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Acceptable Alternative (acceptable + alternative)
Selected AbstractsReliability and validity of a structured interview guide for the Hamilton Anxiety Rating Scale (SIGH-A)DEPRESSION AND ANXIETY, Issue 4 2001M. Katherine Shear M.D. Abstract The Hamilton Anxiety Rating Scale, a widely used clinical interview assessment tool, lacks instructions for administration and clear anchor points for the assignment of severity ratings. We developed a Structured Interview Guide for the Hamilton Anxiety Scale (SIGH-A) and report on a study comparing this version to the traditional form of this scale. Experienced interviewers from three Anxiety Disorders research sites conducted videotaped interviews using both traditional and structured instruments in 89 participants. A subset of the tapes was co-rated by all raters. Participants completed self-report symptom questionnaires. We observed high inter-rater and test-retest reliability using both formats. The structured format produced similar but consistently higher (+ 4.2) scores. Correlation with a self-report measure of overall anxiety was also high and virtually identical for the two versions. We conclude that in settings where extensive training is not practical, the structured scale is an acceptable alternative to the traditional Hamilton Anxiety instrument. Depression and Anxiety 13:166,178, 2001. © 2001 Wiley-Liss, Inc. [source] Non-urgent presentations to a paediatric emergency department: Parental behaviours, expectations and outcomesEMERGENCY MEDICINE AUSTRALASIA, Issue 5-6 2005Mary Ryan Abstract Objectives:, To identify factors that influence the attendance of children with non-urgent medical problems to a tertiary paediatric ED and to define parental expectations of the hospital visit. Methods:, A questionnaire administered to a convenience sample of 200 parents/carers who attended the paediatric ED and whose children were categorized as having non-urgent problems that had been present for at least 4 weeks. Subsequent outpatient attendances were then analysed retrospectively. Results:, Most patients had visited a general practitioner but remained unhappy with the outcome of the consultation. The hospital was expected to provide immediate diagnosis and initiate appropriate treatment by the vast majority of parent. Only four patients required admission. Conclusions:, The expectations of parents who attend the paediatric ED with children who have non-urgent chronic complaints are high. Rapid access to outpatient clinics might provide an acceptable alternative for these patients, and free valuable ED resources. [source] The Effects of Non-Contingent Self-Restraint on Self-InjuryJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 2 2009Denise Marzullo Kerth Background, Self-restraint is a pervasive phenomenon among individuals who engage in self-injurious behaviour (SIB). Materials and Methods, The present study examined the use of clothing as a socially acceptable alternative to self-restraint to reduce SIB and other topographies of self-restraint in an adolescent diagnosed with autism. Two separate functional analyses were conducted for SIB prior to the self-restraint evaluation. A reversal design was then used to evaluate the effect of non-contingent access to a hooded sweatshirt on rates of self-restraint and SIB. Results, Both functional analyses suggested that SIB was maintained by access to tangible items, attention, and perhaps also by escape from demands. The results of the self-restraint evaluation indicated that when access to a hooded sweatshirt was provided, rates of other topographies of self-restraint dropped to zero and rates of SIB were reduced by 54% from baseline levels. Conclusions, These results highlight the idiosyncratic relationship between SIB and self-restraint and suggest that systematic evaluations of this relationship may lead to reductions in both behaviours. [source] Catheter Closure of Coronary Artery FistulasJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2001SHAKEEL A. QURESHI F.R.C.P. Coronary artery fistulas are rare and vary widely in their morphological appearance and presentation. This paper presents experience of catheter closure of coronary artery fistulas in 40 patients. Catheter closure was performed with a variety of techniques, including detachable balloons, stainless steel coils, controlled-release coils, controlled-release patent ductus arteriosus (PDA) coils, and Amplatzer PDA plug. The vast majority of the fistulas were occluded with coils and in particular, controlled-release coils. Successful occlusion of the fistula was achieved in 39 (97%) of 40 patients. In one patient, the detachable balloon deflated prematurely and the patient underwent elective surgery. One 4-month-old infant died approximately 6 hours after the procedure. Immediate occlusion of the coronary artery fistula occurred in 33 (82%) of patients and late occlusion in 4 patients. Thus overall, total occlusion was achieved in 37 (97%) of 39 patients. The main complication was embolization of the occlusion device, which occurred in 6 (17%) of cases. In one of these cases, a detachable balloon deflated prematurely, and in five patients, coils embolized and were retrieved. In one of the patients, all six coils embolized 24 hours after the procedure but were retrieved, and further coils were implanted successfully. Controlled-release coils have made an important contribution to the technique of catheter closure of coronary artery fistulas. Catheter closure of these fistulas is an acceptable alternative to the standard surgical treatment. [source] Comparison of the effects of intravenously and orally administered esomeprazole on acid output in patients with symptoms of gastro-oesophageal reflux diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2005D. C. METZ Summary Background :,Intravenous esomeprazole may be beneficial for patients who cannot take oral medications. Aim :,To compare intravenous esomeprazole with oral esomeprazole for effects on maximal acid output during pentagastrin stimulation in patients with gastro-oesophageal reflux disease symptoms. Methods :,In four separate open-label, randomized, two-way crossover studies, adult patients were administered esomeprazole 20 or 40 mg once daily either orally or intravenously (by 15-min infusion or 3-min injection) for 10 days and switched to the other formulation with no washout period. Basal acid output and maximal acid output were measured on days 11, 13 and 21. Results :,In the four studies (total of 183 patients), least-squares mean maximal acid output ranged from 3.0 to 4.1 mmol/h after intravenous esomeprazole 40 or 20 mg and from 2.2 to 3.3 mmol/h after oral esomeprazole 20 or 40 mg. Differences between formulations were small and not statistically significant but did not meet the prospectively defined criterion for non-inferiority of the intravenous formulation. Median basal acid output values ranged from 0.04 to 0.27 mmol/h after intravenous administration and from 0.05 to 0.25 mmol/h after oral esomeprazole. Conclusions :,Intravenous esomeprazole is an acceptable alternative to the oral formulation for treatment of up to 10 days of duration. [source] A randomised crossover trial comparing the i-gel supraglottic airway and classic laryngeal mask airway,ANAESTHESIA, Issue 6 2009C. Janakiraman Summary In a randomised cross-over study, we compared the performance of the single use i-gel supraglottic airway and reusable classic laryngeal mask airway (cLMATM) in 50 healthy anaesthetised patients who were breathing spontaneously. Primary outcome was successful insertion at first attempt. Secondary outcomes included overall insertion success rate, ease of insertion, leak pressure and fibreoptic position. Success rate for insertion at the first attempt was significantly different (54% with i-gel vs 86% with cLMA; p = 0.001). Overall success after two attempts (when the anaesthetist was allowed to change the size of the device) improved to 84% with i-gel vs 92% with cLMA; p = 0.22. In 14 patients, the i-gel when used first needed to be replaced with a larger size. Leak pressure was higher for the i-gel (median [IQR] 20 [14,24] cm H2O than the cLMA 17 [12,22] cm H2O; p = 0.023). The fibreoptic view through the device was significantly better with the i-gel than the cLMA, which was statistically significant (p = 0.03). We conclude that, with its current sizing recommendations, the i-gel is not an acceptable alternative to cLMA. However because of the significantly improved success rate after a larger sized i-gel was used, we recommend the manufacturer to review the sizing guidelines to improve the success rate. [source] Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic regionANZ JOURNAL OF SURGERY, Issue 11 2004Tahsin Colak Background: Because controversy still continuous to surround use of total thyroidectomy for the management of benign multinodular goiter, the present study aims to prospectively compare the safety and efficacy of total thyroidectomy with subtotal thyroidectomy. Methods: A total of 200 consecutive patients with benign multinodular goiter were assigned to have either total thyroidectomy (n = 105) or subtotal thyroidectomy (n = 95) based on preoperative evaluation, intraoperative macroscopic findings and nodular dissemination. The patients with no healthy tissue or nodules localized in the dorsal part of the gland, which are usually left during normal subtotal resection, were assigned to the total thyroidectomy group. Demographic details, biochemical findings, indications for operation, operating time, specimen weight, complications and hospital stay were noted. Results: There was no significant difference in the sex, hormonal status or duration of goiter between the two groups (P = 0.74, P = 0.59 and P = 0.59, respectively). The mean operating time was longer (148.52 min ± 51.10 vs 135.10 min ± 32.47, P = 0.03), and the mean weight of the specimens was greater (228.40 g ± 229.91 vs 157.01 g ± 151.23, P = 0.01) for total rather than subtotal thyroidectomy. Either temporary recurrent laryngeal nerve (RLN) palsy or hypoparathyroidism occurred in 10 (9.3%) or 12 (11.4%) of the patients undergoing total compared with six (6.3%) or nine (9.5%) of the patients undergoing subtotal thyroidectomy (P = 0.40 and P = 0.65, respectively). Either permanent RLN palsy or hypoparathyroidism was observed in one patient undergoing total thyroidectomy (P = 0.34 for each comparison). The mean hospital stay was longer in the total thyroidectomy group (2.24 days ± 1.18 vs 1.89 days ± 0.72 for subtotal thyroidectomy, P = 0.01). Conclusions: The present study shows that total thyroidectomy can be performed without increasing risk of complication, and it is an acceptable alternative for benign multinodular goiter, especially in endemic regions, where patients present with a huge multinodular goiter. [source] Video as an Effective Method to Deliver Pretest Information for Rapid Human Immunodeficiency TestingACADEMIC EMERGENCY MEDICINE, Issue 2 2009Roland C. Merchant MD Abstract Objectives:, Video-based delivery of human immunodeficiency virus (HIV) pretest information might assist in streamlining HIV screening and testing efforts in the emergency department (ED). The objectives of this study were to determine if the video "Do you know about rapid HIV testing?" is an acceptable alternative to an in-person information session on rapid HIV pretest information, in regard to comprehension of rapid HIV pretest fundamentals, and to identify patients who might have difficulties in comprehending pretest information. Methods:, This was a noninferiority trial of 574 participants in an ED opt-in rapid HIV screening program who were randomly assigned to receive identical pretest information from either an animated and live-action 9.5-minute video or an in-person information session. Pretest information comprehension was assessed using a questionnaire. The video would be accepted as not inferior to the in-person information session if the 95% confidence interval (CI) of the difference (,) in mean scores on the questionnaire between the two information groups was less than a 10% decrease in the in-person information session arm's mean score. Linear regression models were constructed to identify patients with lower mean scores based upon study arm assignment, demographic characteristics, and history of prior HIV testing. Results:, The questionnaire mean scores were 20.1 (95% CI = 19.7 to 20.5) for the video arm and 20.8 (95% CI = 20.4 to 21.2) for the in-person information session arm. The difference in mean scores compared to the mean score for the in-person information session met the noninferiority criterion for this investigation (, = 0.68; 95% CI = 0.18 to 1.26). In a multivariable linear regression model, Blacks/African Americans, Hispanics, and those with Medicare and Medicaid insurance exhibited slightly lower mean scores, regardless of the pretest information delivery format. There was a strong relationship between fewer years of formal education and lower mean scores on the questionnaire. Age, gender, type of insurance, partner/marital status, and history of prior HIV testing were not predictive of scores on the questionnaire. Conclusions:, In terms of patient comprehension of rapid HIV pretest information fundamentals, the video was an acceptable substitute to pretest information delivered by an HIV test counselor. Both the video and the in-person information session were less effective in providing pretest information for patients with fewer years of formal education. [source] Comparison of copper heptonate with copper oxide wire particles as copper supplements for sheep on pasture of high molybdenum contentAUSTRALIAN VETERINARY JOURNAL, Issue 10 2002GJ JUDSON Objective To assess the effectiveness of intramuscular injection of copper heptonate (CuHep) and an oral dose of copper oxide wire particles (COWP) in preventing Cu inadequacy in adult and young sheep on pasture of high Mo content. Design Field experiments with flocks of mature Merino wethers and crossbred weaners. Procedure Adult wethers were given 25 or 37.5 mg Cu as CuHep, 2.5 g COWP or no Cu treatment. The weaners were given 12.5 or 25 mg Cu as CuHep, 1.25 g COWP or no Cu treatment. At intervals over the next 12 (adults) or 8 (weaners) months the sheep were weighed and samples of blood and liver were collected for trace element assay. Wool samples collected from the adults at the end of the experiment were assessed for physical characteristics. Results The higher dosage of CuHep raised liver Cu above control group values for at least 9 months in adults and 3 months in weaners. The lower dosage of CuHep was similarly effective for 3 months in adults but was without effect in weaners. In adults the response to COWP matched that to the higher dosage of CuHep; in weaners it was greater, lasting at least 5 months. No changes indicative of Cu deficiency, apart from a depressed body weight in adults, were seen. Conclusions In sheep on pasture of high Mo content a single intramuscular injection of CuHep providing 37.5 mg Cu to adults or 25 mg Cu to weaners will raise liver Cu reserves for at least 9 and 3 months respectively and may be an acceptable alternative to COWP for preventing seasonal Cu deficiency in sheep in southern Australia. [source] Breast radiation therapy guideline implementation in low- and middle-income countries,CANCER, Issue S8 2008Nuran Senel Bese MD Abstract Radiation therapy plays a critical role in the management of breast cancer and often is unavailable to patients in low- and middle-income countries (LMCs). There is a need to provide appropriate equipment and to improve the techniques of administration, quality assurance, and use of resources for radiation therapy in LMCs. Although the linear accelerator is the preferred equipment, telecobalt machines may be considered as an acceptable alternative in LMCs. Applying safe and effective treatment also requires well trained staff, support systems, geographic accessibility, and the initiation and completion of treatment without undue delay. In early-stage breast cancer, standard treatment includes the irradiation of the entire breast with an additional boost to the tumor site and should be delivered after treatment planning with at least 2-dimensional imaging. Although postmastectomy radiation therapy (PMRT) has demonstrated local control and overall survival advantages in all patients with axillary lymph node metastases, preference in limited resource settings could be reserved for patients who have ,4 positive lymph nodes. The long-term risks of cardiac morbidity and mortality require special attention to the volume of heart and lungs exposed. Alternative treatment schedules like hypofractionated radiation and partial breast irradiation currently are investigational. Radiation therapy is an integral component for patients with locally advanced breast cancer after initial systemic treatment and surgery. For patients with distant metastases, radiation is an effective tool for palliation, especially for bone, brain, and soft tissue metastases. The implementation of quality-assurance programs applied to equipment, the planning process, and radiation treatment delivery must be instituted in all radiation therapy centers. Cancer 2008;113(8 suppl):2305,14. © 2008 American Cancer Society. [source] A medium-term rat liver bioassay for rapid in vivo detection of carcinogenic potential of chemicalsCANCER SCIENCE, Issue 1 2003Nobuyuki Lto A reliable medium-term bioassay system for rapid detection of carcinogenic potential of chemicals in the human environment has been developed. The 8-week-protocol consists of 2 stages; male F344 rats are given a single intraperitoneal injection of diethylnitrosamine (200 mg/kg) for initiation of liver carcinogenesis, followed by a 6-week test chemical treatment starting 2 weeks thereafter. Test chemicals are usually given in the diet or the drinking water and in the 2nd week of test chemical treatment, all rats are subjected to two-thirds partial hepatectomy in order to induce regenerative cell replication. The end-point marker is the glutathione S-transferase placental form (GST-P)-positive hepatic focus, the numbers and sizes of which are analyzed using an image-analyzer and expressed as values per unit liver section (1 cm2). When the yield of GST-P-positive foci is significantly enhanced (P<0.05) over the control value, a chemical is judged to possess carcinogenic or promotion potential for the liver. Among 313 chemicals already tested in this system in our laboratory, 30/31 (97%) mutagenic hepatocarcinogens and 29/33 (88%) non-mutagenic hepatocarcinogens gave positive results. Ten out of 43 (23%) agents known to be carcinogenic in organs other than the liver were also positive. It is particularly important that only one of 48 non-carcinogens gave a very weak positive result, so that the system has a very low false-positivity rate. It is now well documented that the assay system is highly effective for detecting hepatocarcinogens, bridging the gap between traditional long-term carcinogenicity tests and short-term screening assays. At the Fourth International Conference on Harmonization, our medium-term liver bioassay based on an initiation and promotion protocol was recommended in the guidelines as an acceptable alternative to the long-term rodent carcinogenicity test. (Cancer Sci 2003; 94: 3,8) [source] Transcatheter occlusion of a residual muscular ventricular septal defect using an Amplatzer duct occluder in a child with congenitally corrected transposition of the great arteriesCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2006Gary E. Stapleton MD Abstract Transcatheter occlusion has become an acceptable alternative to surgery in patients with congenital muscular and residual post-surgical ventricular septal defects (VSD). We present a case of an 11 year old male with congenitally corrected transposition of the great arteries, dextrocardia, pulmonary atresia, VSD, and advanced second degree atrioventricular block who underwent successful transcatheter occlusion of a residual post-surgical VSD with an Amplatzer duct occluder, in preparation for transvenous pacemaker implantation. © 2006 Wiley-Liss, Inc. [source] The case for venous rather than arterial blood gases in diabetic ketoacidosisEMERGENCY MEDICINE AUSTRALASIA, Issue 1 2006Anne-Maree Kelly Abstract Objectives:, For patients with diabetic ketoacidosis (DKA), arterial blood gas (BG) sampling for measurement of pH and bicarbonate has been considered an essential part of initial evaluation and monitoring of progress. There is growing evidence that venous values can be clinically acceptable alternatives to arterial measurements. This article summarizes the recent evidence regarding the validity of venous BG sampling in DKA. Methods:, Medline search for the years 1995 to present, hand search of reference lists, search of on-line evidence-based medicine sites. Results:, In patients with DKA the weighted average difference between arterial and venous pH was 0.02 pH units (95% limits of agreement ,0.009 to +0.021 pH units) and between arterial and venous bicarbonate was ,1.88 mEq/L. Conclusions:, There is reasonable evidence that venous and arterial pH have sufficient agreement as to be clinically interchangeable in patients with DKA who are haemodynamically stable and without respiratory failure. There is some evidence that venous and arterial bicarbonate also agree closely in DKA but this requires confirmation. [source] Decade of Behavior Distinguished Lecture: Development of physical aggression during infancyINFANT MENTAL HEALTH JOURNAL, Issue 5 2004Richard E. Tremblay Violence is a major public concern in our modern societies. To prevent this violence we need to understand how innocent children grow into violent adolescents and adults. It is generally believed that humans are most frequently physically aggressive during adolescence and early adulthood. With longitudinal studies of large samples of children from different countries that followed them from infancy to adulthood, scientists tried to discover at what age individuals learn how to physically aggress. These studies indicated that the peak age for physical aggression was not during early adulthood, adolescence, or even kindergarten, but rather between 24 and 42 months after birth. Although there are important individual differences in children's use of physical aggression, most of them will learn to use socially acceptable alternatives when angry or frustrated before they enter school. To prevent chronic physical aggression and its terrible consequences over the whole life course, modern societies should provide children with the optimal prenatal and postnatal environments. [source] An interactive procedure for selecting acceptable alternatives in the presence of multiple criteriaNAVAL RESEARCH LOGISTICS: AN INTERNATIONAL JOURNAL, Issue 7 2001Canan Ulu Abstract In this paper, we consider the multiple criteria decision-making problem of partitioning alternatives into acceptable and unacceptable sets. We develop interactive procedures for the cases when the underlying utility function of the decision maker is linear, quasiconcave, and general monotone. We present an application of the procedures to the problem of admitting students to the master's degree program at the Industrial Engineering Department, Middle East Technical University. © 2001 John Wiley & Sons, Inc. Naval Research Logistics 48: 592,606, 2001. [source] Effects of reduced-rate methyl bromide applications under conventional and virtually impermeable plastic film in perennial crop field nurseriesPEST MANAGEMENT SCIENCE (FORMERLY: PESTICIDE SCIENCE), Issue 8 2010Bradley D Hanson Abstract BACKGROUND: Producers of perennial crop nursery stock in California use preplant soil fumigation to meet state phytosanitary requirements. Although methyl bromide (MB) has been phased out in many agricultural industries, it is still the preferred treatment in the perennial nursery industry and is used under Critical Use Exemptions and Quarantine/Preshipment provisions of the Montreal Protocol. The present research was conducted to evaluate reduced-rate MB applications sealed with conventional and low-permeability plastic films compared with the primary alternative material. RESULTS: Reduced rates (100,260 kg ha,1) of MB applied in combination with chloropicrin (Pic) and sealed with a low-permeability plastic film provided weed and nematode control similar to the industry standard rate of 392 kg ha,1 MB:Pic (98:2) sealed with high-density polyethylene (HDPE) film. However, the primary alternative chemical, 1,3-dichloropropene (1,3-D), tended to provide slightly lower pest control even on sites with relatively low plant parasitic nematode, soil-borne pathogen and weed pest pressure. CONCLUSION: If California regulations change to allow the use of low-permeability films in broadcast fumigant applications, the results of this research suggest that reduced rates of MB in perennial crop nurseries could serve as a bridge strategy until more technically, economically and environmentally acceptable alternatives are developed. Published 2010 by John Wiley & Sons, Ltd. [source] | |||||||||||||||||||