Welcome to the Radiology Assistant the Radiology Assistant is the educational web site of the Radiological Society of the Netherlands. We focus on common radiological issues in a problem oriented way for radiology residents and radiologists. Subscribe to the newsletter and get a mail when a new article is published.
They focus on common clinical problems in which imaging plays a major role in the management of the patient. The subjects are presented by experts in the field. The pictures are explained by linked articles usually with a clinical topic. The picture above is accompanied by an article focused on the role of MRI in the diagnosis of dementia.
Have a look, amazingly informative, plenty of explanatory pictures, scans X-Rays, graphics etc. at Radiologyassistant.nl
Lectures have become out of favor with medical students or should I say educationalists. They haven’t completely disappeared but giving a lecture to medical students is often an unsettling endeavor. During the lecture to at least 400 med students their is hardly any interaction. One lecture hall is crowded with 300 med students, the other 100 watch your lecture on screens in the adjourning lecture room. Posing questions to them, such a large audience hardly gets any reactions.
Wouldn’t it be wonderful to use twitter during lectures. Have a twitter break to have a look at the remarks and questions half way your lecture and nearly at the end of the lecture, wouldn’t that improve understanding and possibly also interaction? I got this idea from proceedings from the EduMedia conference held in Salzburg.
The proceedings (pdf download) start by explaining microblogging and a discussion: Can Twitter help to improve interactions among learners, and enhance their learning experiences?
In their proceedings they offered ways in how attendees and organizers of conferences can use twitter.
Before a conference twitter can be used to announce events, workshops and keynote presentations
Before a conference twitter can be used to remind attendees to register or to bring specific items
Twitter can be used by the attendees to organize their trip and share information about accommodations
During the conference twitter can be used to keep the attendees updated of last minute changes, organizational hints and to engage attendees to upload pictures, links to related blog entries
Attendees can use twitter to write personal notes for other or themselfs, discuss topics with other attendees or ask questions about presentations
With a specific hashtag for a presentation you can use twitter breaks to respond to questions
After the conference organizers often use Twitter after the conference to thank attendees for their presence, post reflections and interesting statistics or they gather feedback and ideas for the next conference and spread the wordabout upcoming dates
Attendees of the conference use Twitter to post links to their blogs, where they published longer and deeper reflections about the conference. The community of interest shares links to other interesting meetings and conferences and often stays in touch using the hashtags from the conference
The researchers developed an anonomous survey that could be used online in several different conferences.
The survey was divided into three different sections and comprised multiple choice, matrix, lickert scale and open-ended questions, which enabled the researchers to survey about respondents’ gender and age, their use of Twitter before, during and after the conference, and also about what they liked and disliked microblogging. It was also asked why they used Twitter and what were, in their opinion and experience, the advantages and disadvantages of using Twitter in conferences. In Total, the survey consisted of 34 questions.
Microblogging at conferences seems to be an additional way of discussing presented topics and exchanging additional information. Their research shows that several conference speakers and attendees are using Twitter for various purposes. Communicating and sharing resources seem to be one of the most interesting and relevant ways in which one microblogs. Content attached to tweets was reported to be mostly limited to plain text and web links.
I couldn’t find technical details about using twitter during lectures with twitter pauses. You will probably need a stand alone version with a hashtag, but students should need a way to be online during lecture, anyone experience with this, especially the technical part?
We discussed a prior publication in the Archives of General Psychiatry about the decline of antidepressants use after the FDA black box warning. In a more recent study published in the same journal this prior study was criticized because it had some serious limitations. The study used prevalent use instead of incidence use. This means, used all cases instead of the new cases that started using antidepressants and they included all use instead of the use for depression. Antidepressant indications range from major depression to smoking cessation and weight loss, with varied suicidality risk. The warning for heightened suicidality risk was targeted at depressed patients.
This new study used new antidepressant users from the targeted group (children, adolescents, younger adults 18-24 years) and a comparison group of nontargeted adults over a long period from 1997 to 2007 in a large cohort.
Diagnosing decreases persist. Substitute care did not compensate in pediatric and young adult groups, and spillover to adults continued, suggesting that unintended effects are nontransitory, substantial, and diffuse in a large national population.
In all age groups, 5-18, 18-24 and 25-89, depression diagnosis rates were significantly lower than history predicted based. More specific 44% lower for pediatric, 37% lower for young adults, 29% for adults.
The decline in SSRI prescriptions was 10-15%. Not only did SSRI prescriptions decrease in the targeted populations from 5-18 and 18-24 but it also had an unintended effect. The same decline persists in the adult cohort, which was never a target of the advisory or warnings. Luckily no increase in prescriptions of atypical antipsychotics or anxiolytics for depression was found. Psychotherapy increased significantly for adult, though not pediatric, cases.
Their newest invention is the Green Dam. The Green Dam censorship/spy software is mandated to be installed on all Chinese personal computers sold as of July 1, 2009. They say it is to protect Chinese adolescents from porn, but the fear is that it will be used as another censorship measure.
“We believe there should be an open and healthy dialogue on how parental control software can be offered in the market in ways that ensure privacy, system reliability, freedom of expression, the free flow of information, security and user choice,” read the statement, which was signed by groups including the Software & Information Industry Association and the Information Technology Industry Council, whose members include Lenovo, Dell, Apple and Hewlett-Packard.
Due to foreign pressure and also critique, the Chinese the government has announced that the software is not compulsory. Computer companies still have to hear anything different from the original directive in their discussions with the government. So the game may not be completely over. A blogger who downloaded the software was unable to view his satirical writings.
We examined the Green Dam software and found that it contains serious security vulnerabilities due to programming errors. Once Green Dam is installed, any web site the user visits can exploit these problems to take control of the computer. This could allow malicious sites to steal private data, send spam, or enlist the computer in a botnet. In addition, we found vulnerabilities in the way Green Dam processes blacklist updates that could allow the software makers or others to install malicious code during the update process.
On the positive side, the Green Dam has inspired graphic artists to make “the green dam girl” graphics.These graphics are created in the style of Japanese porno manga. This one on the top of this post is removing the underwear of “Windows XP Girl”. More graphics here and here.
The question remains whether the Green Dam is just another censorship measure easy to get round with all it’s dangers of it’s vulnerabilities or will the Chinese government improve and develop Green Dam to another way to control the Internet? What do you think?
The latest multi-core processors and some smart software allow techniques used by physicists and engineers to simulate the real world in extreme detail to be used to create virtual worlds governed by real physics, rather than the simplified versions used today.
The video above shows how the results are streets ahead of the standard graphics of today. One expert evens predicts that such techniques could be used to create Matrix-like virtual worlds indistinguishable from reality within just a few years.
Interested, read the whole article at NewScientist
Back again. Won’t bother you with the different wines tasted, oysters eaten, hotels and places visited. Just some extraordinary experiences during my vacation. The first is the visit to the Guggenheim Museum in Bilbao. Not for the permanent or temporary exhibitions but mainly the architecture of the museum the building itself. Except for the floor their is no straight line in the whole building. I checked it! Amazing. The main intention of the architect, Frank Gehry, was to incorporate the building in the landscape of the city and surroundings of Bilbao, in which he succeeded.
They only used glass, limestone and titanium for this building. The limestone was chosen to match the colors and facades of the surrounding. The glass is specially treated to protect the interior against heat and radiation. The titanium is half a millimetre thick.
The other peculiar phenomenon encountered was the drinking of cider or sidre as they call it in Asturias Spain. In Sidrerias this drink with low alcohol (3,5%) is poured in glasses in a most extraordinary way. Spanish sidre is poured in small amounts from above the head into a glass held at waist height. The waiter is not supposed to look at the bottle or glass but with a staring gaze out on the green hills. This aerates the still cider and improves the taste, but only if it’s drunk quickly before the bubbles subside. You have to drink the glass in one gulp. It generally splashes all over the floor, their hands, feet and the feet of anyone near them. Out of every bottle of cider, you’d be lucky to actually drink about a third. It’s cheap though. Here is a picture, she cheats.
The next three weeks Dr Shock is enjoying his vacation. Up to Spain. Posts will be scarce but will keep you updated when possible on this blog and twitter @DrShock
The field of placebo response with the use of devices as treatment for major depression is hardly researched. Herb one of my very much appreciated readers and commenter asked me about the evidence on the placebo response to devices for major depression, didn’t have an answer. Tried searching but to no effect until recent. A lot of devices such as treatment with Transcranial Magnetic Stimulation (rTMS), Vagus Nerve Stimulation (VNS) and transcranial direct current stimulation (tDCS) are under study for the treatment of depression, mostly treatment resistant depression.
rTMS studies are not optimal to say the least. The allocation to treatment arm is sometimes not mentioned,most of the randomized controlled trials are only single blind and a minority address the integrity of blinding, some of the trials only use completer analyses instead of intention to treat analyzes. For a recent update on the opinion of Dr Shock on rTMS for depression read a recent post on this blog: Transcranial Magnetic Stimulation Gains approval of the FDA for Depression.
In a recent meta analysis in PLoS Medicine they assessed the placebo response of escitalopram and perform an exploratory comparison with rTMS a non-pharmacological intervention trough a systematic review and meta-analysis of recent clinical trials of major depression.
The authors concluded:
We confirmed that placebo response in MDD is large regardless of the intervention and is associated with depression refractoriness and treatment combination (add-on rTMS studies). The magnitude of the placebo response seems to be related with study population and study design rather than the intervention itself.
Patients with severe depression and with treatment-resistant depression present a lower placebo response; while in trials that rTMS is as augmentation of an antidepressant drug, the placebo response is larger. More important the placebo-drug response appears to be larger than sham-rTMS response. This finding is contrary to conventional wisdom that sham devices would have a higher placebo response than placebo pills.
Drawback of this analysis is the difference in study population. In rTMS trials mostly treatment resistant depressed patients were included in contrast to the medication trial, the duration of the trials is shorter for rTMS trials, blinding in rTMS trials is mostly single blind, the rater doesn’t know the treatment condition. The authors used several statistic techniques to eliminate the influence of heterogeneity.
Why is this important?
I have always found it strange that such a new treatment should be tryed first on difficult to treat medication resistant depressed patients. The authors agree with me, in their meta-analyzes refractoriness is associated with a lower placebo response – and, in fact, a lower depression response. They suggest that since medication resistant depressed patients are very unresponsive to any intervention at all, rTMS studies should focus on non-refractory patients. At least future rTMS trials should quantify the degree of refractoriness of each patient. The placebo response is high in add-on rTMS trials – this could indicate there is a synergistic effect with the drug and, therefore, future trials could use a two-way factorial design (i.e., sham vs. real-rTMS and placebo vs. active drug) to address the relationship among rTMS and drug interventions.
Brunoni, A., Lopes, M., Kaptchuk, T., & Fregni, F. (2009). Placebo Response of Non-Pharmacological and Pharmacological Trials in Major Depression: A Systematic Review and Meta-Analysis PLoS ONE, 4 (3) DOI: 10.1371/journal.pone.0004824
Deep Brain Stimulation (DBS) should only be used when there is a high change that the lives of patients will be improved by its use and when all other possible interventions have been tried
Patients must be fully informed and informed consent must be obtained
The whole procedure should be done by teams of appropriate specialists like neurosurgeons, neurologist, psychiatrist and other health professionals that can help the patient before during and after the operation and who will continuously monitor the patient
The procedure should help restore (but not augment) normal function, should provide relief from pain and distress, and should never be used for law enforcement or for political or social purposes
It is important to provide follow-up for every patient enrolled in a trial if at all possible and to report the outcomes in scientific journals
These ethical guidelines were recently published in the JAMA and I fully agree with these guidelines. The article starts with a brief description of DBS, it’s complications and a short history of the lessons from past errors of psychosurgery.
Important lessons from the abuses of psychosurgery in the last century make it imperative to have solid hypotheses with strong scientific support and appropriate safeguards (eg, interdisciplinary review boards) before proceeding to treat patients using DBS.
Using these guidelines with the recent technological advances DBS can perhaps help a lot of patients in the near future.
Kringelbach, M., & Aziz, T. (2009). Deep Brain Stimulation: Avoiding the Errors of Psychosurgery JAMA: The Journal of the American Medical Association, 301 (16), 1705-1707 DOI: 10.1001/jama.2009.551
