Botulinum-induced facial weakness impairs communication.
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Aged↗
Biomedical subjects
D M Kaufman
Publications and source records attributed to D M Kaufman.
Students' perceptions about their courses in problem-based-learning and conventional curricula.
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Adult↗
Cerebral blood flow in corticobasal degeneration.
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Basal Ganglia↗
A response to the ACME-TRI report: the Dalhousie problem-based learning curriculum.
With the class of 1996, Dalhousie University Faculty of Medicine instituted a totally revised curriculum. The revisions transformed an entirely traditional curriculum to a student-centred curriculum, which is based on learning in context, and incorporates a problem-based approach to the entire curriculum. This paper describes our experience in the actual implementation of our revised curriculum, in the context of the Association of American Medical Colleges Assessing Change in Medical Education--The Road to Implementation (ACME-TRI) Report.
Canada↗
Integrating medical informatics into an undergraduate medical curriculum.
his paper outlines a rationale for medical schools to integrate medical informatics into their curricula. The approach used in the problem-based undergraduate curriculum at Dalhousie University School of Medicine is presented in three areas: organizational structure, implementation, and curriculum development. Seven goal areas defined to guide the curriculum development process are described.
Computer Literacy↗
Medical informatics and problem-based learning in conjunction.
At Dalhousie, we integrated medical informatics as a horizontal theme in the problem-based learning undergraduate medical education curriculum. The rationales for these initiatives can be addressed along the following dimensions: political, philosophical, psychological, educational, and professional practice. Student attitudes towards computers are changing, and incoming students are increasingly computer-literate. Of those Med I students surveyed at the end of the 1993-94 academic year, 94% felt that computers were moderately important or essential to medical education; 86% of Med II students surveyed were of the same opinion. The education of future physicians can be enhanced when medical informatics is introduced into a curriculum in conjunction with the problem-based learning approach.
Attitude to Computers↗
Tutoring in problem-based learning: a teacher development process.
Undergraduate medical curricula have become increasingly innovative in order to better prepare their graduates to enter practice, with the most notable innovation being the introduction of problem-based learning (PBL). This paper describes Dalhousie University's transition to PBL, from a teacher development perspective. The paper reinforces the need for a well-designed teacher development process that is carefully implemented and evaluated in order to ensure a successful curriculum change. A seven-stage process for teacher development of tutors at Dalhousie is described, and programme evaluation data are reported from both students' and teachers' points of view. The results from the evaluation are very positive and suggest ways of improving the teacher development process. These improvements are described, as well as future plans in this area.
Canada↗
Use of botulinum toxin injections for spasmodic torticollis of tardive dystonia.
Because intramuscular injections of type A botulinum toxin (btx) are effective for idiopathic spasmodic torticollis, they were administered to 3 patients who had neck movements as their only manifestation of tardive dystonia. Each improved, with a decrease in involuntary movement and reduction in pain. None had either systemic or local side effects. Although expensive, btx treatment is recommended for involuntary neck movements of tardive dystonia but not yet for the classic buccolingual dyskinesia.
Adult↗
Neurologic history and examination results and their relationship to human immunodeficiency virus type 1 serostatus in hemophilic subjects: results from the hemophilia growth and development study.
In a prospective study of the growth and neuropsychologic function of hemophilic subjects, 333 boys, median age of 12.3 years, had baseline neurologic examinations. The study population included 207 individuals (62%) who were seropositive for human immunodeficiency virus type 1 (HIV-1). Overall results indicated that 11% had abnormalities of cranial nerve function, 17% had abnormal deep tendon reflexes, 23% had abnormal strength, 25% had abnormal coordination, and 31% had abnormal tone, bulk, or range of motion. By contrast, 2% or fewer displayed abnormal movements or had abnormal pain or vibratory sensation, or altered mental status. Abnormalities were more common in older hemophilic subjects (eg, 67 [38%] of 177 subjects > or = 12 years of age had abnormal tone, bulk, or range of motion vs 36 [23%] of 156 subjects < 12 years of age). When compared with regard to HIV-1 status, HIV-seronegative and HIV-seropositive subjects did not differ with regard to head circumference or the frequency of abnormalities of cranial nerve function, sensation, muscle strength, or coordination. However, deep tendon reflexes and tone, bulk, or range of motion were more frequently abnormal in HIV-1-seropositive individuals. More HIV-1-positive subjects had at least one increased deep tendon reflex (13/207 [6.3%] vs 1/126 [0.8%] in seronegatives) and more had non-hemophilia-related decreases in muscle bulk (7/207 [3.4%] vs 0/126 in seronegatives). These results indicate that hemophilia causes substantial neurologic dysfunction and that certain findings, such as changes in muscle-stretch reflexes or muscle bulk, may also reflect the neurologic consequences of HIV infection.
Adolescent↗
Migraine visual auras. A medical update for the psychiatrist.
Auras of visual aberrations as well as other neurological disturbances including somatosensory and perceptual symptoms that precede a headache distinguish migraine with aura (classic migraine) from migraine without an aura (common migraine) and other varieties of headache. Visual auras that characterize migraine with aura can be classified and distinguished from other neurologic and psychiatric causes of visual aberrations. Examples of migraine visual auras, which are often described but rarely shown in the medical literature, are presented and their mechanism is discussed.
Hallucinations↗
Involuntary facial movements, not all medication-induced.
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Antipsychotic Agents↗
The persistent vegetative state: an analysis of clinical correlates and costs.
A review was compiled of 23 patients in the persistent vegetative state; a condition that developed while the patients were in an acute care hospital. Before the onset of the persistent vegetative state, eight patients had had dementia, 11 were functionally dependent, and seven had neurologic disorders that gradually led to the persistent vegetative state. For patients in the persistent vegetative state, three types of mechanical support--respirators, nasogastric or gastrotomy tubes, and intravenous lines--were utilized. All three were necessary in 43% of patients, two types in 52%, and one type in 4%. All patients in the persistent vegetative state required at least one type of mechanical assistance. Their course was complicated in all cases by incontinence, and in the majority, by decubiti, pneumonia, and urinary tract infection. Only one patient improved enough to be able to say a few words. These patients required active medical care and invasive procedures that were costly but futile. The hospital bills obtained for 13 patients averaged $170,000, and the length of stay for all patients averaged 197 days, the equivalent to a total number of bed-days of 12.5 bed-years. The poor outcomes, requirements for mechanical support, and frequency of complications--especially when neurologic impairments were present before the onset of the persistent vegetative state--should be considered when evaluating the cost in hospital bills and bed occupancy.
Adult↗
Experimental trials with Gd(DO3A)--a nonionic magnetic resonance contrast agent.
Gd(DO3A), a member of a new family of nonionic MRI contrast agents, was evaluated in vivo in a rat model. In 10 animals, enhancement of an intracerebral glioma was studied following Gd(DO3A) injection. Correlation with tissue pathology was obtained in all cases. Comparative studies of renal enhancement were performed in 15 animals, utilizing disodium Gd(DTPA)2-, sodium-Gd(DOTA)-, and Gd(DO3A). With the glioma model, Gd(DO3A) administration provided enhancement of tissue with an altered blood brain barrier, thus permitting identification of the bulk of the neoplastic lesion. Comparative studies revealed that enhancement of normal renal medulla was equal or superior with Gd(DO3A).
Animals↗
Facial dyskinesias.
The face is prominently or exclusively involved in several involuntary movement disorders, called "facial dyskinesias," in addition to the common buccolingual form of tardive dyskinesia. This review describes the appearance of the most frequently occurring facial dyskinesias: chorea, dystonia, tremor, and tics. Some new treatments are discussed.
Diagnosis, Differential↗
Anatomy of the proximal femur as seen with three-dimensional magnetic resonance imaging.
Magnetic resonance imaging (MRI) is being applied successfully to the study of the musculoskeletal system with notable recent advances, including the use of three-dimensional imaging techniques. The authors introduce three-dimensional MRI as a technique for examining proximal femoral anatomy and suggest its use as an improvement on current methods for prosthetic hip design. The proximal femurs of 14 cadavers were scanned using a three-dimensional FISP technique and the images were subsequently manipulated on a three-dimensional MRI image-processing workstation to produce rotated surface reconstructions and multiplanar reformatted images. The surface rotations showed that the marrow cavity contours closely follow the contours of the external cortex. Axially reformatted images allowed relative area measurements of the marrow cavity, quantifying the variability between subjects.
Aged↗
The straight and narrow path to good head and spine MRI.
The path to good head and spine images is narrow and treacherous. We have attempted to give the traveller a small but important set of basic rules, enabling him to cross with success. 1. Averaging can be used to achieve sufficient SNR for thin sections, but the cost in terms of scan time is high. Zooming the image (reducing the field of view) should generally be avoided, as the price in terms of SNR is very high. 2. Rectangular pixels and half-Fourier imaging are two methods for decreasing scan time. HFI, which produces high spatial resolution images, can be used when the SNR is not a limiting factor. Rectangular pixels improve the SNR, but decrease resolution. 3. To achieve good T1 contrast with spin echo imaging, set TE less than or equal to 20 msec. and TR less than or equal to 600 msec. For T2 weighted images, a TR between 2.0 and 3.0 sec. is preferred, typically with two echoes: for example, TEs of 25 and 90 msec. 4. Better slice profiles or gaps between slices can be used to combat slice-to-slice interference. This results in improved SNR on T1 weighted images and improved contrast on T2 weighted images. 5. Low bandwidth techniques may be used to improve the SNR on both T1 and T2 weighted images. Chemical shift artifact puts a finite limit on the extent to which this can be applied. 6. Motion compensating gradients are a tremendous boon to MRI and should be utilized in all possible head and spine applications. These reduce image degradation from CSF and vessel pulsation, as well as from involuntary motion. 7. Fast imaging techniques can be used in 2-D multislice mode to decrease scan time. Unfortunately the T2 contrast with this approach is far inferior to that of spin echo technique. 3-D FLASH, with 1 mm. sections, T1 contrast superior to spin echo technique, and the potential for high resolution reformatted images, may replace conventional 2-D, T1 weighted, spin echo imaging. Pulse techniques that combine all the advantages mentioned lie in the future. For example, one possible approach is a T2 weighted head screen that incorporates low bandwidth technique and HFI. This would produce high resolution images with reasonable SNR in approximately half the present scan time. Despite any further new developments, the trade-off between image quality and scan time will likely always remain.(ABSTRACT TRUNCATED AT 400 WORDS)
Head↗
FLASH: clinical three-dimensional magnetic resonance imaging.
Using 3-D FLASH, high resolution, very thin section T1 weighted images of the CNS, spine, and extremities can be obtained. From these single data sets, reformatted images whose resolution is equal to that of the original data set can be constructed in any desired plane. This approach may lead to the replacement of conventional T1 weighted spin echo imaging by 3-D FLASH techniques.
Brain↗
MR imaging section profile optimization: improved contrast and detection of lesions.
A computer-optimized radio-frequency (RF) pulse for sharper section definition was implemented for T2-weighted magnetic resonance (MR) imaging of the head. Twenty-four patients underwent MR imaging with this technique and also with a conventional spin-echo technique with a sinc pulse filtered with a Hamming window. The contrast between gray and white matter improved 20%-40%, depending on the echo time. In ten patients with multiple sclerosis, use of the computer-optimized RF pulse resulted in detection of 37% more lesions, and power deposition was reduced by 36%. The computer-optimized RF pulse improved image contrast and lesion detection.
Brain↗