Clinical problem-solving using video simulation: an investigation

This paper examines the use of videotape simulation as a research method for the exploration of clinical problem-solving, the challenges posed and the strategies employed to overcome the difficulties encountered are discussed. The simulation forms part of a larger comparative study of outcomes of pre-registration nurse education programmes, commissioned by the English National Board for Nursing, Midwifery and Health Visiting.     

Longitudinal relationships between lexical and grammatical development in typical and late-talking children.

PURPOSE: This study examined the longitudinal relationships between lexical and grammatical development in typically developing (TD) and late-talking children for the purposes of testing the single-mechanism account of language acquisition and comparing the developmental trajectories of lexical and grammatical development in late-talking and TD children. METHOD: Participants included 30 children identified as late talkers (LTs) at 2;0 (years;months), and 30 TD children matched on age, nonverbal cognition, socioeconomic status, and gender. Data were collected at 5 points between 2;0 and 5;6. RESULTS: Cross-lagged correlational analyses indicated that TD children showed evidence of bidirectional bootstrapping between lexical and grammatical development between 2;0 and 3;6. Compared with the TD group, LTs exhibited less evidence of syntactic bootstrapping. Linear mixed-effects modeling of language sample data suggested that the relationship between lexical and grammatical growth was similar for the 2 groups. CONCLUSION: Lexical and grammatical development were strongly related in both groups, consistent with the single-mechanism account of language acquisition. The results were mixed in terms of finding longitudinal differences in lexical-grammatical relationships between the TD and late-talking children; however, several analyses suggested that for late-talking children, syntactic growth may be less facilitative of lexical development.     

Odontoma: a clinicopathologic study of 81 cases.

BACKGROUND AND PURPOSE: Odontoma is the most common odontogenic tumor. It includes 2 types, the compound and complex odontomas. There has not been a series study of the clinical and histologic features of odontomas from Taiwan. This study evaluated the clinicopathologic features of odontoma in Taiwanese. METHODS: Cases of odontoma treated from 1998 to 2002 identified from medical records were included. The microscopic features, radiographic features, and clinical history of the patients were reviewed and analyzed. RESULTS: A total of 81 odontomas in 81 patients (36 males and 45 females) were included. There were 62 compound and 19 complex odontomas. The mean age of the patients was 18 years with the majority of odontomas occurring in the first (32%) and second decade (38%) of life. Odontomas had a marked predilection for the maxilla (70%) and for the anterior region of the jaw (83%), particularly for the anterior maxilla (62%). Sixty four (79%) of the 81 odontomas were associated with 80 impacted teeth, including 71 permanent teeth, 2 deciduous teeth, and 7 supernumerary teeth. Of the 71 impacted permanent teeth, the maxillary central incisor (27%) was most commonly affected, followed by the maxillary canine (26%) and mandibular canine (24%). Histologic examination revealed enamel matrix in 90%, dentin in 100%, cementum in 88%, pulp tissue in 96%, fibrous capsule in 93%, ghost cells in 83%, reduced enamel epithelium in 86%, and nests of odontogenic epithelium in 58% of odontomas. Dentigerous cyst was associated with 9% of odontomas. CONCLUSIONS: In this series, odontomas occurred most often in the first and second decade of life. Although complex odontomas are usually found in the posterior jaw, in this Taiwanese series they were most commonly found in the anterior maxilla. Odontoma is frequently associated with an impacted tooth and occasionally with a dentigerous cyst. No recurrence of odontomas was found after surgical excision with follow-up of 1 to 15 years.     

Acute and long-term efficacy of propafenone in patients with sustained ventricular tachyarrhythmias: assessment with programmed ventricular stimulation

To determine the electrophysiological properties of oral propafenone, 50 patients (39 male and 11 female, aged 31 to 80 years) with sustained ventricular tachycardia or ventricular fibrillation underwent serial electrophysiological drug testing, using propafenone (750 to 900 mg daily) as the anti-arrhythmic regimen of first choice. During baseline study, all patients had inducible sustained ventricular tachyarrhythmias. After oral loading of propafenone, 37 patients (74%) remained inducible whereas 13 were rendered non-inducible. Among the still inducible patients, the mean VT rate decreased from 223 +/- 38 b.min-1 (baseline) to 172 +/- 32 b.min +/- 1 (P less than 0.001). Four patients showed an increase of VT rate during propafenone compared to the VT rate at control. Non-inducible patients were discharged on propafenone. During a mean follow-up period of 20 +/- 15 months, there were three non-fatal VT recurrences among the responders, two of them due to non-compliance. Thus, propafenone used as the anti-arrhythmic agent of first choice among patients undergoing serial electrophysiological drug testing for ventricular tachyarrhythmias proved effective in suppressing VT induction in 26%. With regard to arrhythmic events, these patients have a favourable outcome.     

Repair of severed peripheral nerves: Comparison of the “de Medinaceli” and standard microsuture methods

The return of function following transection of the rat sciatic nerve has been assessed after repair by either standard microsurgical techniques (i.e., the use of microsutures to coapt the severed ends) or the new repair technique introduced by de Medinaceli and coworkers. The regeneration after transection was compared with that following sciatic nerve crush, i.e., a lesion in which the return of function is near optimal. Return of function was monitored serially using walking track analysis (i.e., the sciatic functional index, which indicates overall functional performance), the ability to spread the toes (which indicates intrinsic function in the foot), and the determination of muscle twitch tension of the middle digit. Function in the nerve crush group returned to within the normal range by 53 days, but function in the transection and repair groups did not return to normal before the rats were perfused at 85 postoperative days. However, the function regained when nerves were repaired with the de Medinaceli technique was significantly superior to that regained after repair with microsutures. Histological examination of the repair site (at 85 days) revealed that the regenerated nerve fibers in the de Medinaceli group crossed the site of anastomosis in a relatively orderly fashion, whereas they were more randomly arranged when microsutures were used. However, there was no statistical difference between the two groups in the number of regenerated fibers present in the distal stump. The increase in function in the de Medinaceli group may therefore arise primarily from an increase in the proportion of regenerating fibers which reach appropriate targets.(ABSTRACT TRUNCATED AT 250 WORDS)     

Current status of magnetic resonance imaging of the wrist.

Conventional imaging of the wrist has relied heavily on plain radiography, tomography, fluoroscopy and arthrography. More recently, computed tomography and magnetic resonance imaging (MRI) have been added to this armamentarium. In this article the authors review the normal anatomy of the wrist and demonstrate a variety of pathologic conditions that can be assessed with MRI, including avascular necrosis and tears of the intrinsic and the extrinsic ligaments and the triangular fibrocartilage. MRI of the wrist is still evolving rapidly, and its place in the work-up of wrist disorders is only now being defined.     

Manic episode with psychotic symptoms induced by subthalamic nucleus stimulation in a patient with Parkinson's disease.

Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an established therapy for Parkinson's disease (PD). A manic episode with psychotic symptoms induced by STN-DBS occurred in a previously psychiatrically healthy patient, focusing on the role of STN-DBS in influencing not only motor but also emotional behaviour.     

Effectiveness of various forms of therapy in chronic cardiovascular diseases--a vector analysis of the transition probabilities of degrees of severity

The present findings result from a check of probationers representative for approx. 280,000 inhabitants of defined territories, who had been designated as suspects of heart and vessel disease on grounds of X-ray-morphological criterions (classification by Richter). Those about 3,000 suspects, subdivided into 3 comparable patient groups A, B and C, underwent different regimes of treatment of outpatient medical practice after standardized and noninvasive diagnostics in a follow-up during 5 years and had been valued by means of a problem-specific grading. The comparative analysis about the distribution of severe degrees concerning hypertension and coronary heart disease after the conclusion of the intervention showed significant differences concerning the results of treatment to the credit of the patient group A (treated by specialists) contrary to the patient group B (treated by family doctors) and patient group C (principle of announcing the patients themselves). Also the patient group B showed significantly better results of therapy compared with the patient group C. In addition to the concluding rating the estimation of yearly transition of severe degrees gave an insight into the therapeutical decision of the person who looks after as well as the different distribution of severe degrees of special heart diseases in dependence on the starting severe degree in the special period of intervention conditioned on the therapy. The results gain exceptional importance for practice on the grounds of methodics of the study-automatable classification of dv-thorax-X-ray pictures, problem-specific grading of noninvasive, simple parameters, variants of therapy in dependence on the graduated system of medical care.