric pressure air

A repetitively pulsed copper vapor laser (510 and 578 nm) is used to machine an opaque polymer (polyimide‐Vespel) and a transparent polymer (polymethylmethacrylate‐Lucite). Lucite is machinable by coating the surface with an ink which is semi‐opaque to the green and yellow laser light. The repetition rate of the laser was 10 kHz with approximately 0.35 mJ/pulse and 3.5 W average power at the copper vapor laser wavelengths for a pulse width of 40 ns. The copper vapor laser thermally loads the target, generating thermal waves and sound waves in the gas which are investigated using HeNe laser beam deflection. The gas adjacent to the target is heated to steady state on the order of 100–400 s. Above the etching threshold, at approximately 10 mJ/cm2/pulse, the target is rapidly machined: 2‐mm‐diam, 2‐mm‐deep holes are drilled in 300 s in Vespel. At higher fluences of 100–150 mJ/cm2/pulse in 760 Torr of air it takes 180 s to bore through a 2‐mm‐thick disk of Vespel. The machined surfaces of the two polymers are very different. Machined Vespel samples are charred and cratered, whereas the Lucite samples show evidence of melting with little charring. The machining of polymers by visible‐light copper vapor lasers is being compared to UV photoablation by KrF excimer laser light in order to study thermal versus nonthermal etching mechanisms.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71173/2/JAPIAU-72-7-3080-1.pd

Is fear of falling key to identifying gait and balance abnormalities in community-dwelling older adults? Protocol of a mixed-methods approach

Introduction: The ageing population poses an increasing burden to public health systems, particularly as a result of falls. Falls have been associated with poor gait and balance, as measured by commonly used clinical tests for poor gait and balance. Falls in older adults have the potential to lead to long-term issues with mobility and a fear of falling (FoF). FoF is measured by a variety of instruments; the Falls Efficacy Scale International (FES-I) version is widely used within clinical and research arenas. The ability of the FoF, as measured by the FES-I to predict gait and balance abnormalities (GABAb) has not previously been measured; this study aims to be the first to investigate this prospective relationship. Methods and analyses: To investigate the ability of the FES-I to predict GABAb a mixed-methods approach will be used, including quantitative, qualitative and health economics approaches. Initially the ability of the FES-I to identify poor gait and balance will be investigated, along with whether the measure is able to assess change in gait and balance in response to exercise training. The ability of an online FES-I tool to assess poor gait and balance in an alternative pre-existing online strength and balance programme will also be investigated. Interviews will be carried out to investigate participant experiences and motivations of those that are offered Age UK Strength and Balance Training, along with the views of healthcare professionals and Age UK staff involved within the process. Ethics and dissemination: NHS REC Approval has been granted (IRAS ID 314705). Study participation is voluntary; participants will be provided with all necessary information within the participant information sheet, with written consent being sought. Study findings will be disseminated through manuscripts in peer-reviewed journals, at scientific conferences and in a short report to participants and the funding body

Meaning behind measurement : self-comparisons affect responses to health related quality of life questionnaires

Purpose The subjective nature of quality of life is particularly pertinent to the domain of health-related quality of life (HRQOL) research. The extent to which participants’ responses are affected by subjective information and personal reference frames is unknown. This study investigated how an elderly population living with a chronic metabolic bone disorder evaluated self-reported quality of life. Methods Participants (n = 1,331) in a multi-centre randomised controlled trial for the treatment of Paget’s disease completed annual HRQOL questionnaires, including the SF-36, EQ-5D and HAQ. Supplementary questions were added to reveal implicit reference frames used when making HRQOL evaluations. Twenty-one participants (11 male, 10 female, aged 59–91 years) were interviewed retrospectively about their responses to the supplementary questions, using cognitive interviewing techniques and semi-structured topic guides. Results The interviews revealed that participants used complex and interconnected reference frames to promote response shift when making quality of life evaluations. The choice of reference frame often reflected external factors unrelated to individual health. Many participants also stated that they were unclear whether to report general or disease-related HRQOL. Conclusions It is important, especially in clinical trials, to provide instructions clarifying whether ‘quality of life’ refers to disease-related HRQOL. Information on selfcomparison reference frames is necessary for the interpretation of responses to questions about HRQOL.The Chief Scientist Office of the Scottish Government Health Directorates, The PRISM funding bodies (the Arthritis Research Campaign, the National Association for the Relief of Paget’s disease and the Alliance for Better Bone Health)Peer reviewedAuthor final versio

Relación entre el bienestar y el rendimiento académico en alumnos de primer año de medicina

Background: Stress may affect the sense of wellbeing and academic achievement of university students. Aim: To assess the relationship of academic engagement and burnout with academic achievement among first year medical students. Material and Methods: The Utrecht Work Engagement Scale-Student and Maslach Burnout Inventory Student Survey (MBI-SS) were applied to 277 first year medical students of four universities. Their results were correlated with the grades obtained in the different courses. Results: Moderately high engagement and low burnout levels were detected. There was a high level of satisfaction with studies and a moderate exhaustion level. Academic achievement was associated with the degree of engagement with studies but not with burnout. Conglomerate analysis detected a group of students with high levels of wellbeing, characterized by high levels of academic engagement and low burnout. Other group had moderate levels of engagement and lack of personal fulfilment. Other group, identified as extenuated, had high levels of personal exhaustion and depersonalization. Finally the disassociated group had a low academic engagement, low emotional exhaustion, high levels of depersonalization and lack of personal fulfillment. Conclusions: Academic achievement is associated with the level of engagement with studies but not with burnout

telederm.org: Freely Available Online Consultations in Dermatology

Studies have shown that skin disorders can be reliably diagnosed by online consultations. These consultations are provided free of charge by a new nonprofit organization of skin doctors worldwid