Duration of untreated psychosis (DUP): an useful predictor of outcome in schizophrenia?

The concept of DUP has gained much interest as a possible predictor of outcome variables. The review of the current state of research suggests that DUP may be related to remission, social functioning and severity level of symptomatology. In the present retrospective-prospective study 50 first-time admitted patients were interviewed with the "Interview for the Retrospective Assessment of the Onset of Schizophrenia" (IRAOS). Outcome was measured after six months and one year with the "Positive and Negative-Syndrom Scale" (PANSS) and the "Disability Assessment Schedule" (DAS). Patients with long DUP had a worse outcome regarding the severity level of positive symptoms, of general symptoms and social disability. Corresponding well with some other studies, there was no association between DUP and negative symptoms. CONCLUSION: DUP can be regarded as an useful predictor of outcome in schizophrenia. However, further research is required to confirm these results in long-term studies.     

Effect of voluntariness of participation in treatment on short-term outcome of inpatients with schizophrenia

OBJECTIVE: The purpose of this study was to examine associations between the voluntary or coercive nature of patients' participation in inpatient treatment and the short-term outcome of inpatient treatment for patients with schizophrenia. METHODS: Eighty-eight adult patients with schizophrenia and delusional disorders who were consecutively admitted to a 320-bed psychiatric hospital in southern Germany over a three-month period in 2002 were assessed with the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) at admission and discharge, a mean of 36.2 days later. The patients were grouped by whether their participation was voluntary or involuntary in each of five aspects of inpatient treatment: admission, hospital stay, medication, discharge, and intention to continue treatment after discharge. Outcome was defined as the change between admission and discharge in scores on the PANSS and the GAF and change in those scores per inpatient day. RESULTS: The outcome measures were not significantly related to the voluntariness of patients' participation in any aspect of treatment. CONCLUSIONS: The short-term outcome of inpatient treatment is independent of whether treatment is voluntary.     

Student perceptions of effective small group teaching

PURPOSE: The goal of this study was to assess student perceptions of effective small group teaching during preclinical training in a medical school that promotes an integrated, systems-based undergraduate curriculum. In particular, students were asked to comment on small group goals, effective tutor behaviours, pedagogical materials and methods of evaluation. METHODS: Six focus groups were held with 46 Year 1 and 2 medical students to assess their perceptions of effective small group teaching in the 'Basis of Medicine' component of the undergraduate curriculum. Ethnographic content analysis guided the interpretation of the focus group data. RESULTS: Students identified tutor characteristics, a non-threatening group atmosphere, clinical relevance and integration, and pedagogical materials that encourage independent thinking and problem solving as the most important characteristics of effective small groups. Tutor characteristics included personal attributes and the ability to promote group interaction and problem solving. Small group teaching goals providing included opportunities to ask questions, to work as a team, and to learn to problem solve. CONCLUSION: This study highlighted the benefits of soliciting student impressions of effective small group teaching. The students' emphasis on group atmosphere and facilitation skills underscored the value of the tutor as a 'guide' to student learning. Similarly, their comments on effective cases emphasised the importance of clinical relevance, critical thinking and the integration of basic and clinical sciences. This study also suggested future avenues for research, such as a comparison of student and teacher perceptions of small group teaching as well as an analysis of perceptions of effective small group learning across the educational continuum, including undergraduate, postgraduate and continuing professional education.     

PET and functional anatomic fusion imaging in lung and breast cancers

Metabolic imaging with PET is an established adjunct to anatomic imaging methods in patients with bronchial and breast cancers. The functional anatomic fusion imaging with PET/CT can further improve staging and restaging of patients. PET/CT can influence the planning of a surgical intervention or radiation treatment at staging and in patients with suspected locoregional recurrence. The use of a PET/CT whole body imaging protocol may identify extended disease earlier than conventional imaging methods and thus influence treatment decisions.     

An online discussion for medical faculty: an experiment that failed.

OBJECTIVE: Although online discussion groups are being used with increasing frequency in undergraduate and postgraduate education, their usefulness in faculty development has not been explored. The goal of this innovation was to offer an online discussion group following a faculty development workshop in order to reinforce workshop concepts and to allow participants to seek advice related to specific teaching and learning problems. We also wanted to assess the benefits of this educational tool. DESCRIPTION: We originally wanted to implement an online discussion group following a one-day workshop "The "Problem" Resident: Whose Problem Is It?" However, once this proposal was presented to our academic administrators, they asked us not to implement the discussion group because of concerns related to confidentiality and due process. They were worried that an online discussion might replace the faculty's evaluation and promotion guidelines, that teachers might no longer go to the "right" person to discuss a problem, and that we would give teachers a false sense of security. To respect these concerns, we changed the discussion topic and decided to implement an online discussion following a workshop "Promoting Interaction in Small-group Teaching." We chose this venue because it was less "emotionally charged" and because online discussions are seen as a potential adjunct to small-group teaching. We introduced the idea of a facilitated WebCT group discussion at the end of the workshop, and gave faculty members clear instructions on how to access the discussion group. Most of the workshop participants liked the idea of a follow-up to the workshop, but they preferred an e-mail listserv. We therefore decided to offer the WebCT discussion group to half of the participants, and an e-mail listserv to the others. To initiate the discussion, we posted several issues for both groups, and we awaited the participants' responses. To our surprise, only two individuals (8%) responded on the e-mail listserv, after several attempts to stimulate discussion. DISCUSSION: In looking back at our "medical experiment" we were disappointed that our efforts to facilitate an online discussion following a faculty development workshop were not successful. However, based on personal reflections and conversations with a number of the workshop participants, we feel that some important lessons were learned. Time and competing demands clearly pose a major barrier. In addition, the "perceived need" of the initiative is critical. Our faculty members did not see the need for discussing interactive small-group teaching techniques online. Faculty members' comfort with technology must also be considered. Many of our teachers were not familiar with the potential uses of online learning. Moving faculty development beyond workshops also remains a challenge. With these lessons in mind, we plan to initiate another online discussion with faculty members, based on a need that they have defined around a topic that they have identified as critical to their own development as faculty members. We continue to believe that follow-up activities are essential in faculty development and that we need to further assess the potential value of this educational method.     

Influence of the alternative sigma(28) factor on virulence and flagellum expression of Legionella pneumophila

The fliA gene of Legionella pneumophila encoding the alternative sigma(28) factor was inactivated by introducing a kanamycin resistance cassette. Electron microscopy and Western blot analysis revealed that the fliA mutant strain is aflagellate and expresses no flagellin. Reporter gene assays indicated that the flaA promoter is not active in the fliA mutant strain. The fliA mutant strain multiplied less effectively in coculture with amoebae than the wild-type strain and was not able to replicate in coculture with Dictyostelium discoideum.     

Flagellum of Legionella pneumophila positively affects the early phase of infection of eukaryotic host cells

Legionella pneumophila, the etiologic agent of Legionnaires' disease, contains a single, monopolar flagellum which is composed of one major subunit, the FlaA protein. To evaluate the role of the flagellum in the pathogenesis and ecology of Legionella, the flaA gene of L. pneumophila Corby was mutagenized by introduction of a kanamycin resistance cassette. Immunoblots with antiflagellin-specific polyclonal antiserum, electron microscopy, and motility assays confirmed that the specific flagellar mutant L. pneumophila Corby KH3 was nonflagellated. The redelivery of the intact flaA gene into the chromosome (L. pneumophila Corby CD10) completely restored flagellation and motility. Coculture studies showed that the invasion efficiency of the flaA mutant was moderately reduced in amoebae and severely reduced in HL-60 cells. In contrast, adhesion and the intracellular rate of replication remained unaffected. Taking these results together, we have demonstrated that the flagellum of L. pneumophila positively affects the establishment of infection by facilitating the encounter of the host cell as well as by enhancing the invasion capacity.     

Decisions about sectioning and medicating of schizophrenic patients in Germany and England--results of a comparative study

Questionnaires with three case summaries have been presented to 143 psychiatrists in Germany and 27 in England. All three case summaries regard patients with schizophrenia who either show risk to themselves or others. The psychiatrists were asked whether they would recommend sectioning and furthermore whether they would recommend treatment against the patient's will. In the case regarding a risk to others there was widespread approval of sectioning and treatment (Germany 85 %, England 93 %) against the patient's will. Significant differences were seen in the cases of risk to the patients themselves with regards to treatment against the patient's will. This was the case with a scenario involving a young man with his first presentation of schizophrenia as well as in the case of a middle aged man presenting with chronic psychotic symptoms and self-neglect (approval in England: 96 % and 93 % respectively, in Germany: 63 % and 59 % respectively, p < 0.001 for both). When a logistic regression was performed the country of work was the most important predictive factor in deciding whether or not to treat a patient against his will.