Online Medical Database Searching

A wide range of databases and databanks are presently availableto medical researchers. This paper outlines the scope of thedatabases available through a commercial host system and describesthe procedures required for their access and use. A discussionof some of the limitations and likely future developments ispresented in the context of our experience of their use. Requests for reprints should be addressed to: Dr N. Wood, Department of Epidemiology and Community Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK     

Principles and strategies of effective community participation

A framework is offered for understanding the conceptual basisand the strategic implications of community participation, inachieving Health for All goals. Special focus is given to themeaning, settings and levels of participation in official decision-makingstructures and at the community level. Questions such ‘howis participation facilitated?’, ‘who participates?’and ‘what are the benefits and obstacles to participation?’are geared primarily towards the needs of individuals who functionat the city level and expect practical strategic advice andguidance. The structure of the 1989 WHO Healthy Cities Symposiumwhich was devoted to community action was based on the frameworkand conceptual approach of this paper.     

Computer-Assisted Instruction Improves Clinical Reasoning Skills of Dietetics Students

Objective The effects of a computer-assisted instruction (CAI) tutorial program on learning clinical reasoning skills were compared in undergraduate dietetics students.Design A drill-and-practice program to control for time on task, a tutorial program, and a simulation program, as the test vehicle, were developed. The tutorial and simulation programs presented data on a patient with cardiovascular disease.Setting Subjects were tested in 30 undergraduate dietetics programs.Subjects Participants were 413 undergraduate diet therapy students enrolled in a coordinated program in dietetics (CPD) or a didactic program in dietetics (DPD).Intervention After completion of lectures on cardiovascular disease, subjects were given the drill-and-practice program plus a simulation test (group 1), the tutorial plus a simulation test (group 2), or the simulation test only (group 3).Main outcome measures Scores on the simulation test were compared. Variables included type of CAI, dietetics program, year in school, computer experience, and experience using a medical chart. Mastery of objectives related to lower- and higher-level clinical reasoning skills introduced in the tutorial program was compared.Statistical analysis One-way analysis of variance and Student-Newman Keuls tests were conducted to determine any differences among the three groups. Reliability was determined using the Kuder-Richardson Formula 20.Results The reliability coefficient of the simulation test was 0.93. Group 2 scored higher on the simulation test than group 1 or group 3. As a group, the CPD students scored higher than the DPD students. When CPD and DPD students were divided into the three experimental groups, there was no significant difference between the CPD and DPD student simulation scores. Group 2 mastered all objectives for lower-level reasoning skills and the higher-level decision-making objective better than groups 1 and 3.Applications/conclusions A computer tutorial program enhanced clinical reasoning skills in undergraduate dietetics students. This type of program could be used to supplement many topics taught in diet therapy and provide DPD students with experiential learning before their clinical intern practicums. J Am Diet Assoc. 1995; 95:868–873.     

Substance P-like immunoreactivity in human cerebrospinal fluid

In a study to elucidate molecular mechanisms in pain, substance P-like immunoreactivity (SP-LI) was measured in lumbar CSF from 75 patients with lower back pain. Two samples – one before and one after lidocaine treatment – were obtained from each patient, and total SP-LI was measured in unfractionated (no HPLC) samples. SP-LI data were separated into three categories: placebo responders, pharmacological responders, and pharmacological non-responders. A significant difference was observed between the total SP-LI measurement of first and second samples of pharmacological non-responders. Distribution of SP-LI immunoreactive molecular species in two CSF patient samples (no ODS) was analyzed with a combination of reversed phase (RP) HPLC and RIA. Immunoreactivity in collected HPLC fractions was measured at calibrated retention times of synthetic SP-sulfoxide (SP-O), SP, and SP_5–11. Qualitative and quantitative differences in those HPLC-RIA metabolic profiles were observed within and between those two patients' samples. These data indicate that the type and amount of SP metabolism and SP precursor-processing differs in CSF between these two representative patients and within the short amount of time elapsed between acquiring these two samples.     

TRAINING IN FIBREOPTIC TRACHEAL INTUBATION IN THE NORTH OF ENGLAND

Twenty-nine departments of anaesthesia in the North of Englandwere questioned about the availability and teaching of fibreoptictracheal intubation techniques. While 27 departments had bothsuitable equipment and trained consultant staff, only one offeredformal teaching to all its junior anaesthetists.     

LICHEN PLANUS SUBTROPICUS: DIRECT IMMUNOFLUORESCENCE FINDINGS AND THERAPEUTIC RESPONSE TO HYDROXYCHLOROQUINE

A 32-year-old black woman presented with the complained of a l-year history of asymptomatic “dark areas” on her face and neck. New lesions developed throughout this time and, once present, slowly increased in size and persisted. She denied systemic symptoms, including arthralgias and myalgias. Her occupation as a real estate agent involved frequent outdoor work. The family history was noncontributory. On physical examination there were multiple hyperpig-mented round-to-oval macules and papules measuring from 0.5 to 2.0 cm in diameter and located over the photoexposed lateral aspects of the face and neck (Figs. 1 and 2). New lesions were papules characterized by a subtle, raised “thread-like” border (Fig. 1, arrow). Older lesions were mac-ular, some with a slightly atrophic, hypopigmented center (Fig. 1, Flesh-colored polygonal papules were present in the V-shaped area on the anterior neck (Fig. 2). The remainder of the cutaneous examination, including the oral mucosa, was unremarkable. Histopathologic examination of a flesh-colored papule viewed on low power revealed a bandlike lymphohistiocytic infiltrate that focally obscured the dermoepidermal junction. Numerous homogenous eosinophilic bodies (Civatte bodies, cytoid bodies, apoptotic cells) and scattered melanophages were identified. In addition, there was epidermal hyperplasia, overlying orthokeratosis, and V-shaped hyper-granulosis. The rete was jagged and possessed a slightly eosinophilic hue (Fig. 3). Hyperpigmented, oval macules had a more patchy lichenoid infiltrate, less epidermal hyperplasia, but possessed a greater number of melanophages in the papillary dermis than new lesions. Periodic acid-Schiff (PAS) stained sections of either type of specimen were negative for basement membrane thickening and also negative for dermal mucin using the colloidal iron reagent. No deposits of immunoglobulin or complement were identified at the dermoepidermal junction by direct immunofluorescence microscopy, but numerous immunoglobulin-coated cytoid bodies were present. Laboratory testing was significant for a negative antinu-clear antibody (ANA) reaction and RPR. A complete blood cell count, results of serum chemistry, and the angiotensin converting enzyme level were within normal limits. Chest roentgenogram revealed no active cardiopulmonary disease. Based on the distinctive histopathology and the impressive, characteristic clinical presentation, the diagnosis of lichen planus subtropicus was made. Therapy with hydroxy-chloroquine 200 mg per day, topical hydrocortisone valerate 0.2% cream b.i.d. to inflammatory lesions, 3% hydroquinone solution b.i.d. to hyperpigmented lesions, and photoprotection were initiated. Partial resolution of the lichenoid lesions has occurred, new lesions have ceased to appear, and the hyperpigmentation has slightly improved.