Carcinoma of the breast in East Anglia 1960-1975: a changing pattern of presentation?

A study was made of the clinical stage at presentation in 10 081 cases of carcinoma of the breast registered with the East Anglian Cancer Registration Bureau between 1960 and 1975. Information about the length of clinical history was obtained in 8862 cases. There has been a gradual increase in the population-adjusted incidence of breast carcinoma in the region during the period studied. Since 1968, there has been a consistent increase in Stage I and II registrations, but a fall in Stage III registrations. Stage IV registrations have remained constant. A greater proportion of women with Stage I or II lesions present with a short clinical history, and this pattern has not changed during the course of the study. We suggest that increased interest in, and opportunities for, the early diagnosis of breast disease are leading to a change in the pattern of presentation.     

Teaching medical English to foreign-language doctors

Acquisition of an advanced medical degree beyond licensure and specialization is advantageous and encouraged in Swedish medical education. Since a thesis and a number of published works, usually in English are required, there is considerable interest in medical writing by doctors and medical scientists. A voluntary course in 'Biomedical Authorship' which included presentation of oral reports was offered by the Karolinska Institutes' Medical Faculty. This course was intended to prepare participants for their thesis work and for presentations at scientific congresses. The course revealed that the principle difficulty was not in English skills which were rather good, but in the students' inexperience in critically rereading what they had written and making suitable revisions. A case study method was used so that students acquired experience in critically reading and correcting their own work and that of others. An instructor who understood the evolution of academic Swedish was of considerable help in explaining some of the 'Swenglishisms' that arose during the course. The oral presentation portion, which used videotapes of students, showed the students as lacking experience in basic public speaking and as frequently being apprehensive. This was much improved by taped poetry readings, scientific reports and slide shows. This Swedish experience should apply to teaching biomedical writing in the other Scandinavian countries and in Northern Europe.     

Best Interest: A Philosophical Critique

On one conception of "best interest" there can only be one course of action in a given situation that is in a person's best interest. In this paper we will first consider what theories of "best interest" and rational decision-making that can lead to this conclusion and explore some of the less commonly appreciated implications of these theories. We will then move on to consider what ethical theories that are compatible with such a view and explore their implications. In the second part of the paper we will explore a range of possible criticisms of these views. And in the third part we will criticise the view that a court is always or even often in a good position to decide what the patient's best interest is. In the fourth and final part we will put forward a reconstructive proposal aimed at saving whatever is sound in the "best interest" conception.     

天然药物化学说课在医药营销专业教学中的实践

天然药物化学是高职医药营销专业的一门专业基础课程,为顺利完成课程知识技能的传授,达到专业培养目标,该文将说课实践引入到本门课程的教学过程中。说课内容由课程设置、课程设计、课程实施三个方面组成。课程设置做到定位准确、目标具体;课程设计兼顾学习和发展;课程实施针对高职学情,综合应用讲授法、课堂讨论法、实验教学法、对比教学法等授课方法。通过说课实践以提高教师的教学能力和水平,提高课堂教学效果。     

A study of exercise programs and instructors for a fitness program in a corporate setting

The objective of the study was to evaluate the importance of diversity in exercise programs and athletic instructors in a corporate physical fitness program. Subjects were 717 Japanese chemical factory employees (male 524, female 193) in Japan who were surveyed using a questionnaire, with a resultant response rate of 84%. Many employees who participated in regular physical activities on a voluntary basis were motivated to exercise for reasons other than health, with a variety of motivating factors suggested. The total number of sports programs in which male and female employees participated voluntarily were 31 and 15, respectively. For employees not yet participating in physical activities but expressing interest in joining a company sponsored sports class, the total number of programs in which interest was shown was 40 for males and 22 for females. Professional athletic instructors from outside fitness clubs appeared to have far more appeal to employees than athletic instructors who were recruited from company employees and given a short athletic instructor course to become health care leaders at the same factory in addition to their regular job. In order to enhance participation in and adherence to a corporate fitness program, it was suggested that the number of exercise programs be increased and that outside professional athletic instructors be employed.     

综合式学习在中职基础护理教学中的应用与效果评价

目的探讨综合式学习方法在中职学校基础护理学教学中的应用效果。方法选取108名中专护生为研究对象,采取简单随机分组的方法将其分为实验组和对照组,每组54人。实验组在基础护理教学中采取综合式教学法,对照组采取传统的示教法。结果实验组理论考试成绩、综合技能成绩、学生对基础护理学教学与考试方法的评价均高于对照组,差异有统计学意义。结论综合式教学方法有利于提高学生的学习兴趣、思维能力、理论成绩和综合技能。     

An international survey of medical school programmes on nuclear war

Many medical organizations have acknowledged the responsibility of doctors to educate health professionals and the public about the medical, social and ecological consequences of nuclear war. Medical schools have begun the development of programmes on these topics. A total of 1130 medical schools in thirty-one countries were surveyed about their presentation of nuclear-war-related subject matter. Eighty-three (49%) of the 168 schools that responded indicated that they offered an activity on medical aspects of nuclear war. Thirty-two per cent of the programmes consisted of one or more hours in an existing required course. Twelve per cent offered an elective course solely concerned with nuclear war. Although only 15% of the schools responded many of the replies indicated interest in learning more about the programmes of other schools and inquired if curriculum or teaching materials were available. Through the survey it was learned that textbooks and other learning resources have been prepared. Survey information suggests that knowledge of nuclear weapons effects is associated with a reluctance to countenance nuclear war.     

Clinical researchers and pharmaceutical industry. Dangerous liaisons]

Pharmaceutical industry and physician-investigators are mutually dependent for the development of new drugs and clinical trials of such drugs. Under pressure of increasing market orientation, clinical scientific investigations shift more and more from fundamental to clinical drug trials, the results of which sometimes do not justify the excitement with which they are presented in the scientific and lay press. More room and means should be given to less market oriented studies, addressing more fundamental clinical problems. Financial affiliation with the industry may influence the doctors' mind and the presentation and type of investigation. Apart from this type of intellectual subjection there is a form of financial subjugation of doctors to the industry, by participating in so-called 'postmarketing surveillance studies' which they in fact are not, that have no scientific value whatsoever, but only serve the financial interest of the participating doctor and the industry.     

Consultative exercise on dose assessments.

A summary is given of a meeting held at Sussex University, UK, in October 2000, which allowed the exchange of ideas on methods of assessment of dose to the public arising from potential authorised radioactive discharges from nuclear sites in the UK. Representatives of groups with an interest in dose assessments were invited, and hence the meeting was called the Consultative Exercise on Dose Assessments (CEDA). Although initiated and funded by the Food Standards Agency, its organisation, and the writing of the report, were overseen by an independent Chairman and Steering Group. The report contains recommendations for improvement in co-ordination between different agencies involved in assessments, on method development and on the presentation of data on assessments. These have been prepared by the Steering Group, and will be taken forward by the Food Standards Agency and other agencies in the UK. The recommendations are included in this memorandum.     

A model for design of health administration curriculum and instruction

Faculty members in health administration programs as in other professional programs tend to be trained in content appropriate to their field rather than as educators. Enhancement of the teaching skills of faculty will potentially improve the quality of the students' educational experience. Of particular note is the tendency of faculty to teach at the basic knowledge level and expect students to perform at the application and problem-solving levels. The purpose of this paper is to aid faculty in health administration improve their teaching activities and student evaluation. This goal will be accomplished through presentation of a model for systematic design of curriculum application of this model at the course and lesson levels.     

Development of a pilot course in applied pharmacology for nurses working in rural settings

ABSTRACT: In 1991, the Society of Hospital Pharmacists of Australia (SHPA) made a successful application for a seeding grant for a project entitled 'An intensive course in applied pharmacology for nurses working in rural settings'. Funding was provided under the Rural Health Support, Education and Training (RHSET) program, and was used to conduct a pilot course in pharmacology and drug information for nurses at the North West Nurse Education Centre, Whyalla, South Australia, during August/September 1991. A total of 40 nurses attended the course and were provided with course materials which contained background information on the topics to be discussed during a two-day seminar.
In a subsequent mailing to 320 nurses currently practising in the rural south-east region of South Australia, interest levels in a similar seminar proposed for Mount Gambier were canvassed. Keen interest was expressed by nurses working in a variety of country centres in the region, and a formal offer of complimentary use of teaching facilities in the Mount Gambier Hospital was received. A second course was conducted during July 1992, and attracted over 40 nurses from a variety of practice backgrounds. SHPA was able to conduct both courses using considerably less funding than allocated under the original budget of the RHSET grant for the initial project.
A statistically significant improvement in participants' pharmacology and drug information knowledge was demonstrated using a multiple choice assessment prior to, and immediately after the course.     

PERSUADING PARLIAMENTARIANS: ADVOCACY AND LOBBYING ON ALCOHOL-RELATED ISSUES

In New Zealand informing Members of Parliament about alcohol-related issues assumes some importance for various groups because legislative decisions may be made by conscience votes and not necessarily along party lines. Written material on alcohol-related issues sent to a New Zealand backbench Member of Parliament over the period June 1983 to June 1986 was forwarded to the Alcohol Research Unit. As expected, two major interest sectors were identified as sending material: organizations with a direct or indirect pecuniary interest in the sale of alcohol, and organizations with a primary focus on the treatment or reduction of alcohol-related problems. The material was examined in terms of its themes and strategies of presentation. The vested-interest sector was identified as having more potential policy influence through written material than the alcohol-problem groups. Factors which affect the capacity of the interest groups to undertake effective lobbying or advocacy, and the implications for decision-making on health-related policies, are discussed.     

A shared vision of healthcare quality improvement.

SHEA and the American Society for Quality's Health Care Division have been collaborating in areas of common concern to improve healthcare quality. We each possess a heritage of different but complementary approaches and stand a better chance of success together than apart. This presentation describes rapid growth of our interdisciplinary, international, special interest group and progress made thus far, as well as challenges facing hospital epidemiologists and quality improvement professionals.     

Refractory hypotension in a patient with Wernicke's encephalopathy

A 57-year-old male patient with gastric carcinoma underwent radical distal gastrectomy type II?+?Braun anastomosis, and received total parenteral nutrition for 10 days after surgery, followed by small amounts of semi-liquid nutrition for 3 days and liquid nutrition for 2 days. The patient developed refractory hypotension for more than 1 week in the early course of disease, and on Day 15 after surgery presented with characteristic signs of Wernicke's encephalopathy, including diplopia and mental confusion. The hypotension did not improve despite appropriate fluid replacement soon after admission. Treatment with moderate dose of thiamine for 3 months partly relieved ophthalmoplegia and confusion, but not Korsakoff syndrome. This extraordinary presentation with refractory hypotension and the unusual course of the disease encouraged us to present this case.     

臀先露、肩先露未足月胎膜早破对妊娠结局的影响

目的：探讨臀先露、肩先露未足月胎膜早破（PPROM）与妊娠结局间的关系,为临床处理PPROM提供参考。方法：收集单胎PPROM产妇235例,其中臀先露、肩先露并PPROM49例,头先露PPROM186例。观察两种类型PPROM的并发症及妊娠结局情况。结果：臀先露、肩先露组的潜伏期明显短于头先露组,其余一般情况与头先露组比较差异无统计学意义（P〉0．05）。臀先露、肩先露组AFI≤5cm、1minApgar评分≤7、脐带脱垂、死胎死产、新生儿死亡的比例明显高于头先露组（P〈0．05）。臀先露、肩先露是导致1minApgar评分降低的独立危险因素（P=0．021,OR=O．0821）。臀位、横位先露组与头先露组的剖宫产率、阴道分娩率比较差异有统计学意义（P=0．00）。臀先露、肩先露的产妇中行剖宫产者脐带脱垂、死胎死产发生率明显低于阴道分娩。结论：臀先露、肩先露PPROM更容易发生脐带脱垂、lminApgar评分≤7、AFI≤5cm、死胎死产,是1minApgar低评分的独立危险因素,因此一旦确诊为PPROM,且胎位为臀先露、肩先露,应给予及时处理。避免脐带受压,尽快行剖宫产,有利于改善围产儿结局。     

A postgraduate course in community paediatrics

Community paediatrics is assuming increasing importance but is rarely taught as an entity. We have recently organized a course in community paediatrics for general practitioners, doctors working in the area child health services and hospital paediatricians. Features of this day release course are self-instruction at home with specially prepared material, discussion between doctors from different disciplines, discussion with non-medical professionals and the undertaking and presentation of a project. The course is flexible, and once set up can be run without extensive facilities and resources.     

Steroid-induced hallucination following intra-articular administration: a case report and brief review

Amidst the ubiquitous use of steroids, psychiatric side-effects are not uncommon, though the presentation may be curiously diverse. The case of an elderly lady who had 40 mg of methylprednisolone injected in each knee for treatment of suprapatellar bursitis is presented. After 3 days, she reported visual hallucinations, which resolved without treatment 6 days after the steroid injections. We found considerable interest in this case as there were very few reported cases of adverse psychiatric events triggered by intra-articular steroid administration. We follow with a brief review of the incidence, risk factors, presentation, and treatment of steroid-induced psychiatric side-effects.     

Which GP deals better with depressed patients in primary care in Kastamonu, Turkey: the impacts of 'interest in psychiatry' and 'continuous medical education'

BACKGROUND: Little is known about the reasons behind Turkish GPs' limited ability to diagnose and treat major depression. OBJECTIVE: The aim of this preliminary study is to evaluate the impact of a GP's level of interest in psychiatry and participation in previous continuous medical education (CME) on their ability to recognize and treat major depression. METHODS: Thirty-eight GPs from an underdeveloped city in Turkey participated in the study. A survey consisting of questions about their demographic characteristics, self-reported capacity for recognition and antidepressant management of depression, presence of previous CMEs and self-ratings of their interest in psychiatry was given to all GPs. Comparisons were made using hierarchical multiple regression analyses and SPSS software. RESULTS: Almost half of the GPs had participated previously in at least one CME course on depression, and these were significantly more involved with the treatment of depressed patients (P = 0.02). Hierarchical multiple regression analysis indicated that 'interest in psychiatry' was an important factor in predicting the GPs' confidence in recognizing and treating depression even after controlling for other variables such as age, gender (P = 0.01) and participation in previous CME (P = 0.05). CONCLUSION: Our findings suggest that personal characteristics, including a GP's interest in psychiatry, should be considered when planning education and other interventions to improve the detection and treatment of depression in primary care.     

Developing interdisciplinary courses for allied health students: a retrospective view

Innovative interdisciplinary education in allied health has been developed in order to give students insight into role competencies of other professionals, improve the quality of health care while reducing costs, and facilitate the interdependent functioning of allied health care providers in meeting patient or client needs. The process of interdisciplinary course development requires the same communication and needs identification by faculty as is necessary for the provision of team care by practitioners. A retrospective account of interdisciplinary course development in a major health sciences center, together with materials developed for class presentation, may serve to encourage this type of activity elsewhere.