Combining universal and targeted prevention for school-based eating disorder programs

OBJECTIVE: This study examined a step toward providing a universal prevention program to all students while targeting those at risk. METHOD: Seventy-eight 10th-grade female students were provided an on-line eating disorder prevention program and randomized to participate in (1) a higher risk and higher motivated group, (2) a lower risk or lower motivated group, or (3) a combined group. RESULTS: The students in the first group made significantly fewer negative and more positive comments in the on-line group discussion than the higher risk and higher motivated participants in the combined group. However, there were no differences among groups on outcome measures. DISCUSSION: The results suggest that, because it is relatively easy to provide interventions with separate groups, it seems appropriate to do so, if for no other reason than to minimize the few very negative comments that were posted by students that might have created an adverse environment for the higher risk-participants that the intervention specifically targets.     

Simulated Medical Learning Environments on the Internet

Learning anatomy and surgical procedures requires both a conceptual understanding of three-dimensional anatomy and a hands-on manipulation of tools and tissue. Such virtual resources are not available widely, are expensive, and may be culturally disallowed. Simulation technology, using high-performance computers and graphics, permits realistic real-time display of anatomy. Haptics technology supports the ability to probe and feel this virtual anatomy through the use of virtual tools. The Internet permits world-wide access to resources. We have brought together high-performance servers and high-bandwidth communication using the Next Generation Internet and complex bimanual haptics to simulate a tool-based learning environment for wide use. This article presents the technologic basis of this environment and some evaluation of its use in the gross anatomy course at Stanford University.Media-rich learning experiences are widely available on the web. Medical schools and other health care organizations maintain extensive websites for learning, reference, and assessment. Continuing medical education on the Internet is one of the most commonly available and widely used services for health care practitioners. These media-based learning environments, though widely available, represent a passive medium of information retrieval by clicking a mouse.We have been investigating the next generation of Internet-based learning technologies: simulation-oriented learning environments that support interaction, collaboration, and active learning. The topics of learning are anatomy and basic surgical manipulations. To support these topics, we have developed three-dimensional visualizations of anatomy and have enriched these anatomical models with biomechanical tissue properties of elasticity and viscosity such that the learner can use appropriate force-feedback tools to feel tissues at the same time that they visualize them. Access to and interaction with these simulation environments have required that we push the envelope of current Internet capabilities, and that we investigate the role of network bandwidth and latency in the performance of these applications. A preliminary version of this work was presented at MedInfo, 2001.¹     

Criterion-based training with surgical simulators: proficiency of experienced surgeons.

OBJECTIVE: In our effort to establish criterion-based skills training for surgeons, we assessed the performance of 17 experienced laparoscopic surgeons on basic technical surgical skills recorded electronically in 26 modules selected in 5 commercially available, computer-based simulators. METHODS: Performance data were derived from selected surgeons randomly assigned to simulator stations, and practicing repetitively during one and one-half day sessions on 5 different simulators. We measured surgeon proficiency defined as efficient, error-free performance and developed proficiency score formulas for each module. Demographic and opinion data were also collected. RESULTS: Surgeons' performance demonstrated a sharp learning curve with the most performance improvement seen in early practice attempts. Median scores and performance levels at the 10th, 25th, 75th, and 90th percentiles are provided for each module. Construct validity was examined for 2 modules by comparing experienced surgeons' performance with that of a convenience sample of less-experienced surgeons. CONCLUSION: A simple mathematical method for scoring performance is applicable to these simulators. Proficiency levels for training courses can now be specified objectively by residency directors and by professional organizations for different levels of training or post-training assessment of technical performance. But data users should be cautious due to the small sample size in this study and the need for further study into the reliability and validity of the use of surgical simulators as assessment tools.     

Exploration of a new procedure for sterilization by intrauterine instillation of a methylcellulose gel

Background

Our goal was to evaluate a new gel and procedure for non-surgical sterilization.

Study Design

We injected a methylcellulose-based gel containing a radiographic contrast agent into the uteri of 15 women, varying the gel viscosity, volume injected, injection speed and continuity and duration of cervical blockage. We monitored gel distribution with fluoroscopy and spot imaging, and subjects' condition by interview and examination.

Results

The gel and procedure were safe and acceptable. The low-viscosity gel reached at least the ampullae of all tubes, but retention in the isthmuses was shorter than 5 min in more than 25% of tubes studied. The high-viscosity gel did not consistently pass into and through the fallopian tubes.

Conclusions

This study did not identify a gel and insertion procedure that would reliably provide exposure of both fallopian tubes to a sclerosing agent for more than a brief period of time.     

Archival fine-needle aspiration cytopathology (FNAC) samples: untapped resource for clinical molecular profiling

Microarray technologies provide high-resolution maps of chromosome imbalances and epigenomic aberrations in the cancer cell genome. Such assays are often sensitive to sample DNA integrity, voiding the utility of many archival pathology specimens and necessitating the special handling of prospective clinical specimens. We have identified the remarkable preservation of higher-molecular weight DNA in archival fine-needle aspiration cytopathology specimens from patients greater than 10 years of age. We further demonstrate the outstanding technical performance of 57 fine-needle aspiration cytopathology samples for aberration detection on high-resolution comparative genomic hybridization array, DNA methylation, and single nucleotide polymorphism genotyping platforms. Forty-four of 46 malignant aspirates in this study manifested unequivocal genomic aberrations. Importantly, matched Papanicolaou and Diff-Quik fine-needle aspiration cytopathology samples showed critical differences in DNA preservation and DNA integrity. Overall, this study identifies a largely untapped reserve of human pathology specimens for molecular profiling studies, with ramifications for the prospective collection of clinical biospecimens.     

Cytopathology of retrograde renal pelvis brush specimens: An analysis of 40 cases with emphasis on collecting duct carcinoma and low-intermediate grade transitional cell carcinoma

We report our experience with 40 retrograde renal brush samples of pelvic-calyceal lesions with confirmatory tissue studies. On-site cytopathologic evaluation was performed in 38 of these specimens. The final histologic diagnoses included 24 cases of transitional cell carcinoma (TCC), 17 of which were low-intermediate grade tumors. All 24 cases were diagnosed cytologically as TCC (22), or as suspicious for TCC (2). Three cases classified as collecting duct carcinomas were resected; the cytologic specimens in 2 of these cases were interpreted as TCC, and one as reactive change. There were three renal cell carcinomas (RCC); cytologically, one was considered a papillary neoplasm, one suspicious for malignancy, and one as reactive. Two cases of atypical renal cysts were reported as suspicious for malignancy in both cytologic and histologic material. There was one case of metastatic colon carcinoma identified in the brush specimen. Finally, tissue studies in the remaining 7 cases showed reactive/inflammatory changes; however, four of the corresponding pelvic brush specimens were considered abnormal. A review of the above cases is reported with the objective of presenting the cytologic features seen in collecting duct carcinoma, low-intermediate grade TCC, and diagnostically difficult cases with cyto/histomorphologic discrepancies. The contribution of on-site assessment to diagnostic accuracy is also discussed. Diagn Cytopathol 1996;15:312–321. © 1996 Wiley-Liss, Inc.     

The fundamental manipulations of surgery: a structured vocabulary for designing surgical curricula and simulators

A structured vocabulary is proposed for supporting the design and development of advanced surgical simulators. Nine fundamental surgical instrument-tissue actions or manipulations are defined and common synonyms provided. The vocabulary focuses on "target skills" that are familiar to surgeons, in comparison with "enabling skills" from the lexicon of instructional designers and psychometricians. The adoption of this vocabulary can facilitate communication among surgeons and bioengineers developing "high-fidelity" surgical simulators.