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PubMed2004

Problem-based learning: ancient Chinese educational philosophy reflected in a modern educational methodology.

Problem-based learning (PBL) has been widely adopted as a strategy by nurse educators all over the world. Many studies have been carried out to examine its process and outcomes. There are few studies discussing the relevance of PBL to students with different cultural background. This study reports the experiences of Chinese students in Hong Kong using PBL and explores if their experiences were compatible with the educational philosophy documented in traditional Chinese literature. The phenomenological approach was used in the treatment of data. The informants were students enrolled in the post-registration nursing degree programme at a university in Hong Kong during 1997-1998. A total of 94 journals were included in the analysis. Seven main themes emerged from the phenomenological analysis. They were the integration of knowing and doing, critical reflection and debate, individuality of learning, self-motivated learning, critical inquiry and independent thinking, timeliness of instruction and cooperative learning. This study provides evidence to show that PBL is an approach that is compatible with the Chinese way of learning. The result of this study shows that aspects of the modern PBL process harken back to an ancient Chinese learning philosophy that underpins Chinese learning today.

China↗
PubMed2006

Developing professional habitus: a Bernsteinian analysis of the modern nurse apprenticeship.

This paper discusses the development of professional habitus in nursing students from a sociological, and specifically, a Bernsteinian perspective. It outlines the theoretical basis for the development of this trait, regarded as one of the defining characteristics of professional practice, and discusses how its development has shaped the modern nurse apprenticeship with its current emphasis on situated learning. The paper considers some of the pitfalls to this approach and raises some caveats about the assumptions which underpin nursing education at the current time. It discusses how students' legitimate peripheral participation in the workplace may be jeopardised, and outlines how they may be faced with untenable choices in respect of 'fitting in' to the ward team or challenging poor practice where this occurs. Moreover, the paper considers how the increasing abrogation of 'caring' activities to non-registered staff threatens the very notion of professional habitus in nursing and posits some possible explanations for this. The paper concludes by arguing that a better understanding of professional habitus is required by all within the profession, and suggests that this concept provides the means by which two seemingly disparate concepts, 'professionalism' and 'vocationalism' can be brought together to the benefit of the nursing profession.

Attitude of Health Personnel↗
PubMed2004

A prospective, modernized treatment protocol for periprosthetic femur fractures.

This article reports a prospective series of periprosthetic femur fractures in 33 patients treated with a modernized fracture treatment protocol. Some form of operative treatment was selected prospectively based on the categorization of the fracture by the Duncan-Vancouver and Beals-Tower Oregon classification systems. Fractures in which the prosthesis-bone interface was stable were treated with open reduction and internal fixation of the fracture around the stable implant. Unstable prosthesis-bone interfaces required removal of the primary prosthesis and revision to an uncemented long-stem prosthesis after stabilization of the femoral fracture with plates or allograft struts. Complications were minimal over an average follow-up period of 28.3 months; restoration of function was predictable.

Arthroplasty, Replacement, Hip↗
PubMed2004

Effect of cataract surgery on the corneal endothelium: modern phacoemulsification compared with extracapsular cataract surgery.

PURPOSE: To investigate whether modern phacoemulsification surgery results in more damage to the corneal endothelium than extracapsular cataract extraction (ECCE), and to examine which preoperative, operative, and postoperative factors influence the effect of cataract surgery on the endothelium. DESIGN: Randomized controlled trial. PARTICIPANTS: Five hundred patients 40 years or older were randomized into 2 groups (ECCE, 249; phacoemulsification, 251). METHODS: Central corneal endothelial cell counts, coefficient of variation of cell size, and hexagonality were assessed before surgery and up to 1 year postoperatively. MAIN OUTCOME MEASURE: Endothelial cell count. RESULTS: Four hundred thirty-three patients completed the trial. The initial preoperative mean cell count for the entire sample was 2481 (standard error [SE]: 18.6), reduced at 1 year postoperatively to 2239 (SE: 23.5). An average 10% reduction in cell count was recorded by 1 year postoperatively. There was no such change in hexagonality or in the coefficient of variation. There was no significant difference in overall percentage cell loss between the 2 treatment groups. Factors associated with excessive cell loss (> or =15% by 1 year) were a hard cataract (odds ratio [OR]: 2.1, 95% confidence limits: 1.1-4.1; P = 0.036), age (OR: 1.04, P = 0.005), and capsule or vitreous loss at surgery (OR: 2.38, P = 0.106). Phacoemulsification carried a significantly higher risk (OR: 3.7, P = 0.045) of severe cell loss in the 45 patients with hard cataracts relative to ECCE (52.6% vs. 23.1%; chi-square test, P = 0.041), with both procedures achieving similar postoperative visual acuity outcomes. CONCLUSIONS: No significant difference in overall corneal endothelial cell loss was found between these 2 operative techniques. The increased risk of severe cell loss with phacoemulsification in patients with hard cataracts suggests that phacoemulsification may not be the optimal procedure in these cases, and that ECCE should be preferred.

Adult↗
PubMed2006

New endoscopic technique to analyze various modern specialized intraocular lenses in research eyes and human eyes obtained postmortem.

PURPOSE: To describe a new modification of the Miyake-Apple posterior video photographic technique and its 2 variations. We have developed a new endoscopic technique that is especially amenable for observation of modern specialized intraocular lenses (IOLs). DESIGN: Laboratory study. PARTICIPANT: Three cadaver eyes obtained postmortem. METHODS: Human eyes obtained postmortem were prepared according to our modified preparation technique used for analyses of whole globes. An intraocular endoscope was utilized to demonstrate all aspects of the interior of an experimentally implanted IOL, with specialized reference to anterior segment structures, obtaining posterior, oblique, and side view images. MAIN OUTCOME MEASURES: Different interior dynamic views of the anterior segment structures before and after implantation of an IOL. RESULTS: High-magnification images of different intraocular structures both before and after device insertion as well as the device itself were obtained. Oblique and side view images from different locations were also available and informative. These images helped to create a 3-dimensional view of these objects and their relations to the surrounding structures. CONCLUSION: The combination of the intraocular endoscope with the closed-system technique is a useful addition to our 3 previously described techniques: (1) the original Miyake-Apple posterior video/photograph technique and the (2) closed system and (3) side/oblique view (keyhole technique) modifications.

Anterior Eye Segment↗
PubMed2005

Endoluminal gastric surgery: the modern era of minimally invasive surgery.

Laparoendoluminal techniques are the next frontier in modern surgery. They provide a minimally invasive approach to gastric diseases that enables organ preservation while maintaining open surgical principles. Laparoscopic direct access to the stomach provides a magnified, high-resolution image for precise excision using widely available laparoscopic instrumentation. Further improvements in flexible endoscopic equipment, combined with the infusion of robotic instrumentation, will aid in overcoming the technical demands of this procedure and fuel the growth of endo-luminal gastric surgery. Based on the currently available data, inappropriately selected patients, endoluminal gastric surgery affords the patients a definitive surgical procedure with all the advantages of a minimally invasive approach.

Digestive System Surgical Procedures↗
PubMed2004

Rita Levi-Montalcini: the discovery of nerve growth factor and modern neurobiology.

The remarkable accomplishments in developmental neurobiology within the past 60 years have depended on two things: (i) a succession of original histochemical and immunohistochemical methodologies for identifying pathways in the nervous system with increasing precision and sensitivity, and (ii) the discovery of growth factors for neurons. Growth factors are naturally occurring, essential biological mediators that promote cell growth, differentiation, survival and function in specific nerve cell populations. The discovery of nerve growth factor (NGF) by Rita Levi-Montalcini in the 1950s represents an important milestone in the processes that led to modern cell biology. NGF was the first growth factor identified, for its action on the morphological differentiation of neural-crest-derived nerve cells. Later, its effect on neuronal cells of the peripheral and central nervous systems, and on several non-neuronal cells was also determined. Thus, Levi-Montalcini's work on NGF represents, as acknowledged by the Nobel Prize Assembly in its press release of 13 October 1986, "a fascinating example of how a skilled observer can create a concept out of apparent chaos".

Animals↗
PubMed2005

The failure of morphology to contribute to the modern synthesis.

How much, if anything, morphology contributed to the modern synthesis is partly a matter of how one defines that term. In the strict sense, morphology is a purely formal discipline and had very little to contribute. Morphology may also be considered a kind of data, and when it becomes functional a better case can be made for its role in evolutionary studies. Be that as it may, the incorporation of morphology into the synthesis was a later development. The initial focus was at the populational level, including the problems of speciation, which makes sense because that was where the opportunities seemed to be. As the synthesis evolved and matured it expanded its horizons and incorporated a larger range of topics. Very little discussion of morphology occurs in the canonical writings of the so-called architects. At the time when the synthesis was supposedly complete, which was around 1950, the incorporation of morphology into it was just beginning.

Animals↗
PubMed2006

Neuroethics: a modern context for ethics in neuroscience.

Neuroethics, a recently modernized field at the intersection of bioethics and neuroscience, is founded on centuries of discussion of the ethical issues associated with mind and behavior. Broadly defined, neuroethics is concerned with ethical, legal and social policy implications of neuroscience, and with aspects of neuroscience research itself. Advances in neuroscience increasingly challenge long-held views of the self and the individual's relationship to society. Neuroscience also has led to innovations in clinical medicine that have not only therapeutic but also non-therapeutic dimensions that extend well beyond previously charted boundaries. The exponential increase in cross-disciplinary research, the commercialization of cognitive neuroscience, the impetus for training in ethics, and the increased attention being paid to public understanding of science all illuminate the important role of neuroethics in neuroscience.

Bioethical Issues↗
PubMed2005

Therapeutic wisdom in traditional Chinese medicine: a perspective from modern science.

The reasons why the standards of evaluating Western medicine are not suitable for testing traditional Chinese medicine (TCM) are explicit in the therapeutic objective and principles of TCM. TCM aims to correct maladjustments and restore the self-regulatory ability of the body, and not to antagonize specific pathogenetic targets. Maladjustments in a disease can be classified into several 'patterns' according to TCM theory. Multiple diseases might share one 'pattern' and be treated by the same herbal formula whereas one disease might display several different 'patterns' and be treated by multiple formulae. These principles are supported by evidence that multi-system changes in one pattern can be modulated by a herbal formula. The approaches used in systems biology and pharmacogenetics are similar to the practices of TCM. I propose that a combined approach using specific parameters associated with modern medicine, the general condition of individuals, as outlined by TCM, and pattern stratification of diseases should be employed to re-evaluate herbal formulae.

Clinical Trials as Topic↗
PubMed2005

Putting the pieces together: Roger I. Lee and modern transfusion medicine.

Roger Irving Lee (1881-1964) played significant scientific and leadership roles in overcoming the clinical impediments to blood transfusion in the 1910s. He developed the first successful anticoagulant system, paraffinized glass, and the first sterile system for indirect transfusion without defibrination, the Lee-Vincent flask. He used citrate as an anticoagulant before those generally credited with its discovery did. He introduced surgical antisepsis of the donor site and a practical system for maintaining typed blood for a large hospital donor and transfusion service. He was Oswald Robertson's mentor at Harvard as well as his commanding officer in the Harvard Medical Unit on the Western Front during World War I. Lee sent Robertson to perform "his preserved blood cells transfusion" in the casualty clearing stations of the British Third Army and provided Robertson's group with O donors, enabling the most important medical development of the war. Lee put the pieces of modern blood banking and transfusion together.

Anticoagulants↗
PubMed2005

African American renal transplant recipients benefit from early corticosteroid withdrawal under modern immunosuppression.

African Americans have historically been considered high-risk renal transplant recipients due to increased rejection rates and reduced long-term graft survival. Modern immunosuppression has reduced rejections and improved graft survival in African Americans and may allow successful corticosteroid withdrawal. Outcomes in 56 African Americans were compared to 56 non-African Americans enrolled in early withdrawal protocols. Results are reported as African American versus non-African American. Acute rejection at 1 year was 23% and 18% (P = NS), while patient and graft survival was 96% versus 98% and 91% versus 91% (P = NS), respectively. In conclusion, early withdrawal in African Americans is associated with acceptable rejection rates and excellent patient and graft survival, indicating that the risks and benefits of early withdrawal are similar between African Americans and non-African Americans. Additional followup is needed to determine long-term renal function, graft survival, and cardiovascular risk in African Americans with early steroid withdrawal.

Adrenal Cortex Hormones↗
PubMed2006

On the failure of modern species concepts.

The modern age of species concepts began in 1942, when Ernst Mayr gave concept names to several different approaches to species identification. A long list of species concepts then followed, as well as a complex literature on their merits, motivations and uses. Some of these complexities arose as a consequence of the semantic shift that Mayr introduced, in which procedures for identifying species were elevated to concepts. Much of the debate in recent decades over concepts, and over pluralism versus monism, can be seen as an unnecessary consequence of treating species identification criteria as if they were more fundamental concepts. Recently, biologists have begun to recognize both the shortcomings of a lexicon of multiple species concepts and a common evolutionary idea that underlies them.

Animals↗
PubMed2006

Modern approaches to a rapid diagnosis of tuberculosis: promises and challenges ahead.

The limitations of the conventional methods for diagnosing tuberculosis have spurred multi-faceted research activities in this field throughout the world. Chromatographic methods appear promising but may not be widely available in the developing countries. Immuno-diagnostic methods using combinations ("cocktails") of antigens have high sensitivity and specificity and can easily be applied in the peripheral laboratories and in the field settings. Though expensive, molecular methods for diagnosis of tuberculosis have advantages of speed, sensitivity, and specificity. Adequate training of the eligible personnels in molecular methods and prevention of laboratory-dependent contamination may help reduce false positive results. Although, there are no clear guidelines, so far on how to make out the best from the gene amplification methods, yet their use may be encouraged with adequate quality controls, because of the inherent ingenuity and promises of these methods. Phage-based molecular methods provide rapid results in susceptibility tests for anti-tubercular drugs. In future, many sophisticated techniques are expected to hit the market for a rapid diagnosis of tuberculosis. In the developing countries, it is necessary to evaluate availability of suitable infrastructure and trained personnels before adopting modern diagnostic methods.

Antigens, Bacterial↗
PubMed2005

The US smallpox vaccination program: a review of a large modern era smallpox vaccination implementation program.

We describe the US experience with a large-scale smallpox vaccination program in the modern era and quantify the anticipated and unanticipated local and systemic side-effects of smallpox vaccination. In addition, we review unexpected issues, such as the development of myopericarditis discovered during the implementation of this program. These results constitute the largest dataset of a vaccinia vaccination program utilizing calf-lymph derived New York City Board of Health strain vaccine (Dryvax, Wyeth) since the 1970s. These results should inform current and future vaccinia vaccination programs and provide a historical rate of complications against which candidate vaccine side-effects can be compared in future clinical trials.

Animals↗
PubMed2004

Blastocystis in humans and animals: new insights using modern methodologies.

Among the waterborne protozoan parasites of medical and veterinary importance, Blastocystis is perhaps one of the less well-understood. However, in recent years, there has been a surge of interest in the organism, fueled in part by the possible association of Blastocystis infection with intestinal disorders, and its unusual taxonomic affiliations. Although there is information on the parasite's morphology, taxonomy and mode of transmission, its pathogenicity, life cycle, and function of certain organelles continue to baffle investigators. The clinical relevance of Blastocystis will be better answered once an animal model is found. Blastocystis infections have a worldwide distribution but prevalence is highest in areas with poor hygiene and deficient sanitation services and facilities. Application of modern molecular tools has advanced knowledge of the organism's genetic diversity, taxonomy and zoonotic potential.

Animals↗
PubMed2006

The seizures of Peter Alexeevich = Peter the Great, father of modern Russia.

This article deals with the seizures of Tsar Peter the Great, Father of Modern Russia. At the age of 10 in 1682, he witnessed the very brutal deaths of two men who were close to his family and the hacking of these men to pieces, directly in front of him. This savagery could have left scars, explaining possible psychogenic seizures. Also, such great quantities of alcohol were consistently consumed by this giant of a man at 6 ft 8 in. that alcohol withdrawal seizures would also seem possible. However, evidence of the latter two types of seizures is lacking. At the age of 21, he likely had severe encephalitis and, within that year, developed simple partial seizures with jerking movements of his left face that spread to his arm, and occasionally to his leg, finally evolving into a complex partial attack with loss of consciousness later. It is entirely possible that the seizures of Peter the Great are an example of a new entity called acute encephalitis with refractory, repetitive partial seizures, associated at times with epilepsia partialis continua and periodic lateralized epileptiform discharges.

Adult↗
PubMed1998

Obesity as a chronic disease: modern medical and lifestyle management.

The United States is in the midst of an epidemic of obesity involving more than one third of the adult population. The prevalence of obesity increased by 40% between 1980 and 1990. Obesity is a chronic disease with a multifactorial etiology including genetics, environment, metabolism, lifestyle, and behavioral components. A chronic disease treatment model involving both lifestyle interventions and, when appropriate, additional medical therapies delivered by an interdisciplinary team including physicians, dietitians, exercise specialists, and behavior therapists offers the best chance for effective obesity treatment. Lifestyle factors such as proper nutrition, regular physical activity, and changes in eating behaviors should be coordinated by this team. This review addresses the modern epidemic of obesity, the strong association between obesity and comorbidities such as coronary heart disease, type 2 diabetes, hypertension, and dyslipidemia. In addition to obesity, the health risks of abdominal obesity and adult weight gain are discussed. The evidence that supports health benefits from modest weight loss (between 5% and 10% of body weight) is evaluated and the 5 key principles of effective obesity therapy are put forward. Obesity is a therapeutic challenge best met by teams of health care professionals, including dietitians and physicians, working together to deliver optimal treatment.

Body Constitution↗