How can we teach EBM in clinical practice? : an analysis of barriers to implementation of on-the-job EBM teaching and learning.

Introduction: Evidence-based medicine (EBM) improves the quality of health care. Courses on how to teach EBM in practice are available, but knowledge does not automatically imply its application in teaching. We aimed to identify and compare barriers and facilitators for teaching EBM in clinical practice in various European countries. Methods: A questionnaire was constructed listing potential barriers and facilitators for EBM teaching in clinical practice. Answers were reported on a 7-point Likert scale ranging from not at all being a barrier to being an insurmountable barrier. Results: The questionnaire was completed by 120 clinical EBM teachers from 11 countries. Lack of time was the strongest barrier for teaching EBM in practice (median 5). Moderate barriers were the lack of requirements for EBM skills and a pyramid hierarchy in health care management structure (median 4). In Germany, Hungary and Poland, reading and understanding articles in English was a higher barrier than in the other countries. Conclusion: Incorporation of teaching EBM in practice faces several barriers to implementation. Teaching EBM in clinical settings is most successful where EBM principles are culturally embedded and form part and parcel of everyday clinical decisions and medical practice.

External beam radiotherapy ± chemotherapy in the treatment of anal canal cancer: a single-institute long-term experience on 100 patients.

One-hundred patients treated with curative radiotherapy (RT) ± chemotherapy (CT) for an anal canal carcinoma (T1-4N0-3M0) were retrospectively analyzed. Five- and 10-year local control (LC) rates were 73% and 67%, respectively. Acute and late G3-G4 toxicity rates were 32% and 12%, respectively. Two patients underwent a colostomy for a G4 anal toxicity. This study confirms the outcomes of RT ± CT in the treatment of anal canal cancer. Concomitant CT and LC statistically influenced Overall Survival and Colostomy-Free Survival. CT also statistically reduced the risk of nodal relapse. High rates of acute skin toxicity impose tailored volumes and techniques of irradiation.

Renal arteries: navigator-gated balanced fast field-echo projection MR angiography with aortic spin labeling: initial experience.

A cardiac-triggered free-breathing three-dimensional balanced fast field-echo projection magnetic resonance (MR) angiographic sequence with a two-dimensional pencil-beam aortic labeling pulse was developed for the renal arteries. For data acquisition during free breathing in eight healthy adults and seven consecutive patients with renal artery disease, real-time navigator technology was implemented. This technique allows high-spatial-resolution and high-contrast renal MR angiography and visualization of renal artery stenosis without exogenous contrast agent or breath hold. Initial promising results warrant larger clinical studies.

[Illustrations de Faust] / J.P. Laurens, dess. ; Champollion, grav. ; J.W. von Goethe, aut. du texte

Comprend : [Portrait en frontispice : portrait de l'auteur, Goethe.] Goethe, d'après le tableau de May (1779). [Cote : 4 ° Yh 6/Microfilm R 122282] ; [Vignette à la page de titre : marque d'imprimeur avec devise et initiales.] Pictoribus atque Poetis. Occupa Portum. D.J. [Cote : 4 ° Yh 6/Microfilm R 122282] ; [pl. en reg. du Prologue p.11 : dans le ciel, l'archange Gabriel et Méphistophélès.] Prologue. Faust. [Cote : 4 ° Yh 6/Microfilm R 122282] ; [pl. en reg. p.52. : Faust dans son cabinet d'étude avec son chien Barbet qui grandit et gonfle, habité par Méphistophélès.] Le barbet. Faust. [Cote : 4 ° Yh 6/Microfilm R 122282] ; [pl. en reg. p.102 : Faust dans la cuisine de la sorcière, devant un chaudron, ayant la vision d'une femme nue.] La vision. Faust. [Cote : 4 ° Yh 6/Microfilm R 122282] ; [pl. en reg. p.141 : Marguerite et Faust se promènent dans un jardin. Au loin, Marthe et Méphistophélès.] Le jardin. Faust. [Cote : 4 ° Yh 6/Microfilm R 122282] ; [pl. en reg. p.214 : Faust rejoint Marguerite dans son cachot.] La prison. Faust. [Cote : 4 ° Yh 6/Microfilm R 122282] ; [pl. en reg. p.222 : Marguerite, ayant sauvé son âme, est présentée par l'archange Gabriel à Dieu. Elle tient dans ses bras son fils mort, noyé.] Epilogue. Faust. [Cote : 4 ° Yh 6/Microfilm R 122282]

New York versus la tragedia y Edipo. El legado sofocleo -y sofístico- en Crimes and Misdemeanors de W. Allen

Más allá de la referencia explícita a la tragedia griega y Edipo, el objetivo de este artículo es presentar la estrecha relación, en opinión del autor, entre lo que mantienen los protagonistas en Crimes and Misdemeanors y las teorías de los sofistas griegos sobre Dios, la ley, etc. Una confrontación minuciosa de sus textos con el guión de la película revela claramente unas raíces sofísticas que no pueden ser atribuidas, en este caso, a la presencia constante del legado judío en la obra de W. Allen.

New York versus la tragedia y Edipo. El legado sofocleo -y sofístico- en Crimes and Misdemeanors de W. Allen

Más allá de la referencia explícita a la tragedia griega y Edipo, el objetivo de este artículo es presentar la estrecha relación, en opinión del autor, entre lo que mantienen los protagonistas en Crimes and Misdemeanors y las teorías de los sofistas griegos sobre Dios, la ley, etc. Una confrontación minuciosa de sus textos con el guión de la película revela claramente unas raíces sofísticas que no pueden ser atribuidas, en este caso, a la presencia constante del legado judío en la obra de W. Allen.

New York versus la tragèdia i Èdip. El llegat de Sòfocles -i dels sofistes- a Crimes and Misdemeanors de W. Allen

Més enllà de la referència explícita a la tragèdia grega i Èdip, l'objectiu d'aquest article és presentar l'estreta relació, en opinió del autor, entre allò que mantenen els protagonistes a Crimes and Misdemanors i les teories del sofistes grecs sobre Déu, la llei, etc. Una confrontació acurada dels seus textos amb el guió de la pel·lícula revela clarament unes arrels sofístiques que no poden ser atribuïdes, en aquest cas, a la constant presència del llegat jueu en l'obra de W. Allen.

Hydroxyapatite coatings grown by pulsed laser deposition with a beam of 355 nm wavelength

Calcium phosphate coatings, obtained at different deposition rates by pulsed laser deposition with a Nd:YAG laser beam of 355-nm wavelength, were studied. The deposition rate was changed from 0.043 to 1.16 /shot by modification of only the ablated area, maintaining the local fluence constant to perform the ablation process in similar local conditions. Characterization of the coatings was performed by scanning electron microscopy, x-ray diffractometry, and infrared, micro-Raman, and x-ray photoelectron spectroscopy. The coatings showed a compact surface morphology formed by glassy gains with some droplets on them. Only hydroxyapatite (HA) and alpha-tricalcium phosphate (alpha-TCP) peaks were found in the x-ray diffractograms. The relative content of alpha TCP diminished with decreasing deposition rates, and only HA peaks were found for the lowest rate. The origin of alpha TCP is discussed.