In early May 2003, a small group of four, including three family physicians and a media person, visited various family medicine education and training facilities in Edmonton, Alberta, Canada. This paper is a brief discussion of what knowledge and insight was gained during this trip.
Alberta* ; Canada* ; Education ; Humans ; Physicians, Family

To enhance the accuracy for determining the precise localization, the findings of the compound nerve action potentials (CNAPs) of the common peroneal nerve (CPN) were investigated in patients with common peroneal mononeuropathy (CPM) in the knee, and the sural sensory nerve action potentials (SNAPs) were also analyzed. Twenty-five patients with CPM in the knee were retrospectively reviewed. The findings of the CNAPs of the CPN recorded at the fibular neck and the sural SNAPs were analyzed. The lesion was localized at the fibular head (abnormal CNAPs) and at or distal to the fibular head (normal CNAPs). Seven patients were diagnosed as having a lesion at or distal to the fibular neck, and 18 cases were diagnosed as having a fibular head lesion. The sural SNAPs were normal in all the cases of lesion at or distal to the fibular neck. Among 18 cases of fibular head lesion, the sural SNAPs were normal in 7 patients: two cases of conduction block and 5 cases of mild axon loss. Eleven patients showed abnormal sural SNAPs. Of those, 9 cases were severe axon loss lesions and 2 patients were diagnosed as having severe axon loss with conduction block. The recording of the CNAPs may enhance precise localization of CPM in the knee. Moreover, the sural SNAPs could be affected by severe axonal lesion at the fibular head.
Action Potentials ; Humans ; Peroneal Nerve/*physiopathology ; Peroneal Neuropathies/*physiopathology ; Sural Nerve/*physiopathology

Purpose: This study aimed to determine the effects of a 12-week metabolic syndrome BeHaS (Be Happy and Strong) program in elderly people with metabolic syndrome living alone, based on a community-based participatory research (CBPR). Methods: A nonequivalent control group pre-posttest design was used, and the participants were 43 elderly people living alone (experimental group 24, control group 19). The experimental group received a one-hour program per week and two individual health consultations during 12 weeks. The control group received two sessions about the metabolic syndrome and two individual health consultations. The effects of health behavior, blood pressure, blood sugar levels, abdominal circumference, triglycerides, and self-esteem were evaluated. The data were analyzed using the independent t-test and Mann-Whitney U test. Results: The health behavior with respect to the metabolic syndrome in the experimental group increased significantly (t = - 3.19, p = .002). Both diastolic blood pressure and abdominal circumference decreased in the experimental group (t = 2.00, p = .028 and t = 3.91, p < .001). No significant differences were observed between the groups in systolic blood pressure, fasting blood sugar levels, triglycerides, and self-esteem. Conclusion The 12-week metabolic syndrome BeHaS program using community resources improves the health of elderly people with metabolic syndrome living alone. Based on these findings, further studies on the effectiveness of the metabolic syndrome BeHaS program and the experiences of those who participated in the CBPR are warranted.

OBJECTIVE: To investigate the clinical applicability of the somatosensory evoked potentials (SEPs) study in early detection of diabetic neuropathy, and compare the results in different degrees of the disease. METHOD: The study was performed retrospectively with prospective data collection. The Toronto clinical scoring system was taken as well as nerve conduction study, needle electromyography, and SEPs study with median and posterior tibial nerve stimulations in thirty-eight diabetic patients and twenty non-diabetic adults. The subjects were divided into the non-neuropathy group and the neuropathy group, and the latter was divided into three subgroups (suspected, probable, and definite) according to the degree of neuropathy. Statistical analysis was performed with height and age-related correction of reference values of the latency of SEPs with posterior tibial nerve stimulation. RESULTS: The Toronto clinical scoring system showed concordance with the degree of the diabetic neuropathy (p<0.05, correlation coefficient=0.827). SEPs study with posterior tibial nerve stimulations showed statistically significant latency delay, not only in the neuropathy group, but also in the non-neuropathy group, compared with the non-diabetic group (p<0.05). Moreover, the latency delay was noted in proportion to the degree of the diabetic neuropathy within the neuropathy group. Interpretation of the data with height and age-corrected reference values of latency of posterior tibial SEPs had stronger correlation. CONCLUSION: The SEPs study is useful in the early diagnosis of diabetic neuropathy. However, application of the SEPs to clinical use needs to go through height and age correction.
Adult ; Data Collection ; Diabetic Neuropathies ; Early Diagnosis ; Electromyography ; Evoked Potentials, Somatosensory ; Humans ; Needles ; Neural Conduction ; Prospective Studies ; Reference Values ; Retrospective Studies ; Tibial Nerve

OBJECTIVE: To assess the usefulness of the somatosensory evoked potentials in correlating with various clinical features and in predicting the functional outcome in patients with stroke. METHOD: The subjects were 57 patients with first stroke. Somatosensory evoked potential study was performed at the time of transfer to the rehabilitation department. Data of somatosensory evoked potential with median and tibial nerve stimulations were obtained and classified as normal (group 1), abnormal (group 2), and no response group (group 3). Modified Barthel index (MBI), motor and sensory functions were evaluated at the time of transfer and discharge. RESULTS: MBI score was statistically different among the 3 groups based on the findings of median and tibial nerve SSEP at the time of transfer, but not different at the time of discharge. Motor function was statistically different among the 3 groups at the time of transfer and discharge. Sensory function was statistically different among the 3 groups at the time of transfer, but not different at the time of discharge. CONCLUSION: Even though SSEP study reflects the functional status of the patients and correlates well with the findings of brain image, it has limitation in predicting outcome of the patients with stroke.
Brain ; Evoked Potentials, Somatosensory* ; Humans ; Rehabilitation ; Sensation ; Stroke* ; Tibial Nerve

OBJECTIVE: To investigate the frequency of carpal tunnel syndrome (CTS) according to the severity of diabetic polyneuropathy. METHOD: Electrophysiologic study was performed in 456 patients (male 222, female 233, average age 58) with diabetes mellitus. Electrophysiologically diagnosed diabetic neuropathy was classified as suspected, probable or definite. CTS was also diagnosed both in cases with and without underlying diabetic peripheral neuropathy. The ANOVA test was used for statistical analysis. RESULTS: Out of 456 diabetic patients, 228 patients were diagnosed as diabetic peripheral neuropathy. The patients with diabetic neuropathy consisted of 107 cases (23.5%) of sus pected group, 95 cases (20.8%) of probable group and 26 cases (5.7%) of definite group. The frequencies of concomitant CTS were 49 cases (21.5%) in 228 diabetic patients without diabetic polyneuropathy, 31 cases (29%) in suspected group and 30 cases (31.6%) in probable group. These were statistically significant. However, only one case showed concomitant CTS in 26 cases of definite group. CONCLUSION: The frequency of CTS was higher in probable group compared to suspected group. However the frequency decreased in definite group because there is a difficulty in the differential diagnosis of two disease in the cases of advanced peripheral neuropathy.
Carpal Tunnel Syndrome* ; Diabetes Mellitus ; Diabetic Neuropathies* ; Diagnosis, Differential ; Female ; Humans ; Peripheral Nervous System Diseases

Background: To assess the normal retina of the pigeon eye using spectral domain optical coherence tomography (SD-OCT) and establish a normative reference. Methods: Twelve eyes of six ophthalmologically normal pigeons (Columba livia) were included. SD-OCT images were taken with dilated pupils under sedation. Four meridians, including the fovea, optic disc, red field, and yellow field, were obtained in each eye. The layers, including full thickness (FT), ganglion cell complex (GCC), thickness from the retinal pigmented epithelium to the outer nuclear layer (RPE-ONL), and from the retinal pigmented epithelium to the inner nuclear layer (RPE-INL), were manually measured. Results: The average FT values were significantly different among the four meridians (p < 0.05), with the optic disc meridian being the thickest (294.0 ± 13.9 µm). The average GCC was thickest in the optic disc (105.3 ± 27.1 µm) and thinnest in the fovea meridian (42.8 ± 15.3 µm). The average RPE-INL of the fovea meridian (165.5 ± 18.3 µm) was significantly thicker than that of the other meridians (p < 0.05). The average RPE-ONL of the fovea, optic disc, yellow field, and red field were 91.2 ± 5.2 µm, 87.7 ± 5.3 µm, 87.6 ± 6.5 µm, and 91.4 ± 3.9 µm, respectively. RPE-INL and RPE-ONL thickness of the red field meridian did not change significantly with measurement location (p > 0.05). Conclusions Measured data could be used as normative references for diagnosing pigeon retinopathies and further research on avian fundus structure.

Background: To assess the normal retina of the pigeon eye using spectral domain optical coherence tomography (SD-OCT) and establish a normative reference. Methods: Twelve eyes of six ophthalmologically normal pigeons (Columba livia) were included. SD-OCT images were taken with dilated pupils under sedation. Four meridians, including the fovea, optic disc, red field, and yellow field, were obtained in each eye. The layers, including full thickness (FT), ganglion cell complex (GCC), thickness from the retinal pigmented epithelium to the outer nuclear layer (RPE-ONL), and from the retinal pigmented epithelium to the inner nuclear layer (RPE-INL), were manually measured. Results: The average FT values were significantly different among the four meridians (p < 0.05), with the optic disc meridian being the thickest (294.0 ± 13.9 µm). The average GCC was thickest in the optic disc (105.3 ± 27.1 µm) and thinnest in the fovea meridian (42.8 ± 15.3 µm). The average RPE-INL of the fovea meridian (165.5 ± 18.3 µm) was significantly thicker than that of the other meridians (p < 0.05). The average RPE-ONL of the fovea, optic disc, yellow field, and red field were 91.2 ± 5.2 µm, 87.7 ± 5.3 µm, 87.6 ± 6.5 µm, and 91.4 ± 3.9 µm, respectively. RPE-INL and RPE-ONL thickness of the red field meridian did not change significantly with measurement location (p > 0.05). Conclusions Measured data could be used as normative references for diagnosing pigeon retinopathies and further research on avian fundus structure.

OBJECTIVE: To investigate the influence of a nasogastric tube (NGT) on swallowing simulated saliva in stroke patients. METHODS: Three groups of participants were enrolled into the study: group A (20 stroke patients with a NGT), a control group B (25 stroke patients without a NGT), and group C (25 healthy adults with no brain lesions or dysphagia). Participants swallowed 1 mL of water to simulate saliva. Patients in group A were tested twice: once with a NGT (group A1) and once after the NGT was removed (group A2). The distance of hyoid bone movement was measured by subtracting the shortest distance between the mandible and hyoid bone (S) from the distance at resting state (R) measured with ultrasonography. The degree of the movement was calculated by (R–S)/R. The trajectory area of hyoid bone movement (Area) and the interval between the beginning of hyoid bone movement and the moment of the shortest hyoid−mandible approximation (Interval) was calculated by a computer program. RESULTS: From group A: R–S and (R–S)/R of group A2 at 1.14±0.36 cm and 0.30±0.09 cm and were significantly greater than those of group A1 at 0.81±0.36 cm and 0.22±0.08 cm (p=0.009 and p=0.005). After removing the NGT as seen in group A2, R–S and (R–S)/R were improved to the level of those of group B at 1.20±0.32 cm and 0.30±0.09 cm (p=0.909 and p=0.997). The Area of group A2 was larger and the Interval of group A2 was shorter than those of group A1 though a comparison of these factors between A2 and A1 did not show a statistically significant difference. CONCLUSION: A NGT interferes with the movement of the hyoid bone when swallowing 1 mL of water in stroke patients though the movement is restored to normal after removing the NGT.
Adult ; Brain ; Deglutition Disorders ; Deglutition* ; Humans ; Hyoid Bone* ; Mandible ; Saliva ; Stroke* ; Ultrasonography* ; Water

Objective: Repetitive transcranial magnetic stimulation (rTMS) has contributed to increase in the remission rate for patients with major depressive disorder (MDD). However, current rTMS treatment is practically inconvenient because it requires daily treatment sessions for several weeks. Accelerated rTMS treatment is as efficient and safe for MDD patients as conventional rTMS. Methods: Fifty-one patients with MDD participated in this study; they were randomized into accelerated rTMS (n = 21), conventional rTMS (n = 22), and sham-treatment (n = 8) groups. The accelerated and conventional rTMS groups received 15 sessions for 3 days and 3 weeks, respectively. The sham-treatment group received 15 sham rTMS sessions for 3 days. Primary outcome was assessed using self-report and clinician-rated Korean Quick Inventory of Depressive Symptomatology (KQIDS-SR and KQIDS-C, respectively). Adverse effects were monitored using the Frequency, Intensity, and Burden of Side Effects Rating scale. Changes in depressive symptoms were compared among the three groups using mixed model analyses. Results: For the KQIDS-SR score, there was a significant main effect of “time” (F3,47 = 11.05, p < 0.001), but no effect of “group” (F2,47 = 2.04, p = 0.142), and a trend-level interaction effect of “group × time” (F6,47 = 2.26, p = 0.053). Improvement in depressive symptoms, based on the KQIDS-SR score 3 weeks after treatment, was more prominent in the accelerated rTMS group than in the sham-treatment group (p = 0.011). Tolerability was comparable among the three groups. Conclusion The accelerated rTMS treatment group showed rapid improvement of depressive symptoms compared with the sham-treatment and conventional rTMS treatment groups. Therefore, accelerated rTMS treatment could be a viable option for MDD, with improved accessibility.