A randomized, controlled, single-blind trial of teaching provided by a computer-based multimedia package versus lecture.

BACKGROUND: Computer-based teaching may allow effective teaching of important psychiatric knowledge and skills. AIMS: To investigate the effectiveness and acceptability of computer-based teaching. METHOD: A single-blind, randomized, controlled study of 166 undergraduate medical students at the University of Leeds, involving an educational intervention of either a structured lecture or a computer-based teaching package (both of equal duration). RESULTS: There was no difference in knowledge between the groups at baseline or immediately after teaching. Both groups made significant gains in knowledge after teaching. Students who attended the lecture rated their subjective knowledge and skills at a statistically significantly higher level than students who had used the computers. Students who had used the computer package scored higher on an objective measure of assessment skills. Students did not perceive the computer package to be as useful as the traditional lecture format, despite finding it easy to use and recommending its use to other students. CONCLUSIONS: Medical students rate themselves subjectively as learning less from computer-based as compared with lecture-based teaching. Objective measures suggest equivalence in knowledge acquisition and significantly greater skills acquisition for computer-based teaching.

Medical student appraisal of interactive computer-assisted learning programs embedded in a general pathology course.

Computer-assisted learning programs (CALs) were embedded in a course on general pathology for medical students at the University of Edinburgh Medical School. Students' reactions to the programs were evaluated. Students completed written questionnaires and were interviewed and observed as they used the CALs. Students liked the CALs and felt that they were integrated with other parts of their teaching and aided them in understanding the subject material. Different question styles were variably appreciated. The most useful aspects of the CALs were the interactive parts (questions and answers), summaries, pictures, learning at the individual's own pace, and question practice, especially with MCQs. Students found the CALs an effective learning tool, particularly when linked with other course components as a complement to, rather than a replacement for, other learning methods.

Mullerian inhibiting substance inhibits breast cancer cell growth through an NFkappa B-mediated pathway.

Müllerian inhibiting substance (MIS), a member of the transforming growth factor-beta superfamily, induces regression of the Müllerian duct in male embryos. In this report, we demonstrate MIS type II receptor expression in normal breast tissue and in human breast cancer cell lines, breast fibroadenoma, and ductal adenocarcinomas. MIS inhibited the growth of both estrogen receptor (ER)-positive T47D and ER-negative MDA-MB-231 breast cancer cell lines, suggesting a broader range of target tissues for MIS action. Inhibition of growth was manifested by an increase in the fraction of cells in the G(1) phase of the cell cycle and induction of apoptosis. Treatment of breast cancer cells with MIS activated the NFkappaB pathway and selectively up-regulated the immediate early gene IEX-1S, which, when overexpressed, inhibited breast cancer cell growth. Dominant negative IkappaBalpha expression ablated both MIS-mediated induction of IEX-1S and inhibition of growth, indicating that activation of the NFkappaB signaling pathway was required for these processes. These results identify the NFkappaB-mediated signaling pathway and a target gene for MIS action and suggest a putative role for the MIS ligand and its downstream interactors in the treatment of ER-positive as well as negative breast cancers.

Systematic assessment of World Wide Web materials for medical education: online, cooperative peer review.

OBJECTIVE: : To develop a generic methodology for the online assessment of medical education materials available on the World Wide Web and to implement it for pilot subject areas. DESIGN: An online questionnaire was developed, based on an existing scheme for computer-based learning material. It was extended to involve five stages, covering general suitability, local suitability, the user interface, educational style, and a general review. It is available on the Web, so expert reviewers may be recruited from outside the home institution. The methodology was piloted in three subjects areas--clinical chemistry, radiology, and medical physics--concentrating initially on undergraduate teaching. MEASUREMENTS: The contents of completed questionnaires were stored in an offline database. Selected fields, likely to be of use to students and educators searching for material, were input into an online database. RESULTS: The online assessment was used successfully in clinical chemistry and medical physics but less well in radiology. Fewer resources were found to fit local needs than expected. CONCLUSION: The methodology was found to work well for topics where teaching is highly structured and formal and is potentially applicable in other such disciplines. The approach produces more structured and applicable lists of resources than can be obtained from search engines.

Quantitative determination of tryptophan enantiomers by capillary electrophoresis.

A novel capillary electrophoretic method is reported which allows efficient detection of 0.1% L-tryptophan in the presence of the D-enantiomer. The optimised conditions employed a triethanolamine-phosphoric acid electrolyte containing alpha-cyclodextrin. The method is also capable of acceptable injection precision resulting from the incorporation of an internal standard. The care and maintenance of the separation capillary are discussed. Acceptable validation criteria for sensitivity, precision, linearity, repeatability and recovery are included. The importance of including instrument-to-instrument method transfer in method validation is stressed and demonstrated.

Flow cytometry and AgNORs in benign, borderline, and malignant mucinous and serous tumours of the ovary.

We performed flow cytometry and AgNOR counts on 117 serous and mucinous ovarian tumours, comprising 56 cystadenomas, 21 borderline tumours, and 40 cystadenocarcinomas. DNA aneuploidy was present in one cystadenoma and in 11% of mucinous and 46% of serous cystadenocarcinomas. All borderline tumours were DNA diploid. Major and minor FIGO stages and flow cytometrically determined DNA ploidy and DNA index were prognostically significant. Age, histological type (serous versus mucinous), flow cytometric proliferative index, and AgNOR counts were not predictive of survival. Cystadenomas and borderline tumours had lower rates of proliferation than cystadenocarcinomas. AgNORs correlated with DNA ploidy and proliferative index. Borderline tumours showed elevated AgNOR numbers despite low proliferative indices and universal DNA diploidy, suggesting that AgNOR numbers may be related to nuclear events other than proliferation and DNA ploidy.

Pathological variables determining the prognosis of non-Hodgkin's lymphomas.

The aim of the study was to assess the role of pathological grade, cell proliferation, ploidy, immunophenotype and site in determining the prognosis of non-Hodgkin's lymphomas. Of particular interest was the relative value of grades derived from the Kiel classification as opposed to the National Cancer Institute (NCI) working formulation. The study consisted of 181 cases, treated in a relatively uniform way over an 18-month period spanning 1986. Using life table analysis, both NCI working formulation grade and Kiel grade correlated strongly with survival. However, the differences between grades were entirely due to an excess of early deaths in the high-grade and intermediate-grade categories. In patients surviving greater than 0.1 years (37 days), phenotype, site, ploidy and cell proliferation had no effect on survival. There was no evidence that intermediate-grade tumours, when subdivided into Kiel low- and high-grade types, differed in survival from tumours graded as low- or high-grade by both methods. However, NCI working, formulation high-grade tumours, especially those with a high proliferation rate, formed a group with a very high likelihood of death within 0.1 years.

Computer assisted selection and assessment of antibodies in the diagnosis of lymphomas.

With increasing numbers of reagents the problem of selecting appropriate antibodies to solve problems in the diagnosis of lymphoma is becoming more complex. One approach is to use a computer program to optimise the selection process. Such a program was devised, incorporating data from an extensive literature search. When presented with a differential diagnosis it selects the most appropriate antibody panel and when given the results evaluates the relative likelihood of each possible diagnosis. In a retrospective study 81% of the tests used had been non-discriminatory, but using the results of the remaining 19% of the tests, the computer was able to select the "correct" diagnosis with a high degree of certainty. The development and use of this system illustrated several problems in the application of computer assisted diagnostic techniques in histopathology. These problems include incomplete data and lack of understanding of the process of histopathological diagnosis.

Morphometric assessment of ovarian stromal proliferation--a clinicopathological study.

Ovarian stromal hyperplasia is commonly observed in peri- and post-menopausal ovaries. Assessment has, hitherto, been largely subjective or dependent on arbitrary criteria, which has made comparison of studies difficult. In this study, the stroma of a large number of ovaries was assessed morphometrically. Data were related to clinicopathological and cytomorphological information. A significant association was noted between the degree of stromal proliferation and post-menopausal endometrial adenocarcinoma (P = 0.004). There were no significant correlations between the degree of stromal proliferation and average cytomorphological dimensions.

How do we teach pathology? The laser videodisc and computer-assisted learning.

A laser videodisc, holding 54,000 still frames per side, can be used to provide visual material of excellent quality for pathology teaching. In a collaborative project between ten pathology departments, the first pathology videodisc has recently been completed and the production of the disc is described. When used as illustrative material for computer-assisted learning programs, the videodisc offers accurate random access of still frames and allows the overlay of computer-generated graphics onto the video picture. This can be used to pre-identify every individual feature of a particular frame, and an example tutorial program is described to show how this may be used to improve the students' understanding of what they see. Details and costs are given for a workstation suitable for this application and potential future developments for this teaching method are discussed. Although objective assessment of the cost-effectiveness of interactive video in teaching pathology has yet to be undertaken, one suitably designed program can give individual tuition to many students, making this a most efficient use of teaching time.

Continual audit of clinical diagnostic accuracy by computer: a study of 592 autopsy cases.

In a prospective study of 592 autopsy cases, correlations between clinical and pathological data were made by computer from a novel protocol on which morphological and functional diagnoses were separated. The accuracy of diagnosis was analysed with respect to time in hospital, specialty, consultant in charge, and other criteria. Overall, there were 168 clinical 'overdiagnoses', not confirmed at autopsy; 492 'underdiagnoses', not made clinically; and 432 'agreements' between clinical and pathological diagnoses. The computer program allows the data to be analysed at any time as the number of cases increases. Entry of information entails comparatively little extra work and a similar system could be incorporated into the service commitment of any pathology department with a suitable microcomputer and access to a mainframe computer.