Criteria for evaluating a computer aid to clinical reasoning

The acceptance or rejection of computer aids to clinical reasoning is determined not only by the preferences and prejudices of potential users, but also by whether the output generated by the computer aid represents sound clinical judgment. This paper deals with the issue of the appropriate criteria for evaluating the clinical 'reasoning' of computer aids. Evaluation of a computer aid should include an assessment of the accuracy or appropriateness of its conclusions and an assessment of the scope of its considerations. In order to use a conclusion generated by a computer aid as a basis for clinical action, information must be available on the alternative conclusions that might have been drawn, the degree of confidence in each conclusion, and the consequences that may result from acting upon the wrong conclusion. If this information is not generated as part of the output of a computer aid, it may be obtained through the use of its explanation and display capabilities, if the aid has such capabilities. Explanation and display capabilities permit the examination of the operations of the computer aid. Examination of a computer's operations is also the most feasible means to evaluate the soundness of its 'reasoning'.

Activity of isotretinoin against squamous cell cancers and preneoplastic lesions

We investigated the effect of the synthetic vitamin A derivative isotretinoin (13-cis-retinoic acid) on advanced cancers in 103 patients and on preneoplastic lesions in five patients. Six of 14 patients with squamous cell epithelial cancers had objective regressions of skin or subcutaneous metastases. Three of five patients with preneoplastic lesions had objective responses. The major dose-limiting toxic effects were reversible dermatitis, emotional lability, and headaches. We conclude that the growth of some squamous cell epithelial malignancies can be inhibited by isotretinoin and suggest that other retinoids should be evaluated as antitumor agents.

A language-cultural course for foreign psychiatric residents

Foreign medical graduates are an important component of the health care system in the United States. All foreign medical graduates have acculturation problems, but they are especially aggravating among foreign psychiatric residents. These difficulties affect the personal lives of the foreign residents as well as crucial teacher-student and doctor-patient relationships. The authors report on an effort to further define these problems in a residency program and their systematic attempts to solve them by offering a special course. The program they describe benefitted not only the foreign residents but their families and the residency program itself.

Verbal conditioning of male and female schizophrenics as a function of experimenter proximity

Verbal conditioning of male and female schizophrenics and nonschizophrenics was observed as Ss sat at different distances and orientations from an E who delivered a positive word/positive tone reinforcer ("Good"). Results indicated that the presence vs. absence of diagnostic differences in learning depended on (a) the sex of the Ss; and (b) the distance that Ss sat from the E. The absence of overall diagnostic group differences in learning and the finding that in some proxemic conditions schizophrenics learned more than nonschizophrenics are consistent with the view that under appropriate conditions schizophrenics emit behaviors that are incompatible with an assumption of schizophrenic deficit.

General practitioners in the Western Metropolitan Health Region of Sydney

A comprehensive survey of the number of general practitioners in the Western Metropolitan Health Region of Sydney identified 753 general practitioners with one or more practice locations in the region; this was the equivalent of 711 full-time general practitioners, and represented a general practitioner-population ratio of 1:1533.

Stimulation of gastric inhibitory polypeptide in normal and duodenal ulcer patients

To investigate the role of gastric inhibitory polypeptide (GIP), a potent inhibitor of gastric acid secretion, in the hypersecretion associated with duodenal ulcer, we compared the serum GIP concentrations in 11 healthy subjects and 16 duodenal ulcer patients after the stimulation of GIP release by a mixed meal. Fasting and postprandial serum gastrin and GIP concentrations were measured by radioimmunoassay at frequent intervals after the ingestion of a test meal. The duodenal ulcer patients showed an augmented and significantly greater release of GIP as well as of gastrin compared to normal subjects. These results indicate that a defective GIP release cannot account for the gastric hypersecretion seen in patients with duodenal ulcer. The mechanism of the increased GIP response in patients with duodenal ulcer is not clear from these studies.

Evolution of treatment of paralytic scoliosis at Rancho Los Amigos Hospital

Between 1954 and 1970, 351 patients with severe paralytic scoliosis were treated at Rancho Los Amigos Hospital. During this time the treatment evolved through five stages: body cast alone, halo cast, halo cast with buttons and traction wires, Harrington instrumentation, and finally preoperative halo-femoral traction and Harrington instrumentation. Coincident with this evolution, correction improved from 20 to 57 per cent, the incidence of curve progression dropped from 38 to 0 per cent, and curve extension decreased from 25 to 0 per cent, while postoperative recumbency was reduced from one year to about three weeks. In addition, complications changed, in general decreasing except for the rate of pseudarthrosis, which remained essentially the same. Clinically significant hyperlordosis involving the thoracic and lumbar spine was seen in sixteen patients who had long fusions from the fourth cervical vertebra and above to the fourth lumbar vertebra or the sacrum.