Cognitive-behavioural therapy for adolescents with bulimic symptomatology: the acceptability and effectiveness of internet-based delivery.

BACKGROUND: The evidence base for the treatment of adolescents with bulimia nervosa (BN) is limited. AIMS: To assess the feasibility, acceptability, and clinical outcomes of a web-based cognitive-behavioural (CBT) intervention for adolescents with bulimic symptomatology. METHOD: 101 participants were recruited from eating disorders clinics or from beat, a UK-wide eating disorders charity. The programme consisted of online CBT sessions ('Overcoming Bulimia Online'), peer support via message boards, and email support from a clinician. Participants' bulimic symptomatology and service utilisation were assessed by interview at baseline and at three and six months. Participants' views of the treatment package were also determined. RESULTS: There were significant improvements in eating disorder symptoms and service contacts from baseline to three months, which were maintained at six months. Participants' views of the intervention were positive. CONCLUSIONS: The intervention has the potential for use as a first step in the treatment of adolescents with bulimic symptomatology.

Effect of bone material properties on the initial stability of a cementless hip stem: a finite element study.

In previous finite element studies of cementless hip stems reported in the literature, the effect of bone quality on the initial micromotion and interface bone strain has been rarely reported. In this study, the effect of varying cortical and cancellous bone modulus on initial stem micromotion and interface bone strain was examined and the potential consequence of these changes on bone ingrowth and implant migration was reported. A finite element (FE) model of a total hip replacement (THR) was created and the Young's moduli of cortical and cancellous bone were systematically varied to study the relative effect of the quality of both types of bone on the initial stability of a cementless THR. It was found that the initial micromotion and interface bone strain in a THR was significantly affected by the overall stiffness of the femur. In other words, both the reduction of the modulus of cortical and cancellous bone caused an increase in the initial micromotion and interface bone strain. This suggests that for FE studies to be truly predictive, a range of bone quality must be examined to study the performance envelope of a particular stem and to allow comparison with clinical results.

The role of handouts, note-taking and overhead transparencies in veterinary science lectures.

OBJECTIVE: To study student and staff views of the role and use of handouts, note-taking and overhead transparencies in veterinary science lectures at the University of Queensland METHODS: The Nominal Group Technique was used to help develop a questionnaire, which was completed by 351 students (a response rate of 84%) and 35 staff (76%) from the 5 years of the veterinary course. The data were analysed using the SAS statistical computer package. RESULTS: Staff and students held different views as to the frequency with which handouts should be used, their educational value, and whether they should be complete or partial. Fewer students than staff agreed that handouts discourage further reading in a subject. Almost all staff and students saw the central functions of note-taking to be provision of notes for subsequent revision and encoding information given by the lecturer. More students than staff however, considered that note-taking in lectures interferes with understanding. Staff and students held similar views as to the uses of overheads in lectures. Interestingly however, more staff than students agreed that overheads often contain too much information. CONCLUSION: Both students and staff saw the central role of note-taking as providing a set of good notes for revision. Generally students preferred that this information be provided in the form of partial or complete handouts, while staff preferred students to take notes and to read outside lectures. Surprisingly, more staff than students felt that overhead transparencies often contained too much information. Note-taking, handouts and overhead transparencies need to be linked in a coherent educational strategy to promote effective learning.

Sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer.

BACKGROUND: Sentinel lymph node biopsy (SLNB) is a developing alternative to axillary dissection and may prove to be accurate in the detection of micrometastases in lymph nodes of breast cancer patients. Limited studies exist in the use of SLNB after neoadjuvant therapy. This study was undertaken to determine the accuracy of SLNB after neoadjuvant chemotherapy. METHODS: Thirty-one patients with stage I or II breast cancer underwent SLNB after neoadjuvant chemotherapy. RESULTS: Lymphatic mapping was performed by radioisotope, blue dye, or both techniques. Sentinel nodes (SN) were identified in 29 patients (93.5%). The SN was positive in 11 patients (38.0%), and was the only positive node in 5 patients (45.5%). There were no false negative SN by hematoxyin and eosin stain or immunohistochemistry (IHC) studies. CONCLUSIONS: Sentinel node identification rate is similar to that in nonneoadjuvant studies. The sentinel node accurately predicted metastatic disease in the axilla. IHC studies failed to detect any additional micrometastases. This diagnostic technique may provide treatment guidance for patients after neoadjuvant therapy.

Persistence of non-standard dialect in school-age children.

This study investigated the persistence of non-standard dialect production among 114 African American and White children in grades 3, 5, and 7. A dialect shift premise suggests that a large and uniform decline in dialectal features occurs in the language of school-age children. Three experimental tasks were administered. The results indicated that dialect awareness and discrimination increased as grade in school increased; a dialect shift occurred between grades 3 and 5; non-standard dialect production and comprehension of standard dialect were not associated; and that there was no difference in non-standard dialect production among African American and White students.

Teaching consultation skills by videotaping interviews: a study of student opinion.

The need to teach undergraduate medical students the skills of conducting a consultation now seems well established. Several authors have also established the efficacy of using constructive feedback on videotapes of each student's interaction with a patient to enhance such skills. To date, however, students' perceptions of this process have not been reported. Here we present the results of such a study, together with a review of the relevant literature. In our study we found that students felt that their skill at analysing and evaluating consultations had been enhanced, but that they would have liked to have more than one of their consultations taped and reviewed. This last suggestion is discussed in the light of the literature reviewed, as are the advantages and disadvantages of using real or surrogate patients for this kind of training.

Surgical knowledge base augmentation by medical rotations: does it happen?

A study of 4 groups of fifth year medical students taking Surgery during the 4 terms of 1989 at the University of Queensland was undertaken to determine whether there was assimilation of factual material relevant to the surgical knowledge base from the other specialty rotations done during the same year of the course. The records of multiple choice question (MCQ) examination results for the 210 students were retrieved and reviewed. The performance of the same students during their fourth-year rotation in Surgery was checked to make sure that the 4 groups did not already display unusual surgical aptitude or incompetence. The questions were categorized in order to ascertain that the content of all the examinations was similar. The results of students doing Surgery during the first of the 4 terms in 1989 were compared with subsequent groups. The difference between the groups was that those in the first term had not had the benefit of fifth year rotations through Internal Medicine, Psychiatry, General Practice and electives. Subsequent groups had increasing experience in the other specialties. The fourth and final group in the year had undertaken all four of the other rotations before doing Surgery. Significant improvement was found in the performance of each of the subsequent groups of students compared with the first-term group. This implies that there is an escalating accural of factual knowledge related to surgery from the fifth-year courses in Internal Medicine, Child Health and Psychiatry.

Competency for military arrest as a psychiatric problem.

Military law does not invest doctors with the authority to determine whether a soldier is competent to enter military arrest. This determination is legal in nature. Therefore, medical (or psychiatric) examination which is carried out before or within military arrest or detention, is aimed at preventing deterioration in the health of the soldier in prison. Hence, medical opinion serves only as 'credentials' of sorts. This is the formal language of the military law. In reality, the examining psychiatrist has to consider many factors, bearing in mind that his conclusions will probably become a prominent basis for the final decision on the military legal officer (whether to enforce military arrest). In order to illustrate the complicated considerations which are set forth before military psychiatrists, several case reports are presented of soldiers, who were examined in the Israel Defence Forces central psychiatric clinic for the determination of competency for military arrest.

Lecture note-taking, learning and recall.

Note-taking by students is generally seen as an integral and essential part of the process of learning from lectures. Here we review the literature on the efficiency of students' note-taking and the extent to which they actually learn as a direct or an indirect result of taking notes. Attention is also paid to the relevance of research in this area to modern lecturing practice and to the problems of researching in the area.

A comparison of normal, bipolar and seasonal affective disorder subjects using the Seasonal Pattern Assessment Questionnaire.

The Seasonal Pattern Assessment Questionnaire is an instrument for retrospective self-rating of change in mood and vegetative functions with the seasons. It has been used in studies to identify and characterise patients with Seasonal Affective Disorder (SAD) in three countries. In this paper, the test-retest reliability of all items and the sensitivity to differences between groups have been investigated. Clear differences were found between the SAD group and a normal group. A group of bipolar affective disorder patients had intermediate scores on reported seasonal changes between the normal and SAD groups. All groups reported significant changes in mood and vegetative functions during the winter in the direction symptomatic for SAD suggesting that SAD patients may suffer an exaggerated form of a normal seasonal variation.

Phototherapy and its mechanisms of action in seasonal affective disorder.

Eleven depressed patients with seasonal affective disorder completed three different treatments of 1 week each given in a balanced order with a 1-week withdrawal between each week of treatment. The three treatments were photoperiod extension with bright light, or with dim light, and light augmentation with bright light without a change in photoperiod. Most patients improved on all treatments, with a trend in favour of bright light over dim. Only light augmentation was significantly better than dim light and was also superior to photoperiod extension. These findings do not replicate earlier studies and, as the most successful treatment involved no change in photoperiod, they suggest that modification of melatonin secretion may not be the mechanism of action of phototherapy.