Clin Med
-
If the first two or three antiepileptic drugs used do not control epilepsy, there is little chance that subsequent medications will be effective. In individuals with refractory focal epilepsy, neurosurgery can have a 60-70% chance of bringing long-term remission and these cases should be referred to a specialised centre for evaluation. The standard evaluation includes clinical review, brain imaging with magnetic resonance imaging, recording of seizures with prolonged scalp electroencephalography (EEG) and video, neuropsychological and psychiatric assessments. ⋯ In some individuals further evaluation with functional imaging and intracranial EEG recordings may be necessary. The most commonly performed resective operation is an anterior temporal lobe resection to remove a sclerotic hippocampus, followed by lesionectomies and neocortical resections. Palliative manoeuvres, to reduce seizure frequency and severity include corpus callosotomy, subpial transection and vagal nerve stimulation.
-
Advantages of web-based learning (WBL) in medical education include overcoming barriers of distance and time, economies of scale, and novel instructional methods, while disadvantages include social isolation, up-front costs, and technical problems. Web-based learning is purported to facilitate individualised instruction, but this is currently more vision than reality. ⋯ Rather than trying to decide whether WBL is superior to or equivalent to other instructional media (research addressing this question will always be confounded), we should accept it as a potentially powerful instructional tool, and focus on learning when and how to use it. Educators should recognise that high fidelity, multimedia, simulations, and even WBL itself will not always be necessary to effectively facilitate learning.
-
This study evaluated a new six-point ordinal scale for measuring pain intensity. Seventy-two participants aged between 23 and 87 years rated the intensity of 'present pain' as well as remembered episodes of 'severe' and 'mild' pain on the scale of pain intensity (SPIN), a 10 cm visual analogue scale (VAS) and a 0-10 numeric scale, in random order. Retesting followed an intervening assessment. ⋯ Some found numbers easier to use whereas others found the SPIN more helpful. We conclude that the SPIN provides a valid measure of pain intensity in patients fully able to communicate their views and experiences. Investigation in patients with cognitive or communication impairments is now required.