Promoting clinically effective practice: general practitioners' awareness of sources of research evidence

BACKGROUND: Practitioners are being encouraged to base their clinical practice on research evidence. In order to do this, they must be aware of and use the sources of evidence. METHODS: A questionnaire survey was undertaken to establish GPs' awareness of research evidence in their clinical practice and, in fundholding practices, its influence on purchasing plans. Questionnaires were sent to 360 lead fundholders in North Thames Region and 440 of a random sample of the remaining general practitioners in the region for comparison. RESULTS: Questionnaires were returned by 62% of lead fundholders and 63% of GPs in the random sample. There was limited use of the electronic sources of clinical effectiveness. There was greater reported awareness of published sources of research evidence and fundholding GPs were significantly more likely to have referred to publications summarizing research evidence. CONCLUSIONS: GPs seem to make more use of published clinical effectiveness sources than the electronic databases. Consequently, they need educational and technical support if they are to make full use of the available sources of research evidence available in other media.      

6-(4-酰基-1-哌嗪乙酰氨基)-3,4-二氢-2(1H)-喹啉酮类化合物的合成及正肌力活性初探

目的 :寻找具有正性肌力活性的化合物。方法 :根据文献报道的二氢喹啉酮类正性肌力药物的结构特点 ,设计、合成了其类似物。以苯胺为起始原料经多步合成 ,对所得化合物用离体豚鼠心脏与主动脉观察了心肌收缩力、扩血管作用及心率。结果 :合成了 1 0个 6 ( 4 酰基 1 哌嗪乙酰氨基 ) 3 ,4 二氢 2 ( 1H) 喹啉酮类化合物 ( 4a～ 4j) ,均为未见文献报道的化合物。结论 :初步药理试验表明 ,化合物 ( 4h)显示了正性肌力及扩血管活性。     

Differential diagnosis of head and neck lesions based on their space of origin. 2. The infrahyoid portion of the neck

The infrahyoid portion of the neck can be considered as a series of contiguous fascial planes and intervening spaces that lend themselves well to axial imaging. These spaces can serve as a basis on which to formulate differential diagnoses for diseases in this region. This pictorial essay describes the fascia and fascial spaces of the infrahyoid portion of the neck. The contents of each space, the common abnormalities affecting the space, and the characteristic displacements produced by disease in each space are reviewed.     

The CT and MR imaging features of carcinoma arising in thyroglossal duct remnants

BACKGROUND AND PURPOSE: Carcinoma arising in thyroglossal duct remnants is a well-described entity in the pathology and surgery literature, but it has little recognition in the radiology literature. Preoperative diagnosis may alter surgical management, although this diagnosis is rarely made. This study was undertaken to determine the radiologic features that might differentiate carcinoma from benign thyroglossal duct cysts. METHODS: Twenty-one cases of nonpediatric thyroglossal duct anomalies imaged at our institution during a 15-year period were reviewed retrospectively. The images were assessed for lesion wall thickness, enhancement, soft-tissue component, calcification, and loculation of the cystic component. Three additional cases of thyroglossal duct carcinoma obtained from outside institutions were reviewed for these features also. RESULTS: Six cases of thyroglossal duct carcinoma were reviewed. All cases of carcinoma had solid soft-tissue elements visible on CT scans or MR images, compared with three of 18 cases of benign thyroglossal duct cysts. The malignant component was seen as a small peripherally based mass in relation to a cyst, a solid mass in the expected course of the thyroglossal duct, or a complex invasive mass also in the midline of the neck. CT only revealed calcification in cases of carcinoma, within either the primary carcinoma mass or a metastatic node. CONCLUSION: Thyroglossal duct carcinoma should be suspected in an adult patient in the presence of a solid nodule or invasive features in association with a thyroglossal duct lesion visible on CT scans or MR images. The presence of calcification, which is seen best on CT scans, may be a specific marker for carcinoma.