Lumbar instability: an evolving and challenging concept

Identification and management of chronic lumbar spine instability is a clinical challenge for manual physical therapists. Chronic lumbar instability is presented as a term that can encompass two types of lumbar instability: mechanical (radiographic) and functional (clinical) instability (FLI). The components of mechanical and FLI are presented relative to the development of a physical therapy diagnosis and management. The purpose of this paper is to review the historical framework of chronic lumbar spine instability from a physical therapy perspective and to summarize current research relative to clinical diagnosis in physical therapy.     

Medical students' attitudes towards psychotherapy: an intervention-based pre-post comparison

BACKGROUND: Despite a wealth of studies on medical students' attitudes towards psychiatry in general, little is known about their specific attitudes towards psychotherapy. There is no evidence on the flexibility of these attitudes in the context of a curriculum-implemented psychotherapy information session. OBJECTIVES: To assess medical students' attitudes towards psychotherapy and short-term flexibility therein, with an introductory course on psychotherapy as the relevant intervention for this pre-post comparison. METHODS: A random sample of 159 advanced medical students completed a short questionnaire before and after a short course on psychotherapy. The questionnaire consisted of indirect attitude measures towards psychotherapy (associations and connotations), a likelihood rating for future training in psychotherapy, a statement about one's most preferred medical specialty for one's future career, and basic demographics. RESULTS: Participants' pre-interventional connotations of psychotherapy were predominantly positive. In the pre-post comparison, more than one third of the connotation measures shifted substantially and favorably. Post-interventionally, participants' distinctive static word association style regarding psychotherapy was attenuated in favor of a more differentiated style and an enlarged field of associations. The data are suggestive of significant pre-interventional sex differences, with females holding more positive views towards psychotherapy and reporting a greater likelihood of future psychotherapeutic training. The data also suggest that the intervention acted differently upon the sexes. Likelihood ratings for future training in psychotherapy did not decline after the course, despite the fact that the cost and duration of training were mentioned in the course. CONCLUSIONS: Even minimal educational interventions can enhance medical students' predominantly positive attitudes towards psychotherapy. This finding calls for further implementation of psychotherapy-related material in medical curricula.     

Medical psychotherapy

Medical psychotherapy is often practiced by family physicians unknowingly. It shares certain features with all other forms of psychotherapy, but it also possesses its own unique qualities. Medical psychotherapy represents combinations of techniques, learned largely by experience, that are useful in treating the patient in crisis, as well as the patient with chronic psychiatric or physical illness. It contributes to higher quality medical care.     

The evolving concept of gene therapy

The use of molecular techniques to correct human genetic diseases is a concept that was considered extremely remote by many investigators until quite recently. Several factors were responsible for changing the scientific community's attitude toward gene therapy: the development of recombinant DNA technology including the ability to clone disease-related genes; maturation of scientific and ethical reflection following apparent failures of early human experiments; and the development of efficient techniques for the transfer of genes into mammalian cells. Now is the time for the scientific and medical communities to come together and to cooperate to make human gene therapy a clinically useful procedure.     

Biliary atresia: an evolving perspective

From 1967 to 1984, 50 of our patients with extrahepatic biliary atresia had surgical exploration. Of 40 biliary drainage procedures, bile drained in 21 (52%). Thirty-four patients had portoenterostomy, three had portocholecystostomy, and the most recent six patients had a valved hepatoduodenal conduit. Successful biliary drainage was related to the presence of microscopic ducts at the porta hepatis in 20 of 21 infants. Twenty patients are alive, 12 from two to six years postoperatively (one with a liver transplant). Seven have normal serum bilirubin values. Height and weight exceed the 50th percentile in 5/15 patients studied. Multiple episodes of cholangitis have occurred in 11 patients with portoenterostomy and two with hepatoduodenal conduits. In 12 patients, hemorrhage from the stoma necessitated closure of the stoma before 1 year of age. Five of the six patients with hepatoduodenal conduit are alive two years postoperatively.     

The minimal model: an evolving methodology

After more than 20 years, minimal model analysis of intravenous glucose tolerance test glucose and insulin concentrations continues to be widely employed in studies of insulin sensitivity and insulin resistance. Moreover, problems encountered in solving the minimal model equations continue to find new solutions. Bayesian techniques enable prior knowledge to be incorporated into parameter estimation routines. They offer particular advantages in the measurement of insulin sensitivity with the minimal model, and provide an elegant means of improving model identification success rates and parameter precision. This comment describes the study by Agbaje and colleagues in this issue of Clinical Science that exemplifies a new phase in the evolution of minimal model practice.     

Medical photography: current technology,evolving issues and legal perspectives

Medical photographic image capture and data management has undergone a rapid and compelling change in complexity over the last 20 years. This is because of multiple factors, including significant advances in ease of photograph capture, alongside an evolution of mechanisms of data portability/dissemination, combined with governmental focus on health information privacy. Literature to guide medical, legal, governmental and business professionals when dealing with issues related to medical photography is virtually nonexistent. Herein, we will address the breadth of uses of medical photography, device properties/specific devices utilised for image capture, methods of data transfer and dissemination and patient perceptions and attitudes regarding photography in a medical setting. In addition, we will address the legal implications, including legal precedent, copyright and privacy law, informed consent, protected health information and the Health Insurance Portability and Accountability Act (HIPAA), as they pertain to medical photography.     

Left ventricular assist devices: an evolving journey

2012 Annual Scientific Meeting and Exposition of the American Society of Hypertension

New York, NY, USA, 19–22 May 2012

For the last several years, the annual American Society of Hypertension meeting has held a segment called ‘Hypertension Highlights’ featuring state-of-the art talks by leaders in the field who share current research, and clinical management, organized around themes in hypertension. This year there were nine lectures grouped into three domains: the artery, the kidney and the heart.     

Palliative care: an evolving field in medicine

Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems: physical, psychosocial, and spiritual. This article discusses illness trajectories and prognostic estimates, prognostic tools, educating physicians and nurses in palliative care, research in palliative medicine, and palliative care in hospitals and the community.     

Treating calcific aortic stenosis: an evolving science

Calcific aortic stenosis is a common valvular disease, but its pathophysiology remains undetermined and important considerations exist for treatment. Pathophysiology, treatment by the advanced practice nurse, and literature review are discussed in the context of a case study.     

Primer on medical genomics. Part VII: The evolving concept of the gene

The draft sequence of the human genome was reported 2 years ago, and the task of filling gaps and polishing the sequence is nearing completion. However, despite this remarkable achievement, there is still no definitive assessment of the number of genes contained in the human genome. In part, this uncertainty reflects our growing understanding of the complexity and diversity of gene structure. Examples of complex gene structure are considered in the context of a discussion about the evolution of our understanding of gene structure and function.