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Routine
Kinds of Routine Terms modified by Routine Selected Abstracts[Commentary] SUPPORTING GPS IN THE PROVISION OF SMOKING CESSATION INTERVENTION,FROM RESEARCH TO DAILY ROUTINEADDICTION, Issue 2 2008CHRISTIAN MEYER No abstract is available for this article. [source] Routine immunophenotyping in acute leukemia: Role in lineage assignment and reassignmentCYTOMETRY, Issue 5 2006Misbah Qadir Abstract Diagnostic evaluation of acute leukemia at Roswell Park Cancer Institute has routinely included immunophenotyping by multiparameter flow cytometry. In a retrospective analysis of 646 cases, morphology and cytochemistry established lineage in 612, but not in 34 (5%), of which 26, 5, and 3 were myeloid, undifferentiated, and lymphoid, respectively, based on immunophenotyping. In addition, immunophenotyping changed the lineage assigned based on morphology and cytochemistry in 11 cases (2%); 8 changed from lymphoid to myeloid, and 3 from myeloid to lymphoid. The data support routine inclusion of at least limited immunophenotyping in the diagnostic evaluation of acute leukemia. © 2006 International Society for Analytical Cytology [source] Approaches to measuring the effects of wake-promoting drugs: a focus on cognitive functionHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 5 2009Christopher J. Edgar Abstract Objectives In clinical drug development, wakefulness and wake-promotion may be assessed by a large number of scales and questionnaires. Objective assessment of wakefulness is most commonly made using sleep latency/maintenance of wakefulness tests, polysomnography and/or behavioral measures. The purpose of the present review is to highlight the degree of overlap in the assessment of wakefulness and cognition, with consideration of assessment techniques and the underlying neurobiology of both concepts. Design Reviews of four key areas were conducted: commonly used techniques in the assessment of wakefulness; neurobiology of sleep/wake and cognition; targets of wake promoting and/or cognition enhancing drugs; and ongoing clinical trials investigating wake promoting effects. Results There is clear overlap between the assessment of wakefulness and cognition. There are common techniques which may be used to assess both concepts; aspects of the neurobiology of both concepts may be closely related; and wake-promoting drugs may have nootropic properties (and vice versa). Clinical trials of wake-promoting drugs often, though not routinely, assess aspects of cognition. Conclusions Routine and broad assessment of cognition in the development of wake-promoting drugs may reveal important nootropic effects, which are not secondary to alertness/wakefulness, whilst existing cognitive enhancers may have underexplored or unknown wake promoting properties. Copyright © 2009 John Wiley & Sons, Ltd. [source] Needs and risks of patients in a state-wide inpatient forensic mental health populationINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 4 2010Ariel Segal ABSTRACT Routine needs assessments have become mandated requirements for public mental health services. However, the appropriateness of these generic health needs assessments to specialist populations remains questionable. This study sought to assess individual needs assessed using a widely used clinician rated assessment (Health of the Nation Outcome Scales-Secure; HoNOS-Secure), a subjective needs assessment that considers both staff and patient perspectives (Camberwell Assessment of Need-Forensic version; CANFOR), and a measure of risk for general criminal recidivism (Level of Service Inventory: Screening Version; LSI:SV) in a secure forensic mental health service. Results revealed significant positive correlations between staff ratings on HoNOS-Secure, CANFOR total needs, and CANFOR met needs scores, but no significant association between CANFOR ratings or HoNOS-Secure ratings and LSI:SV scores. Although patients and staff reported the same number of needs overall according to CANFOR (7.2 vs. 7.5, P > 0.05), patients reported that more of these needs were unmet (3.1 vs. 2.3, P < 0.05). Differences between staff and patient ratings of need suggest that needs assessments should include patient perspectives to facilitate more collaborative and comprehensive care planning. Divergent perspectives between patients and staff may impair patient engagement in treatment and therefore negatively impact on outcome. Service planning issues and opportunities for future research are discussed. [source] Standardized routine outcome measurement: Pot holes in the road to recoveryINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 4 2004Richard Lakeman Abstract: Routine ,outcome measurement' is currently being introduced across Australian mental health services. This paper asserts that routine standardized outcome measurement in its current form can only provide a crude and narrow lens through which to witness recovery. It has only a limited capacity to capture the richness of people's recovery journeys or provide information that can usefully inform care. Indeed, in its implementation nurses may be required to collude in practices or account for practice in ways which run counter to the personal recovery paradigm. Nurses should view a focus on outcomes as an opportunity for critical reflection as well as to seek ways to account for recovery stories in meaningful ways. [source] Predicting Recurrence of Vasovagal Syncope: A Simple Risk Score for the Clinical RoutineJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2009MUHAMMET A. AYDIN M.D. Background: Predictors for recurrence of syncope are lacking in patients with vasovagal syncope. The aim of this study was to identify risk factors for recurrence of syncope and develop a simple prognostic risk score of clinical value. Methods: Two hundred seventy-six patients with a history of vasovagal syncope were prospectively followed for 2 years. Diagnosis of vasovagal syncope was based on clinical history and negative standard work-up. Inclusion in the study was independent from the result of the head-up tilt test, which was performed in all cases. Risk factors for syncope recurrence were evaluated by the Cox proportional hazards regression model and implemented in a risk score, which was validated with the log-rank test and an internal cross-validation. Results: The Cox-regression analysis identified the number of previous syncopal events, history of bronchial asthma, and female gender as predictors for syncope recurrence (all P < 0.05). In contrast, head-up tilt test response had no predictive value (P = 0.881). Developing a risk score, study patients were identified as having high (recurrence rate during 2 years of follow-up: 37.2%), intermediate (24.8%), and low (6.5%) risk for syncope recurrence (receiver operating characteristic [ROC] of score 0.83, P < 0.01; Log-rank test for event-free survival, P < 0.005). Conclusions: In patients with vasovagal syncope, risk of recurrence can be stratified and is predictable based on a simple risk score. [source] Periodontal repair in dogs: space-providing ePTFE devices increase rhBMP-2/ACS-induced bone formationJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 8 2003Ulf M.E. Wikesjö Abstract Background: Recombinant human bone morphogenetic protein-2 (rhBMP-2) technologies have been shown to enhance alveolar bone formation significantly. Biomaterial (carrier) limitations, however, have restricted their biologic potential for indications where compressive forces may limit the volume of bone formed. The objective of this proof-of-principle study was to evaluate the potential of a space-providing, macroporous ePTFE device to define rhBMP-2-induced alveolar bone formation using a discriminating onlay defect model. Methods: Routine, critical size, 5,6 mm, supra-alveolar, periodontal defects were created around the third and fourth mandibular premolar teeth in four young adult Hound Labrador mongrel dogs. All jaw quadrants received rhBMP-2 (0.4 mg) in an absorbable collagen sponge (ACS) carrier. Contralateral jaw quadrants in subsequent animals were randomly assigned to receive additionally the dome-shaped, macroporous ePTFE device over the rhBMP-2/ACS implant or no additional treatment. The gingival flaps were advanced to cover the ePTFE device and teeth, and sutured. Animals were scheduled for euthanasia to provide for histologic observations of healing at 8 weeks postsurgery. Results: Healing was uneventful without device exposures. New bone formation averaged (±SD) 4.7±0.2 mm (98%) and 4.5±0.4 mm (94%) of the defect height, respectively, for jaw quadrants receiving rhBMP-2/ACS with the ePTFE device or rhBMP-2/ACS alone (p>0.05). In contrast, the regenerated bone area was significantly enhanced in jaw quadrants receiving rhBMP-2/ACS with the ePTFE device compared to rhBMP-2/ACS alone (9.3±2.7 versus 5.1±1.1 mm2; p<0.05). Cementum formation was similar for both treatment groups. Ankylosis compromised periodontal regeneration in all sites. Conclusions: The results suggest that the novel space-providing, macroporous ePTFE device appears suitable as a template to define rhBMP-2/ACS-induced alveolar bone formation. Zusammenfassung Hintergrund: Es wurde gezeigt, dass das rekombinante menschliche knochenmorphogenetische Protein 2 (rhBMP-2) die alveoläre Knochenbildung signifikant erhöht. Limitationen des Biomaterials (Träger) haben jedoch die biologischen Potenzen des Materials für die Indikationen, wo komprimierende Kräfte das Volumen des zu bildenden Knochen limitierten, eingeengt. Das Ziel dieser prinzipiellen geprüften Studie war die Evaluation der Platzhalterfunktion einer makroporösen e-PTFE Membran, um die von rhBMP-2 induzierten Knochenbildung unter Nutzung eines differenzierenden Onlaydefektmodells zu definieren. Methoden: Routinemäßig wurden supraalveoläre parodontale Defekte mit der kritischen Größe von 5,6 mm um die dritten und vierten Prämolaren bei 4 jungen adulten Labrodormischhunden geschaffen. Alle Quadranten erhielten rhBMP-2 (0.4 mg) in einem resorbierbaren Kollagenschwamm (ACS). Kontralaterale Quadranten bei den aufeinander folgenden Tieren wurden zufällig ausgewählt, um zusätzlich eine domförmige makroporöse e-PTFE Membran über das rhBMP-2/ACS Implantat oder keine zusätzliche Therapie zu erhalten. Die gingivalen Lappen wurden so präpariert, dass sie die e-PTFE Membran und Zähne bedeckten und vernäht. Die Tiere wurden 8 Wochen nach der Operation getötet und für histologische Untersuchungen vorbereitet. Ergebnisse: Die Heilung war komplikationslos ohne Exposition der Membran. Die neue Knochenbildung betrug durchschnittlich (±SD) 4.7±0.2 mm (98%) und 4.5±0.4 mm (94%) der Defekthöhe für die Quadranten, die rhBMP-2/ACS mit der e-PTFE Membran erhielten oder rhBMP-2/ACS allein (p>0,05). Im Kontrast dazu war das regenerierte Knochenfeld signifikant erweitert bei den Kieferquadranten, die rhBMP-2/ACS mit e-PTFE Membran erhielten im Vergleich zu denjenigen mit rhBMP-2/ACS allein (9.3±2.7 vs. 5.1±1.1 mm2; p<0.05). Die Zementbildung war in beiden Behandlungsgruppen ähnlich. Ankylosen gefährdeten die parodontalen Regeneration in allen Flächen. Schlussfolgerungen: Die Ergebnisse zeigen, dass die neue makroporöse Platzhalter e-PTFE Membran als Schablone nützlich ist, um die rhBMP-2/ACS induzierte alveoläre Knochenbildung zu betonen. Résumé Contexte: Des technologies utilisant la protéine-2 osseuse morphogénétique humaine recombinée (rhBMP-2) ont montré qu'elle permettait d'augmenter significativement la formation d'os alvéolaire. Les limites du biomatériel (vecteur), cependant, ont restreint leur potentiel biologique aux indications pour lesquels des forces compressives pourraient limiter le volume d'os en formation. L'objectif de cette étude fut d'évaluer le potentiel d'un dispositif en ePTFE macro-poreux permettant de créer un espace pour définir la formation d'os alvéolaire induit par la rhBMP-2 en utilisant un modèle discriminatoire de lésion. Méthodes: Des lésions parodontales supra-alvéolaires de taille critique, 5,6 mm, furent créées autour des troisièmes et quatrièmes prémolaires chez 4 Labrador adultes. Chaque quadrant a été traité par des éponges de collagène résorbables utilisé comme vecteur (ASC) contenant rhBMP-2 (0.4 mg). Les quadrants contralatéraux des animaux furent aléatoirement distribués pour recevoir (ou pas) en plus un dispositif macro-poreux en ePTFE, en forme de dôme sur les implants de rhBMP-2/ACS. Les lambeaux furent déplacés pour recouvrir le dispositif en ePTFE et les dents et suturés. Les animaux furent sacrifiés après 8 semaines pour fournir des observations histologiques de la cicatrisation. Résultats: La cicatrisation ne posait pas de problèmes et on ne nota pas d'exposition des dispositifs. La moyenne de la formation osseuse était de (±SD) 4.7±0.2 mm (98%) et 4.5±0.4 mm (94%) de la hauteur de la lésion, respectivement, pour les quadrants ayant été traités par la rhBMP-2/ACS avec le dispositif en ePTFE ou la rhBMP-2/ACS seule (p>0.05). A l'inverse, la surface osseuse régénérée était significativement plus importante dans les quadrants traités par la rhBMP-2/ACS et les dispositifs en ePTFE par rapport au site traités seulement par la rhBMP-2/ACS (9.3±2.7 vs. 5.1±1.1 mm2; p<0.05). La formation cémentaire était similaire pour les deux groupes de traitement. L'ankylose compromettait la régénération parodontale dans tous les sites. Conclusions: Ces résultats suggèrent que le dispositif en ePTFE macro-poreux, qui assure un espace, semble convenir comme standard pour définir la formation osseuse induite par la rhBMP-2/ACS. [source] The Importance of Screening, Assessing, and Managing Urinary Incontinence in Primary CareJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 3 2003FAANArticle first published online: 24 MAY 200, Mikel Gray PhD Purpose To present evidence that routine screening for urinary incontinence is justified because it is a clinically relevant and prevalent disorder that responds to treatment, resulting in improved outcomes for many patients managed by the nurse practitioner (NP). Data Source Selected scientific literature. Conclusions The prevalence of urinary incontinence and success of treatment options justify routine screening, individualized assessment, and treatment. Implications for Practice Routine screening for urinary incontinence by NPs is uncommon. Based on the relative risk, the potential success of treatment and improved quality-of-life outcomes after treat-ment, NPs should regularly screen and assess for incontinence. [source] Routine and adaptive expert strategies for resolving ICT mediated communication problems in the team settingMEDICAL EDUCATION, Issue 7 2009Lara Varpio Context, The use of information and communication technologies (ICTs) for supporting interprofessional communication is becoming increasingly common in health care. However, little research has explored how ICTs affect interprofessional communication, or how novices are trained to be effective interprofessional ICT users. This study explores the interprofessional communication strategies of nurses and doctors (trainees and experts) when their communications were mediated by a specific ICT: an electronic patient record (EPR). Methods, A total of 72 doctors and nurses participated in this 8-month study on a paediatric in-patient ward. Eighty hours of non-participant observations and 20 semi-structured interviews were conducted. All data were rendered anonymous prior to analysis. Using a constructivist grounded theory approach, one researcher read and analysed all data recursively. As emergent themes were identified, exemplary portions of the data were discussed with three additional researchers to resolve discrepancies and confirm the coding structure. Expertise literatures informed the final analyses. Results, Three interprofessional communication strategies were identified: (i) all participants routinely formulated ,workarounds' to circumvent problematic EPR-mediated communications; (ii) workarounds were classifiable as instances of Abandoning, Forcing or Submitting to the EPR, and (iii) novices learned workaround strategies through an informal curriculum, but they did not learn to manage the interprofessional effects of these workarounds. Conclusions, Trainees relied on workarounds as simplified routines, demonstrating routine expertise. Staff members, demonstrating adaptive expertise, used workarounds as part of a broader network of people and communication tools. Explicit training regarding this network and the ways in which workarounds conceal this network may help trainees develop adaptive expertise. [source] Genetic analysis of SCA 2 and 3 repeat expansions in essential tremor and atypical ParkinsonismMOVEMENT DISORDERS, Issue 13 2007Eng-King Tan MD Abstract Anecdotal reports suggest that patients with spinocerebellar ataxia (SCA 2) patients can present with postural tremor with ataxia. We determined the prevalence of SCA2 and SCA3 mutations in a cohort of ET and atypical Parkinsonism patients. A total of 277 subjects comprising of 177 ET and 100 atypical Parkinsonism were examined. We identified one positive case of SCA3 among those who were diagnosed with ET, yielding a prevalence of 0.5%, but a zero prevalence among our atypical Parkinsonism patients. No study subjects carried an abnormal SCA2 repeat expansion. Our study highlights that SCA3 can present initially with ET symptoms, expanding the spectrum of genetic diseases that can be associated with ET-like phenotype. Routine screening for SCA2 and SCA3 in ET and atypical Parkinsonism patients may not be cost effective. However, in the long-term follow-up of patients who present with an ET phenotype, clinicians should be vigilant for other neurological signs, which may be point to an alternate diagnosis. © 2007 Movement Disorder Society [source] Hepatitis infection in haemodialysis patientsNEPHROLOGY, Issue 3 2002Chiu-Ching HUANG SUMMARY: Known hepatitis infections among haemodialysis patients include hepatitis B, hepatitis C, hepatitis G and TT virus. Haemodialysis patients with hepatitis B and/or hepatitis C infection may progress to develop significant morbidity, such as cirrhosis, hepatitic failure or hepatocellular carcinoma. Hepatitis B infection may be treated with ,-interferon or lamivudine. Hepatitis C infection may be treated with ,-interferon, but frequent severe adverse effects were observed, while ribavirin is contraindicated for patients with renal failure. Treatment for hepatitis B and/or hepatitis C are costly, and the risk of post-transplant reactivation of hepatitis has been reported. Prevention of nosocomial transmission of hepatitis infection with strict infection control and universal precautions is more important. Accumulating evidence suggests that both hepatitis G virus and TT virus (TTV) are not significant causes of liver disease. Routine screening for hepatitis G or TTV viraemia in haemodialysis patients is not indicated at present. [source] Routine and ritual elements in family mealtimes: Contexts for child well-being and family identityNEW DIRECTIONS FOR CHILD & ADOLESCENT DEVELOPMENT, Issue 111 2006Barbara H. Fiese This chapter focuses on how the routine elements of family mealtimes such as assigned tasks and the more emotional ritual aspects such as recognition of feelings are related to children's well-being and the creation of a family identity. [source] Familial Atrophia Maculosa Varioliformis Cutis: An Ultrastructural StudyPEDIATRIC DERMATOLOGY, Issue 3 2001Federica Dall'Oglio M.D. We describe two brothers, ages 14 and 16 years, with spontaneously appearing, asymptomatic, varioliform and linear atrophic lesions. Their past medical history was positive for varicella occurring in childhood without residual facial scarring. Routine laboratory investigations and screening for circulating autoantibodies were negative. Both patients were concordant for HLA A2 and DQ4.1. Routine and ultrastructural histologic examination of a punch biopsy specimen showed the presence of scarce, small, fragmented elastic fibers and compact collagen bundles associated with hypertrophic fibroblasts in the dermis. Our patients remained clinically stable, untreated, over a 2-year follow-up period. No long-term follow-up data have previously been reported. [source] Psychological impact of the detection of soft markers on routine ultrasound scanning: a pilot study investigating the modifying role of informationPRENATAL DIAGNOSIS, Issue 7 2002Melanie S. Watson Abstract Objectives To determine the impact on maternal anxiety of detecting a soft marker, and the association between anxiety and the information given during the scan. Methods Routine 20-week fetal anomaly scans were audiotaped in the obstetric ultrasound unit of a London teaching hospital, across a four month study period. The study sample comprised 28 pregnant women: 14 in whom a soft marker was detected and a comparison group of 14 women in whom no marker was identified. Telephone interviews were conducted within one week of the scan, at 30,weeks' gestation, and one month after the birth of their children. The main outcome was anxiety, assessed using a standardized scale. Information provided during the scan was coded from transcripts. Results In the week following the scan, women with soft markers had clinically significant levels of anxiety. At 30,weeks' gestation and one month post-partum their levels were within the normal range. Women who were told during their scan that their baby would probably be all right, compared with women not told this, were significantly less anxious and worried about their baby. Conclusions Results from this small longitudinal study suggest that the detection of soft markers on routine prenatal ultrasound causes considerable short-term anxiety for women and that providing reassurance during the scan may prevent some of this anxiety. Copyright © 2002 John Wiley & Sons, Ltd. [source] Routine Screening for Asymptomatic Abdominal Aortic Aneurysm in High-risk Patients Is Not Recommended in Emergency Departments That Are Frequently CrowdedACADEMIC EMERGENCY MEDICINE, Issue 11 2009Beatrice Hoffmann MD Abstract Objectives:, The objectives were to examine the feasibility of offering abdominal aortic aneurysm (AAA) screening to consecutive, asymptomatic high-risk patients in a busy emergency department (ED) and to compare the prevalence of undetected AAA among ED patients to the prevalence among similarly aged men from the general population. Methods:, A prospective cohort study was conducted at an academic community ED with an annual census of 58,000 patients. Dedicated study coordinators attempted to approach all consecutive male ED patients >50 years who presented in June,August 2007 during hours of high patient volume. To be eligible, older males had to have a smoking history or a family history of AAA. Patients were excluded if they presented with AAA symptoms, had a previous history of AAA screening or repair, had hemodynamic instability, or had an altered mental status. Study coordinators completed a brief interview with all enrolled subjects to obtain demographic and health information. A credentialed ED provider performed the ultrasound (US) screening exam and documented all findings. The US director reviewed representative images of the sonographic exam for correct visualization and measurement during quality assurance. The ED sonographers also completed a survey regarding their attitudes toward AAA screening in the ED. The primary study outcomes were the feasibility of AAA screening in the ED (screening rate, enrollment rate, US success rate, and providers' opinions) and the prevalence of AAA (aortic diameter of ,3.0 cm) in the study sample. Results:, During the 12-week study period, the study coordinators successfully approached 96% (700/729) of males > 50 years who were in the ED during study enrollment hours. Of those approached, 278 were eligible (40%), 25% were ineligible, 20% were not at high risk, and for 15% we could not determine risk factor status because of altered mental status. Of the 278 eligible, 196 (70%) underwent an US exam; 10% were not scanned because the providers were too busy, and 20% declined participation. Of those scanned, the ED sonographer was able to completely visualize and correctly measure the abdominal aortas of 71% of subjects. The prevalence rate of AAA in the study sample was 5.7% (95% confidence interval [CI] = 1.9% to 9.6%), similar to reported rates of 6 or 7% in other studies. More than half of the ED sonographers reported that US screening for AAA improved the quality of ED care (58%) and patient satisfaction (63%). However, 47% reported that AAA screening reduced ED efficiency, and 74% felt that the ED was not an appropriate setting for routine AAA screening. Conclusions:, Routine screening for asymptomatic AAA required substantial ED resources for a relatively low success rate of completed screens. The prevalence rate of AAA in our ED sample was not significantly different than prevalence estimates obtained from older men in the general population. ED sonographers reported benefits of screening in terms of improving the quality of emergency care and patient satisfaction, but also reported that it reduced operational efficiency. For EDs that have problems with crowding, we do not recommend implementing a routine screening program for AAA, even among high-risk patients. [source] Bleeding disorders in teenagers presenting with menorrhagiaAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2005Yasmin JAYASINGHE Abstract Objective:, To assess the prevalence of bleeding disorders and establish the clinical variables that are predictive of a bleeding disorder in adolescent women. Design:, A retrospective audit of all patients who had coagulation tests following presentation with menorrhagia. Setting:, Inpatient and outpatients of a tertiary adolescent gynaecology service. Patients:, Subjects aged 9,19 years with menorrhagia who had coagulation tests performed, and who did not have a known bleeding disorder prior to presentation were included. Outcome measures:, A bleeding screen was performed to assess prevalence of bleeding disorders in the population. Variables that were investigated as predictive of a bleeding disorder included clinical history, family history, and haematological indices of blood loss. Results:, The prevalence of an inherited bleeding disorder was 10.4%. The only statistically significant predictor was a family history of bruising and bleeding. Menstrual history was not predictive. Conclusion:, Severity of menstrual loss was not predictive of a bleeding disorder, as a significant cause of teenage metrostaxis is due to anovulatory dysfunctional uterine bleeding. The authors recommend that a careful personal and family history of bruising and bleeding be taken in all teenagers who present de novo with menorrhagia. Routine screening in a primary care setting is impractical, but should be mandatory in all patients with a positive family history. [source] Everolimus drug interactions: application of a classification system for clinical decision makingBIOPHARMACEUTICS AND DRUG DISPOSITION, Issue 9 2006John M. Kovarik Abstract Introduction. More than half of all drugs used in medical practice are metabolized by cytochrome CYP3A. Coadministration of drugs that share this elimination pathway may lead to pharmacokinetic drug interactions. Efforts are underway by clinical, drug development and regulatory scientists to classify CYP3A-related drug interactions with the ultimate goal of improving guidance for clinical intervention. The CYP3A inhibitory classification system ranks inhibitors according to the fold-increase in area-under-the-curve (AUC) of a probe substrate as: strong (,5-fold), moderate (>2.0- to 4.9-fold), or weak (,2.0-fold). This classification system was applied to characterize everolimus as a CYP3A substrate. Methods. Five open-label crossover drug interaction studies were performed in 12,16 healthy subjects each. Subjects received a single 2 mg dose of everolimus alone and again during single- or multiple-dose treatment with the probe inhibitors ketoconazole, erythromycin, verapamil, cyclosporine and atorvastatin. Results. The fold-increase in everolimus AUC was: 15.0 with the strong inhibitor ketoconazole; 4.4, 3.5 and 2.7 with the moderate inhibitors erythromycin, verapamil and cyclosporine; and no change with the weak inhibitor atorvastatin. Subjects with low baseline AUCs when everolimus was given alone tended to have AUC increases of a higher magnitude (more potent interaction) in the presence of an inhibitor. Conclusions. Strong CYP3A inhibitors should be avoided when possible during everolimus treatment as compensatory everolimus dose reductions could be difficult to manage. Everolimus therapeutic drug monitoring should be used to guide individualized dose adjustments when moderate CYP3A inhibitors are added to or withdrawn from the regimen. Routine everolimus therapeutic drug monitoring should be sufficient to determine whether dose adjustments are needed when weak CYP3A inhibitors are coadministered. This rational and systematic approach to drug interactions on everolimus yielded clinically useful, structured guidelines for dose adjustment. Copyright © 2006 John Wiley & Sons, Ltd. [source] Amniotomy for Shortening Spontaneous LabourBIRTH, Issue 2 2001W.D. Fraser A substantive amendment to this systematic review was last made on 25 June 1999. Cochrane reviews are regularly checked and updated if necessary. ABSTRACT Background: Early amniotomy has been advocated as a component of the active management of labour. Several randomised trials comparing routine amniotomy to an attempt to conserve the membranes have been published. Their limited sample sizes limit their ability to address the effects of amniotomy on indicators of maternal and neonatal morbidity. Objectives: To study the effects of amniotomy on the rate of Cesarean delivery and on other indicators of maternal and neonatal morbidity (Apgar less than 7 at 5 minutes, admission to NICU). Search strategy: The register of clinical trials maintained and updated by the Cochrane Pregnancy and Childbirth Group. Selection criteria: All acceptably controlled trials of amniotomy during first stage of labour were eligible. Data collection and analysis: Data were extracted by two trained reviewers from published reports. Trials were assigned methodological quality scores based on a standardised rating system. Typical odds ratios (ORs) were calculated using Peto's method. Main results: Amniotomy was associated with a reduction in labour duration of between 60 and 120 minutes. There was a marked trend toward an increase in the risk of Cesarean delivery: OR = 1.26; 95% Confidence Interval (CI) = 0.96,1.66. The likelihood of a 5-minute Apgar score less than 7 was reduced in association with early amniotomy (OR = 0.54; 95% CI = 0.30,0.96). Groups were similar with respect to other indicators of neonatal status (arterial cord pH, NICU admissions). There was a statistically significant association of amniotomy with a decrease in the use of oxytocin: OR = 0.79; 95% CI = 0.67,0.92. Reviewers' conclusions: Routine early amniotomy is associated with both benefits and risks. Benefits include a reduction in labour duration and a possible reduction in abnormal 5-minute Apgar scores. The meta-analysis provides no support for the hypothesis that routine early amniotomy reduces the risk of Cesarean delivery. Indeed there is a trend toward an increase in Cesarean section. An association between early amniotomy and Cesarean delivery for fetal distress is noted in one large trial. This suggests that amniotomy should be reserved for women with abnormal labour progress. Citation: Fraser WD, Turcot L, Krauss I, Brisson-Carrol G. Amniotomy for shortening spontaneous labour (Cochrane Review). In: The Cochrane Library, 1, 2001. Oxford: Update Software. MeSH: Amnion/*surgery; Cesarean Section; Female; Human; *Labor; Labor Complications/*prevention & control; Pregnancy The preceding reports are abstracts of regularly updated, systematic reviews prepared and maintained by the Cochrane Collaboration. The full text of the reviews are available in The Cochrane Library (ISSN 1464-780X). The Cochrane Library is prepared and published by Update Software Ltd. All rights reserved. See www.update-software.com or contact Update Software, info@update.co.uk, for information on subscribing to The Cochrane Library in your area. Update Software Ltd, Summertown Pavilion, Middle Way, Oxford OX2 7LG, United Kingdom. (Tel: +44 1865 513902; Fax: +44 1865 516918). [source] Routine versus Selective Abdominal Computed Tomography Scan in the Evaluation of Right Lower Quadrant Pain: A Randomized Controlled TrialACADEMIC EMERGENCY MEDICINE, Issue 2 2007Christopher C. Lee MD Objectives To determine the role of abdominal computed tomography (CT) imaging in patients with right lower quadrant (RLQ) pain. The authors hypothesized that selective use of abdominal CT would reduce imaging without increasing the rates of negative appendectomy and perforated appendicitis. Methods A prospective randomized clinical trial was conducted in a community teaching emergency department. Adult patients with acute RLQ abdominal pain with suspected acute appendicitis were included. Patients were randomized to mandatory (all patients) or selective (based on clinical evaluation) abdominal CT imaging. The primary outcome was the negative appendectomy rate. Results A total of 152 patients were randomized to selective (n= 80) and mandatory (n= 72) intervention groups. The mean (±SD) age was 34.1 (±3.5) years, and 48% were female. CT imaging was performed in 54 of 80 patients (68%; 95% confidence interval [CI] = 56% to 78%) in the selective group and in 70 of 72 patients (97%; 95% CI = 90% to 100%) in the mandatory group. There was a trend to a decreased rate of negative appendectomy in the mandatory group (1/39 [2.6%]; 95% CI = 0.5% to 13.2%) as compared with the selective group (6/43 [13.9%]; 95% CI = 6.6% to 27.3%), with a difference in prevalence rates of 11.3% (95% CI =,3.5% to 26.3%). There was also a trend to a decreased perforated appendix rate in the mandatory group (4/39 [10.3%]) as compared with the selective group (7/38 [18.4%]), with a difference in prevalence rates of 8.2% (95% CI =,8.0% to 24.4%). Conclusions In this small sample of adult patients with RLQ abdominal pain and suspected acute appendicitis, CT imaging was performed less frequently in the selective group and there was a trend with mandatory CT imaging to reduced rates of negative appendectomy and perforated appendices. [source] GENETIC STUDY: Heritability and a genome-wide linkage analysis of a Type II/B cluster construct for cannabis dependence in an American Indian communityADDICTION BIOLOGY, Issue 3 2009Cindy L. Ehlers ABSTRACT Subtyping of substance dependence disorders holds promise for a number of important research areas including phenotyping for genetic studies, characterizing clinical course, and matching treatment and prevention strategies. This study sought to investigate whether a dichotomous construct similar to Babor's Types A/B and Cloninger's Types I/II for alcohol dependence can be identified for cannabis dependence in a Native American sample. In addition, heritability of this construct and its behavior in a genetic linkage analyses were evaluated. Information on cannabis use and dependence symptoms and other psychiatric disorders was obtained using the Semi-Structured Assessment for the Genetics of Alcoholism from a community sample of 606 American Indians. Hierarchical average linkage and K means cluster analysis was used, and a three-cluster solution was found to generate the best separation of variables. Ninety-one per cent of cannabis-dependent participants fell into one of the two subtypes: Type A/I cluster (n = 114, 56%) and Type B/II cluster (n = 70, 35%). Heritability (estimated using Sequential Oligogenic Linkage Analysis Routines) was only significant for the Type B/II cluster (h2 = 0.44, SE = 0.18, P < 0.01). Evidence for linkage was found for the Type B/II cluster (versus no diagnosis) on chromosome 16 [at 139 centimorgans (cM), Log of the Odds (LOD) score = 4.4], and on chromosome 19 (at 74 cM, LOD score = 6.4). Regions of interest for this phenotype (LOD > 1.5) were also located on chromosomes 14, 21, 22. These findings suggest that a Type B/II cannabis dependence phenotype can be identified in this population and that it is in part heritable and linked to areas of the genome identified previously for drug dependence phenotypes in this population as well as in other studies. [source] Organizational Routines as Sources of Connections and UnderstandingsJOURNAL OF MANAGEMENT STUDIES, Issue 3 2002Martha S. Feldman Organizational routines are increasingly identified as an aspect of organizations that allows them to achieve the balance between adaptability and stability. We contribute to this discussion by showing that the connections that organizational routines make between people contribute to both stability and the ability to adapt. We argue that the connections between people that are formed as they engage together in organizational routines are important for developing understandings about both what needs to be done in a specific instance of performing a routine and about the goals of the organization that routines presumably help accomplish. Together the two sets of understandings influence organizational performance by affecting the ability of organizations to adapt to changing circumstances. These arguments lead to a general recognition of the importance to organizations of connections and the suggestion that the connections, themselves, may be an important outcome of organizational routines. [source] Genome-wide linkage analysis of quantitative biomarker traits of osteoarthritis in a large, multigenerational extended familyARTHRITIS & RHEUMATISM, Issue 3 2010Hsiang-Cheng Chen Objective The genetic contributions to the multifactorial disorder osteoarthritis (OA) have been increasingly recognized. The goal of the current study was to use OA-related biomarkers of severity and disease burden as quantitative traits to identify genetic susceptibility loci for OA. Methods In a large multigenerational extended family (n = 350), we measured 5 OA-related biomarkers: hyaluronan (HA), cartilage oligomeric matrix protein (COMP), N-propeptide of type IIA collagen (PIIANP), C-propeptide of type II procollagen (CPII), and type II collagen neoepitope (C2C). Single-nucleotide polymorphism markers (n = 6,090) covering the whole genome were genotyped using the Illumina HumanLinkage-12 BeadChip. Variance components analysis, as implemented in the Sequential Oligogenic Linkage Analysis Routines, was used to estimate heritabilities of the quantitative traits and to calculate 2-point and multipoint logarithm of odds (LOD) scores using a polygenic model. Results After adjusting for age and sex, we found that 4 of the 5 biomarkers exhibited significant heritability (PIIANP 0.57, HA 0.49, COMP 0.43, C2C 0.30; P , 0.01 for all). Fourteen of the 19 loci that had multipoint LOD scores of >1.5 were near to or overlapped with previously reported OA susceptibility loci. Four of these loci were identified by more than 1 biomarker. The maximum multipoint LOD scores for the heritable quantitative biomarker traits were 4.3 for PIIANP (chromosome 8p23.2), 3.2 for COMP (chromosome 8q11.1), 2.0 for HA (chromosome 6q16.3), and 2.0 for C2C (chromosome 5q31.2). Conclusion Herein, we report the first evidence of genetic susceptibility loci identified by OA-related biomarkers in an extended family. Our results demonstrate that serum concentrations of PIIANP, HA, COMP, and C2C have substantial heritable components, and using these biomarkers, several genetic loci potentially contributing to the genetic diversity of OA were identified. [source] Examining Management Accounting Change as Rules and Routines: The Effect of Rule PrecisionAUSTRALIAN ACCOUNTING REVIEW, Issue 2 2010Rodney Coyte This study examines change in management accounting practices as change in rules and routines. Informed by the institutional theory-inspired framework of,Burns and Scapens (2000),,the rules and routines relating to capital expenditure controls in a capital-intensive organisation are analysed. We explain how preciseness of rules affects not only the coupling of rules to routines, but also the emergence of multiple routines, enhancing the understanding of how management accounting practices remain stable and/or change over time. These results extend and refine recent research relating to management accounting change and offer new empirical insights into practice. [source] Fast, Exact, Linear BooleansCOMPUTER GRAPHICS FORUM, Issue 5 2009Gilbert Bernstein Abstract We present a new system for robustly performing Boolean operations on linear, 3D polyhedra. Our system is exact, meaning that all internal numeric predicates are exactly decided in the sense of exact geometric computation. Our BSP-tree based system is 16-28× faster at performing iterative computations than CGAL's Nef Polyhedra based system, the current best practice in robust Boolean operations, while being only twice as slow as the non-robust modeler Maya. Meanwhile, we achieve a much smaller substrate of geometric subroutines than previous work, comprised of only 4 predicates, a convex polygon constructor, and a convex polygon splitting routine. The use of a BSP-tree based Boolean algorithm atop this substrate allows us to explicitly handle all geometric degeneracies without treating a large number of cases. [source] Pediatric Interventional Cardiology in the United States is Dependent on the Off-label Use of Medical DevicesCONGENITAL HEART DISEASE, Issue 1 2010Jamie S. Sutherell MD ABSTRACT Objective., A substantial unmet medical device need exists in pediatric care. As a result, the off-label use of approved devices is routine in pediatric interventional cardiology, but the extent and nature of this practice has not been previously described. The purpose of this study, therefore, is to evaluate the prevalence and nature of off-label cardiac device use in an active pediatric interventional program in the United States. Study Design., This study is a retrospective review of all interventional cardiac procedures performed at our institution from July 1, 2005 to June 30, 2008. Diagnostic (noninterventional) catheterizations, myocardial biopsies, invasive electrophysiology studies, and studies involving investigational devices were excluded. Interventions performed were compared with the manufacturer's labeled indications for each device. Results., During this 3-year period, 473 patients (median age 4.1 years) underwent 595 transcatheter interventions. An approved device was utilized for an off-label application in 63% of patients, and in 50% of all interventions performed. The most frequent off-label procedures were stent implantations (99% off-label), balloon dilations (78% off-label), and coil embolizations (29% off-label). In contrast, the off-label use of septal and ductal occluders was relatively uncommon. Conclusions., In our routine (noninvestigational) practice of pediatric interventional cardiology, 63% of patients underwent procedures utilizing medical devices for off-label indications. These data underscore the need to enhance cardiac device review and approval processes in the United States to include pediatric applications. [source] Local Participation in Natural Resource Monitoring: a Characterization of ApproachesCONSERVATION BIOLOGY, Issue 1 2009FINN DANIELSEN conservación; evaluación de la biodiversidad; esquemas de monitoreo; intereses locales; manejo de recursos naturales Abstract:,The monitoring of trends in the status of species or habitats is routine in developed countries, where it is funded by the state or large nongovernmental organizations and often involves large numbers of skilled amateur volunteers. Far less monitoring of natural resources takes place in developing countries, where state agencies have small budgets, there are fewer skilled professionals or amateurs, and socioeconomic conditions prevent development of a culture of volunteerism. The resulting lack of knowledge about trends in species and habitats presents a serious challenge for detecting, understanding, and reversing declines in natural resource values. International environmental agreements require signatories undertake systematic monitoring of their natural resources, but no system exists to guide the development and expansion of monitoring schemes. To help develop such a protocol, we suggest a typology of monitoring categories, defined by their degree of local participation, ranging from no local involvement with monitoring undertaken by professional researchers to an entirely local effort with monitoring undertaken by local people. We assessed the strengths and weaknesses of each monitoring category and the potential of each to be sustainable in developed or developing countries. Locally based monitoring is particularly relevant in developing countries, where it can lead to rapid decisions to solve the key threats affecting natural resources, can empower local communities to better manage their resources, and can refine sustainable-use strategies to improve local livelihoods. Nevertheless, we recognize that the accuracy and precision of the monitoring undertaken by local communities in different situations needs further study and field protocols need to be further developed to get the best from the unrealized potential of this approach. A challenge to conservation biologists is to identify and establish the monitoring system most relevant to a particular situation and to develop methods to integrate outputs from across the spectrum of monitoring schemes to produce wider indices of natural resources that capture the strengths of each. Resumen:,El monitoreo de tendencias en el estatus de especies o hábitats es rutinario en los países desarrollados, donde es financiado por el estado o por grandes organizaciones no gubernamentales y a menudo involucra a grandes números de voluntarios amateurs competentes. El monitoreo de recursos naturales es menos intenso en los países en desarrollo, donde las agencias estatales tienen presupuestos pequeños, hay menos profesionales o amateurs competentes y las condiciones socioeconómicas limitan el desarrollo de una cultura de voluntariado. La consecuente falta de conocimientos sobre las tendencias de las especies y los hábitats presenta un serio reto para la detección, entendimiento y reversión de las declinaciones de los recursos naturales. Los tratados ambientales internacionales requieren que los signatarios realicen monitoreos sistemáticos de sus recursos naturales, pero no existe un sistema para guiar el desarrollo y la expansión de los esquemas de monitoreo. Para ayudar al desarrollo de tal protocolo, sugerimos una tipología de categorías de monitoreo, definidas por el nivel de participación local, desde ningún involucramiento local con el monitoreo realizado por investigadores profesionales hasta un esfuerzo completamente local con el monitoreo llevado a cabo por habitantes locales. Evaluamos las fortalezas y debilidades de cada categoría de monitoreo, así como su sustentabilidad potencial en países desarrollados o en desarrollo. El monitoreo basado localmente es particularmente relevante en los países en desarrollo, donde puede llevar a decisiones rápidas para resolver amenazas clave sobre sus recursos naturales, puede facultar a las comunidades locales para un mejor manejo de sus recursos naturales y puede refinar las estrategias de uso sustentable para mejorar la forma de vida local. Sin embargo, reconocemos que la precisión y exactitud del monitoreo llevado a cabo por comunidades locales en situaciones diferentes requiere de mayor estudio y los protocolos de campo requieren de mayor desarrollo para obtener lo mejor del potencial de este método. Un reto para los biólogos de la conservación es la identificación y establecimiento del sistema de monitoreo más relevante para la situación particular, así como el desarrollo de métodos para integrar los resultados de una gama de esquemas de monitoreo para producir índices de recursos naturales más amplios que capturen las fortalezas de cada uno. [source] The impact of operational characteristics on firms' EMS decisions: strategic adoption of ISO 14001 certificationsCORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 4 2010Takuya Takahashi Abstract Firms choose to seek environmental management system (EMS) certifications such as ISO 14001 for a variety of reasons. In this paper we put forward a hypothesis that firms seek ISO 14001 certifications for their establishments when their operations involve low degrees of complexity. Another hypothesis we consider is that firms facing more uncertainty in their operations (and hence more risk) seek ISO 14001 certifications. These hypotheses have not been yet addressed in the literature and are of particular interest to business managers and policymakers. We empirically test these hypotheses using probit and duration models using matched establishment,firm,industry data for large Japanese manufacturers. Our findings support the first as well as the second hypotheses. This suggests that firms tend to certify more routine and less complex operations first, and that firms use ISO 14001 certifications as an insurance scheme. Copyright © 2009 John Wiley & Sons, Ltd and ERP Environment. [source] Personality disorders in prisoners and their motivation for dangerous and disruptive behaviourCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 3 2002Professor Jeremy W. Coid MD FRCPsych Objectives To examine the associations between DSM-III, axis II, personality disorder, motivation and disruptive behaviour in prisoners. Method Interviews were carried out with 81 prisoners in prison special units in England using research diagnostic instruments and an item sheet measuring disruptive behaviours and their motivations. Independent associations were established using logistic regression. Results Specific associations were established between psychopathy and axis II disorders with violent and disruptive behaviour and motivations for these behaviours. Conclusions The study supported a cognitive model explaining the functional association between personality disorder and antisocial behaviour. Personality disorders act as predisposing factors influencing the development of motivations and subsequently facilitate the enactment of disordered behaviour, in a linear progression. Assessment of personality disorder should be routine in disruptive and dangerous prisoners. Copyright © 2002 Whurr Publishers Ltd. [source] Federal University of Santa Catarina follow-up management routine for traumatized primary teeth , part 1DENTAL TRAUMATOLOGY, Issue 6 2004Mariane Cardoso Abstract,,, The objective of this study was to verify if the follow-up management routine of traumatized primary teeth set up by Federal University of Santa Catarina, which performs clinical and radiographic assessments (15 and 45 days; 4, 8 and 12 months) after the oral trauma, enabled an early diagnosis of sequelae which would indicate the need for endodontic intervention, as well as the influence a type of trauma and the child's age could have in the severity of the sequelae. In this study 52 sets of records were used of patients being seen in the last 6 months, with a total of 70 teeth that were receiving follow-up treatment. Patients returned for regular visits set up by the management routine, where clinical and radiographic examinations were performed to check for sequelae, which justified endodontic intervention. Mobility (51.2%) and crown discoloration (25.6%) were the most common sequelae found in the patient's first appointment. In the follow-up visits, replacement root resorption (22.5%) was the second most common sequela found, suggesting endodontic intervention. No significant association was found between severe sequelae, types of trauma and a child's age (,2 = 0.3, P = 0,8613). During the intervals of the follow-up visits, it was noticed that between 46 days and 8 months a higher number of sequelae were diagnosed (P < 0.05). The diagnosis of sequelae such inflammatory and replacement root resorption, which can lead to an early loss of a primary tooth, are frequent and that the interval between the follow-up visits has to be changed, suggesting the setting up of management routine 2. The study also concluded that the type of trauma and the child's age are not fundamental factors in the diagnosis of severe sequelae. [source] Randomized Nonblinded Comparison of Convalescence for 2 and 7 Days After Split-Thickness Skin Grafting to the Lower LegsDERMATOLOGIC SURGERY, Issue 4 2009BEN TALLON MBChB BACKGROUND There is an increasing expectation of shortened postoperative recovery times and a suggestion that shorter convalescence times may not compromise lower leg split-thickness skin graft results. OBJECTIVE To determine whether mobilization after 2 days of convalescence compromises graft survival or patient morbidity. METHODS AND MATERIALS A pilot study was initiated in which patients undergoing split-thickness skin grafting to the lower legs were randomized to 2 or the routine 7 days of convalescence. Baseline characteristics were determined, and patients were followed up in dressing clinics and with a standardized telephone interview. RESULTS There was no difference in baseline patient comorbidities and no significant difference in the number of grafts lost, the number of dressing clinics, bleeding, or wound infections. CONCLUSION The results suggest that 2 days of convalescence after split-thickness skin grafting to the lower legs may not compromise graft survival or increase patient morbidity. Further study with larger numbers is required to confirm this finding. [source] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||