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Important Principles (important + principle)
Selected AbstractsSleep disturbances in Parkinson's disease,MOVEMENT DISORDERS, Issue S1 2010Matthew Menza MD Abstract Sleep disturbances are very common in patients with PD and are associated with a variety of negative outcomes. The evaluation of sleep disturbances in these patients is complex, as sleep may be affected by a host of primary sleep disorders, other primary medical or psychiatric conditions, reactions to medications, aging or the neuropathophysiology of PD itself. In this article, we review the evaluation of the common disturbances of sleep seen in PD. This includes the primary sleep disorders, the interaction of depression and insomnia, the impact that medications for PD have on sleep, as well as the role of factors such as nocturia, pain, dystonia, akinesia, difficulty turning in bed, and vivid dreaming. The treatment of sleep disturbances in PD is largely unstudied but recommendations based on clinical experience in PD and research studies in other geriatric populations can be made. Important principles include, diagnosis, treating the specific sleep disorder or co-occurring disorder, and control of the motor aspects of PD. © 2010 Movement Disorder Society [source] Evidence and simplicity: why we should reject homeopathyJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2010Scott Sehon PhD Abstract Homeopathic medications are used by millions, and hundreds of millions of dollars are spent on these remedies in the USA alone. In the UK, the NHS covers homeopathic treatments. Nonetheless, homeopathy is held in considerable disrepute by much of the medical and scientific community. Many proponents of homeopathy are well aware of these criticisms but remain unimpressed. The differences of opinion run deep, and the debate seems deadlocked. We aim to shed some light on this situation. We briefly recap some of the major arguments on each side, but we try to go further by making explicit an underlying philosophical presupposition. In particular, we will claim that there is an important principle, which has ancient roots going back at least to Occam, some version of which constrains all empirical reasoning. We call this constraint the simplicity principle. We argue that this is not something specific to a scientific paradigm, but that, all of us, including proponents of homeopathy, are themselves deeply committed to the simplicity principle. However, once the simplicity principle is made explicit and applied to homeopathy, allegiance to homeopathy is clearly seen as irrational. The point is not merely the lack of clinical trials supporting homeopathy; rather, belief in the efficacy of homeopathy leaves a mountain of unexplained mysteries, and thereby flies in the face of the simplicity rule that guides the homeopaths' own reasoning and arguments. If nothing else, we hope that defenders of homeopathy will gain a greater understanding of why critics are so deeply reluctant to accept the efficacy of homeopathic interventions , and that this reluctance is not mere stubbornness or artificial allegiance to western medicine. Finally, we also hope thereby to illustrate the usefulness of philosophy in unearthing presuppositions in seemingly deadlocked debates. [source] Ventilation Time of the Middle Ear in Otitis Media With Effusion (OME) After CO2 Laser MyringotomyTHE LARYNGOSCOPE, Issue 4 2002Benedikt Sedlmaier MD Abstract Objective The aim of this study was to investigate the transtympanic ventilation time, the healing course of the tympanic membrane, the early and late complications, and the recurrence rate of otitis media with effusion (OME) within 6 months after CO2 laser myringotomy with the CO2 laser otoscope Otoscan. Study Design Prospective clinical study. Materials and Methods In this study, laser myringotomy was performed with the CO2 laser otoscope Otoscan in a patient population comprising 81 children (159 ears) with a history of otitis media with effusion (OME) associated with adenoidal and sometimes tonsillar hyperplasia. The procedure on the tympanic membrane was accordingly combined with an adenoidectomy, a CO2 laser tonsillotomy, or a tonsillectomy and therefore performed under insufflation anesthesia. In all ears, approximately 2 mm circular perforations were created in the lower anterior quadrants with a power of 12 to 15 W, a pulse duration of 180 msec, and a scanned area of 2.2 mm in diameter. Results None of the children showed postoperative impairment of cochleovestibular function such as sensorineural hearing loss or nystagmus. Otomicroscopic and videoendoscopic monitoring documented the closure time and healing pattern of tympanic membrane perforations. The mean closure time was found to be 16.35 days (minimum, 8 days; maximum, 34 days). As a rule, an onion-skin-like membrane of keratinized material was seen in the former myringotomy perforations at the time of closure. At the follow-up 6 months later, the condition of the tympanic membrane of 129 ears (81.1%) could be checked by otomicroscopy and videoendoscopy and the hearing ability by audiometry and tympanometry. The CO2 laser myringotomy sites appeared normal and irritation-free. Two of the tympanic membranes examined (1.6%) showed atrophic scar formation, and 1 (0.8%) had a perforation with a diameter of 0.3 mm. The perforation was seen closed in a control otoscopy 15 months postoperatively. OME recurred in 26.3% of the ears seen intraoperatively with mucous secretion (n = 38) and in 13.5% of the ears with serous secretion (n = 37;P <.05). Conclusion The most important principle in treating OME is ventilation of the tympanic cavity. CO2 laser myringotomy achieves this through a self-healing perforation in which its diameter roughly determines the duration of transtympanic ventilation. Laser myringotomy competes with ventilation tube insertion in the treatment of OME. It may be a useful alternative in the surgical management of secretory otitis media. [source] OTOLARYNGOLOGIC HEURISTICS: A RHINOLOGIC PERSPECTIVEANZ JOURNAL OF SURGERY, Issue 12 2008Erik Kent Weitzel Rhinological heuristics are adapted from common principles within the field of otolaryngology. The most important principle in achieving quality endoscopic sinus surgery is good haemostatic control of the surgical field. Once this is achieved, the surgeon can then begin advancing to other heuristic principles. Thinking one to two moves in advance allows the surgeon to take advantage of the many dually purposed instruments available. Learning to visualize buried structures by their subtle projections quickly follows. Finally, an ergonomically positioned surgeon with intricate anatomical knowledge of the sinonasal cavities permits a second surgeon to assist and greatly expand the limit of what is possible. [source] Measurement and data analysis methods for field-scale wind erosion studies and model validation,EARTH SURFACE PROCESSES AND LANDFORMS, Issue 11 2003Ted M. Zobeck Abstract Accurate and reliable methods of measuring windblown sediment are needed to con,rm, validate, and improve erosion models, assess the intensity of aeolian processes and related damage, determine the source of pollutants, and for other applications. This paper outlines important principles to consider in conducting ,eld-scale wind erosion studies and proposes strategies of ,eld data collection for use in model validation and development. Detailed discussions include consideration of ,eld characteristics, sediment sampling, and meteorological stations. The ,eld shape used in ,eld-scale wind erosion research is generally a matter of preference and in many studies may not have practical signi,cance. Maintaining a clear non-erodible boundary is necessary to accurately determine erosion fetch distance. A ,eld length of about 300 m may be needed in many situations to approach transport capacity for saltation ,ux in bare agricultural ,elds. Field surface conditions affect the wind pro,le and other processes such as sediment emission, transport, and deposition and soil erodibility. Knowledge of the temporal variation in surface conditions is necessary to understand aeolian processes. Temporal soil properties that impact aeolian processes include surface roughness, dry aggregate size distribution, dry aggregate stability, and crust characteristics. Use of a portable 2 tall anemometer tower should be considered to quantify variability of friction velocity and aerodynamic roughness caused by surface conditions in ,eld-scale studies. The types of samplers used for sampling aeolian sediment will vary depending upon the type of sediment to be measured. The Big Spring Number Eight (BSNE) and Modi,ed Wilson and Cooke (MWAC) samplers appear to be the most popular for ,eld studies of saltation. Suspension ,ux may be measured with commercially available instruments after modi,cations are made to ensure isokinetic conditions at high wind speeds. Meteorological measurements should include wind speed and direction, air temperature, solar radiation, relative humidity, rain amount, soil temperature and moisture. Careful consideration of the climatic, sediment, and soil surface characteristics observed in future ,eld-scale wind erosion studies will ensure maximum use of the data collected. Copyright © 2003 John Wiley & Sons, Ltd. [source] Consumer participation: Ensuring suicide postvention research counts for end usersINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 1 2010Anne Wilson PhD RN BN MN Wilson A. International Journal of Nursing Practice 2010; 16: 7,13 Consumer participation: Ensuring suicide postvention research counts for end users Primary health-care research is about working with those who have a vested interest in the outcomes of that research, including consumers, service providers and service organizations. This article describes how consumers were included in the research processes of a South Australian study into suicide postvention services, and illustrates important principles to consider when including consumers in research. A concurrent mixed-method approach facilitated the collection of mixed data through the application of questionnaires. The study was conducted in an Australian metropolitan area. Because of media releases, a large number of people rang to enquire and volunteer their participation. From over 200 expressions of interest, 161 individuals participated. The participation of consumers in the research process ensured the findings were relevant for end users. A number of recommendations for the care and support of those bereaved through suicide were developed as a result. [source] Evidence-Based Medicine and Clinical Trials in Pain Practice and OrthopedicsPAIN PRACTICE, Issue 4 2005Ludger Gerdesmeyer MD Abstract: Medical practices should be based on scientific findings pursuant to the rules of evidence-based medicine. Quality standards for interventional pain therapy and orthopedic clinical studies have been lacking. As a result, the efficacy of many forms of therapy is insufficiently documented, making the level of evidence low. This article identifies common deficiencies in the conduct of clinical trials, as well as limitations in conducting randomized controlled studies. Recommendations for improvement are provided. The discussion provides the clinically active physician with interpretation aids for the evaluation of meta-analyses, supports personal evidence-based decisions, and reviews the most important principles for planning and conducting of experimental clinical studies. Current examples in the literature verify the implementation of these principles and present current findings in accordance with evidence-based medicine (EBM) criteria. In spite of an increasing emergence of EBM-based studies, we conclude that the number of well-designed, high quality, controlled studies conducted in accordance with the guidelines of Good Clinical Practice examining interventional pain therapy and orthopedic clinical studies remains unacceptably low. [source] Design and Analysis of Clinical Trials in Transplantation: Principles and PitfallsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2008J. D. Schold The contributions of prospective randomized controlled trials (RCTs) to the advancement of solid organ transplantation are well appreciated. However, some misconception exists that results deriving from RCTs uniformly provide clinically relevant, definitive and generalized evidence. While there is little doubt that RCTs are the gold standard to test cause-and-effect relationships, the quality and subsequent utility of trials carried out in this field vary substantially. As with all other disciplines, our ability to interpret and implement the findings of RCTs into practice is strongly dependent on the study design and statistical rigor of the analysis. Failure to conduct trials with appropriate standards or interpret trials with the appropriate limitations may place patients at risk or waste valuable healthcare resources. The purpose of this review is to delineate important principles of study design and analysis of RCTs that are commonly overlooked. This review will discuss possible limitations of trials with specific applications in the field of transplantation. Progress in the field of transplantation is highly dependent on critical examination of existing clinical trials and vigilance regarding the optimal development of future trials. [source] Science, engineering, and statisticsAPPLIED STOCHASTIC MODELS IN BUSINESS AND INDUSTRY, Issue 5-6 2006T. P. Davis Abstract Symmetry and parsimony, together with unification through synthesis are important principles that govern the character of physical law. We show how these principles can be applied to engineering to develop an approach to reliability, and engineering in general, that centres on the identification, detection, and avoidance of failure modes through design. A definition of reliability, not presented in terms of probability, but rather based on physics, geometry, and the properties of materials, will be emphasized to support this approach. We will also show how the nature of the inductive,deductive learning cycle provides the framework for statistical science to be embedded into engineering practice, with particular regard to improving reliability through failure mode avoidance. Copyright © 2006 John Wiley & Sons, Ltd. [source] | ||||||||||