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Selected AbstractsBotulinum Toxin, Physical and Occupational Therapy, and Neuromuscular Electrical Stimulation to Treat Spastic Upper Limb of Children With Cerebral Palsy: A Pilot StudyARTIFICIAL ORGANS, Issue 3 2010Gerardo Rodríguez-Reyes Abstract Spasticity has been successfully managed with different treatment modalities or combinations. No information is available on the effectiveness or individual contribution of botulinum toxin type A (BTA) combined with physical and occupational therapy and neuromuscular electrical stimulation to treat spastic upper limb. The purpose of this study was to assess the effects of such treatment and to inform sample-size calculations for a randomized controlled trial. BTA was injected into spastic upper limb muscles of 10 children. They received 10 sessions of physical and occupational therapy followed by 10 sessions of neuromuscular electrical stimulation on the wrist extensors (antagonist muscles). Degree of spasticity using the Modified Ashworth scale, active range of motion, and manual function with the Jebsen hand test, were assessed. Meaningful improvement was observed in hand function posttreatment (P = 0.03). Median spasticity showed a reduction trend and median amplitude of wrist range of motion registered an increase; however, neither of these were significant (P > 0.05). There is evidence of a beneficial effect of the combined treatment. Adequate information has been obtained on main outcome-measurement variability for calculating sample size for a subsequent study to quantify the treatment effect precisely. [source] Watching moving images specifically promotes development of medial area of secondary visual cortex in ratDEVELOPMENTAL NEUROBIOLOGY, Issue 9 2009Baonan Sun Abstract It is generally accepted that the cortex can be divided into numerous regions depending on the type of information each processes, and that specific input is effective in improving the development of related regions. In visual cortex, many subareas are distinguished on the basis of their adequate information. However, whether the development of a subarea can be specifically improved by its particular input is still largely unknown. Here, we show the specific effects of motion information on the development of the medial area of secondary visual cortex (V2M), a subarea associated with processing the movement component of visual information. Although watching a moving or a still image had similar effects in primary visual cortex, the moving image induced multistage development of V2M in dark-reared rats: both mRNA and protein levels of GluR2 were upregulated, the density and protein content of GluR2-positive synapses increased, and the spine density and the frequency of spontaneous excitatory postsynaptic currents (EPSCs) of pyramidal neurons in Layer 5 were elevated. Our results suggest that rats are able to identify motion information, distribute it to V2M, and then use this input to specifically improve the development of V2M. © 2009 Wiley Periodicals, Inc. Develop Neurobiol 2009 [source] Modelling daily precipitation features in the Volta Basin of West AfricaINTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 7 2009P. Laux Abstract The combination of a conventional Markov chain model (zero and first order) and a gamma distribution model are found to be applicable to derive meaningful agricultural features from precipitation in the Volta Basin (West Africa). Since the analysis of the monthly or annual precipitation amount does not provide any adequate information on rainfall timing and sufficiency of crop water requirement, rainfall modelling was performed on a daily time scale for 29 rainfall stations. The modelled rainfall features follow distinct spatial patterns, which will be presented as maps of(1) rainfall occurrence probabilities and (2) recommendations of optimal planting dates. In addition, the effective drought index (EDI) working on daily time scales is calculated in order to assess drought properties of five different rainfall regions within the Volta Basin. Apart from the common way of separately modelling the duration and intensity due to their different distributions, a copula approach is chosen in this study to construct a bivariate drought distribution. Application of the measures derived to agricultural decision support will be discussed briefly. Copyright © 2009 Royal Meteorological Society [source] Cell proliferation and cell cycle control: a mini reviewINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 12 2004C.H. Golias Summary Tumourigenesis is the result of cell cycle disorganisation, leading to an uncontrolled cellular proliferation. Specific cellular processes-mechanisms that control cell cycle progression and checkpoint traversation through the intermitotic phases are deregulated. Normally, these events are highly conserved due to the existence of conservatory mechanisms and molecules such as cell cycle genes and their products: cyclins, cyclin dependent kinases (Cdks), Cdk inhibitors (CKI) and extra cellular factors (i.e. growth factors). Revolutionary techniques using laser cytometry and commercial software are available to quantify and evaluate cell cycle processes and cellular growth. S-phase fraction measurements, including ploidy values, using histograms and estimation of indices such as the mitotic index and tumour-doubling time indices, provide adequate information to the clinician to evaluate tumour aggressiveness, prognosis and the strategies for radiotherapy and chemotherapy in experimental researches. [source] Repeat dispensing of prescriptions in community pharmacies: a systematic review of the UK literatureINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 1 2006Charles W. Morecroft Research associate Objective To identify, review and evaluate the published literature that focused on the impact of repeat dispensing in community pharmacies in the United Kingdom. Method Electronic databases (e.g. Medline, Embase and CINAHL) were searched from 1992 to May 2005. This was supplemented by searching PJ-online, IJPP online conference abstracts and the bibliographies of retrieved articles. Analysis of the findings explored the quality of the assessed papers, stakeholders' perceptions of repeat dispensing, the impact on professional relationships and workload, quality of care and prescription cost savings. Key findings Four randomised controlled trials (RCTs) and one before-and-after study were identified; most studies also incorporated a qualitative component. The findings indicated that patients' satisfaction with repeat dispensing was high, mainly as the service was seen as more convenient and time saving. While pharmacists considered that their relationship with patients had improved, one study found that patients did not necessarily agree and considered that pharmacists still remained in their dispensaries. Quality of care was considered in two RCTs, which indicated that more adverse reactions and compliance issues were identified in the intervention group. However, no direct comparisons were reported in differences in rates between intervention and control groups. Likewise, it was not possible to determine if any of the reported cost savings were solely attributable to repeat dispensing, as direct comparisons between groups were not reported. Conclusions Definitive conclusions about the effectiveness and impact of repeat dispensing are difficult to draw given a lack of transparency and systematicity when reporting these studies. Nevertheless, the findings suggest that there are high levels of patient satisfaction with the service. Likewise, it was not possible to draw conclusions about the possible savings on the NHS drug budget. Important policy decisions are being made about the implementation of repeat dispensing; however they are currently been made in a vacuum of adequate information. [source] Effects of interval between diagnosis and time of survey upon preferred information format for prostate cancer patientsJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 2 2009CF Sharpley Summary Previous data indicate that receiving adequate information about their cancer can assist patients to cope with treatment and comply with treatment regimes. The aim of the present study was to determine whether time since diagnosis affected patients' evaluations of the information they had received at the time of their diagnosis. Two hundred and thirty-seven patients who had received a diagnosis and treatment for prostate cancer 4 months earlier completed a questionnaire about their ratings of, and preferences for, various types of information, their anxiety and depression levels and some background data. The most common and preferred form of information that the patients in the current study received was verbal information during an interview with their oncologist. Demographic factors and levels of anxiety and depression did not influence patient information preferences. Time since diagnosis was associated with elevated anxiety and depression, and consequent lower recall of having received information, but also with positive inflation of the value of the material that they did recall having received. Patients may not recall information given to them early after diagnosis and may make unreliable evaluations of its value to them due to psychological state. [source] Finite element analysis on preferable I-bar clasp shapeJOURNAL OF ORAL REHABILITATION, Issue 5 2001Y. Sato An I-bar clasp is one of the most popular direct retainers for distal-extension removable partial dentures. However, no adequate information is available on preferable shape as determined by biomechanics. This study aimed (1) to investigate, by finite element analysis (FEA), the dimensions and stress of I-bar clasps having the same stiffness, and (2) to estimate a mechanically preferable clasp design. Three-dimensional FEA models of I-bar clasps were created with vertical and horizontal straight sections connected by a curved section characterized by six parameters: thickness of the clasp tip, width of the clasp tip, radius of the curvature, horizontal distance between the base and the vertical axis, vertical dimension between the tip and the horizontal axis, and taper (change of width per unit length along the axis). Stress was calculated with a concentrated load of 5 N applied 2 mm from the tip of the clasp in the buccal direction. A thinner and wider clasp having an taper of 0·020,0·023 and radius of curvature of 2·75,3·00 showed less stress. The results suggest that such a shape might be the preferable I-bar clasp shape as biomechanical viewpoint. [source] A systematic review on the clinical diagnosis of gastrointestinal stromal tumorsJOURNAL OF SURGICAL ONCOLOGY, Issue 5 2008Marco Scarpa MD Abstract Background The aim of this work was to assess the prevalence of symptoms of gastrointestinal stromal tumors (GISTs) and the diagnostic yield of clinical procedures for its diagnosis. Methods Medical databases were consulted between 1998 and 2006 for potentially relevant publications. All studies dealing with the clinical presentation of GIST and related diagnostic procedures were included. Two researchers worked independently on the study selection, quality assessment, data extraction, and analysis phases of the study. Results Forty-six observational studies were included with a total of 4,534 patients. Gastrointestinal bleeding was the most common clinical presentation. Twenty studies provided adequate information on the diagnostic yield of various procedures. The pooled diagnostic yield of endoscopy,+,mucosal biopsy and of intestinal contrast radiography was 33.8% (0,100%) and 35.1% (11,100%), respectively, while that of EUS and that of EUS-FNA was 68.7% (40,100%) and 84.0% (73.8,100%), respectively. Abdominal CT scan and MRI had similar pooled diagnostic yields: 73.6% (34.8,100%), and 91.7% (75,100%), respectively. Conclusion Endoscopy,+,mucosal biopsy should be reserved to patients with gastrointestinal bleeding. EUS-FNA provides direct visualization of the neoplasm and adequate samples for molecular diagnosis. EUS, abdominal CT and MRI may be considered valid alternatives whenever EUS-FNA is unavailable or a cytological diagnosis is unnecessary. J. Surg. Oncol. 2008;98:384,392. © 2008 Wiley-Liss, Inc. [source] Stereotypical Relations and Utterance Understanding: An Introduction to Xu Sheng-Huan's Stereotypical Relation-Based Approach to PragmaticsLINGUISTICS & LANGUAGE COMPASS (ELECTRONIC), Issue 1 2010Wu Bing-zhang An utterance hardly provides adequate information for its understanding, but the stereotypical relations (SRs) suggested by its linguistic components and mode of expression help to complement the explicitly expressed content, thus making the utterance serve its communicative function. Stereotypical relations are a speaker/hearer's perception and memory of the relations between things in the experiential world. Such relations, once entrenched, are the cognitive device by which humans understand, represent, and express the world. Things in SRs are interdependent; the presence of one entails that of another. Therefore, an utterance implicates the necessary information by SRs to ,fill up' the information gap in the context of communication. Stereotypical relations can be characterized in terms of similarity and proximity, both of which are categories of degree. [source] Sociocultural influences on infant feeding decisions among HIV-infected women in rural Kwa-Zulu Natal, South AfricaMATERNAL & CHILD NUTRITION, Issue 1 2005Lucy N. Thairu msc Abstract The promotion of exclusive breastfeeding for 6 months, followed by rapid transition to alternative food sources may be an important public health approach to the reduction of mother-to-child transmission of HIV through breastmilk. The basic ethical principle of ,informed choice' requires that HIV positive women are provided with adequate information about their options. However, information is only one factor that affects their decisions. The objective of this ethnographic study was to identify sociocultural influences on infant feeding decisions in the context of a large cohort study designed to assess the impact of a breastfeeding counselling and support strategy to promote exclusive breastfeeding on postnatal transmission of HIV in African women. Following an initial period of exploratory interviewing, ethnographic techniques were used to interview 22 HIV positive women about their views on infant feeding and health. Interviews were tape-recorded, transcribed and analysed with a text analysis program. Five themes of influences on feeding decisions emerged: (1) social stigma of HIV infection; (2) maternal age and family influences on feeding practices; (3) economic circumstances; (4) beliefs about HIV transmission through breastmilk; and (5) beliefs about the quality of breastmilk compared to formula. The study highlights the role of cultural, social, economic and psychological factors that affect HIV positive women's infant feeding decisions and behaviour. [source] Addiction-Related Assessment Tools and Pain Management: Instruments for Screening, Treatment Planning, and Monitoring CompliancePAIN MEDICINE, Issue 2008Steven D. Passik PhD ABSTRACT Objective., To review and critique the various assessment tools currently available to pain clinicians for assessing opioid use and abuse in patients with chronic noncancer pain to allow pain clinicians to make informed selections for their practices. Methods., A literature search on PubMed was conducted in June 2006 using the search terms opioid plus screening or assessment with or without the additional term risk, and opioid-related disorders/prevention and control in order to identify clinical studies published in English over the previous 10 years. Additional studies were identified using the PubMed link feature and Google. When abstracts described or referred to a tool for opioid abuse screening, the corresponding publication was acquired and reviewed for relevance to the pain treatment setting. Results., Forty-three publications were selected for review from the abstracts identified, and 19 were rejected because they did not describe a specific tool or provide adequate information regarding the screening tool used. The remaining 24 publications described relevant screening tools for opioid abuse risk and were reviewed. Conclusions., A variety of self-administered and physician-administered tools differing in their psychometrics and intended uses have been developed, but not all have been validated for use in chronic pain patients seen in a clinical practice setting. Some tools assess abuse potential in patients being considered for opioid therapy, whereas other tools screen for the presence of substance abuse. By recognizing the psychometrics of each tool, clinicians can select the ones most appropriate for their patient population and screening needs. [source] Latest news and product developmentsPRESCRIBER, Issue 3 2007Article first published online: 14 MAR 200 PPIs and hip fracture Treatment with a PPI may increase the risk of hip fracture, with longer use associated with higher risk according to a study in UK patients (J Am Med Assoc 2006;297:2947-53). The case control study compared use of PPIs by 13 556 patients with hip fracture and 135 386 controls in the UK General Practice Research Database. Use of a PPI for more than one year was associated with an increase of 44 per cent in the odds of hip fracture. The risk was higher for longer- term use (59 per cent after four years) and at higher doses (more than doubled with long-term high doses). The mechanism for this possible effect may be impaired calcium absorption associated with hypochlorhydria and reduced bone resorption. CHD NSF Statin prescribing has increased by 30 per cent every year since the publication of the Coronary Heart Disease NSF, the Department of Health says. The estimated number of lives saved attributable to statins had risen to 9700 in 2005. The proportion of patients with acute MI who were given thrombolysis within 30 minutes of admission has increased to 83 per cent. Flu jabs cut pneumonia deaths A US study suggests that flu vaccine protects against death during the flu season in patients admitted with community-acquired pneumonia (Arch Intern Med 2007;167:53-9). Nineteen per cent of patients admitted with pneumonia during the winters of 1999-2003 were known to have been vaccinated against flu. Their risk of death during their hospital stay was 70 per cent lower than that of nonvaccinated individuals. After adjustment for antipneumococcal vaccination and comorbidity, the odds of death were still 39 per cent lower. Model to predict admissions The King's Fund, together with New York University and Health Dialog, has published a model that predicts the risk of emergency hospital admission (see www.kingsfund.org.uk). The model is intended for use by PCTs and draws on data from secondary and primary care to define clinical profiles, allowing patients whose condition is deteriorating to be identified before they need admission. Problem drinking The National Treatment Agency for Substance Misuse (NTA), a special authority within the NHS, has published a critical appraisal of the evidence for various treatments for alcohol problems (www.nta.nhs.uk). The 212-page document estimates that over seven million hazardous or harmful drinkers may benefit from brief interventions by any health workers, and over one million dependent drinkers may benefit from specialist intervention. It concludes that cognitive behavioural approaches to specialist treatment are most effective and that treatment probably accounts for about one-third of improvements made in problem drinking. of patients remained on the same treatment after one year, falling to half at two years and about 40 per cent at three years. Treatment was more frequently stopped for lack of efficacy than for adverse effects. Stopping anti-TNFs Discontinuation of treatment with anti-TNF agents is more common in clinical practice than in clinical trial populations, a French study has found (J Rheumatol 2006;33:2372-5). The retrospective analysis of a single centre's experience of treating 770 patients with etanercept (Enbrel), infliximab (Remicade) or adalimumab (Humira) found that fewer than two-thirds of patients remained on the same treatment after one year, falling to half at two years and about 40 per cent at three years. Treatment was more frequently stopped for lack of efficacy than for adverse effects. There were no statistically significant differences between the three agents but there was a trend for infliximab to be least well tolerated. Generic statin savings The Department of Health has estimated that prescribing simvastatin and pravastatin generically would save £85 million per year. Its analysis of the ,Better care, better value' indicators (see www.productivity.nhs.uk) shows that statin prescribing has increased by 150 per cent in the past five years, with costs totalling £600 million in 2005. The Department says that if every PCT prescribed pravastatin and simvastatin by generic name in only 69 per cent of cases ,the level achieved by the top quarter of trusts ,the savings would be over £85 million a year. Herceptin reporting Press reports of a two-year trial of trastuzumab (Herceptin) were generally accurate in reporting its effectiveness but few reported an increased risk of adverse effects, according to the NHS National Library for Health (www.library.nhs.uk). The Herceptin Adjuvant (HERA) trial (Lancet 2007;369:29-36) found that, after an average follow-up of two years, 3 per cent of women treated with trastuzumab died compared with 5 per cent of controls; estimated three-year survival rates were 92.4 and 89.7 per cent respectively. All four press articles reported these findings accurately, but only two mentioned the increased risk of adverse effects. Updated guidance on CDs The Department of Health has published updated guidance on the strengthened governance requirements for managing controlled drugs, taking into account new regulations that came into force on 1 January (seewww.dh.gov.uk/asset Root/04/14/16/67/04141667.pdf). Statin adherence lowers MI mortality Patients with acute myocar- dial infarction (MI) who take their statins as prescribed are significantly more likely to survive for two to three years than those with low adherence (J Am Med Assoc 2007;297: 177-86). The four-year observational study of 31 455 patients with acute MI found that, compared with those who had taken at least 80 per cent of prescribed daily doses, the risk of death in those with less than 40 per cent adherence was 25 per cent greater over 2.4 years. For individuals with intermediate adherence (40-79 per cent), the risk was 12 per cent greater. Both differences were statistically significant after adjustment for potential confounding factors. The authors believe their finding is explained by differences in adherence rather than healthier behaviour because the excess risk of low adherence was less marked with beta-blockers and not significant for calcium-channel blockers. Improving community medicines management Mental health trusts need to improve medicines management by their community teams and improve information sharing with GPs, the Healthcare Commission has found (www.healthcare commission.org.uk). Its national report revealed limited evidence of pharmacist involvement in community mental health teams, even though 90 per cent of patients were cared for in the community. Only 11 per cent of assertive outreach patients had the tests necessary to ensure safe use of their medicines. Medication reviews found that 46 per cent of patients in mental health trusts and 12 per cent of those in acute trusts were not taking their medication appropriately. The Commission also reported that acute trusts received a complete drug history from GPs for fewer than half of audited patients when they were admitted to hospital, and only 30 per cent of PCTs reported that GPs received adequate information on patients' medicines on discharge. Copyright © 2007 Wiley Interface Ltd [source] Transitions from hospital to residential aged care in AustraliaAUSTRALASIAN JOURNAL ON AGEING, Issue 4 2009Rosemary Karmel Aim:, To investigate movement of people from hospital into residential aged care. Methods:, An innovative record linkage method was implemented to create a national database to investigate transitions from hospital into aged care. Results:, In 2001,2002, 3.2% of hospitalisations for people aged 65+ ended with admission into residential aged care. A further 5.5% were for people already living permanently in care. Nationally, more people were admitted into permanent care from hospital than from the community. Factors important in predicting admission to aged care from hospital included length of hospital stay, diagnoses, region of usual residence and hospital jurisdiction. Conclusion:, Individually, national hospital and aged care datasets do not provide adequate information on movement between the sectors. Linking the data allowed the first national investigation into movement from hospital into aged care. Results indicate the importance of investigating interactions of service provision (both supply and demand driven) at the local level. [source] Parental knowledge of topical therapies in the treatment of childhood atopic dermatitisCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 5 2003P. E. Beattie Summary Poor adherence with therapy is a major cause of treatment failure in atopic dermatitis. Reasons given are multifactorial, and include fear of real or imaginary side-effects, under-prescribing, failure to renew prescriptions on time, lack of time, and child refusal of therapy. Most important, however, is lack of knowledge about treatment, in particular the use of topical corticosteroid (TCS) therapy. We conducted a questionnaire-based study to determine the level of use and knowledge of commonly prescribed TCS preparations amongst parents or carers of 100 children attending paediatric outpatient clinics. Weakly potent TCSs were the most commonly used (86%), but poorly understood. Only 35 (41%) who had used hydrocortisone were aware that it was weakly potent, and 44% graded it as moderately potent. Of 65 who had used the moderately potent TCS clobetasone butyrate 0.05% (Eumovate®; Glaxo Wellcome, Uxbridge, UK), 19 (29%) graded it as potent and eight (12%) as weak. Of 50 who had used betamethasone valerate 0.1% (Betnovate®; Glaxo Wellcome, Uxbridge, UK), 42% did not grade it as potent. Understanding of TCS/antimicrobial combinations was generally worse. The hydrocortisone 1%/fusidic acid 2% combination (Fucidin H®; Leo, Risborough, Bucks, UK) was graded as moderate or strong by 88% of the 74 who had used it. Over half (53%) of the 34 using the combination of clobetasone butyrate 0.05%/nystatin 100 000 i.u./g tetracycline 3% (Trimovate®; Glaxo Wellcome, Uxbridge, UK) assumed that it was a potent TCS. Forty-nine had used Fucibet® (betamethasone valerate 0.1%, fusidic acid 2%; Leo, Risborough, Bucks, UK) but 34.5% did not grade it as potent. There was poor knowledge of the strengths of some of the most commonly used TCSs, and all steroid/antimicrobial combinations were perceived as being of greater potency than the constituent steroid alone. Fusidic acid was thought to be a steroid by almost half (46.9%) of the respondents. The packaging of the different products by some pharmaceutical companies is remarkably similar and labelling contains information on the compound and percentage rather than potency of the TCS. This may be a source of confusion. We recommend that manufacturers clearly label TCS products by potency as mild, moderate, potent or very potent and that packaging is sufficiently different for each strength of TCS or emollient to avoid confusion. In order to achieve optimal topical treatment for atopic dermatitis, patients and their carers must receive adequate information and training in how and when to use topical therapies in conjunction with written care plans. [source] | ||||||||||