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1 We conducted an overview and quantitative meta-analysis of all experimental literature on the protective effects of serial agitated dilutions (SADs) of toxin preparations. 2 Articles were systematically collected and evaluated for scientific quality using pre-defined methodological criteria and then independently analysed for validity. 3 We found 105 publications exploring the effects of SAD preparations in toxicological systems. 4 The quality of evidence in these studies was low with only 43% achieving one half of the maximum possible quality score and only 31 % reported in a fashion that permitted reevaluation of the data. 5 Very few studies were independently replicated using comparable models. 6 Among the high quality studies, positive effects were reported 50% more often than negative effects. 7 Four of 5 outcomes meeting quality and comparability criteria for meta-analysis showed positive effects from SAD preparations. 8 Average percent protection over controls in these preparations was 19.7 (95%Cl 6.2-33.2). 9 Further research with special attention to methodological detail and independent replicafion should be done.

Under both normal and pathophysiological conditions the relationship between bony histology and the regionally associated vascular pattern was studied. Three independent methods of research were employed (microangiography, fuchsin stained ground sections, polychrome sequential labeling) and, thus, the limitations inherent in each method were minimized. Animals of different ages and different species were found to have relatively different amounts of primary and secondary bone. In all instances primary bone was associated with a network vascular pattern emanating from the periosteal surface and secondary bone was associated with an arborial vascular pattern arising from the endosteal circulation. Adult dogs, unlike sheep, were found to have a significant complement of secondary bone and, therefore, in consideration of human bony regeneration, the dog is a superior experimental model.

The aim of this paper was to examine all studies that compared operative and conservative treatment of anterior cruciate ligament (ACL) rupture. Covering a period of 22 years all relevant articles were retrieved from the medical databases Medline, Embase, and Cochrane. The results of these studies were judged on to the criteria of subjective stability (giving-way phenomenon), objective stability (pivot shift test), and return to the preinjury level of sports. There were 11 different studies published in 16 articles consisting of 2 randomized,2 prospective, and 7 retrospective trials. Except in one study the results in the operative groups were always better than in the conservative groups. The meta-analysis of both randomized studies showed significant advantages for the operative treatment. Although arthroscopic ligament plasty is an established standard method for the treatment of ACL rupture, there is almost no basis for this procedure in the literature.Thus,new clinically applicable studies are necessary to develop objective guidelines for the treatment of anterior cruciate ligament tears.

Medicine has evolved toward rationalization since the Enlightenment, favouring quantitative measures. Now, a paradigm shift toward control through formalization can be observed in health care whose structures and processes are subjected to increasing standardization. However, educational reforms and curricula do not yet adequately respond to this shift. The aim of this article is to describe innovative approaches in medical education for adapting to these changes. The study design is a descriptive case report relying on a literature review and on a reform project's evaluation. Concept mapping is used to graphically represent relationships among concepts, i.e. defined terms from educational literature. Definitions of 'concept map', 'guideline' and 'algorithm' are presented. A prototypical algorithm for organizational decision making in the project's instructional design is shown. Evaluation results of intrinsic learning motivation are demonstrated: intrinsic learning motivation depends upon students' perception of their competence exhibiting path coefficients varying from 0.42 to 0.51. Perception of competence varies with the type of learning environment. An innovative educational format, called 'evidence-based learning (EBL)' is deduced from these findings and described here. Effects of formalization consist of structuring decision making about implementation of different learning environments or about minimizing variance in teaching or learning. Unintended effects of formalization such as implementation problems and bureaucracy are discussed. Formalized tools for designing medical education are available. Specific instructional designs influence students' learning motivation. Concept maps are suitable for controlling educational quality, thus enabling the paradigm shift in medical education.