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Medical Interventions (medical + intervention)
Selected AbstractsCuring and Healing: Medical Anthropology in Global Perspective; Everyday Spirits and Medical Interventions: Ethnographic and Historical Notes on Therapeutic Conventions in Zanzibar Town; Some Spirits Heal, Others Only Dance: A Journey into Human Selfhood in an African Village; The Straight Path of the Spirit: Ancestral Wisdom and Healing Traditions in Fiji; Healing Makes Our Hearts Happy: Spirituality and Cultural Transformations among the Ju!'hoansiMEDICAL ANTHROPOLOGY QUARTERLY, Issue 1 2001Helle Samuelsen Curing and Healing: Medical Anthropology in Global Perspective. Andrew Strathern and Pamela J. Stewart. Durham, NC: Carolina Academic Press, 1999. vii+224 pp. Everyday Spirits and Medical Interventions: Ethnographic and Historical Notes on Therapeutic Conventions in Zanzibar Town. Tapio Nisula. Saarijanjarvi: Transactions of the Finnish Anthropological Society 43,1999. 321 pp. Some Spirits Heal, Others Only Dance:. Journey into Human Selfhood in an African Village. Roy Willis with K. B. S. Chisanga. H. M. K. Sikazwe. Kapembwa B. Sikazwe. and Sylvia Nanyangwe .Oxford: Berg, 1999. xii. 220pp. The Straight Path of the Spirit: Ancestral Wisdom and Healing Traditions in Fiji. Richard Katz. Rochester, VT. Park Street Press, 1999.413 pp. Healing Makes Our Hearts Happy: Spirituality and Cultural Transformations among the Ju!'hoansi. Richard Katz. Megan Biesele. and Verna St. Denis. Rochester, VT: Inner Traditions, 1997. xxv. 213 pp. [source] Some Spirits Heal, Others Only Dance: A Journey into Human Selfhood in an African Village; Everyday Spirits and Medical Interventions: Ethnographic and Historical Notes on Therapeutic Conventions in Zanzibar TownAMERICAN ANTHROPOLOGIST, Issue 2 2001Judy Rosenthal Some Spirits Heal, Others Only Dance:. Journey into Human Selfhood in an African Village. Roy Willis. New York: Berg, 1999. 220 pp. Everyday Spirits and Medical Interventions: Ethnographic and Historical Notes on Therapeutic Conventions in Zanzibar Town. Tapio Nisula. Helsinki, Finland: The Finnish Anthropological Society, 1999. 321 pp. [source] 2224: Oxygenation of the human retinaACTA OPHTHALMOLOGICA, Issue 2010E STEFANSSON Purpose Partial pressure of oxygen in the optic nerve and retina is regulated by the intraocular pressure and systemic blood pressure, the resistance in the blood vessels and oxygen consumption of the tissue. The PO2 is autoregulated and moderate changes in intraocular pressure, blood pressure or tissue oxygen consumption do not affect the retinal and optic nerve oxygen tension. Methods If the intraocular pressure is increased above 40 mmHg or the ocular perfusion pressure decreased below 50 mmHg the autoregulation is overwhelmed and the optic nerve becomes hypoxic. The levels of perfusion pressure that lead to optic nerve hypoxia in the laboratory correspond remarkably well to the levels that increase the risk of glaucomatous optic nerve atrophy in human glaucoma patients. Medical intervention can affect optic nerve PO2. Lowering the intraocular pressure tends to increase the optic nerve PO2, even though this effect may be masked by the autoregulation when the optic nerve PO2 and perfusion pressure is in the normal range. Results Carbonic anhydrase inhibitors increase retinal PO2 through a mechanism of vasodilatation and lowering of the intraocular pressure. Carbonic anhydrase inhibition reduces the removal of CO2 from the tissue and the CO2 accumulation induces vasodilatation resulting in increased blood flow and improved oxygen supply. This effect is inhibited by indomethacin but not other cyclo-oxygenase inhibitors. Conclusion Carbonic anhydrase inhibitors increase retinal blood flow and increase oxygen delivery. Glaucoma drugs and glaucoma surgery lower intraocular pressure, increase ocular perfusion pressure and blood flow. Demand of oxygen by retinal cells may be reduced through apoptosis and tissue atrophy, as well as active destruction of tissue by laser photocoagulation. [source] Resurfacing of Pitted Facial Acne Scars with a Long-Pulsed Er:YAG LaserDERMATOLOGIC SURGERY, Issue 2 2001Jeung-Tae Jeong MD Background. Conventional short-pulsed Er:YAG lasers show less effective hemostasis and weak photothermal damage on papillary dermis. Recently, newer long-pulsed Er:YAG laser systems has been developed. Objective. To evaluate the clinical and histologic effects of long-pulsed Er:YAG laser resurfacing for pitted facial acne scars. Methods. Thirty-five patients with pitted facial acne scars were treated with a long-pulsed Er:YAG laser. All patients had Fitzpatrick skin phototypes III,V. A pulsed Er:YAG laser with a 5 mm handpiece at a setting of 7.0,7.5 J/cm2 with a 10-msec pulse duration was used. The laser was fired at 5 Hz, with four to five passes. In 28 patients, the results of laser treatment were evaluated for the degree of clinical improvement, duration of erythema, pigmentary change, and any adverse events at 2 weeks, 1 month, and 3 months. In seven patients, skin biopsy specimens were obtained at the following intervals: immediately, 1 week, 2 weeks, 4 weeks, and 8 weeks postoperatively for histologic examination. Results. The results of long-pulsed Er:YAG laser resurfacing for pitted facial acne scars were excellent in 10 patients (36%), good in 16 patients (57%), and fair in 2 patients (7%). Erythema occurred in all patients after laser treatment and lasted longer than 3 months in 15 patients (54%). Postinflammatory hyperpigmentation occurred in 8 patients (29%). But the pigmentation faded or disappeared within 3 months. One patient (4%) experienced mild hypopigmentation. Pruritic symptoms that required medical intervention occurred in 16 patients (57%). Mild to moderate postoperative acne flare-up occurred in 8 patients (29%). No other adverse effects such as scarring, bacterial infection, or contact dermatitis were observed. Conclusion. In conclusion, resurfacing with a long-pulsed Er:YAG laser is a safe and very effective treatment modality for pitted facial acne scars. [source] Adverse events during use of intranasal desmopressin acetate for haemophilia A and von Willebrand disease: a case report and review of 40 patientsHAEMOPHILIA, Issue 1 2000Dunn We report our experience with the incidence of adverse events during the use of Stimate® brand intranasal desmopressin acetate (IN DDAVP) for patients with haemophilia A (HA) or von Willebrand disease (vWD) after noting two severe adverse events in one adult patient. All patients with documented vWD (type 1 or 2 A) or haemophilia A (mild, moderate or symptomatic carrier) from the Emory Comprehensive Hemophilia Center who had IN DDAVP challenge testing or were using Stimate® for treatment of bleeding were evaluated for adverse events by patient report or nursing observation of clinical signs and symptoms. Forty patients were studied. Sixty-eight per cent (27/40) experienced clinical signs and/or symptoms. The majority of these symptoms were mild, however several patients reported moderate to severe side-effects and one adult patient required medical intervention for symptomatic hyponatraemia. In our experience, two-thirds of patients tested experienced adverse signs and/or symptoms with the use of Stimate®; considerably higher than that reported from preliminary results in the literature. Young age did not correlate positively with adverse reactions. Severe adverse events requiring medical intervention were rare, however symptoms such as moderate to severe headache, nausea, vomiting and weakness may necessitate evaluation for hyponatraemia. This is the first report of symptomatic hyponatraemia in an adult patient with recommended dosing of Stimate®. Side-effects may be minimized if patients adhere to instructions regarding fluid intake and composition while using IN DDAVP. [source] The successful use of maggots in necrotizing fasciitis of the neck: A case reportHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2004Simon F. Preuss MD Abstract Background. The use of maggots to digest necrotic tissue as a form of wound debridement has a long history in medicine. Necrotizing fasciitis of the neck has a high mortality rate despite aggressive surgical and medical intervention. The use of maggots in this disease has been reported only once before. Methods. We report the case of a 73-year-old woman, who underwent neck dissection and had necrotizing fasciitis of the neck develop shortly after. After initial surgical wound debridement, we used maggots as a biosurgical method for further debridement. A net containing 100 maggots (Biobag; BioMonde, Germany) was used. Results. Daily wound dressing showed rapid improvement of the wound; 4 days after beginning treatment, the wound was free of necroses. Conclusion. In this case, we could avoid repeated surgical wound debridement with the use of sterile maggots. The frequently rapid progression of necrotizing fasciitis could be well controlled. © 2004 Wiley Periodicals, Inc. Head Neck26: 747,750, 2004 [source] Does early medical intervention have a role in the management of intracerebral haemorrhage?INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 4 2008A. Bhalla Summary Introduction:, An increasing amount of research is now being directed towards the medical treatment of patients who have suffered an intracerebral haemorrhage (ICH). Despite this, no routine drug treatment to date has been shown to be unequivocally effective in unselected patients. Treatments/Discussion:, Approaches to treatment are based upon our understanding of the pathophysiological sequelae following ICH. Strategies to reduce haematoma growth, subsequent oedema formation and perihaematoma ischaemia are key targets for further research. Whether these therapies become valuable tools for the future is as yet unclear. Until then, the mainstay of the medical management of ICH remains individualised care. Conclusions:, There is now a pressing need for large prospective randomised controlled trials to determine the effectiveness of pharmacological therapies for this condition. [source] A literature review: factors that impact on nurses' effective use of the Medical Emergency Team (MET)JOURNAL OF CLINICAL NURSING, Issue 24 2009Lisa Jones Aims and objectives., The aim of this literature review is to identify factors, both positive and negative, that impact on nurses' effective use of the Medical Emergency Team (MET) in acute care settings. Background., Outcomes for patients are often dependent on nurses' ability to identify and respond to signs of increasing illness and initiate medical intervention. In an attempt to improve patient outcomes, many acute hospitals have implemented a rapid response system known as the Medical Emergency Team (MET) which has improved management of critically ill ward patients. Subsequent research has indicated that the MET system continues to be underused by nurses. Design., A comprehensive thematic literature review. Methods., The review was undertaken using key words and the electronic databases of Cumulative Index to Nursing and Allied Health Literature (CINAHL), OVID/MEDLINE, Blackwell Synergy, Science Direct and Informit. Fifteen primary research reports were relevant and included in the review. Results., Five major themes emerged from the analysis of the literature as the major factors effecting nurses' use of the MET system. They were: education on the MET, expertise, support by medical and nursing staff, nurses' familiarity with and advocacy for the patient and nurses' workload. Conclusions., Ongoing education on all aspects of the MET system is recommended for nursing, medical and MET staff. Bringing MET education into undergraduate programs to prepare new graduates entering the workforce to care for acutely ill patients is also strongly recommended. Further research is also needed to determine other influences on MET activation. Relevance to clinical practice., Strategies that will assist nurses to use the MET system more effectively include recruitment and retention of adequate numbers of permanent skilled staff thereby increasing familiarity with and advocacy for the patient. Junior doctors and nurses should be encouraged to attend ward MET calls to gain skills in management of acutely ill patients. [source] Telemedicine: barriers and opportunities in the 21st centuryJOURNAL OF INTERNAL MEDICINE, Issue S741 2001B. Stanberry Abstract. Stanberry B (Centre for Law Ethics and Risk in Telemedicine, Cardiff, Wales, UK). Telemedicine: barriers and opportunities in the 21st century (Internal Medicine in the 21st Century). J Intern Med 2000; 247: 615,628. This paper aims to examine how health telematics will develop in the first 10 years of the new millennium and, in particular, to assess what operational, ethical and legal barriers may lie in the way of this development. A description of the key principles and concepts involved in telemedicine and a short historical overview of telemedicine's evolution over the past century are followed by consideration of why empirical research into ,info-ethics' and other deontological and legal issues relating to telemedicine is being necessarily catalysed by, amongst others, the European Commission. Four evolving health telematics applications are examined in some detail: electronic health records; the transmission of visual media in disciplines such as teleradiology, teledermatology, telepathology and teleophthalmology; telesurgery and robotics and the use of call centres and decision-support software. These are discussed in the light of their moral, ethical and cultural implications for clinicians, patients and society at large. The author argues that telemedicine presents unique opportunities for both patients and clinicians where it is implemented in direct response to clear clinical needs, but warns against excessive reliance upon technology to the detriment of traditional clinician,patient relationships and against complacency regarding the risks and responsibilities , many of which are as yet unknown , that distant medical intervention, consultation and diagnosis carry. [source] Telemedicine: barriers and opportunities in the 21st centuryJOURNAL OF INTERNAL MEDICINE, Issue 6 2000B. Stanberry Abstract. Stanberry B (Centre for Law Ethics and Risk in Telemedicine, Cardiff, Wales, UK). Telemedicine: barriers and opportunities in the 21st century (Internal Medicine in the 21st Century). J Intern Med 2000; 247: 615,628. This paper aims to examine how health telematics will develop in the first 10 years of the new millennium and, in particular, to assess what operational, ethical and legal barriers may lie in the way of this development. A description of the key principles and concepts involved in telemedicine and a short historical overview of telemedicine's evolution over the past century are followed by consideration of why empirical research into ,info-ethics' and other deontological and legal issues relating to telemedicine is being necessarily catalysed by, amongst others, the European Commission. Four evolving health telematics applications are examined in some detail: electronic health records; the transmission of visual media in disciplines such as teleradiology, teledermatology, telepathology and teleophthalmology; telesurgery and robotics and the use of call centres and decision-support software. These are discussed in the light of their moral, ethical and cultural implications for clinicians, patients and society at large. The author argues that telemedicine presents unique opportunities for both patients and clinicians where it is implemented in direct response to clear clinical needs, but warns against excessive reliance upon technology to the detriment of traditional clinician,patient relationships and against complacency regarding the risks and responsibilities , many of which are as yet unknown , that distant medical intervention, consultation and diagnosis carry. [source] Pilot study examining the combined use of pulsed dye laser and topical Imiquimod versus laser alone for treatment of port wine stain birthmarksLASERS IN SURGERY AND MEDICINE, Issue 9 2008Cheng-Jen Chang MD Abstract Background and Objective The objective of this study was to improve port wine stain (PWS) therapeutic outcome in response to laser therapy. Our specific aim was to determine whether the combined use of pulsed dye laser (PDL) therapy and topical Imiquimod versus PDL alone can improve PWS therapeutic outcome. Study Design/Materials and Methods This pilot study involved a retrospective review of 20 subjects, all Asian, with PWS. Subject ages ranged between 3 and 56 years. Upon enrollment, three test sites were prospectively identified on each subject for treatment assignments to the following regimens: (A) PDL+Imiquimod; (B) PDL alone; and (C) Imiquimod alone. PDL test sites received a single treatment with a 585 nm wavelength; 1.5 milliseconds pulse duration; spot size 7 mm using a light dosage of 10 J/cm2 with cryogen spray cooling. For the PDL+Imiquimod and Imiquimod alone test sites, subjects were instructed to apply Imiquimod topically to the sites once daily for 1 month after PDL exposure. Subjects were followed-up at 1, 3, 6, and 12 months after PDL exposure to evaluate each of the three test sites. The primary efficacy measurement was the quantitative assessment of blanching responses as measured by a DermoSpectrometer to calculate the hemoglobin-index of each site at 1, 3, 6, and 12 months after PDL exposure. Subjects were also closely monitored for any adverse effects. Results Based on paired sample test analysis, there were clinically, and statistically significant, differences in blanching responses over time favoring PWS receiving PDL+Imiquimod as compared to either PDL or Imiquimod alone (P<0.05). At 12 months, it should be noted that there was some evidence of redarkening of PWS test sites treated by PDL+Imiquimod and PDL alone, presumably due to revascularization of blood vessels. However, based on comparison of the hemoglobin-indices determined at 1 and 12 months after PDL exposure, there was less revascularization of PWS test sites treated with PDL+Imiquimod as compared to PDL alone (P<0.05). Transient hyperpigmentation was noted in 10% (n,=,2) and 40% (n,=,8) of subjects on the PDL+Imiquimod and PDL alone test sites, respectively. On all sites, hyperpigmentation resolved spontaneously without medical intervention within 6 months. Permanent hypopigmentation or scarring was not observed on any test site. Conclusion Based on the results of this pilot study, PDL+Imiquimod resulted in superior blanching responses over time as compared to PDL alone for treatment of test sites on PWS lesions. Although the PDL+Imiquimod approach is intriguing, clinical validation in large PWS patient samples is required. Lesers Surg. Med. 40:605,610, 2008. © 2008 Wiley-Liss, Inc. [source] Raised intracranial pressure in a neonate presenting as stridorPEDIATRIC ANESTHESIA, Issue 8 2006KATE SOLAN FRCA Summary Neonatal stridor is an important sign of upper airway obstruction. This is most commonly secondary to laryngeal pathology and investigated by otolaryngologists. However neurological causes of stridor, secondary to vocal cord paralysis also occur for a variety of reasons (1). In cases of meningomyelocele up to 20% of infants may develop stridor (2). Respiratory distress may be severe and require prompt surgical and medical intervention. We describe a neonate born with a meningomyelocele, who developed stridor secondary to evolving hydrocephalus after surgical repair of the meningomyelocele. This was treated acutely by direct tapping of cerebrospinal fluid from the right coronal horn via the coronal suture with immediate symptomatic improvement prior to a definitive shunt procedure. [source] Managing "healthy" late preterm infantsPEDIATRICS INTERNATIONAL, Issue 5 2009Akio Ishiguro Abstract Background:, Late preterm infants are often managed in nursery rooms despite the risks associated with prematurity. The objective of this study was to determine the risks facing late preterm infants admitted to nursery rooms and to establish a management strategy. Methods:, A total of 210 late preterm infants and 2648 mature infants were assessed. Infants born at 35 and 36 weeks' gestation weighing ,2000 grams admitted to a nursery room and not requiring medical intervention at birth were of particular interest. The admission rates to the neonatal intensive care unit were evaluated according to the chart review. Results:, Infants born at 35 and 36 weeks' gestation weighing ,2000 grams had significantly higher admission rates than term infants at birth (Cochran,Mantel,Haenszel test, P < 0.001; common risk ratio, 4.27; 95% confidence interval, 2.41,7.55) and after birth (P < 0.001; common risk ratio, 3.57; 95% confidence interval, 2.40,5.33). More than 80% of admissions from the nursery room to the neonatal intensive care unit after birth were due to apnea or hypoglycemia in neonates born at 35 and 36 weeks' gestation. The admission rates due to apnea increased with decreasing gestational age. The admission rates due to hypoglycemia with no cause other than prematurity accounted for 24.3% of admissions for those born at 35 weeks' gestation and 14.1% of admissions for those born at 36 weeks' gestation; hypoglycemia due to other causes accounted for fewer admissions. Conclusion:, The management strategy for late preterm infants should be individualized, based on apnea and hypoglycemia. The respiratory state of late preterm infants should be monitored for at least 2 days, and they should be screened for hypoglycemia on postnatal day 0. [source] Priapism: Pathogenesis, Epidemiology, and ManagementTHE JOURNAL OF SEXUAL MEDICINE, Issue 1pt2 2010Gregory A. Broderick MD ABSTRACT Introduction., Priapism describes a persistent erection arising from dysfunction of mechanisms regulating penile tumescence, rigidity, and flaccidity. A correct diagnosis of priapism is a matter of urgency requiring identification of underlying hemodynamics. Aims., To define the types of priapism, address its pathogenesis and epidemiology, and develop an evidence-based guideline for effective management. Methods., Six experts from four countries developed a consensus document on priapism; this document was presented for peer review and debate in a public forum and revisions were made based on recommendations of chairpersons to the International Consultation on Sexual Medicine. This report focuses on guidelines written over the past decade and reviews the priapism literature from 2003 to 2009. Although the literature is predominantly case series, recent reports have more detailed methodology including duration of priapism, etiology of priapism, and erectile function outcomes. Main Outcome Measures., Consensus recommendations were based on evidence-based literature, best medical practices, and bench research. Results., Basic science supporting current concepts in the pathophysiology of priapism, and clinical research supporting the most effective treatment strategies are summarized in this review. Conclusions., Prompt diagnosis and appropriate management of priapism are necessary to spare patients ineffective interventions and maximize erectile function outcomes. Future research is needed to understand corporal smooth muscle pathology associated with genetic and acquired conditions resulting in ischemic priapism. Better understanding of molecular mechanisms involved in the pathogenesis of stuttering ischemic priapism will offer new avenues for medical intervention. Documenting erectile function outcomes based on duration of ischemic priapism, time to interventions, and types of interventions is needed to establish evidence-based guidance. In contrast, pathogenesis of nonischemic priapism is understood, and largely attributable to trauma. Better documentation of onset of high-flow priapism in relation to time of injury, and response to conservative management vs. angiogroaphic or surgical interventions is needed to establish evidence-based guidance. Broderick GA, Kadioglu A, Bivalacqua TJ, Ghanem H, Nehra A, and Shamloul R. Priapism: Pathogenesis, epidemiology and management. J Sex Med 2010;7:476,500. [source] Seasonality in sperm parameters in normal men and dyspermic patients on medical interventionANDROLOGIA, Issue 2 2009D. A. Adamopoulos Summary This study attempted to investigate the presence of seasonal variations in sperm parameters and to evaluate the season's impact on the response to treatment in men with idiopathic oligozoospermia (IO). To this end, a retrospective analysis of the records of 294 men, who participated in a controlled study, was performed. This sample included IO men (n = 106) treated with tamoxifen citrate (10 mg b.i.d.) and testosterone undecanoate (40 mg t.i.d.) or placebo (n = 106) and normozoospermic men (n = 82) serving as controls. Outcome measures included sperm parameters, functional sperm fraction (FSF) and incidence of pregnancy. Analysis showed a raised frequency of high FSF values and increased area under the response curve (AURC) for FSF mean during autumn-winter seasons in patients on active treatment compared with those in placebo (P < 0.05,P < 0.04). Moreover, receiver operation characteristics (ROC) curves for a >100% FSF rise significantly discriminated autumn-winter from other seasons (P < 0.001, all), whereas active treatment showed higher than placebo FSF values particularly during autumn and winter (P < 0.001, all). The pregnancy incidence was higher in the autumn in all groups. It is concluded that FSF values showed a better response to active treatment during autumn and winter, indicating that commencement of empirical treatment at this time in IO men may stand a better chance to succeed. [source] PRIMARY PERITONITIS IN ADULTS: IS IT TIME TO LOOK FOR A BETTER DIAGNOSTIC CLASSIFICATION?ANZ JOURNAL OF SURGERY, Issue 3 2006John Jarvis Background: The occurrence of primary peritonitis is rare. The experience of a single institution and the definition of this disease are reviewed. Methods: A retrospective audit of primary peritonitis at a single institution was undertaken. Age, sex, clinical presentation, initial diagnosis, imaging and blood tests, comorbidities, recent medical intervention, surgical treatment and operative findings, antibiosis, bacterial isolates, the course of hospital treatment and follow up, including later diagnoses, were reviewed. Results: The audit was carried out at Christchurch Hospital between January 1998 and March 2005. A total of 115 patients were identified with a diagnosis of non-specific peritonitis, of which five patients were identified with a diagnosis of primary peritonitis. All were women aged 22,38 years. Three had undergone a caesarean section in the last 3 months. The details of these cases are presented in detail. Conclusion: Five cases of primary peritonitis are reported, and from a review of published work, a classification of primary peritonitis is suggested, which more clearly identifies the cause of the disease. [source] Prevalence of rheumatoid arthritis in persons 60 years of age and older in the United States: Effect of different methods of case classificationARTHRITIS & RHEUMATISM, Issue 4 2003Elizabeth K. Rasch Objective To determine prevalence estimates for rheumatoid arthritis (RA) in noninstitutionalized older adults in the US. Prevalence estimates were compared using 3 different classification methods based on current classification criteria for RA. Methods Data from the Third National Health and Nutrition Examination Survey (NHANES-III) were used to generate prevalence estimates by 3 classification methods in persons 60 years of age and older (n = 5,302). Method 1 applied the "n of k" rule, such that subjects who met 3 of 6 of the American College of Rheumatology (ACR) 1987 criteria were classified as having RA (data from hand radiographs were not available). In method 2, the ACR classification tree algorithm was applied. For method 3, medication data were used to augment case identification via method 2. Population prevalence estimates and 95% confidence intervals (95% CIs) were determined using the 3 methods on data stratified by sex, race/ethnicity, age, and education. Results Overall prevalence estimates using the 3 classification methods were 2.03% (95% CI 1.30,2.76), 2.15% (95% CI 1.43,2.87), and 2.34% (95% CI 1.66,3.02), respectively. The prevalence of RA was generally greater in the following groups: women, Mexican Americans, respondents with less education, and respondents who were 70 years of age and older. Conclusion The prevalence of RA in persons 60 years of age and older is ,2%, representing the proportion of the US elderly population who will most likely require medical intervention because of disease activity. Different classification methods yielded similar prevalence estimates, although detection of RA was enhanced by incorporation of data on use of prescription medications, an important consideration in large population surveys. [source] Serum phytoestrogens and prostate cancer risk in a nested case-control study among Japanese menCANCER SCIENCE, Issue 1 2004Kotaro Ozasa The purpose of this study was to examine whether a high serum concentration of phytoestrogens reduces the risk of prostate cancer in a case-control study nested in a community-based cohort in Japan (Japan Collaborative Cohort (JACC) Study). Information on lifestyles and sera of the subjects were collected in 1988,90, and they were followed up to 1999. Incident and dead cases of prostate cancer and controls were matched for study area and age. Phytoestrogens and sex hormones in sera stored at ,80°C were measured in 2002. Of 14,105 male subjects of the cohort who donated their sera, 52 cases and 151 controls were identified. Three datasets were analyzed; 1) all subjects, 2) 40 cases and 101 controls after excluding subjects with low testosterone levels who were suspected of having had medical intervention, and 3) 28 cases and 69 controls with prostate specific antigen level of ,10.0 ng/ml. The odds ratio (OR) for the highest level to the lowest was 0.38 (95% confidence interval (CI); 0.13, 1.13) for genistein, 0.41 (0.15, 1.11) for daidzein, and 0.34 (0.11, 1.10) for equol for the second dataset. Genistein and daidzein showed similar findings in the third one. Equol and equol/daidzein ratio showed consistent findings in all three datasets (OR=0.39, 95% CI; 0.13, 0.89, trend P=0.02 for the first dataset). Their effects seemed to be independent of serum sex hormones. In conclusion, serum genistein, daidzein, and equol seemed to dose-dependently reduce prostate cancer risk. (Cancer Sci 2004; 95: 65,71) [source] 33 cases of airsoft gun pellet ocular injuries in Copenhagen, Denmark, 1998,2002ACTA OPHTHALMOLOGICA, Issue 6 2006Jon Peiter Saunte Abstract. Purpose:, To evaluate the incidence and ocular effects of blunt trauma due to injury from airsoft gun pellets. Methods:, We conducted a non-comparative case series based on the files of 33 patients who suffered ocular injury from airsoft guns and were admitted to one university emergency eye clinic in Copenhagen during a 5-year period. Results:, A total of 33 eyes in 33 patients were examined. Thirty male and three female patients were affected. Mean age was 13 years (range 3,49 years). Mean follow-up time was 6.5 days (range 1,540 days). On initial examination, we found: hyphaema (n = 28), corneal abrasion (n = 22), retinal oedema (n = 11), subconjunctival haemorrhage (n = 10), palpebral haemorrhage and/or oedema (n = 9), iris dialysis (n = 7), intraocular pressure (IOP) >,31 mmHg (n = 4), IOP <,9 mmHg (n = 4), vitreous haemorrhage (n = 2) and cataract (n = 1). One patient had brown corneal discoloration due to severe chronic hyphaema that required surgery. The final visual acuity was 1.0 in 20 patients and ,,0.7 in five patients. Conclusion:, The airsoft gun trauma resulted in anterior and posterior segment ocular injuries that required acute medical intervention and for which some patients were hospitalized. Trauma mainly occurred in children and youths. A longterm risk of glaucoma is expected. Eye care professionals and parents as well as manufacturers of airsoft guns should advise participants to wear adequate protection when involved in this activity. [source] Relation between change of hearing and (modified) Amsterdam Inventory for Auditory Disability and Handicap ScoreCLINICAL OTOLARYNGOLOGY, Issue 6 2004A.G.W. Meijer This study investigates the test,retest distributions and the interval for true score change of the (modified) Amsterdam Inventory for Auditory Disability and Handicap [(m)AIAD], when the latter is used to measure the effect of an intervention. In a previous study the reliability and validity of the (m)AIAD in a cohort of hearing impaired patients were found to have satisfactory high values. In this prospective study, 66 patients underwent a tympanoplasty operation. Preoperatively and postoperatively pure tone audiometry was performed, and at the same time the subjective hearing ability was established by means of the (m)AIAD. The correlation between threshold change and score change was 0.35 (Pearson's r). Scores on the (m)AIAD had to change by at least 16 to be qualified as a true change. For only nine of 66 subjects this criterion was fulfilled. No clear relation exists, except for these nine subjects, between threshold change and score change in this patient population. The study also shows that disability questionnaires have their limitations, when using them to measure the result of a medical intervention in an individual patient. [source] Growth hormone in short children: beyond medicine?ACTA PAEDIATRICA, Issue 1 2001LLE Bolt The indications for growth hormone (GH) treatment in non-GH-deficient short children are in debate, with some arguing that this treatment does not belong solely in the medical domain. We describe three different approaches to the issue, and argue that neither a disease-oriented nor client-oriented approach is sufficient. Both lead to withdrawal of medical interventions or to an undesirable application. Conclusion: An approach focusing on suffering as an indication for treatment of short stature is the most appropriate. The challenge is to develop proper tools by which to evaluate suffering and the efficacy of GH treatment in these children in order to relieve or prevent suffering. [source] Cost and cost-effectiveness of standard methadone maintenance treatment compared to enriched 180-day methadone detoxificationADDICTION, Issue 6 2004Carmen L. Masson ABSTRACT Aims To compare the cost and cost-effectiveness of methadone maintenance treatment and 180-day methadone detoxification enriched with psychosocial services. Design Randomized controlled study conducted from May 1995 to April 1999. Setting Research clinic in an established drug treatment program. Participants One hundred and seventy-nine adults with diagnosed opioid dependence. Intervention Patients were randomized to methadone maintenance (n = 91), which required monthly 1 hour/week of psychosocial therapy during the first 6 months or 180-day detoxification (n = 88), which required 3 hours/week of psychosocial therapy and 14 education sessions during the first 6 months. Measurements Total health-care costs and self-reported injection drug use. A two-state Markov model was used to estimate quality-adjusted years of survival. Findings Methadone maintenance produced significantly greater reductions in illicit opioid use than 180-day detoxification during the last 6 months of treatment. Total health-care costs were greater for maintenance than detoxification treatment ($7564 versus $6687; P < 0.001). Although study costs were significantly higher for methadone maintenance than detoxification patients ($4739 versus $2855, P < 0.001), detoxification patients incurred significantly higher costs for substance abuse and mental health care received outside the study. Methadone maintenance may provide a modest survival advantage compared with detoxification. The cost per life-year gained is $16 967. Sensitivity analysis revealed a cost-effectiveness ratio of less than $20 000 per quality-adjusted life-year over a wide range of modeling assumptions. Conclusions Compared with enriched detoxification services, methadone maintenance is more effective than enriched detoxification services with a cost-effectiveness ratio within the range of many accepted medical interventions and may provide a survival advantage. Results provide additional support for the use of sustained methadone therapy as opposed to detoxification for treating opioid addiction. [source] Industry sponsorship and selection of comparators in randomized clinical trialsEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 2 2010D. N. Lathyris Eur J Clin Invest 2010; 40 (2): 172,182 Abstract Background, Most clinical trials on medical interventions are sponsored by the industry. The choice of comparators shapes the accumulated evidence. We aimed to assess how often major companies sponsor trials that involve only their own products. Methods, Studies were identified by searching ClinicalTrials.gov for trials registered in 2006. We focused on randomized trials involving the 15 companies that had sponsored the largest number of registered trials in ClinicalTrials.gov in that period. Results, Overall, 577 randomized trials were eligible for analysis and 82% had a single industry sponsor [89% (166/187) of the placebo-control trials, 87% (91/105) of trials comparing different doses or ways of administration of the same intervention, and 78% (221/285) of other active control trials]. The compared intervention(s) belonged to a single company in 67% of the trials (89%, 81% and 47% in the three categories respectively). All 15 companies strongly preferred to run trials where they were the only industry sponsor or even the only owner of the assessed interventions. Co-sponsorship typically reflected co-ownership of the same intervention by both companies. Head-to-head comparison of different active interventions developed by different companies occurred in only 18 trials with two or more industry sponsors. Conclusions, Each company generates a clinical research agenda that is strongly focused on its own products, while comparisons involving different interventions from different companies are uncommon. This diminishes the ability to understand the relative merits of different interventions for the same condition. [source] Why ethnic minority groups are under-represented in clinical trials: a review of the literatureHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2004Mahvash Hussain-Gambles MA Abstract Randomised controlled trials (RCTs) are considered to be the gold standard in evaluating medical interventions; however, people from ethnic minorities are frequently under-represented in such studies. The present paper addresses a previously neglected debate about the tensions which inform clinical trial participation amongst people from ethnic minorities, in particular, South Asians, the largest ethnic minority group in the UK. In a narrative review of the available literature, based mainly on US studies, the present authors aim to make sense of the issues around under-representation by providing a theoretical reconciliation. In addition, they identify a number of potential barriers to ethnic minority participation in clinical trials. In so doing, the authors recognise that the recent history of eugenic racism, and more general views on clinical trials as a form of experimentation, means that clinical trial participation among people from ethnic minorities becomes more problematic. Lack of participation and the importance of representational sampling are also considered, and the authors argue that health professionals need to be better informed about the issues. The paper concludes by offering a number of strategies for improving ethnic minority accrual rates in clinical trials, together with priorities for future research. [source] International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness?HEALTH ECONOMICS, Issue 4 2010Takeru Shiroiwa Abstract Although the threshold of cost effectiveness of medical interventions is thought to be £20,000,£30,000 in the UK, and $50,000,$100,000 in the US, it is well known that these values are unjustified, due to lack of explicit scientific evidence. We measured willingness-to-pay (WTP) for one additional quality-adjusted life-year gained to determine the threshold of the incremental cost-effectiveness ratio. Our study used the Internet to compare WTP for the additional year of survival in a perfect status of health in Japan, the Republic of Korea (ROK), Taiwan, Australia, the UK, and the US. The research utilized a double-bound dichotomous choice, and analysis by the nonparametric Turnbull method. WTP values were JPY 5 million (Japan), KWN 68 million (ROK), NT$ 2.1 million (Taiwan), £23,000 (UK), AU$ 64,000 (Australia), and US$ 62,000 (US). The discount rates of outcome were estimated at 6.8% (Japan), 3.7% (ROK), 1.6% (Taiwan), 2.8% (UK), 1.9% (Australia), and 3.2% (US). Based on the current study, we suggest new classification of cost-effectiveness plane and methodology for decision making. Copyright © 2009 John Wiley & Sons, Ltd. [source] The role of doctor's opinion in shared decision making: what does shared decision making really mean when considering invasive medical procedures?,HEALTH EXPECTATIONS, Issue 2 2005Dennis J. Mazur MD Abstract Objective, The goal of this study was to gain understanding about patients' perspectives on decision making in the context of invasive medical interventions and whether patients' decision-making preferences influenced the type of information they desired to be provided by physicians. Design, Questionnaire study of consecutive patients in a university-based general medicine clinic. Interventions, Patients were presented with a randomized list of three types of information that physicians could provide (risk, benefit and physician's opinion on whether they should undergo the procedure). Patients were asked whether they preferred patient-based, physician-based, or shared decision making and then were asked to select which one or combination of these three information types was most important to them in their own decision making. Patients were also asked to self-report on how many invasive procedures they had undergone in their own lives. Participants, A total of 202 consecutive patients (mean age = 65.1 years, SD = 12.3, range 28,88; mean education 13.3 years, SD 2.9, range 2,23). Main outcome measures, Patient reports. Results, Of the 202 patients, two patients reported no decision-making preference. These two patients were excluded from the analysis. Of the 200 remaining patients, 62.5% (125/200) preferred shared, 22.5%(45/200) preferred physician-based, and 15.5% (31/200) preferred patient-based decision making. More than half of all subjects chose physician opinion as the most important type of information for decision making. Older patients (odds ratio 1.028; confidence interval 1.003,1.053) were more likely to have ranked the doctor's opinion as the most important in their decision making for invasive medical interventions. Conclusions, Although most patients want to share decision making with their physicians regarding invasive procedures, the majority of these patients report relying on the doctor's opinion on whether to undergo the procedure as the most important information in their own decision making. [source] European AIDS Clinical Society (EACS) guidelines on the prevention and management of metabolic diseases in HIV,HIV MEDICINE, Issue 2 2008JD Lundgren Background Metabolic diseases are frequently observed in HIV-infected persons and, as the risk of contracting these diseases is age-related, their prevalence will increase in the future as a consequence of the benefits of antiretroviral therapy (ART). Summary of guidelines All HIV-infected persons should be screened at regular intervals for a history of metabolic disease, dyslipidaemia, diabetes mellitus, hypertension and alteration of body composition; cardiovascular risk and renal function should also be assessed. Efforts to prevent cardiovascular disease will vary in intensity depending on an individual's absolute risk of ischaemic heart disease and should be comprehensive in nature. Lifestyle interventions should focus on counselling to stop smoking, modify diet and take regular exercise. A healthy diet, exercise and maintaining normal body weight tend to reduce dyslipidaemia; if not effective, a change of ART should be considered, followed by use of lipid-lowering medication in high-risk patients. A pre-emptive switch from thymidine analogues is recommended to reduce the risk of development or progression of lipoatrophy. Intra-abdominal fat accumulation is best managed by exercise and diet. Prevention and management of type 2 diabetes mellitus and hypertension follow guidelines used in the general population. When using medical interventions to prevent and/or treat metabolic disease(s), impairment of the efficacy of ART should be avoided by considering the possibility of pharmacokinetic interactions and compromised adherence. Specialists in HIV and specialists in metabolic diseases should consult each other, in particular in difficult-to-treat cases. Conclusion Multiple and relatively simple approaches exist to prevent metabolic diseases in HIV-infected persons; priority should be given to patients at high risk of contracting these diseases. [source] The fatal outcome of an individual with anorexia nervosa and Sheehan's syndrome as a result of acute enterocolitis: A case reportINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 1 2010Werner Köpp MD Abstract Objectives: To illustrate the close association between a disturbed psychosocial up-bringing, frequent physical illness, and medical interventions. Method: We report a case of a 44-year-old woman with anorexia nervosa (AN) and Sheehan's syndrome who died as a result of a toxic cardiac arrest. Results: The patient presented with a BMI of 13.6 kg/m2. She refused any intensive-care treatment and died from toxic cardiac arrest. Postmortem examination revealed an acute gastroenterocolitis. Discussion: The history of this patient illustrates how psychological deprivation led to eating disturbances, early pregnancy, and the life-threatening delivery of twins. This resulted in a diagnosis of Sheehan's syndrome, hepatitis C, and a ventricular ulcer. A psychosocial event triggered a late exacerbation of her AN. A helpful alliance between patient and staff did not occur as she rejected it. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010. [source] Challenging behaviours in nursing home residents with dementia: a randomized controlled trial of multidisciplinary interventionsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2002Janet Opie Abstract Objectives To test the premise that individually tailored psychosocial, nursing and medical interventions to nursing home residents with dementia will reduce the frequency and severity of behavioural symptoms. Methods A four-member team comprising a psychiatrist, psychologist and nurses conducted detailed assessments of 99 nursing home residents with advanced dementia who were rated by staff as having frequent, severe behavioural disturbances. Residents were then randomly assigned to an ,early' or ,late' intervention group and observed for four weeks. Interventions encompassed psychosocial strategies, nursing approaches, psychotropic medications and management of pain. Outcome measures included the frequency and severity of disruptive behaviours and assessments of change by senior nursing home staff. Results While improvements in behaviour were noted in both groups from the outset of observations, pointing to a powerful Hawthorne effect, consultancies were associated with a modest but statistically significant decrease in challenging behaviours. Staff assessments of the interventions were highly favourable. Conclusions The consultancies were effective and well received by staff. The change-inducing nature of any new endeavour is an integral part of research in a long-term setting. Copyright © 2002 John Wiley & Sons, Ltd. [source] The Medical Assessment of Migrants: Current Limitations and Future PotentialINTERNATIONAL MIGRATION, Issue 2 2001V.P. Keane Attempts to control the importation of infectious diseases through the medical screening and evaluation of immigrants and refugees represent the modern application of some of the earliest recorded public health interventions. States with long-standing immigration programmes continue to require the medical examination and screening of migrants for certain diseases. In some instances, the public health effectiveness of these immigration medical assessments is of questionable value when considered from a population health basis. This article reviews current practices and describes recent studies where more modern and epidemiologically based immigration medical interventions have been undertaken. A more effective immigration medical assessment process is proposed through the use of results of this more empirical approach to immigration medical screening. [source] | ||||||||||||||||||||||||||||||||||