Understanding and teaching key concepts and tools of evidence-based medicine: perspectives of a clinician-researcher pharmaceutical physician

Clinical practice benefits from research to inform good decision making. Evidence-based medicine (EBM) helps physicians integrate experience and individual expertise with the best evidence. Various philosophical concepts, including "primum non nocere," are balanced to achieve this. The tools of EBM, such as number needed to treat, are easy to calculate and to use. Other valuable tools include number needed to harm, attributable risk, and likelihood of being helped or harmed. It is also important to distinguish between relative risk and absolute risk to avoid drawing the wrong conclusions. With the right teaching techniques to grab attention and encourage active participation, real examples can be used to impart practical skills that the clinician can employ in translating research findings into something that helps the individual patient.     

Rare silent ischemic ventricular septal aneurysm and rupture: A multimodality diagnostic approach

A multimodality approach in addition to high level of clinical suspicion and thorough physical examination is important in the diagnosis and management of left ventricular aneurysm and rupture after a silent inferior infarction.     

Team building: key to executive success

The key to executive success is management of the information overload provided by today's high technology era. Team building, through identification of behavioral styles, helps to enhance self-esteem, utilize inherent skills of individuals, and maximize decision making. The style of the team leader who shares leadership promotes communication patterns that lead to participatory management and harmony within institutions.     

Early detection of and diagnostic tools for Asperger's disorder

Case identification of children with high-functioning pervasive developmental disorders (HFPDD) including Asperger's disorder tends to be delayed. A delay of case identification prevent from access to early intervention for children and parents. Although early diagnosis of HFPDD is difficult and less sensitive at present, several objective evaluation scales, such as CARS, ADOS-G and ADI-R, can be applied to very young children and are found to be relatively sensitive and stable. Recently autism-specific screening tools, such as the Checklist for Autism in Toddlers (CHAT), the Modified Checklist for Autism in Toddlers (M-CHAT), have been developed. The current research using the Japanese version of the M-CHAT and its clinical use combined with the infant health check-up system are described.     

Informal peer support: a key to success for nurse prescribers

A study was conducted in Leicestershire and Rutland (NHS) Healthcare Trust to determine the continuing professional development needs of nurse prescribers. Qualitative and quantitative approaches were applied to the sample frame of 350 nurse prescribers to elicit the most significant factors which have influenced the development of nurse prescribing. The majority of nurse prescribers considered prescribing to be a skill, which is now an essential part of core practice. The study indicated that informal peer support seems to have compensated for the absence of formal clinical supervision. Any development such as nurse prescribing has the added benefit of examining practice from new perspectives. Reflection on how this was achieved highlights important issues as to how the next stage can be even more successful.     

Current diagnostic tools and treatment modalities for rectal prolapse

Rectal prolapse is a circumferential, full-thickness protrusion of the rectum through the anus. It is a rare condition, and only affects 0.5% of the general population. Multiple treatment modalities have been described, which have changed significantly over time. Particularly in the last decade, laparoscopic and robotic surgical approaches with different mobilization techniques, combined with medical therapies, have been widely implemented. Because patients have presented with a wide range of complaints (ranging from abdominal discomfort to incomplete bowel evacuation, mucus discharge, constipation, diarrhea, and fecal incontinence), understanding the extent of complaints and ruling out differential diagnoses are essential for choosing a tailored surgical procedure. It is crucial to assess these additional symptoms and their severities using preoperative scoring systems. Additionally, radiological and physiological evaluations may explain some vague symptoms and reveal concomitant pelvic disorders. However, there is no consensus on or standardization of the optimal extent of dissection, type of procedure, and materials used for rectal fixation; this makes providing maximum benefits to patients with minimal complications difficult. Even recent publications and systematic reviews have not recommended the most appropriate treatment options. This review explains the appropriate diagnostic tools for different conditions and summarizes the current treatment approaches based on existing literature and expert opinions.     

Peptide-based radiopharmaceuticals: future tools for diagnostic imaging of cancers and other diseases

Small synthetic receptor-binding peptides are the agents of choice for diagnostic imaging and radiotherapy of cancers due to their favorable pharmacokinetics. Molecular modification techniques permit the synthesis of a variety of bioactive peptides with chelating groups, without compromising biological properties. Various techniques have been developed that allow efficient and site-specific labeling of peptides with clinically useful radionuclides such as (99m)Tc, (123)I, (111)In, and (18)F. Among them, (99m)Tc is the radionuclide of choice because of its excellent chemical and imaging characteristics. Recently, many (99m)Tc-labeled peptides have proven to be useful imaging agents. Beside (99m)Tc-labeled peptides, several peptides radiolabeled with (111)In and (123)I have been prepared and characterized. In addition, (18)F-labeled peptides hold clinical potential due to their ability to quantitatively detect and characterize a variety of human diseases using positron-emission tomography. The availability of this wide range of peptides labeled with different radionuclides offers multiple diagnostic and therapeutic applications. Various receptors are over-expressed in particular tumor types and peptides binding to these receptors can be used to visualize tumor lesions scintigraphically. Thus, radiolabeled peptides have potential use as carriers for the delivery of radionuclides to tumors, infarcts, and infected tissues for diagnostic imaging and radiotherapy. Many radiolabeled peptides are currently under investigation to determine their potential as imaging agents. These peptides are designed mainly for thrombus, tumor, and infection/inflammation imaging. This article presents recent developments in small synthetic peptides for imaging of thrombosis, tumors, and infection/inflammation.