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Selected AbstractsThe attitudes to ageing questionnaire (AAQ): development and psychometric propertiesINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2007K. Laidlaw Abstract Objective This paper describes the development of the Attitudes to Ageing Questionnaire (AAQ) which is a self-report measure with which older people themselves can express their attitudes to the process of ageing. Method The development of the AAQ followed a coherent, logical and empirical process taking full account of relevant gerontological knowledge and modern and classical psychometric analytical methods. Pilot testing with 1,356 participants from 15 centres worldwide refined the scale and provided the basis for a field test. A total of 5,566 participants from 20 centres worldwide contributed to the further development of this new scale with the derivation involving both classical and modern psychometric methods. Results The result is a 24-item cross-cultural attitudes to ageing questionnaire consisting of a three-factor model encompassing psychological growth, psychosocial loss, and physical change. The three-factor model suggests a way of conceptualizing and measuring successful ageing in individuals. Conclusions The AAQ provides researchers, clinicians and policy makers with a unique scale to measure the impact of successful ageing interventions. It also provides a vehicle for the measurement of how individuals age across cultures and under different economic, political and social circumstances. Copyright © 2006 John Wiley & Sons, Ltd. [source] TOWARD GREENER DIALYSIS: A CASE STUDY TO ILLUSTRATE AND ENCOURAGE THE SALVAGE OF REJECT WATERJOURNAL OF RENAL CARE, Issue 2 2010Andrew Connor MRCP SUMMARY Climate change is now considered to be a major global public health concern. However, the very provision of health care itself has a significant impact upon the environment. Action must be taken to reduce this impact. Water is a precious and finite natural resource. Vast quantities of high-grade water are required to provide haemodialysis. The reverse osmosis systems used in the purification process reject approximately two-thirds of the water presented to them. Therefore, around 250 litres of ,reject water' result from the production of the dialysate required for one treatment. This good quality reject water is lost-to-drain in the vast majority of centres worldwide. Simple methodologies exist to recycle this water for alternative purposes. We describe here a case study of the only UK renal service we know to have implemented such water-saving methodologies. We outline the benefits in terms of financial and environmental savings. [source] Isolated limb infusion: A reviewJOURNAL OF SURGICAL ONCOLOGY, Issue 2 2009Hidde M. Kroon MD Abstract Isolated limb perfusion is the preferred treatment option for locally advanced melanoma and sarcoma confined to a limb. This treatment results in high response rates with a satisfying duration of response in both tumours. A drawback of isolated limb perfusion, however, is the invasive and complex character of the procedure. Isolated limb infusion has been designed as a minimally invasive alternative to isolated limb perfusion. Treatment results of this simple technique, reported by various centres worldwide, show comparable response rates for melanoma and sarcoma. Therefore isolated limb infusion may replace isolated limb perfusion in the future as the preferred treatment option for these locally advanced limb tumours. J. Surg. Oncol. 2009;100:169,177. © 2009 Wiley-Liss, Inc. [source] Aspects of biopsy procedures prior to preimplantation genetic diagnosisPRENATAL DIAGNOSIS, Issue 9 2001Anick De Vos Abstract Today, preimplantation genetic diagnosis (PGD) is offered in over 40 centres worldwide for an expanded range of genetic defects causing disease. This very early form of prenatal diagnosis involves the detection of affected embryos by fluorescent in situ hybridization (FISH) (sex determination or chromosomal defects) or by polymerase chain reaction (PCR) (monogenic diseases) prior to implantation. Genetic analysis of the embryos involves the removal of some cellular mass from the embryos (one or two blastomeres at cleavage-stage or some extra-embryonic trophectoderm cells at the blastocyst stage) by means of an embryo biopsy procedure. Genetic analysis can also be performed preconceptionally by removal of the first polar body. However, additional information is then often gained by removal of the second polar body and/or a blastomere from the embryo. Removal of polar bodies or cellular material from embryos requires an opening in the zona pellucida, which can be created in a mechanical way (partial zona dissection) or chemical way (acidic Tyrode's solution). However, the more recent introduction of laser technology has facilitated this step enormously. Different biopsy procedures at different preimplantation stages are reviewed here, including their pros and cons and their clinical applications. The following aspects will also be discussed: safety of zona drilling by laser, use of Ca2+/Mg2+ -free medium for decompaction, and removal of one or two cells from cleavage-stage embryos. Copyright © 2001 John Wiley & Sons, Ltd. [source] COMPARISON OF INFECTION RATE USING DIFFERENT METHODS OF ASSESSMENT FOR SURVEILLANCE OF TOTAL HIP REPLACEMENT SURGICAL SITE INFECTIONSANZ JOURNAL OF SURGERY, Issue 7 2007Yoke-Fong Chiew Background: The surveillance of surgical site infections (SSI) has been undertaken in many centres worldwide to ascertain the extent of the problem and where possible, to improve the incidence rates, thereby decreasing the undesirable outcomes. The study investigates the processes and outcomes of total hip replacement SSI surveillance carried out in Dunedin Public Hospital in 2004. Methods: Two hundred and six patients were enlisted in the study and 189 primary replacements and 22 revision replacements were carried out. Four methods of diagnosis of SSI were applied: (i) clinician diagnosis; (ii) ASEPSIS score; (iii) presence of pus cells; and (iv) assessment by a clinical microbiologist. Infection rates were calculated according to the risk indexes. Results: The incidence of infections varies considerably among these four methods. The infection rates for risk index 0 were 4.35% (method 1), 2.61% (method 2), 0.87% (methods 3 and 4); and for risk indexes 1 and 2 were 4.17% (method 1), 2.08% (method 2), 1.04% (methods 3 and 4). Conclusion: There is a need for accurate infection data so that the appropriate follow-up responses, including infection control measures for total hip replacement SSI can be carried out. The preponderance of elderly patients in the study who are frequently on ,polypharmacy' regimens adds pressure to the need to obtain true infection rates. This is because when antimicrobials are prescribed to them, drug interactions, adverse effects of the antimicrobials and the selective pressure of antimicrobials causing resistances may occur. More resources and a multidisciplinary approach are required for future studies of similar nature. [source] Management of the axilla in early breast cancer: is it time to change tack?ANZ JOURNAL OF SURGERY, Issue 4 2000Philip Crowe The standard surgical treatment of the axilla in patients with early breast cancer is about to undergo a radical change. Although axillary dissection is an excellent procedure for both staging and local control, particularly in the clinically positive axilla, it has considerable morbidity and may understage a significant proportion of patients, because it will usually miss micrometastases that can occur in approximately 10% of ,node negative' patients. An increasing number of patients whose tumours are either non-invasive (ductal carcinoma in situ; DCIS), micro-invasive, tubular cancers or low-grade T1a tumours without lymphovascular invasion may be spared axillary surgery because the risk of axillary disease is 0,3%. Many studies, both prospective trials and large retrospective series, show that axillary radiotherapy alone provides similar local control rates to axillary dissection in patients with clinically negative axillas. Primary treatment of the axilla with radiotherapy alone, however, does not allow appropriate staging. Sentinel lymph node biopsy is being increasingly used in patients with breast cancer to provide this information. When a sentinel node is identified it is equal to or better than axillary dissection for staging the axilla and, if the node is positive, it will help select patients who should then proceed to further axillary surgery or axillary radiotherapy. Although sentinel lymph node biopsy is being rapidly adopted in many centres worldwide, the results of randomized controlled trials are needed before it can be recommended as the standard of care. [source] Positive pressure ventilation at neonatal resuscitation: review of equipment and international survey of practiceACTA PAEDIATRICA, Issue 5 2004CPF O'Donnell Background: The equipment used to provide positive pressure ventilation to newborns needing resuscitation at delivery varies between institutions. Devices were reviewed and their use surveyed in a sample of neonatal centres worldwide. Aim: To determine which equipment is used to resuscitate newborns at delivery in a sample of teaching hospitals around the world. Methods: A questionnaire was sent via e-mail to a neonatologist at each of 46 NICUs in 23 countries on five continents, asking which resuscitation equipment they used. If it was not returned, follow-up was by e-mail. Results: Data were obtained from 40 (87%) centres representing 19 countries. Round face masks are used at 34 (85%) centres, anatomically shaped masks are used exclusively at six (15%) and a mixture of types are used at 11 (28%). Straight endotracheal tubes are used exclusively at 36 (90%) centres; shouldered tubes are used infrequently at three of the four centres that have them. The self-inflating bag is the most commonly used manual ventilation device (used at 33 (83%) centres), the Laerdal Infant Resuscitator± the most popular model. Flow-inflating bags are used at 10 (25%) centres. The Neopuff Infant Resuscitator± is used at 12 (30%) centres. Varying oxygen concentrations are provided during neonatal resuscitation at half of the centres, while 100% oxygen is routinely used at the other half. Conclusions: This survey shows considerable variation in practice, reflecting this lack of evidence and consequent uncertainty among clinicians. Comparison of the two most popular manual ventilation devices, the Laerdal Infant Resuscitator and the Neopuff Infant Resuscitator, is urgently required. [source] | ||||||||||