Creating a spirituality curriculum for family practice residents

The purpose of this pilot study was to investigate issues related to the creation of a curriculum to teach spirituality to family practice residents; specifically, (1) to determine whether there was support among family practice residents and faculty to include such teaching in the residency curriculum, and (2) to determine specifically what should be taught and how it should be taught. The hypothesis was that residents and faculty would support such a curriculum and that specific educational methodologies could be identified to implement it. This was accomplished by conducting one-on-one interviews and focus groups and by administering a written curriculum needs assessment to family practice residents and faculty, compiling and interpreting the results, and subsequently writing an integrated curriculum.     

Venous thromboembolism, radiology by the organ, combined diagnostic imaging, clinical radiology

OBJECTIVE: To describe mortality and morbidity during a period of 2 years after coronary artery bypass grafting (CABG) in relation to a history of hypertension. PATIENTS: All patients in western Sweden in whom CABG was undertaken between June 1988 and June 1991 and in whom simultaneous valve surgery was not performed were included in the study. DESIGN: A prospective 2-year follow-up study. RESULTS: Patients with a history of hypertension (n = 777) differed from patients without such a history (n = 1348) in that the proportion of women was higher, they were older and more frequently had a history of congestive heart failure, diabetes mellitus, renal dysfunction, cerebro-vascular disease, intermittent claudication and obesity, and the number of smokers and patients with previous CABG was lower. They were also more likely to develop post-operative cerebrovascular complications and signs of myocardia damage. Patients with hypertension tended to have increased mortality during the first 30 days after CABG and the late mortality (between day 30 and 2 years) was significantly higher than in non-hypertensive participants. Whereas the development of myocardial infarction was similar in both groups, the hypertensive study participants more frequently developed stroke during 2 years of follow-up. In a multivariate analysis including age, sex, history of different cardiovascular diseases, smoking, ejection fraction, and the occurrence of three-vessel disease, hypertension did not emerge as an independent predictor of death in the early or late phase or during a total of 2 years of follow-up. CONCLUSION: Among CABG patients, those with a history of hypertension have a different pattern of risk factors. They have a higher mean age, include a higher proportion of women and have a higher prevalence of congestive heart failure, diabetes mellitus, renal dysfunction, cerebro-vascular disease, intermittent claudication, and obesity. They also have an increased frequency of immediate post-operative complications and an increased 2-year mortality, even if a history of hypertension was not an independent predictor of death during 2 years of follow-up.     

Head trauma: CT scan interpretation by radiology residents versus staff radiologists

The determination of diagnostic features in recorded heart sounds was investigated with Carpentier-Edwards (CE) bioprosthetic valves. Morphological features, extracted using the Choi-Williams distribution, achieved between 96 and 61% correct classification. The time-scale wavelet-transform feature set achieved 100% correct classification with native valve populations, and 87% with the CE replacements.     

Dedicated PET scanners for breast imaging

We have used computer simulations to compare two designs for a PET scanner dedicated to breast imaging with a whole-body PET scanner. The new designs combine high spatial resolution, high sensitivity, and good energy resolution to detect small, low-contrast masses. The detectors are position sensitive NaI(Tl) scintillators. The first design is a ring scanner surrounding the breast and the second consists of two planar detectors placed on opposite sides of the breast. We have employed standard performance measures to compare the different designs: contrast, percentage standard deviation of the background, and signal-to-noise ratios of reconstructed images. The results of the simulations show that both of the proposed designs have better lesion detectability than a whole-body scanner. The results also show that contrast is higher in the ring breast system but that the noise is lower in the planar breast system. Overall, the ring system yields images with the best signal-to-noise ratios, although the planar system offers practical advantages for imaging the breast and axilla.     

Functional radiology of the liver: magnetic resonance imaging

Magnetic Resonance (MR) images sensitive to the flowing blood are defined as images of MR angiography. Proton movement within a magnetic field modifies both the intensity and the phase of Nuclear Magnetic Resonance (NMR) signal; two techniques of MR angiography are thus distinguished: (TOF) the "time of flight" (intensity) and the "phase-contrast" (phase) technique. In the time of flight MR angiography the blood may appear as hypointense or hyperintense compared to stationary tissues. Blood hypointensity in vessels is due to the flow void phenomenon while hyperintensity is due to the phenomenon of flow-related enhancement. In phase contrast MR angiography, protons moving within a magnetic field modify their phase directly proportional to the displacement velocity and gradient intensity. Moreover, MRI allows noninvasive measurement of blood flow. Flow velocity is measured with TOF sequences or phase-contrast sequences. In TOF sequences quantitative measurement is performed with the bolus tracking procedure. In contrast-phase sequences the velocity is measured based on the extent of signal phase modification induced by the proton displacement velocity. The recent use of liver-specific contrast media supplies information on parenchymal liver function.     

Desmoplastic ameloblastoma: correlative histopathology, radiology and CT-MR imaging

A desmoplastic variant of ameloblastoma with osteoplasia in the stroma is reported. This tumour presented in the canine/premolar region of the left maxilla of a 31-year-old woman. It was treated by partial hemimaxillectomy and immediate reconstruction with a non-vascularised iliac graft. The location of this lesion, its histology and radiological features differ from those of the conventional ameloblastoma. The behaviour and prognosis of the desmoplastic ameloblastoma (DA) cannot at this stage be predicted due to the small number of cases that have been reported and a lack of long-term follow-up. To our knowledge this is the first documentation of the CT and MRI features of desmoplastic ameloblastoma with pathologic correlation.     

Monte Carlo study of grid performance in diagnostic radiology: task dependent optimization for screen-film imaging

An optimization of anti-scatter grid design using Monte Carlo techniques in diagnostic radiology is presented. The criterion for optimization was to find the combinations of the grid parameters (lead strip width, grid ratio and strip density) and tube potential which result in the lowest mean absorbed dose in the patient at fixed image contrast. The optimization was performed in three irradiation geometries, representing different scattering conditions (paediatric examinations, and two adult lumbar spine examinations) and was restricted to grids using fibre materials in covers and interspaces. Grid designs currently available were studied, as were designs which use thinner strips (< 30 microns) and higher grid ratios (> 18). It was found that grids with widely different strip densities (strips cm-1) and grid ratios can have good performance provided that they are used with appropriate strip width and tube potential. With increasing amounts of scatter, the optimal grid requires thicker strips and higher grid ratios. Increasing the strip density and using thinner strips and higher grid ratios are generally required. Grids with low strip density (25 strips cm-1) were found to be less sensitive to alterations in strip width. Optimal grids for paediatric radiology require thinner strips (10-20 microns) than those in currently available grids. Grids on the market are best suited for examinations of the adult body in anteroposterior (AP) view. In the adult lateral view, representing the largest scattering volume, higher grid ratios (> 18) than those in existing grids would be optimal. Examples of good grid designs are given for each examination.     

Use of formal and informal sources of mental health care among older African-American public-housing residents

BACKGROUND: Elderly residents of public housing have high rates of psychiatric disorders, but most of those in need of care do not use any mental health service. This study examines the use of formal and alternative informal sources of mental health care in a sample of elderly African-American public-housing residents. METHOD: Data from an epidemiological survey of six Baltimore public-housing developments for the elderly (weighted N = 818) were analysed to examine the utilization of mental health services by older African-American residents. Logistic regression analyses were used to determine correlates of using formal and informal sources by those needing mental health care. RESULTS: Thirty-five per cent of subjects needed mental health care. Less than half (47%) of those in need received any mental health care in the previous 6 months. Residents in need were more likely to use formal (38.5%) than informal sources (18.6%) for care. The strongest correlates of using formal providers were substance use disorder (OR = 15.62), Medicare insurance (OR = 10.31) and psychological distress (OR = 10.27). The strongest correlates of using informal sources were perceiving little or no support from religious/spiritual beliefs (OR = 21.65), cognitive disorder (OR = 19.71) and having a confidant (OR = 15.07). CONCLUSIONS: Contrary to elderly African-Americans in general, those in public housing rely more on formal than informal sources for mental health problems. Nevertheless, both sources fail to fill the gap between need and met need. Interventions to increase identification, referral and treatment of elderly public-housing residents in need should target general medical providers and clergy and include assertive outreach by mental health specialists.     

18-FDG imaging in breast cancer

A previously isolated parsley (Petroselinum crispum) cDNA with high sequence similarity to cinnamate 4-hydroxylase (C4H) cDNAs from several plant sources was expressed in yeast (Saccharomyces cerevisiae) containing a plant NADPH:cytochrome P450 oxidoreductase and verified as encoding a functional C4H (CYP73A10). Low genomic complexity and the occurrence of a single type of cDNA suggest the existence of only one C4H gene in parsley. The encoded mRNA and protein, in contrast to those of a functionally related NADPH:cytochrome P450 oxidoreductase, were strictly coregulated with phenylalanine ammonia-lyase mRNA and protein, respectively, as demonstrated by coinduction under various conditions and colocalization in situ in cross-sections from several different parsley tissues. These results support the hypothesis that the genes encoding the core reactions of phenylpropanoid metabolism form a tight regulatory unit.     

A mentor-based laboratory management elective for residents

BACKGROUND: A combination metered-dose inhaler aerosol containing ipratropium bromide and albuterol sulfate has been reported to be more effective than either of its components in patients with chronic obstructive pulmonary disease. The dose of albuterol sulfate is equal in moles per liter to the dose of albuterol base used in the commercially available metered-dose inhalers. OBJECTIVE: To compare the safety and efficacy of the combination of ipratropium bromide and albuterol sulfate with a commonly prescribed albuterol metered-dose inhaler containing albuterol base alone. METHODS: Investigators at different sites performed a double-blind, 29-day trial involving 357 patients with chronic obstructive pulmonary disease. Efficacy measurements were taken at 15, 30, and 60 minutes after treatment with study medication and then hourly up to 6 hours on days 1 and 29 of the trial. The primary end point was improvement in forced expiratory volume in 1 second. Clinical status was followed up and safety monitoring was also performed. RESULTS: The combination produced a significantly greater peak and mean improvement in forced expiratory volume in 1 second over albuterol base alone on both test days. Similar changes were seen with forced vital capacity. Evaluations of clinical status were better for patients receiving combination therapy, and some improvements were statistically significant. The overall incidence of adverse effects was similar in the 2 treatment groups. CONCLUSION: We conclude that a combination of ipratropium bromide and albuterol sulfate is more effective at improving pulmonary function than albuterol base alone, with no potentiation of adverse effects.     

A resume or curriculum vitae for success

Nurses who are searching for new positions can enhance their job employment potential with well-written resumes. Scholarship and award recognition also can be improved by creating well-written resumes and/or curricula vitae. Appropriate cover letters effectively introduce nurses to employers or review committees. This article presents a few basic suggestions that can simplify the creation of any of these documents and help nurses produce a quality product.     

Serendipity in diagnostic imaging: magnetic resonance imaging of the breast

BACKGROUND: Magnetic resonance imaging (MRI) of the breast has been proposed as a noninvasive diagnostic test for evaluation of suspicious ("index") lesions noted on mammography and/or clinical breast examination (CBE). However, women may have incidental ("serendipitous") lesions detected by MRI that are not found on mammography or CBE. To understand better whether or not biopsy procedures should be performed to evaluate serendipitous lesions, we estimated the breast cancer risk for women with this type of lesion. METHODS: A decision analysis model was used to estimate the positive predictive value (i.e., the chance that a woman with a serendipitous lesion has cancer) of MRI for serendipitous lesions in women who had an abnormal mammogram and/or CBE suspicious for cancer (where a biopsy procedure is recommended). We restricted the analysis to data from women whose index lesions were noncancerous and used meta-analysis of published medical literature to determine the likelihood ratios (measures of how test results change the probability of having cancer) for MRI and the combination of CBE and mammography. The positive predictive value of MRI was calculated using the U.S. population prevalence of cancer (derived from registry data) and the likelihood ratios of the diagnostic tests. RESULTS: Under a wide variety of assumptions, the positive predictive value of MRI was extremely low for serendipitous lesions. For instance, assuming sensitivity and specificity values for MRI of 95.6% and 68.6%, respectively, approximately four of 1000 55- to 59-year-old women with serendipitous lesions would be expected to have cancer (positive predictive value = 0.44%, 95% confidence interval = 0.24%-0.67%). CONCLUSION: In women with a suspicious lesion discovered by mammography and/or CBE that is found to be benign, serendipitous breast lesions detected by MRI are extremely unlikely to represent invasive breast cancer. Immediate biopsy of such serendipitous lesions may, therefore, not be required.     

Multicoil array for high resolution imaging of the breast

An RF multicoil array for high resolution imaging of the breast is presented. The RF multicoil is incorporated into a dedicated breast imaging apparatus that holds either breast in gentle compression during imaging. Simulations and imaging experiments demonstrate the high sensitivity and RF homogeneity of the multicoil array. Direct comparisons are made between the multicoil and a surface coil. In vivo images are presented to demonstrate the homogeneity of the RF field of the multicoil over the entire breast. An in vivo image of both high temporal and spatial resolution is shown, which demonstrates the sensitivity of the RF multicoil array that may be achieved in a practical imaging experiment.     

Magnetic resonance imaging in breast cancer staging

For many solid carcinomas, high-resolution cross-sectional imaging has changed cancer staging, the evaluation of therapeutic response, the detection of recurrence, and even how therapy is selected and performed. Such imaging has not yet had similar effects on breast cancer. Evaluations of therapeutic response in breast carcinomas have been impeded by the current limited methods of evaluating breast tumor size and extent: clinical palpation, ultrasonography, and mammography. The use of magnetic resonance imaging (MRI) of the breast in the evaluation of breast tumors brings the advantages of high-resolution cross-sectional imaging to breast cancer staging and treatment evaluation and is likely to greatly enhance research efforts in this complex disease. MRI of the breast has evolved to be the most accurate noninvasive technique for local staging of breast cancer. MRI is most accurate in measuring tumor size and detecting multicentric disease. These staging characteristics affect the selection of therapy and initial determination of prognosis; therefore, MRI of the breast can change the assessment of fundamental parameters on which treatment is selected. Because clinical trials of new cancer treatments are predicated on proper and accurate characterization of the tumor, MRI also should affect how clinical trials are performed and evaluated.     

A note on formal learning theory

Previous investigations have challenged the generality of the claim that perceived motion in an effective stimulus for smooth pursuit eye movements. The experiments extend the scope of these investigations. Three experiments test the hypothesis that perceived motion can serve as the stimulus for pursuit when the eye movement does not generate constraining retinal error information. Observers viewed retinally stabilized displays that elicited the perception that a stationary target was moving or that a moving target was moving faster than it was actually moving. The results failed to confirm the hypothesis. Relevant literature is reviewed. We conclude that perceived movement can act as a stimulus for pursuit only when the "perceptual target" has no retinal counterpart.