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Selected AbstractsIntraoperative cytology,Role in bone lesionsDIAGNOSTIC CYTOPATHOLOGY, Issue 9 2010Khaliqur Rahman M.D. Abstract In spite of becoming an integral part of surgical pathology, very few reports are available regarding the utility of intraoperative cytology (IOC) exclusively for bone lesions. This study was undertaken in a view to fill this lacuna. Sixty bone lesions were evaluated intraoperatively with the help of cytology smears prepared by touch, scrape, or crush technique. The diagnosis made on cytological preparation was compared with histopathological diagnosis taking the latter as gold standard. Different parameters like reasons for Intraoperative consultation, best technique for preparation of smear, average time taken to render a diagnosis, and finally the accuracy of IOC was evaluated. Common reasons for the intraoperative consultation were to make or confirm a diagnosis for proper surgical intervention and to evaluate the surgical resection margin. Scrape was found to be the best method for cytological smear preparation. Average time taken to render a diagnosis was 20 minutes. Sensitivity, specificity, and overall diagnostic accuracy was 96.7, 96.6, and 96.6%, respectively. Cytology can play a valuable role in the intraoperative diagnosis of bone lesions. The method is simple, cheap, quick, and has no complication. It should be undertaken routinely, as a rapid intraoperative diagnosis will expedite timely and proper management of the patients, along with early post operative treatment and thus avoid the aggravating delays. Diagn. Cytopathol. 2010;38:639,644. © 2009 Wiley-Liss, Inc. [source] Lifetime multiple substance use pattern among heroin users before entering methadone maintenance treatment clinic in Yunnan, ChinaDRUG AND ALCOHOL REVIEW, Issue 4 2010LEI LI Abstract Introduction and Aims. Multiple substance use leads to greater levels of psycho-behavioural problems, unsafe sex, and therefore a high risk of contracting sexually transmitted diseases, and is also more difficult to treat. This study aims to determine pattern of lifetime multiple substance use among Chinese heroin users before entering methadone maintenance treatment clinic. Design and Methods. A survey to obtain retrospective longitudinal data on lifetime multiple substance use was conducted among 203 heroin users in two of the biggest methadone maintenance clinics in Kunming City, Yunnan province. Results. All participants used more than one substance in their lifetime. Most of them used four or more substance groups (range two to seven groups). The most common substance patterns in lifetime use were alcohol, tobacco, opiates and depressants. Approximately 80% of them had a history of simultaneous substance use (co-use). The most common combination of co-use pattern was heroin with depressant. Common reasons for co-use were to get high, to experiment, to sleep and to increase the potency of other drugs. Determinants of co-use were education, marital status and family relationship. Discussion and Conclusions. Multiple substance use is highly prevalent among Chinese heroin users. Depressants are the most common substances used in combination with heroin.[Li L, Sangthong R, Chongsuvivatwong V, McNeil E, Li J. Lifetime multiple substance use pattern among heroin users before entering methadone maintenance treatment clinic in Yunnan, China. Drug Alcohol Rev 2010] [source] Effect of Professional Postpartum Support on Infant Feeding Patterns Among Breastfeeding Participants in the WIC ProgramFAMILY & CONSUMER SCIENCES RESEARCH JOURNAL, Issue 4 2004Jo Carol Chezem The purpose of this study was to determine if professional breastfeeding support could postpone formula introduction and prolong breastfeeding among participants in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Fifty women in the experimental group received home visits and phone calls from a lactation educator following hospital discharge; 50 control group women were encouraged to contact a lactation educator as needed. Infants' ages at formula introduction and breastfeeding continuation rates were not significantly different between the groups. Common reasons for breastfeeding cessation included returning to work/school, inadequate milk supply, and latch-on/suckling problems. Use of telephone contacts, delay of breastfeeding support until after hospital discharge, and early formula supplementation may have contributed to the ineffectiveness of the intervention. [source] Drug information for patients,an update of long-term results: type of enquiries and patient characteristics,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 2 2009Martin Huber MPharm Abstract Purpose To analyse the type of enquiries to a drug information service in Germany, available exclusively for patients. Methods Sociodemographic characteristics of the patients who used the service, number and kind of drugs taken, existing diseases, reasons for enquiry as well as type of answers provided were recorded. For the present evaluation we analysed all enquiries to the service from August 2001 to January 2007. Results A total of 5587 enquiries were received. 5013 enquiries from 4091 patients were available for further analysis in detail. The patient group using the service most frequently were women between 61 and 70 years (23.3%). 1457 enquiries (29.1%) were made by patients who had contacted the information service once or several times before. The group of drugs most often asked about were cardiovascular drugs (33.4%), followed by drugs for the nervous system (16.2%) and for the alimentary tract and metabolism (12.4%). On average, each patient had questions about 2.6 (median 1; 1,22) drugs simultaneously. Common reasons for contacting the service were adverse drug reactions (22.1%), the need for general information about the drug (19.9%), information about therapy (12.4%) and drug interactions (10.2%). Conclusions A lot of patients need additional information about their medication, especially concerning drug groups that are frequently prescribed. The presented drug information service can be one helpful tool to counteract these information deficits and to increase patients' knowledge about their drugs. Copyright © 2008 John Wiley & Sons, Ltd. [source] Geropsychiatric consultation in a general hospital in TaiwanPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 3 2005YEONG-YUH JUANG md Abstract, The aim of this study was to characterize clinically significant issues in a psychiatric consultation service for geriatric inpatients in a general hospital in Taiwan. This was a case-control study. During a 5-month period, 100 geriatric (age ,65 years) inpatients consecutively referred for consultation-liaison psychiatric service from non-psychiatric departments formed the study group. Another 100 medical inpatients, also referred for consultation-liaison to the psychiatric service, but aged 17,50, formed the control (non-geriatric) group. The diagnosis, demography, reason for referral, symptomatology, and other clinical characteristics were determined by consensus between two psychiatrists. Psychiatric diagnosis was made according to criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders. The geropsychiatric consultation rate was 0.9%. Geriatric patients constituted 20.1% of all psychiatric referrals. Common reasons for referral of geriatric inpatients were confusion (32%), depression (17%), disturbing behaviors (14%), and psychosis (14%). The most common psychiatric disorder among geriatric patients was an organic mental disorder (79%), followed by a depressive disorder (13%). More geriatric patients suffered from cancers and cerebrovascular diseases than non-geriatric patients. The geriatric group was more likely to have multiple physical illnesses. Organic mental disorder and depressive disorders are the most common psychiatric diagnoses in the geropsychiatric consultation service of the authors. In the authors' experience, both psychotropic medication treatment and psychosocial intervention are important in geropsychiatric consultation. [source] Witnessing invasive paediatric procedures, including resuscitation, in the emergency department: A parental perspectiveEMERGENCY MEDICINE AUSTRALASIA, Issue 3 2005Jonathon Isoardi Abstract Objective:, To determine whether parents prefer to be present during invasive procedures performed on their children in the ED. Methods:, A prospective study using a written survey was carried out in the ED of a secondary level regional hospital in south-east Queensland. The survey conducted between August 2003 and November 2003 consisted of parental demographics, seven theoretical paediatric procedural scenarios with increasing level of procedural invasiveness (including resuscitation) and reasons for the decisions of parents to either stay with the child or leave the room. Parents of children with Australasian Triage Scale (ATS) triage category 3, 4 and 5 were surveyed. Results:, Of 573 surveys collected, 553 (96.5%) were completed correctly. The number of parents expressing a desire to be present during a procedure performed on their child was 519 (93.9%) for phlebotomy or i.v. cannulation of an extremity, 485 (87.7%) for nasogastric tube insertion, 461 (83.4%) for lumbar puncture, 464 (83.9%) for urinary catheter insertion, 430 (77.8%) for suprapubic bladder aspiration, 519 (93.4%) during procedural sedation and 470 (85%) during a resuscitation where the possibility existed that their child may die. The most common reason for wanting to be present was to provide comfort to their child (542/98%). The most common reason for not wanting to be present was a parental concern of getting in the way (181/33%). Conclusion:, Most parents surveyed would want to be present when invasive procedures are performed on their children in the ED. With increasing invasiveness, parental desire to be present decreased. However, the overwhelming majority of parents would want to be in attendance during procedural sedation or resuscitation. [source] Customer Satisfaction in a Large Urban Fire Department Emergency Medical Services SystemACADEMIC EMERGENCY MEDICINE, Issue 1 2004David E. Persse MD Objectives: The purpose of this study was to determine if emergency medical services (EMS) customer satisfaction could be assessed using telephone-survey methods. The process by which customer satisfaction with the EMS service in a large, fire department,based EMS system is reported, and five month results are presented. Methods: Ten percent of all patients transported during the period of October 15, 2001, through March 15, 2002, were selected for study. In addition, during the same period, all EMS incidents in which a patient was not transported were identified for contact. Customer-service representatives contacted patients via telephone and surveyed them from prepared scripts. Results: A total of 88,528 EMS incidents occurred during the study period. Of these, 53,649 resulted in patient transports and 34,879 did not. Ten percent of patients transported (5,098) were selected for study participation, of which 2,498 were successfully contacted; of these, 2,368 (94.8%) reported overall satisfaction with the service provided. Of the 34,879 incidents without transport, only 5,859 involved patients who were seen but not transported. All of these patients were selected for study. Of these, 2,975 were successfully contacted, with 2,865 (96.3%) reporting overall satisfaction. The most common reason given for nonsatisfaction in both groups was the perception of a long response time. Conclusions: It is possible to conduct a survey of EMS customer satisfaction using telephone-survey methods. Although difficulties exist in contacting patients, useful information is made available with this method. Such surveys should be an integral part of any EMS system's quality-improvement efforts. In this survey, the overwhelming majority of patients, both transported and not transported, were satisfied with their encounter with EMS. [source] Study of laryngopharyngeal pathology in Thoroughbred horses in southern CaliforniaEQUINE VETERINARY JOURNAL, Issue 9 2009S. DIAB Summary Reasons for performing study: There is increasing anecdotal evidence among horse owners, trainers and equine clinicians of a high prevalence of subepiglottic ulcers, suggested to have a negative effect on racing performance. Objectives: To provide a prevalence study and pathological characterisation of laryngopharyngeal lesions with emphasis in the subepiglottic area and, in particular, subepiglottic ulcers. Methods: The study was carried out on 91 Thoroughbred racehorses received for post mortem examination from 4 major Southern California racetracks. The most common reason for submission was catastrophic musculoskeletal injury, but others include sudden death, laminitis, colic, colitis, neurological disorders, pleuropneumonia and arytenoid chondropathy. Laryngopharyngeal specimens were collected and examined grossly; selected cases were also examined histopathologically. Results: Thirteen horses (14.3%) had at least one type of laryngopharyngeal abnormality, 7 horses (7.7%) had lesions in the subepiglottic soft tissues, including 4 subepiglottic ulcers, 2 soft palate ,kissing lesions' and one 'subepiglottic scar'. Eight horses (8.8%) had lesions elsewhere in the laryngopharynx, including mucosal ulcerations, arytenoid chondropathy, epiglottic entrapment and partial absence of arytenoid cartilage. Conclusions and potential relevance: Lesions in the subepiglottic area were among the most prevalent in this study, suggesting that an important percentage of laryngopharyngeal abnormalities may be missed during routine endoscopy of the standing horse, which often does not include the examination of subepiglottic tissues. Pathologically, subepiglottic ulcers were chronic-active with viable hyperplastic epithelial margins, suggesting that proper healing and re-epithelialisation should occur with appropriate treatment. In most cases, the lesions observed do not necessarily indicate a clinical problem and more extensive prevalence studies and correlation between abnormalities found and performance are needed to assess the clinical relevance of subepiglottic soft tissue lesions accurately. [source] Clinical findings, diagnosis, prevalence and predisposing factors for lameness localised to the middle carpal joint in young Standardbred racehorsesEQUINE VETERINARY JOURNAL, Issue 2 2006C. M. Steel Summary Reasons for performing study: Lameness related to the middle carpal joint (MCJ) occurs in up to 30% of young Standardbred horses in race training and the incidence increase with radiographic severity of third carpal bone (C3) sclerosis on DPr-DDIO (skyline) view of the carpus. Factors predisposing horses to carpal injury have not been well investigated. Objectives: To determine the importance of MCJ lameness as a cause of wastage in young Standardbred racehorses, stage of training at which it occurs and predisposing factors, and to describe clinical findings and diagnosis. Methods: Standardbred horses (n = 114) entering their first year of race training were examined at approximately 3-month intervals over 12,18 months. For 87 of the horses, a training diary was available and these horses were trained at 3 different stables, each using a different exercise regime. At each examination, forelimb conformation, MCJ effusion, MCJ lameness and radiographic findings were graded, and training history and reasons for lost training days recorded. Nuclear scintigraphy and exploratory arthroscopy were performed on a limited selection of horses. Results for horses that developed MCJ lameness during the study period were compared statistically with results for horses that did not. Results: Carpal lameness occurred in 28% of horses and was present in 56% with forelimb lameness. In most cases lameness was mild, bilateral and with little or no MCJ effusion and was attributed to subchondral bone pain associated with radiographic evidence of C3 sclerosis. Carpal lameness was the most common reason for >1 month's rest during the study period. It occurred at any stage of training but, in most cases, some speed training had begun. Of the variables studied, poor forelimb conformation and more intense speed training were predisposing factors. Conclusions and potential relevance: The information gained should assist in making recommendations regarding training young Standardbreds to reduce the incidence of MCJ lameness. However, further investigations to determine the optimal training regime are warranted. [source] Neutralization of IL-17 by active vaccination inhibits IL-23-dependent autoimmune myocarditisEUROPEAN JOURNAL OF IMMUNOLOGY, Issue 11 2006Ivo Sonderegger Abstract The most common reason for heart failure in young adults is dilated cardiomyopathy often resulting from myocarditis. Clinical studies and animal models provide evidence that an autoimmune response against heart myosin is the underlying reason for the disease. IL-12 has been suggested to play a key role in development of experimental autoimmune myocarditis (EAM), as IL-12p40 and IL-12R,1 knockouts are protected from disease. In this study, we have compared IL-12p40,/, mice, IL-12p35,/, mice and mice treated with a neutralizing IL-23 antibody in EAM and found that in fact IL-23, not IL-12, is responsible for inflammatory heart disease. However, these cytokines appear to have redundant activity for priming and expansion of autoreactive CD4 T cells, as specific T cell proliferation was only defective in the absence of both cytokines. IL-23 has been suggested to promote a pathogenic IL-17-producing T cell population. We targeted IL-17 by capitalizing on an active vaccination approach that effectively breaks B cell tolerance. Neutralization of IL-17 reduced myocarditis and heart autoantibody responses, suggesting that IL-17 is the critical effector cytokine responsible for EAM. Thus, targeting of IL-23 and IL-17 by passive and active vaccination strategies holds promise as a therapeutic approach to treat patients at risk for development of dilated cardiomyopathy. See accompanying commentary: http://dx.doi.org/10.1002/eji.200636760 [source] Characteristics of adult dentally fearful individuals.EUROPEAN JOURNAL OF ORAL SCIENCES, Issue 4 2000A cross-cultural study This cross-cultural study investigated adult dental fear patients in three countries. A joint intake interview questionnaire and a dental anxiety scale explored the level, background and concomitant factors of dental anxiety among patients at the Universities of Tel Aviv (Israel), Göteborg (Sweden), and Pittsburgh (USA). It was shown that patients at all three sites were quite similar with regard to age, sex, level of dental anxiety (DAS) and avoidance time. Negative emotions were common, with more negative everyday life effects among Swedish patients. Regardless of country, most patients stated that they had always been fearful, but environmental etiologic factors were frequently reported. Swedish patients more often reported both direct and indirect learning patterns than Israeli patients. Patients' motivation for treatment was high, while the belief in getting fear reduction was clearly lower. The most common reason for Israeli patients to seek treatment was a personal decision to try to cope with the situation, while for Swedish patients it was pain. Israeli and US patients preferred more ,active' modes of treatment such as behavioral management therapies, while Swedish patients equally preferred active and more ,passive' treatment approaches such as general anesthesia. Preference for dentist attributes were similar among groups and underlined the strong emphasis that fearful individuals place upon dentists' behaviors and their performance of dentistry. [source] Correlation between ejaculatory and erectile dysfunctionINTERNATIONAL JOURNAL OF ANDROLOGY, Issue 2005E. A. JANNINI Summary Premature ejaculation (PE) and erectile dysfunction (ED) are different sexological issues. However, they have many little-known links. PE is the most common male sexual dysfunction, but ED is undoubtedly the most common reason that medical help is sought. As a consequence, PE is largely under-diagnosed and under-treated, while ED has received great scientific and clinical attention in recent years. There are plenty of reasons for this: (i) PE is classically considered as psychogenic in nature; (ii) it is traditionally treated with behavioural psychotherapies; (iii) clear and accepted clinical definition(s) are lacking; (iv) the aetiologies are largely unknown; (v) the pathogenesis is still obscure , there is a lack of awareness and acknowledgement of PE as a symptom of medical disease; (vi) lacking a medical presence in the field and requests for help from patients are low. Finally, erectile dysfunctions (ED) and ejaculatory dysfunctions frequently overlap. The aim of this review article is to propose a new taxonomy of PE, which considers ED as an important factor of PE and vice versa. [source] Accuracy of reported weight and menstrual status in teenage girls with eating disordersINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 4 2005Ingemar Swenne MD Abstract Objective The current study investigated the accuracy of reported current and historical weights and of menstrual status in teenage girls with eating disorders. Method Reported current weight in one interview was compared with measured weight at another occasion. Reported historical weights were compared with documented weights from growth charts of the school health services. Reports of menstrual status from two different interviews were compared. Results The overall correlation between reported and measured/documented weight was high. Current weight was reported with high accuracy in all diagnostic groups and without tendencies to underreport. Patients with bulimia nervosa, but not those with anorexia nervosa, underreported their historical top weight. The most common reason for large discrepancies between reported and documented historical weights was that the two weights compared referred to different time points. The reports on menstrual status were divergent for 13% of the patients, most notably 4 of 15 patients on oral contraceptives had been categorized as having menstruations in one of the interviews. Conclusion Reported weight history and menstrual status are of high accuracy in teenage girls with eating disorders. © 2005 by Wiley Periodicals, Inc. [source] Special acute care unit for older adults with Alzheimer's diseaseINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2008Maria E. Soto Abstract Objective To describe the cognitive, functional, and nutritional features of patients admitted to a Special Acute Care Unit (SACU) for elderly patients with Alzheimer's disease (AD). Methods One-year observational study of patients with AD and other related disorders hospitalized in the SACU, Department of Geriatrics, Toulouse university Hospital during 2005. A comprehensive neurocognitive and non-cognitive geriatric assessment was performed. Data on full clinical evaluation, nutritional status, activities of daily living (ADL), gait and balance disturbance, behavioural and psychological symptoms (BPSD), and sociodemographics were recorded. Results Four-hundred and ninety-two patients were assessed. Their mean age was 81.1,±,7.7, the mean length of stay was 10.7,±,6.3 days, 62% were female, 63.9% were admitted from their own home and 30.4% from a nursing home. Eighty percent of patients had probable Alzheimer's disease or mixed dementia, less than 20% had other causes of dementia. Results of their comprehensive assessment showed a mean mini-mental state examination of 14.5,±,7.4; a mean total ADL score of 3.7,±,1.7. Seventy-seven percent had gait or balance disturbances; 90% of patients presented an unsatisfactory nutritional status. The most common reason for admission was BPSD. Conclusion AD complications are responsible for many acute admissions. Elderly patients suffering from dementia represent a population with unique clinical characteristics. Further randomised clinical trials are needed to evaluate the effectiveness of Special Acute Care Units for patients with AD and other related disorders. Copyright © 2007 John Wiley & Sons, Ltd. [source] Evaluation of patient opinions in a pharmacy-level intervention studyINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 3 2003M. C. M. Pronk PhD researcher ABSTRACT Objective To explore patients' satisfaction with their community pharmacy's services and to evaluate the effects of an intervention programme in which a trained technician organised patient education activities in the pharmacy. Method We surveyed patients visiting the participating pharmacies at three stages: at the start of the intervention period (0 months, T0), at the end (after 12 months, T1), and 12 months after the intervention had been completed (24 months from baseline, T2). At each stage, 500 questionnaires were distributed by each pharmacy. Setting 28 Dutch community pharmacies: 14 intervention and 14 controls. Key findings The response rates were 54%, 44% and 43% at T0, T1 and T2, respectively. Baseline data showed that patients reported satisfaction with helpfulness, waiting time, ease of asking questions, answers to questions, and patient leaflets provided. Around two thirds (59.5%) of the patients said they would ask a pharmacy employee questions if they were concerned about side effects of their medication. Asking questions was not reported to be difficult for most patients (88.9%). The reasons most often given for experiencing difficulties with asking questions were related to lack of privacy (16.9% of all patients), waiting time of other patients (8.8%) and busy pharmacy employees (6.7%). The most frequently reported reason for being less satisfied with the answers to questions was receiving too little information (7.5%). Our analyses showed a significant improvement only on the outcome variable "helpfulness" experienced by patients between 0 (T0) and 12 months (T1), and this was found to be sustained one year later (T2). Conclusion The overall findings on patient satisfaction showed that almost two-thirds of the respondents saw the pharmacy as a source of information about medication. Community pharmacies clearly have an important role in providing such information. Lack of privacy was the most common reason for patients reporting difficulties in asking questions about medicines and this needs pharmacists' attention. Our analysis showed that the intervention had an effect on "helpfulness" experienced by patients, which slightly increased in the intervention period (T0-T1 differences) and appeared to have remained at the higher level one year later (T2). [source] Who Are the Uninsured Elderly in the United States?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2004James W. Mold MD Because of the Medicare program, a common assumption is made that virtually all older Americans have health insurance coverage. Data from the 2000 National Health Interview Survey were analyzed to estimate the number of people aged 65 and older without health insurance; their stated reasons for being uninsured; and the associations between lack of insurance and sociodemographic variables, health status, and access to and use of healthcare services. In 2000, there were approximately 350,000 older Americans with no health insurance. Those without insurance were more likely to be younger, Hispanic, nonwhite, unmarried (widowed, divorced, or never married), poor, and foreign-born. They were less likely to hold U.S. citizenship. Despite relatively high rates of chronic medical conditions, they were unlikely to receive outpatient or home healthcare services. The most common reason given for lack of insurance was its cost. This study reveals important gaps in the availability of health insurance for the elderly, gaps that are likely to affect an increasing number of older Americans in the coming decade. [source] Pre-ovulatory temperature gradients within mammalian ovaries: a reviewJOURNAL OF ANIMAL PHYSIOLOGY AND NUTRITION, Issue 7-8 2005R. H. F. Hunter Summary The existence of a temperature gradient between the testis and deep body temperature has been accepted for many years. It is based on two simultaneous principles: cooling of the testis through the scrotal wall and transfer of heat between the testicular blood vessels. The ovary is positioned in the abdomen; a temperature difference parallel to the male system therefore seems less likely. However, the temperature of large follicles has been found to be 0.5 to 1.5 °C cooler than the ovarian stroma in rabbits, pigs and, probably, women. The temperature difference seems to be based on a heat-consuming process in the expanding follicullar fluid, and a local transfer of heat between intra-ovarian blood vessels. The reason for the temperature gradient is not yet known; one may speculate of a common reason for the cooling of the gamete in male and female. [source] ASH Position Paper: Adherence and Persistence With Taking Medication to Control High Blood PressureJOURNAL OF CLINICAL HYPERTENSION, Issue 10 2010Martha N. Hill RN J Clin Hypertens (Greenwich). 2010;12:757-764. © 2010 Wiley Periodicals, Inc. Nonadherence and poor or no persistence in taking antihypertensive medications results in uncontrolled high blood pressure, poor clinical outcomes, and preventable health care costs. Factors associated with nonadherence are multilevel and relate not only to the patient, but also to the provider, health care system, health care organization, and community. National guideline committees have called for more aggressive approaches to implement strategies known to improve adherence and technologies known to enable changes at the systems level, including improved communication among providers and patients. Improvements in adherence and persistence are likely to be achieved by supporting patient self-management, a team approach to patient care, technology-supported office practice systems, better methods to measure adherence, and less clinical inertia. Integrating high blood pressure control into health care policies that emphasize and improve prevention and management of chronic illness remains a challenge. Four strategies are proposed: focusing on clinical outcomes; empowering informed, activated patients; developing prepared proactive practice teams; and advocating for health care policy reform. With hypertension remaining the most common reason for office visits, the time is now. [source] Breastfeeding Support and Early CessationJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 2 2006Lynne Porter Lewallen Objective:, To examine the types of help women received with breastfeeding both in the hospital and at home and the reasons why women stopped breastfeeding earlier than intended. Design:, A descriptive design with open-ended questions. Setting:, After participant recruitment in the postpartum hospital room, data were collected by phone 8 weeks after delivery. Patients/Participants:, Three hundred seventy-nine women planning to breastfeed for at least 8 weeks after uncomplicated delivery. Main Outcome Measures:, Breastfeeding status at 8 weeks postpartum; report of help with breastfeeding in the hospital and at home. Results:, Sixty-eight percent of women were still breastfeeding at 8 weeks, although 37% of those reported supplementing with formula. Of those who had stopped, the most common reason was insufficient milk supply. Other reasons included painful nipples and latch problems, personal reasons, returning to work or school, and drugs/illness of the mother or baby. Most women received help with breastfeeding in the hospital, but only 55% received help with breastfeeding after hospital discharge. Conclusions:, The primary reasons for early cessation of breastfeeding are amenable to nursing intervention. Every opportunity should be taken to address these issues both in the hospital and through follow-up calls. JOGNN, 35, 166-172; 2006. DOI: 10.1111/J.1552-6909.2006.00031.x. [source] General practitioners: Their contact with maternal and child health nurses in postnatal careJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 2 2000C Mbwili-Muleya Objective: To assess the level of contact of general practitioners (GP) with maternal and child health nurses (MCHN) in postnatal care. Methodology: A postal survey of 1104 Victorian GP was used, with a response rate of 70%. To account for the clustered sampling frame, hierarchical data analysis techniques were used. Results: Half of the GP (351/710) had no contact with their local MCHN in the previous month; and one in 10 had four or more contacts. Eighty-eight per cent of GP described the contact as helpful. In 56% of cases the MCHN was reported as the usual initiator of the contact. The most common reason for contact concerned the baby's physical problems (42%). After adjusting for the number of women seen for the routine 6-week postnatal review and other GP characteristics, male GP were as likely as female GP to report MCHN contact (odds ratio (OR) = 1.00; 95% confidence interval (CI) = 0.67,1.62). General practitioners aged 31,40 years were more likely to report contact with MCHN than GP aged 51,60 (OR = 0.45; 95% CI = 0.22,0.86) as were GP with the FRACGP qualification (OR = 1.64; 95% CI = 1.21,2.45). Conclusions: This study provides baseline information on the level of GP contact with MCHN as they provide postnatal care. Although there were GP in Victoria who maintained a level of contact with MCHN, almost half reported no contact in the previous month. Most GP who reported contact with MCHN found it useful. This finding should encourage GP and MCHN coordination to improve continuity and postnatal care outcomes. [source] Clinical Use of Blood Products in Cats: A Retrospective Study (1997,2000)JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 4 2004Ivanov Castellanos The records of the Transfusion Medicine Service of the Veterinary Teaching Hospital at The Ohio State University were searched for client-owned cats that received whole blood (WB), packed red blood cells (PRBCs), or fresh frozen plasma (FFP) transfusions between December 1, 1997, and April 1, 2000. Eighty-one cats received 112 units of blood products, consisting of 49 units of WB (administered to 35 cats), 44 units of PRBCs (administered to 34 cats), and 19 units of FFP (administered to 13 cats); 10 cats received more than 1 product each. Anemia was the most common reason for transfusing RBC-containing blood products, requiring 33 units of WB (75%) and 39 units of PRBCs (80%). The 2 most common causes of anemia were blood loss (27%) and renal disease (20%). Hypoalbuminemia (n = 9) and coagulopathies (n = 6), primarily due to liver disease (n = 7), were the 2 most common reasons for cats to receive transfusions of FFP. There were no differences in increase in PCV after administration of either 1 unit of WB or 1 unit of PRBCs (P= .22). Transfusion reactions occurred in 3 cats; 2 reactions were mild febrile events, but a fatal reaction occurred when a type B cat inadvertently received type A blood. [source] Immunotherapy of idiopathic inflammatory neuropathiesMUSCLE AND NERVE, Issue 3 2003Peter D. Donofrio MD Abstract Evaluation of peripheral neuropathy is a common reason for referral to a neurologist. Recent advances in immunology have identified an inflammatory component in many neuropathies and have led to treatment trials using agents that attenuate this response. This article reviews the clinical presentation and treatment of the most common subacute inflammatory neuropathies, Guillain,Barré syndrome (GBS) and Fisher syndrome, and describes the lack of response to corticosteroids and the efficacy of treatment with plasma exchange and intravenous immunoglobulin (IVIG). Chronic inflammatory demyelinating polyneuropathy, although sharing some clinical, electrodiagnostic, and pathologic similarities to GBS, improves after treatment with plasma exchange and IVIG and numerous immunomodulatory agents. Controlled trials in multifocal motor neuropathy have shown benefit after treatment with IVIG and cyclophosphamide. Also discussed is the treatment of less common inflammatory neuropathies whose pathophysiology involves monoclonal proteins or antibodies directed against myelin-associated glycoprotein or sulfatide. Little treatment data exist to direct the clinician to proper management of rare inflammatory neuropathies resulting from osteosclerotic myeloma; POEMS syndrome; vasculitis; Sjögren's syndrome; and neoplasia (paraneoplastic neuropathy). Muscle Nerve 28: 273,292, 2003 [source] Methadone in the Treatment of Chronic Nonmalignant Pain: A 2-Year Follow-upPAIN MEDICINE, Issue 3 2000William F. Taylor MD Objective. To examine the longitudinal use of methadone in a pain clinic. Design. Follow-up study of 40 patients initially treated with methadone and re-evaluated 2 years later, comparing those maintained on methadone with those who were switched to other opioids. Setting. Pain clinic at a university hospital. Results. The 14 patients (35%) who stayed on methadone for the duration of the study, had higher employment rates (P < .05) and higher functional ratings (P < .02) than those on other opioids. Side effects were the most common reason (33.4%) for discontinuation of methadone. Dose escalation occurred in 11 of 14 patients (78.6%). Conclusions. Chronic pain patients may be safely and effectively treated with methadone. Those not responding or tolerating methadone may be benefited by treatment with other opioids. [source] Trans-facet Joint Approach to Pulsed Radiofrequency Ablation of the L5 Dorsal Root Ganglion in a Patient with Degenerative Spondylosis and ScoliosisPAIN PRACTICE, Issue 3 2008David Abejón MD, FIPP ,,Abstract: Mechanical low back pain secondary to degenerative facet joint changes is a common reason for referral to pain clinics. When these changes cause encroachment into the intervertebral foramen, radicular pain may result. While pulsed radiofrequency of the dorsal root ganglion can be used in this setting, the anatomic deformity may make the transforaminal approach difficult. We report a case where a trans-facet approach was used successfully and describe the technique.,, [source] Life with continuous subcutaneous insulin infusion (CSII) therapy: child and parental perspectives and predictors of metabolic controlPEDIATRIC DIABETES, Issue 2 2001Aristides k Maniatis Abstract: Objective:, The purpose of this study was twofold (i): to evaluate metabolic control in patients receiving CSII therapy in a routine pediatric diabetes clinic by describing reasons for initiating therapy and daily management issues, including needle fear; and (ii) to assess the change in parental involvement and anxiety once their child initiated CSII therapy. Research design and methods: The study included 52 subjects (aged 7.6,23.6 yr) from a general pediatric diabetes clinic. Management issues were defined as diet, exercise, home blood glucose monitoring (HBGM) frequency, and self/staff assessment of needle fear. Characteristics were analyzed both according to a 0.5% change in HbA1c status (decreased vs. stable vs. increased) compared with pre-CSII therapy, and final HbA1c achieved (, 8.1 vs. > 8.1%). Results: The primary recommendation source for CSII use was most often the physician/diabetes team (48.1%), followed by a combination of the former with a personal referral source (32.7%). The most common reason (71.2%) for CSII initiation was a combination of wanting to achieve better metabolic control, dislike of insulin injections, and/or increased flexibility in daily living. Over one-quarter (26.9%) of subjects were identified as being needle-fearful, and this characteristic was predictive of final metabolic control (3/25 subjects ,,8.1% vs. 11/27 subjects >,8.1%, p =,0.03). On CSII therapy, dietary carbohydrate consistency was highly variable, and most subjects (65.3%) exclusively used an insulin to carbohydrate ratio for insulin bolus dosage calculation. The most common adjustment strategy (63.5%) for exercise was a combination of decreasing the insulin basal rate, disconnecting the pump, and/or eating extra carbohydrates. For the total cohort, the frequency of HBGM significantly increased on CSII therapy (4.31,4.85 tests/day, p =,0.02). Females did not have a significant change in HBGM frequency, while the youngest subjects had the highest HBGM frequency. Parental involvement and anxiety primarily stayed the same or decreased, regardless of the child's age (, 18 vs. > 18 yr) or metabolic control. Conclusions:, Analyses of the various characteristics identified only needle fearfulness as being predictive of poor metabolic control. Interestingly, poor control with CSII therapy did not result in a significant increase in parental involvement and/or anxiety. [source] Addressing disparities in diagnosing and treating depression: A promising role for continuing medical educationTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue S1 2007Karen M. Overstreet EdD Abstract Depression is a very common reason that individuals seek treatment in the primary care setting. However, advances in depression management are often not integrated into care for ethnic and racial minorities. This supplement summarizes evidence in six key areas,current practices in diagnosis and treatment, disparities, treatment in managed care settings, quality improvement, physician learning, and community-based participatory research,used to develop an intervention concept described in the concluding article. Evidence of gaps in the care for minorities, while discouraging, presents unique opportunities for medical educators to develop interventions with the potential to change physician behavior and thereby reduce disparities and enhance patient outcomes. [source] ORIGINAL RESEARCH,ED PHARMACOTHERAPY: Post-Radical Prostatectomy Pharmacological Penile Rehabilitation: Practice Patterns Among the International Society for Sexual Medicine PractitionersTHE JOURNAL OF SEXUAL MEDICINE, Issue 7 2009Patrick Teloken MD ABSTRACT Introduction., Despite the fact that there is minimal evidence-based data supporting it, the concept of pharmacological penile rehabilitation following radical prostatectomy (RP) is receiving great attention. Aim., To define attitudes and practice patterns of clinicians who were members of the International Society for Sexual Medicine (ISSM) and/or its affiliated societies. Methods., Members of the ISSM and its regional affiliates were invited to participate in a web-based survey. Main Outcome Measures., Demographic factors, current practice status, and opinions regarding post-RP erectile dysfunction and penile rehabilitation. The statistical methods used included chi-square, Student's t -tests, and logistic regression analysis. Results., Three hundred-one physicians from 41 countries completed the questionnaire (82% were urologists). Sixty-five percent of the responders had formal sexual medicine specialty training, 44% had uro-oncology specialty training, and 60% performed RPs. Eighty-seven percent performed some form of rehabilitation. As part of the primary rehabilitation strategy, 95% used phosphodiesterase type 5 inhibitors (PDE5), 30% used vacuum device, 75% used intracavernosal injections, and 9.9% used intraurethral prostaglandin. Fifty-four percent commenced rehabilitation immediately/just after urethral catheter removal, and 37% within the first 4 months after RP. Neither the number of years in medical practice, clinician age, nor country/region of practice differed between rehabilitation performers and nonperformers. With regard to the primary reason for avoiding rehabilitation: 50% responded said it is the cost; 25% said the fact that it is not evidence-based; and 25% said they were not familiar with the concept. Performing rehabilitation was positively associated with urologic oncology training (P = 0.03), performing RP (P < 0.001), and seeing over 50 post-RP patients per year (P = 0.011). Conclusions., Among ISSM members post-RP penile rehabilitation is widely practiced, commenced early, and based predominantly on PDE5 inhibitors and intracavernosal injections. Clinicians who perform RP or see over 50 such patients per year are the most likely to perform rehabilitation. Cost represents the most common reason for rehabilitation neglect. Teloken P, Mesquita G, Montorsi F, and Mulhall J. Post-radical prostatectomy pharmacological penile rehabilitation: Practice patterns among ISSM practitioners. J Sex Med 2009;6:2032,2038. [source] Sleep-Disordered Breathing in Children: Survey of Current PracticeTHE LARYNGOSCOPE, Issue 6 2006Ron B. Mitchell MD Abstract Objectives: The American Academy of Pediatrics recommends objective testing with polysomnography (PSG) before adenotonsillectomy for sleep-disordered breathing (SDB) in children. Several studies have also shown that a clinical diagnosis correlates poorly with the presence or severity of SDB as confirmed by PSG. The purpose of this study was to examine surgical practice patterns among members of the American Society of Pediatric Otolaryngologists (ASPO). Methods: A questionnaire was sent electronically to all members of ASPO asking about demographics, PSG facilities, and pre- and postoperative management of children with SDB. Results: A total of 245 questionnaires were sent, and 105 (43%) were completed. The results of the survey show that up to 50% of pediatric visits in individual practices were for SDB. Only 10% of children who underwent adenotonsillectomy had PSG, and the most common reason to request it was doubt about diagnosis. The average wait for PSG was 3 to 6 weeks. Preoperative PSG was routinely requested in children under 1 year of age and children with morbid obesity, craniofacial abnormalities, or neuromuscular disease. The majority of pediatric otolaryngologists proceeded with an adenotonsillectomy in symptomatic children with normal PSG findings. Postoperative PSG was requested in less than 5% of children. Approximately 20% of children who underwent adenotonsillectomy for suspected SDB were observed overnight in hospital. Conclusions: A majority of respondents from this survey rely on a clinical diagnosis rather than PSG to recommend an adenotonsillectomy for SDB in children. PSG was generally used when the diagnosis was in doubt. [source] Factors Associated with Failure to List HIV-Positive Kidney Transplant CandidatesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2009D. Sawinski With improved survival in the antiretroviral era, data from ongoing studies suggest that HIV patients can be safely transplanted. The disproportionate burden of HIV-related end-stage renal disease in minority populations may impose additional obstacles to successful completion of the transplant evaluation. We retrospectively reviewed 309 potentially eligible HIV patients evaluated for kidney transplant at our institution since 2000. Only 20% of HIV patients have been listed, compared to 73% of HIV-negative patients evaluated over the same period (p < 0.00001). Failure to provide documentation of CD4 and viral load (36% of candidates) was the most common reason for failure to progress beyond initial evaluation. Other factors independently associated with failure to complete the evaluation included CD4 < 200 at initial evaluation (OR 15.17; 95% CI 1.94,118.83), black race (OR 2.33; 95% CI 1.07,5.06), and history of drug use (OR 2.56; 95% CI 1.22,5.37). More efficient medical record sharing and an awareness of factors associated with failure to list HIV-positive transplant candidates may enable transplant centers to more effectively advocate for these patients. [source] Antibiotic Prescriptions Are Associated with Increased Patient Satisfaction With Emergency Department Visits for Acute Respiratory Tract InfectionsACADEMIC EMERGENCY MEDICINE, Issue 10 2009Cordelia R. Stearns Abstract Objectives:, Health care providers cite patient satisfaction as a common reason for prescribing antibiotics for viral acute upper respiratory infections (URIs), even though quality performance measures emphasize nonantibiotic treatment for these conditions. In a secondary analysis of a cluster-randomized trial to test a combined patient and physician educational intervention to reduce antibiotic prescribing for URIs, the authors examined whether satisfaction is greater among patients diagnosed with URIs who are prescribed antibiotics in emergency department (ED) settings. Methods:, This was a follow-up telephone survey of 959 patients who received care for acute respiratory infections at any of eight Veterans Administration (VA) hospital EDs or eight location-matched non-VA hospital EDs around the United States. Patients reported their satisfaction with the amount of time spent in the ED, the explanation of treatment, the provider treatment, and overall satisfaction on a five-point Likert scale. The primary measure of effect was the association between antibiotic prescription and visit satisfaction, adjusted for patient and visit characteristics. Results:, Antibiotic treatment was significantly associated with increased overall visit satisfaction in non-VA EDs (adjusted odds ratio [OR] = 1.97, 95% confidence interval [CI] = 1.23 to 3.17), but not VA EDs (adjusted OR = 1.13, 95% CI = 0.81 to 1.58). Patients managed in non-VA EDs who received antibiotics were also significantly more likely to be satisfied with the explanation of treatment and the manner in which they were treated by the provider. Conclusions:, Antibiotic prescriptions are associated with increased overall patient satisfaction in non-VA, but not VA, ED visits for URIs. Continued efforts to reduce unnecessary prescriptions in these settings must address ways to maintain patient satisfaction and still reduce antibiotic prescriptions. [source] | ||||||||||||||||