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     

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.     

RED BLOOD CELL 2,3-DIPHOSPHOGLYCERIC ACID FOLLOWING ETHANOL CONSUMPTION IN MAN

The red blood cell 2,3-diphosphoglycerate (DPG) concentrationis reported in 33 ethanol abusers. 16 healthy ethanol usersand 14 non-users The results demonstrate an ethanol-associatedincrease in DPG content which returns to normal exponentiallyin the week following alcohol withdrawal As well as implyinga significant degree of hypoxia in association with quite moderatedrinking, the fact that ethanol is not catabolized in red cellsindicates that this effect is transmitted there, and hence tothe rest of the organism, by some other agent. Carbon dioxidein subnormal quantities has the necessary characteristics.     

Continuous observations of the arterial oxygen saturation at rest and during exercise in congenital heart disease

Continuous observations, made with the Millikan compensated circuit oximeter, of the arterial oxygen saturation of nineteen normal subjects and of twenty patients with cyanotic and noncyanotic types of congenital cardiac defects are presented.When normal individuals were given pure oxygen to breathe, their arterial oxygen saturation increased, on the averag,, 2.7 percentage points (to reach 100 per cent saturation) in 1.3 minutes. In fifteen patients with a cyanotic type of congenital cardiac defect, breathing pure oxygen produced an average increase in oximeter saturation reading of 6.2 percentage points attained in an average period of 3.0 minutes.Normal subjects showed practically no change in their arterial oxygen saturation when they changed from the supine to the erect position or when they walked on a treadmill for five minutes at 1.7 miles per hour. Patients with a cyanotic type of congenital cardiac defect showed an average decrease in oximeter saturation reading of 2.4 percentage points when they stood up and 10.9 percentage points when they exercised on the treadmill.It is suggested that the compensated circuit oximeter is of considerable value in studying patients with congenital cardiac defects for two reasons: (1) Its use in conjunction with Van Slyke analyses of arterial blood makes possible a more accurate estimation of the resting arterial oxygen saturation of such patients. (2) Measurements of the arterial oxygen saturation can be made continuously during the performance of various cardiovascular and respiratory function tests, thus greatly facilitating an objective interpretation of the results obtained. Such tests serve as a valuable adjunct in the judging of the efficacy of corrective surgical procedures in these patients.