Best evidence continuous medical education

Health care professionals need to approach their profession with a view to life long learning. They need to develop a strategy to meet their learning needs in a reflective and effective manner. Continuous medical educational (CME) is the traditional tool for learning and updating knowledge. Most of them are in the forms of courses, conferences, journal clubs and workshops. They are mostly didactic sessions and evidence suggests that they are not effective to improve the clinical skills and attitude. Systematic review of teaching evidence-based medicine shows that interactive and clinically integrated learning is the most effective form of learning. It enhances knowledge and skills. Professionals should view CME in a holistic manner in the context of continuous professional development (CPD) and even in the wider concept of knowledge translation, which encompasses both CME and CPD. e Learning is one of the most important forms of non-traditional CME. It provides an efficient and increasingly interactive delivery system that can handle complex and layered information. More work needs to be done to see its effectiveness for practising clinicians.     

Effectiveness of nifedipine versus atosiban for tocolysis in preterm labour: a meta-analysis with an indirect comparison of randomised trials

Objective To explore the effectiveness of nifedipine compared with atosiban for tocolysis in preterm labour.
Design A systematic review of randomised controlled trials with meta-analysis using adjusted indirect comparison.
Population Six hundred and seventy-nine women recruited in nine randomised trials evaluating the effectiveness of nifedipine versus β-agonists, and 852 women recruited in four trials of atosiban versus β-agonists. There were no trials comparing nifedipine directly with atosiban.
Methods We performed meta-analysis with a technique involving an adjusted indirect comparison between nifedipine and atosiban using β-agonists as the common comparator. This approach preserves the benefit accrued by randomisation in the original comparisons.
Main outcome measures Reduction in neonatal respiratory distress syndrome and delay in delivery by 48 hours.
Results Nifedipine tocolysis was associated with a significant reduction in respiratory distress syndrome compared with atosiban (OR 0.55, 95% CI 0.32–0.97). It also increased the number of women whose delivery was delayed by 48 hours (OR 1.20, 95% CI 0.73–1.95), although this result was not statistically significant.
Conclusions When indirectly compared with atosiban, nifedipine tocolysis is more effective. In the absence of a direct comparison, our analysis provides a way to explore the potential benefits of nifedipine versus atosiban.     

Elective cervical cerclage for prevention of preterm birth: a systematic review

BACKGROUND: Elective cervical cerclage has been purported to prevent spontaneous preterm birth. We present a systematic review to determine the effectiveness of cervical cerclage in preventing spontaneous preterm birth before 34 weeks' gestation. METHODS: Searches were conducted in MEDLINE, EMBASE, Cochrane Library, and Science Citation Index to identify randomized trials published between 1966 and 2002. All randomized trials that evaluated the effectiveness of elective cerclage compared with no cerclage in women who were at risk of preterm birth before 34 weeks' gestation were included for analysis. Quality assessment and data extraction were performed in duplicate. RESULTS: There were seven relevant trials, comprising 2354 women. Meta-analysis was inappropriate because of large differences in the quality of the studies. However, in the largest single trial of good quality, cerclage was shown to prevent birth before 34 weeks' gestation. In this single study the reported number to be treated to prevent one additional preterm birth before 34 weeks was 24 women (95% CI: 10-61). The results of other trials were consistent with the finding of the largest trial. Data on complications were sparse and inconclusive. CONCLUSION: Our systematic review shows that elective cervical cerclage has a significant effect in preventing spontaneous preterm birth before 34 weeks' gestation. Further research should focus on identification and quantification of possible complications, and of risk factors and tests that identify high-risk women who would benefit most from cerclage.     

A novel approach for EIT regularization via spatial and spectral principal component analysis

Electrical impedance tomography, EIT, is an imaging modality in which the internal conductivity distribution of an object is reconstructed based on voltage measurements on the boundary. This reconstruction problem is a nonlinear and ill-posed inverse problem, which requires regularization to ensure a stable solution. Most popular regularization approaches enforce smoothness in the inverse solution. In this paper, we propose a novel approach to build a subspace for regularization using a spectral and spatial multi-frequency analysis approach. The approach is based on the construction of a subspace for the expected conductivity distributions using principal component analysis. It is shown via simulations that the reconstructed images obtained with the proposed method are better than with the standard regularization approach. Using this approach, the percentage of misclassified finite elements was reduced up to twelve fold from the initial percentages after five iterations. The advantage of this technique is that prior information is extracted from the characteristic response of an object at different frequencies and spatially across the finite elements.     

Biomechanical analysis of gait adaptation in the nematode Caenorhabditis elegans

To navigate different environments, an animal must be able to adapt its locomotory gait to its physical surroundings. The nematode Caenorhabditis elegans, between swimming in water and crawling on surfaces, adapts its locomotory gait to surroundings that impose approximately 10,000-fold differences in mechanical resistance. Here we investigate this feat by studying the undulatory movements of C. elegans in Newtonian fluids spanning nearly five orders of magnitude in viscosity. In these fluids, the worm undulatory gait varies continuously with changes in external load: As load increases, both wavelength and frequency of undulation decrease. We also quantify the internal viscoelastic properties of the worm's body and their role in locomotory dynamics. We incorporate muscle activity, internal load, and external load into a biomechanical model of locomotion and show that (i) muscle power is nearly constant across changes in locomotory gait, and (ii) the onset of gait adaptation occurs as external load becomes comparable to internal load. During the swimming gait, which is evoked by small external loads, muscle power is primarily devoted to bending the worm's elastic body. During the crawling gait, evoked by large external loads, comparable muscle power is used to drive the external load and the elastic body. Our results suggest that C. elegans locomotory gait continuously adapts to external mechanical load in order to maintain propulsive thrust.