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PubMed1979

Behavioral science and family practice: a status report.

The purpose of this study was to assess the current status of behavioral science instruction in family practice residency training programs. The primary areas of interest were: (1) characteristics of those who teach behavioral science (number of persons teaching behavioral science by discipline and academic degree, number and percent of time behavioral science personnel employed, work responsibilities, academic unit responsible for instruction, description of those who provide inservice training in behavioral science ), (2) the relative importance of various behavioral science topics as perceived by faculty/staff (21 topics), and (3) preferred methods of instruction. The data revealed a wide variety of persons involved in behavioral science instruction, a strong emphasis placed on communication and counseling skills, and similar, but not innovative, teaching methods used for behavioral science instruction.

Behavioral Sciences↗
PubMed1982

Future faculty training requirements and job opportunities: a survey of U.S. dental school deans.

A questionnaire was sent to all 60 U.S. dental school deans to obtain their opinions concerning future faculty training requirements and job opportunities. Two rounds of mailings produced a 95 percent response rate. The deans expressed a greater need for faculty in clinical fields than in the basic sciences but they strongly indicated that the majority of future clinical faculty would have to possess the training and skill necessary to conduct independent research. Additionally, the deans indicated a preference for faculty jointly trained in two disciplines, wither two clinical fields or a clinical and basic science field. An analysis of current data on the number of dentists in formal research training programs was compared with the deans' estimation of projected faculty openings. This analysis led to the conclusion that there is a significant undersupply of dentists trained jointly in two disciplines who are capable of independent research. In the absence of corrective action, an opportunity to strengthen dental faculties and dental research will be lost.

Administrative Personnel↗
PubMed1976

An experiment in teaching MEDLINE.

The design and implementation of an experimental MEDLINE module at Case Western Reserve University School of Library Science is described. The module places MEDLINE within the context of multiple data bases and networking operations andis embedded in a course in health science communications. The module consists of eight weeks of lectures, demonstrations, videotapes, and exercises on terminals.

Bibliography of Medicine↗
PubMedDate not supplied

Interventions to prevent HIV risk behaviors.

OBJECTIVE: To provide health care providers, patients, and the general public with a responsible assessment of behavioral intervention methods that may reduce the risk of HIV infection. PARTICIPANTS: A non-Federal, nonadvocate, 12-member panel representing the fields of psychiatry, psychology, behavioral and social science, social work, and epidemiology. In addition, 15 experts in psychiatry, psychology, behavioral and social science, social work, and epidemiology presented data to the panel and a conference audience of 1,000. EVIDENCE: The literature was searched through Medline and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS PROCESS: The panel, answering predefined questions, developed its conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. CONCLUSIONS: Behavioral interventions to reduce risk for HIV/AIDS are effective and should be disseminated widely. Legislative restriction on needle exchange programs must be lifted because such legislation constitutes a major barrier to realizing the potential of a powerful approach and exposes millions of people to unnecessary risk. Legislative barriers that discourage effective programs aimed at youth must be eliminated. Although sexual abstinence is a desirable objective, programs must include instruction on safer sex behaviors. The erosion of funding for drug abuse treatment programs must be halted because research data clearly show that such programs reduce risky drug abuse behavior and often eliminate drug abuse itself. Finally, new research must focus on emerging risk groups such as young people, particularly those who are gay and who are members of ethnic minority groups, and women, in whom transmission of the HIV virus to their children remains a major public health problem.

Adolescent↗
PubMed1998

The Army psychological autopsy: then and now.

The conduct and reporting of an Army psychological autopsy is a complex and relatively infrequent event. The details of these reports may not be completely clear to the behavioral sciences personnel tasked with collecting the data. This paper reviews the current status of the Army psychological autopsy and contrasts it with the development of civilian psychological autopsies. The current thinking of the Department of Defense Health Affairs working group on psychological autopsies is presented. The epidemiological content of the Army psychological autopsy as a scientific resource is presented in the form of an analysis of the psychological autopsies for the 1995 Army suicide data. Suggestions for updating this unique command tool are included.

Adolescent↗
PubMed1976

[Value of results of animal experiments for the evaluation of drugs. 3. Animal trials and subjective probability].

Inasmuch as the findings in pharmacology and toxicology are based on animal trials these disciplines have to be considered as subjective sciences, since the experimentally obtained objective data become medically relevant only on the basis of subjective probabilities. The value of pharmacological and toxicological tests is dependent on the quality of the investigator. Data obtained in animals trials are of no relevance for human medicine unless the investigator substantiates his subjective probabilities and at the same time demonstrates how the hypotheses won in animal trials can be verified in man. Toxicological testing methods allowing the "preselection" of drugs or any other kind of deductions without verification in man do not exist. Animal studies which are not based on the principles of decision theory serve merely as an alibi and may lead to wrong conclusions. Besides, they interfere with the German Animal Protection Law. Methodological problems can neither be solved by normative regulations of an administrative authority nor by increasing experimental activity.

Animals↗
PubMedDate not supplied

Is crime scene examination science, and does it matter anyway?

This short piece aims to assess the kind of data collected by Crime Scene Examiners (CSEs), and to discuss whether this collection constitutes a scientific process. It also seeks to examine the balance of roles performed by the CSE, between data gatherer and investigator. The piece also aims to conclude on whether a clearer understanding of the structure of data collected by CSEs might be of some practical use in developing a greater understanding of the architecture of knowledge that forensic science as a whole relies upon. As a piece of work it is unapologetically theoretical in its perspective, and seeks to prompt further discussion regarding the structure of scientific knowledge, and any relevance this might have to its application in a forensic context. Ultimately, it seeks the inclusion of the processes of data gathering performed largely by CSEs within the wider processes of forensic science.

Crime↗
PubMed2026

Cisplatin-Induced Hearing Loss Prevention With Intratympanic Therapy Systematic Review and Meta-Analysis.

INTRODUCTION: Cisplatin-induced hearing loss (CIHL) is a well-described, long-term consequence of cisplatin treatment for malignancy. Intratympanic (IT) injections have been trialed to prevent CIHL in humans. To provide clarity on which agents have been studied through IT injection and to review their efficacy for hearing loss prevention, we performed a systematic review and meta-analysis. DATA SOURCES: OVID Medline, Embase, Web of Science, and Cochrane Library were queried. METHODS: Databases were searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Prospective randomized trials were included, and a systematic review was performed for all studies. Demographic, audiometric, and therapeutic data were collected. Random-effects models were used to compare across studies, and subgroup analyses were performed for each IT agent. RESULTS: The initial database search yielded 1017 articles, which were screened according to inclusion and exclusion criteria. Ten studies were identified, involving a total of 284 patients. Studies included data on IT dexamethasone, IT N-acetylcysteine (NAC), and IT sodium thiosulfate (STS). Pooled analysis across all agents and frequencies did not reveal a significant difference in hearing thresholds between treatment and control ears [prediction interval [-3.77, 3.20], negative favors treatment). Subgroup analysis of IT dexamethasone [-1.74, 3.80] and IT NAC [-1.02, 4.64] also did not demonstrate significant differences. STS data were not amenable to pooled analysis; however, one study demonstrated a significant decrease in ASHA-defined ototoxicity (40% vs. 85%, P =0.0027). CONCLUSIONS: To date, no IT agent has consistently prevented CIHL, although limited data suggest that IT STS may decrease ototoxicity. More trials are necessary to fully elucidate these effects.

Humans↗
PubMed2003

Statistical validation of a commonly used method for personnel dosimetry issuance determinations.

In 1992, the federal requirements for personnel monitoring of occupational radiation doses were modified, making monitoring compulsory only for individuals "likely" to exceed 10% of the applicable annual dose limits. This regulatory change served as a catalyst for many radiation protection programs to re-evaluate their personnel monitoring issuance criteria to determine if some monitoring services might be reduced or eliminated. But in the absence of any clear definition of the term "likely," radiation protection programs relied on adjustments largely based on reviews of previous monitoring results and professional judgment. Although such semi-quantitative assessments may have been appropriate, the approach was not without inherent programmatic risks, as radiation dosimetry programs have been shown to be a consistent source of regulatory non-compliance upon inspection and serve as essential elements in defense against litigation efforts purporting workplace-related radiation injury. The objective of this study was to subject this commonly used method for post-regulatory change dosimetry issuance determinations to statistical validation. Personnel monitoring data from The University of Texas Health Science Center at Houston Radiation Safety Program pre- and post-1992 regulatory changes were accessed and descriptively analyzed. The dynamic nature of the institutional environment made direct comparisons of individuals between years impractical, so 1990 mean dose levels for various independent variables were compared using the Kruskal-Wallis non-parametric ANOVA test at a significance level of alpha = 0.05. The data from 1998 were then analyzed to ascertain if the groupings identified as statistically different in 1990 were still being monitored. The analyses statistically validated the monitoring program reductions made by the University of Texas Health Science Center at Houston radiation protection program. In addition, statistical support for further monitoring program reductions were identified, if such reductions were deemed to be necessary in the future.

Government Agencies↗
PubMed1997

Apoptosis: its role in the development of malignancies and its potential as a novel therapeutic target.

OBJECTIVE: To review the current literature regarding the role of apoptosis in the development of malignant cells and how the induction of this pathway could be used in cancer therapy. DATA SOURCE: A MEDLINE search of basic science articles pertinent to the understanding of the normal physiologic process of apoptosis was conducted. STUDY SELECTION: Because of the rapidly growing literature regarding apoptosis, only articles describing key processes in the biology of the cell and the genetic control of apoptosis were included. DATA SYNTHESIS: Apoptosis is imperative for host survival since it discards unwanted, damaged, and atypical cells. The process is therefore implicated in the continuous regulation of development, differentiation, and homeostasis. Furthermore, apoptosis is a response to physiologic and pathologic stresses that disrupt the balanced rates of cell generation and elimination. In a disease such as cancer, there is a lack of equilibrium between the rates of cell division and cell death; agents that promote or suppress apoptosis can manipulate these rates, influencing the anomalous accumulation of neoplastic cells. Pharmacologic manipulation of apoptosis can manipulate these rates, influencing the anomalous accumulation represents a novel approach in targeting malignant cells and has far-reaching implications for new directions in cancer therapy. CONCLUSIONS: Apoptosis is a highly organized physiologic mechanism of destroying injured and abnormal cells as well as maintaining homeostasis in multicellular organisms. Both the activation and inhibition of apoptosis are tightly controlled. Pharmacologic manipulation of this pathway is a novel therapeutic target in cancer therapy.

Animals↗
PubMed2005

Meta-analysis: The value of clinical assessment in the diagnosis of deep venous thrombosis.

BACKGROUND: Clinical assessment of suspected deep venous thrombosis (DVT) should be based on systematically evaluated evidence. PURPOSE: To determine whether clinical findings, risk scores, and physicians' empirical judgments affect the likelihood of detecting DVT on definitive testing. DATA SOURCES: MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, Database of Reviews of Effectiveness, ACP Journal Club, and citation lists (1966 to January 2005). STUDY SELECTION: Cohort studies published in English, French, Spanish, or Italian that compared clinical assessment with a reference standard. DATA EXTRACTION: The authors extracted standardized data, including setting, exclusions, population characteristics, reference standard, and results, and assessed quality against validated criteria. DATA SYNTHESIS: The authors combined data by using random-effects meta-analysis and, if appropriate, used meta-regression to identify covariates that predicted diagnostic accuracy. Only malignancy (likelihood ratio [LR], 2.71), previous DVT (LR, 2.25), recent immobilization (LR, 1.98), difference in calf diameter (LR, 1.80), and recent surgery (LR, 1.76) were useful for ruling in DVT, while only absence of calf swelling (LR, 0.67) or difference in calf diameter (LR, 0.57) was useful for ruling out DVT. The Wells clinical score was more valuable than the individual characteristics; it stratified patients into groups with high (LR, 5.2), intermediate, and low (LR, 0.25) probability of DVT. The Wells score seemed able to stratify patients by risk only for proximal DVT, and it performed better in cohorts that were younger or excluded patients with previous thromboembolism. LIMITATIONS: Pooled estimates were subject to substantial heterogeneity. This may limit extrapolation between observers and settings. Only published studies were included, so findings may be subject to publication bias. CONCLUSION: Individual clinical features are of limited value in diagnosing DVT. Overall assessment of clinical probability by using the Wells score is more useful.

Humans↗
PubMed2004

Predicting academic and National Board Dental Hygiene Examination performance based on Academic Factors.

PURPOSE: Numerous studies have explored reliable variables that predict student success in dental hygiene programs and on the National Board Dental Hygiene Examination (NBDHE). However, no studies were found using data collected since the NBDHE format changed in 1998 to investigate if traditional predictors hold true. The objective of this study was to examine the relationship between pre-admission requirements, basic college science requirements, site of academic preparation, cumulative dental hygiene grade point average (CDHYGPA) and the NBDHE score. METHODS: Data from the academic records of 173 graduates of the dental hygiene program at The Ohio State University from 1998 through 2002 were entered into an Excel spreadsheet using identification numbers. Demographic information for the description of the subjects, course transfer data, course grades in program prerequisites and basic science requirements, CDHYGPA, and NBDHE scores were entered. Data were analyzed using the Statistical Package for the Social sciences (SPSS-version 10), Pearson's r correlations, regression analysis, and ANOVA with a predetermined level of significance at .05. RESULTS: Of the 173 records entered, 132 had complete data (76.3%). Results indicate the existing prerequisites for the dental hygiene program remain strong predictors for success. A strong correlation was noted between human nutrition courses and the CDHYGPA. Other core science courses completed while in the program-anatomy, physiology and microbiology--also rendered a moderately strong correlation to the CDHYGPA. The greatest predictors for success on the NBDHE were the student's CDHYGPA and the prerequisite three science GPA. Consistency in site of science preparation also revealed a positive correlation to the CDHYGPA. CONCLUSIONS: This study confirmed the continued use of the three science GPA pre-requisite and entering GPA for predicting success in this dental hygiene program and on the NBDHE even after the format changed to include case-based items. Other predictors for success that were identified in the study may aide dental hygiene program admission committees in their selection process. These committees may also consider the site of science preparation noting that institution consistency played a role in academic performance.

Achievement↗
PubMed2006

Tension-free vaginal tape: analysis of risk factors for failures.

To investigate whether there are any demographic, clinical, or urodynamic variables associated with an increased risk of failure in women undergoing surgery with tension-free vaginal tape (TVT). We retrospectively analysed 325 consecutive patients who had been operated with the TVT procedure. Patients were assessed with a complete history, physical examination, and urodynamic testing. The operation was done under local or epidural anesthesia and any further surgical procedure was added as indicated. The postoperative evaluation included collection of data on intra- and postoperative complications and analysis of outcomes. The outcome of surgical treatment was evaluated subjectively and objectively. The Statistical Package for Social Sciences (SPSS, Chicago, Illinois, USA) was used for data analysis; P<0.05 was considered significant. The overall complication rate was 14%, voiding dysfunction being the most common. Three hundred and one women were available for the analysis of surgical outcome and the mean follow-up was 34+12 months (median 32 months). Subjectively, 269 women (89%) were cured by the procedure and 13 (4.3%) reported marked improvement. An objective cure was achieved in 263 (87%); 38 patients still having leakage while coughing during postoperative cystometry. Among the numerous presumed risk factors for failed antiincontinence surgery only urethral hypomobility and recurrent stress urinary incontinence were significantly associated with failure of the TVT procedure in our study. However, even in these complicated situations, the cure rate was more than 70%.

Aged↗
PubMed2005

The role of basic science knowledge and clinical knowledge in diagnostic reasoning: a structural equation modeling approach.

PURPOSE: To examine four theories on the role of basic science knowledge and clinical knowledge in diagnostic reasoning. METHOD: In 2000-01, the authors tested the basic science and clinical knowledge and diagnostic performances of 59 family physicians and 184 second- to sixth-year medical students at Maastricht University, The Netherlands. Structural equation modeling was used to analyze the data. Four theoretical models were tested. In the first model only basic science knowledge is involved in diagnostic reasoning; in the second model only clinical knowledge is related to diagnostic reasoning; in the third model, clinical knowledge is related to diagnostic reasoning, but basic science knowledge is integrated in clinical knowledge; and in the fourth model, both basic science knowledge and clinical knowledge independently influence diagnostic reasoning. RESULTS: Forty-four (75%) of the family physicians and 184 (100%) of the students responded. The results indicated that the third model, which is based on the knowledge encapsulation theory, provided the best fit to the data, whereas the models that had directly related basic science knowledge with diagnostic performance did not fit the data adequately. CONCLUSION: The results generally supported the third model by Schmidt and Boshuizen of knowledge encapsulation theory suggesting that basic science knowledge is activated in expert diagnostic reasoning through its relation with clinical knowledge.

Clinical Competence↗
PubMed2002

Source-monitoring deficits for self-generated stimuli in schizophrenia: multinomial modeling of data from three sources.

INTRODUCTION: Schizophrenia patients, particularly those with specific types of hallucinations and delusions, may have a deficit in monitoring the generation of thought. This deficit, termed autonoetic agnosia, may result in the conclusion that self-generated thoughts come from an external source. METHODS: This study assessed autonoetic agnosia in 29 schizophrenic patients and 19 controls by applying a recently developed technique from cognitive science: multinomial modeling of source-monitoring data. RESULTS: Schizophrenic patients demonstrated deficits in monitoring the source of self-generated information, yet performed similarly to controls in monitoring the source of visual and auditory information. Schizophrenic patients with specific "target" symptoms such as auditory hallucinations and thought insertion had greater deficits than other patients in recognizing self-generated information. CONCLUSION: This study offers partial support for the notion that schizophrenic patients manifest autonoetic agnosia.

Adult↗