Analyzing Commercial Video Game Instruction through the Lens of Instructional Design

This paper will examine how Gagne’s Nine Events of Instruction (1992) may appear, perhaps inadvertently, within commercial games that guide the user from novice to expert player. By employing a qualitative artifact analysis methodology, we examine a popular action adventure video game to determine if game designers encourage players to build game expertise by employing similar events to Gagne’s instructional design model. We demonstrate that our artifact of analysis does consistently employ Gagne’s events, though often in a manner unique to a digitally mediated space. We conclude that an experiential game setting has the potential to be a platform for instructional delivery

Is there an indication for computed tomography and magnetic resonance imaging in the evaluation of coronary artery bypass grafts?

This meta-analysis evaluates the diagnostic accuracy of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) for bypass graft occlusion and stenosis detection compared with coronary angiography in post-coronary artery bypass graft patients. The indication for noninvasive imaging in post-coronary artery bypass graft patients with these techniques is discussed. Overall, MRI had significantly lower sensitivity (81%) and specificity (91%) for occlusion detection than MDCT (96% and 98%, respectively). Only 2 studies assessed the accuracy of stenosis detection with MRI. Stenosis detection with MDCT had a pooled sensitivity of 89% and specificity of 97%. Multidetector computed tomography is therefore superior to MRI for the noninvasive detection of coronary bypass graft occlusion and stenosis. For stenosis detection, the accuracy of MDCT is, however, not sufficient to warrant a wide clinical use. The remaining indication for MRI-guided bypass graft assessment is in combination with myocardial evaluation such as magnetic resonance perfusion, wall motion, and stress test as a "one-stop-shop" procedur

Effectiveness of multifaceted implementation strategies for the implementation of back and neck pain guidelines in health care: a systematic review

Background: For the optimal use of clinical guidelines in daily practice, mere distribution of guidelines and materials is not enough, and active implementation is needed. This review investigated the effectiveness of multifaceted implementation strategies compared to minimal, single, or no implementation strategy for the implementation of non-specific low back and/or neck pain guidelines in health care. Methods: The following electronic databases were searched from inception to June 1, 2015: MEDLINE, Embase, PsycInfo, the Cochrane Library, and CINAHL. The search strategy was restricted to low back pain, neck pain, and implementation research. Studies were included if their design was a randomized controlled trial, reporting on patients (age ≥18years) with non-specific low back pain or neck pain (with or without radiating pain). Trials were eligible if they reported patient outcomes, measures of healthcare professional behaviour, and/or outcomes on healthcare level. The primary outcome was professional behaviour. Guidelines that were evaluated in the studies had to be implemented in a healthcare setting. No language restrictions were applied, and studies had to be published full-text in peer-reviewed journals, thus excluding abstract only publications, conference abstracts, and dissertation articles. Two researchers independently screened titles and abstract, extracted data from included studies, and performed risk of bias assessments. Results: After removal of duplicates, the search resulted in 4750 abstracts to be screened. Of 43 full-text articles assessed for eligibility, 12 were included in this review, reporting on 9 individual studies, and separate cost-effectiveness analyses of 3 included studies. Implementation strategies varied between studies. Meta-analyses did not reveal any differences in effect between multifaceted strategies and controls. Conclusion: This review showed that multifaceted strategies for the implementation of neck and/or back pain guidelines in health care do not significantly improve professional behaviour outcomes. No effects on patient outcomes or cost of care could be found. More research is necessary to determine whether multifaceted implementation strategies are conducted as planned and whether these strategies are effective in changing professional behaviour and thereby clinical practice

Severe delayed posttonsillectomy haemorrhage due to a pseudoaneurysm of the lingual artery

A 3.5-year-old child is presented with severe, recurrent haemorrhages after a tonsillectomy. The haemorrhages were caused by a pseudoaneurysm of the lingual artery, which was visualised more than 2 weeks postoperatively by angiography. The pseudoaneurysm was successfully embolised by coils. Coiling is an adequate therapeutic option for severe posttonsillectomy haemorrhage due to arterial damage

Treatment of recurrent respiratory papillomatosis and adverse reactions following off-label use of cidofovir (Vistide®)

Recurrent respiratory papillomatosis (RRP) is caused by a human papilloma virus (HPV). It is a rare, sometimes debilitating disease compromising voice and airway. RRP is characterized by a variable course of disease, potentially leading to frequent annual surgical procedures, the number of which may exceed a hundred during the life time. The therapy focuses on surgical removal of the mucosal lesions in order to keep the airway open and the voice satisfactory. Till now, there is no curative therapy for the virus infection in itself. As recurrent surgery alone has proven to be insufficient in many cases, adjuvant therapy is increasingly being used. One of the mainstays of adjuvant therapy is the administration of intralesional cidofovir (Vistide Ò). Cidofovir is an antiviral agent, registered for the treatment of cytomegalovirus (CMV) retinitis in patients wit

Effectiveness of cidofovir intralesional treatment in recurrent respiratory papillomatosis

To present the results of recurrent respiratory papillomatosis (RRP) treatment with surgical excision and adjuvant anti-viral cidofovir intralesional use and to examine the correlation between the cidofovir effectiveness and the patient previous history of multiple larynx procedures, age, extension of lesion and dose. 32 patients with laryngeal papillomas were treated with cidofovir in our Department between I.2009 and I.2011. The number of previous RRP debulking procedures ranged from 1 to 100. The intensity of papillomatosis differed from one anatomic site and moderate growth to four or five localizations with heavy extension. The number of injections per patient varied from 1 to 7, and the total volume of 5 mg/ml solution varied from 2 to 33 ml. The injections were combined with laser debulking of the lesions. In disperse papillomata, the injections were administered in particular anatomical sites in 4–6 weeks intervals, in massive lesions injections were repeated in the same anatomical site in 2–4 weeks. Complete remission was observed in 18 out of 32 patients. 13 patients showed remission in a place of cidofovir injection. One patient did not react to the drug. In four patients, new changes in injection places appeared. In two patients, hepatic toxic side effects were observed. Intralesional cidofovir injection has been shown to be an effective and safe therapy for laryngeal papillomatosis and should be considered in those patients who experienced disease relapse

Dilatation tracheoscopy for laryngeal and tracheal stenosis in patients with Wegener’s granulomatosis

Wegener’s granulomatosis (WG) frequently involves the subglottis and trachea and may compromise the upper airway. The objective of this study is to evaluate retrospectively the effect of treatment of subglottic stenosis (SGS) and tracheal stenosis (TS) by dilatation tracheoscopy (DT) in patients with WG. We performed a cohort study on all patients who underwent DT between February 2001 and September 2005 in our institution. From this cohort we identified a total of nine WG patients. In all patients, clinical, serological and histopathological data had been prospectively collected by a standardized protocol from the time point of diagnosis. In the nine patients that were identified with SGS or TS due to WG (eight women and one man), a total of 22 DT’s were performed. Two patients needed a tracheostoma (one temporarily). The mean follow-up after the first DT was 25.4 ± 14.1 months. Two patients did not experience a recurrence of SGS or TS. Six patients required a second DT without recurrence of local disease. The remaining patient underwent 8 DT's in a 4-year period. DT can offer a simple and repeatable solution to SGS and TS due to WG. Seven of the nine patients required more than one dilatation and some patients experience a functional restriction. One patient has a definitive tracheostoma