EVOLUTION, Issue 3 2006
Peter A. Abrams
Abstract Mathematical models of consumer-resource systems are used to explore the evolution of traits related to resource acquisition in a generalist consumer species that is capable of exploiting two resources. The analysis focuses on whether evolution of traits determining the capture rates of two resources by a consumer species produce one generalist, two specialists, or all three types, when all types are characterized by a common fitness function. In systems with a stable equilibrium, evolution produces one generalist or two specialists, depending on the second derivative of the trade-off relationship. When there are sustained population fluctuations, the nature of the trade-off between the consumer's capture rates of the two resources still plays a key role in determining the evolutionary outcome. If the trade-off is described by a choice variable between zero and one that is raised to a power n, polymorphic states are possible when n > 1, which implies a positive second derivative of the curve. These states are either dimorphism, with two relatively specialized consumer types, or trimorphism, with a single generalist type and two specialists. Both endogenously driven consumer-resource cycles, and fluctuations driven by an environmental variable affecting resource growth are considered. Trimorphic evolutionary outcomes are relatively common in the case of endogenous cycles. In contrast to a previous study, these trimorphisms can often evolve even when new lineages are constrained to have phenotypes very similar to existing lineages. Exogenous cycles driven by environmental variation in resource growth rates appear to be much less likely to produce a mixture of generalists and specialists than are endogenous consumer-resource cycles. [source]

Dermatologists Perform More Skin Surgery Than Any Other Specialist: Implications for Health Care Policy, Graduate and Continuing Medical Education

DERMATOLOGIC SURGERY, Issue 3 2008
RANDALL K. ROENIGK MD
First page of article [source]

Justifying the expense of the cancer Clinical Nurse Specialist

EUROPEAN JOURNAL OF CANCER CARE, Issue 1 2010
C.A. POLLARD ba
POLLARD C.A., GARCEA G., PATTENDEN C.J., CURRAN R., NEAL C.P., BERRY D.P. & DENNISON A.R. (2009) European Journal of Cancer Care19, 72,79 Justifying the expense of the cancer Clinical Nurse Specialist In order to maximise patient care, assessment of the adequacy of the service provision by the Clinical Nurse Specialist (CNS) must be regularly undertaken. This study attempted to determine whether CNSs were providing an adequate service via retrospective and prospective audit. The results of a comprehensive audit of the work of the CNS within a tertiary referral Hepatobiliary Unit are presented. The audit involved postal and telephone questionnaires as well as prospective collection of data. The majority of responses from patients were positive, with many finding the CNS a useful and well-utilised contact. Overall, the CNSs performed well in each of their designated tasks; however, areas were still identified which could be further improved. Audit is essential in providing feedback to the CNS and to identify areas which require improvement. The CNS has evolved to meet a clinical gap in patient care, and as a result, the role of a CNS is frequently nebulous or poorly defined. This renders evaluation of the CNS problematic and fraught with difficulties. However, a thorough assessment can still be made using carefully constructed audit looking at each task of the CNS. [source]

Staging of Hypertension and Total Cardiovascular Risk Assessment: Related but Not the Same,Challenge for the Hypertension Specialist

JOURNAL OF CLINICAL HYPERTENSION, Issue 11 2008
Thomas D. Giles MD
No abstract is available for this article. [source]

Hypertensive Patients With Reduced Blood Pressure Still Have Hypertension: The Role of the Hypertension Specialist

JOURNAL OF CLINICAL HYPERTENSION, Issue 7 2007
Thomas D. Giles MD
"There is no good theory of disease which does not at once suggest a cure.",Ralph Waldo Emerson [source]

Should You Become a Specialist in Clinical Hypertension?

JOURNAL OF CLINICAL HYPERTENSION, Issue 3 2007
Article first published online: 20 MAR 200
No abstract is available for this article. [source]

Stoma coloproctology nurse specialist: a case study

JOURNAL OF CLINICAL NURSING, Issue 6 2007
Ursula Chaney DPSN
Aims and objectives., The aim of this paper is to provide insight into the role of a Stoma Coloproctology Nurse Specialist. This paper presents the findings of an in-depth case study of a stoma coloproctology nurse specialist employed in one health board area in Northern Ireland. This case study was part of a larger study exploring innovative nursing and midwifery roles in Northern Ireland. Background., Specialist nursing roles have evolved and developed in response to changing health care needs, patient expectations, changes in professional regulation and government initiatives. Design., A case study approach was adopted. Method., Semi-structured interviews with the post holder (PH), her line manager and the human resource manager were undertaken. Non-participant observation of the PH's practice was also carried out. Analysis was undertaken on secondary data such as job specification, annual reports and other documentation relating to the post. Results., Findings illustrate the PH's function and the impact of the role on patient care. Examples of innovative practices relating to providing care, support and guidance for patients and their families were identified; however, limitations to her role were also identified. Conclusions., The PH provides an invaluable service to patients, demonstrating a positive impact on care. However, the findings suggest the importance of establishing clear role boundaries, which may lead to professional growth and practice development. Relevance to clinical practice., Although this study provides a valuable insight into the role of a Stoma Coloproctology Nurse Specialist a number of challenges exist, as the CNS role requires policy and appropriate educational preparation to practice at an advanced level. Further research investigating the development of the CNS role in the clinical setting and its relationship to members of the multi-professional team would be beneficial. [source]

Extended scope practitioners and clinical specialists: A place in rural health?

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2008
Sally A. Ruston
Abstract This review identifies two models of allied health advanced practitioner practice that are currently in place in the National Health Service in the United Kingdom (UK). A review of the background to advanced practitioner status is given for UK allied health professionals and comments made on the outcomes of the UK roles. Description of the work of Clinical Specialist and Extended Scope Practitioner is given. Alignment with senior physiotherapy staff roles in Australia is commented upon. Some barriers or impediments to implementation of such a system in Australia are discussed with respect to registration, funding and support. The feasibility of such advanced practice roles for physiotherapy is discussed while benefits and cautions are identified. The potential for such a model of health service to be used in Australia, particularly in rural and remote areas, is identified for debate. [source]

Recognition of Host Plant Volatiles by Pheidole minutula Mayr (Myrmicinae), an Amazonian Ant-Plant Specialist

BIOTROPICA, Issue 5 2009
Wesley F. C. Dáttilo
ABSTRACT In the tropics, several ant species are obligate inhabitants of leaf pouches and other specialized structures in plants known as myrmecophytes. However, the cues used by ant queens to locate suitable host-plants following dispersal remain poorly understood. Here we tested the hypothesis that Pheidole minutula queens use volatiles to distinguish their host Maieta guianensis (Melastomataceae) from other sympatric myrmecophytes. To do so, we used a Y-tube olfactometer to quantify the preference for volatiles of different plant species. Our results indicate that P. minutula queens discriminate the chemical volatiles produced by its host-plant from those of other sympatric ant-plant species. However, queens failed to distinguish the volatiles of Maieta from those of the ant-plant Tococa bullifera (Melastomataceae), with which P. minutula is not mutualistically associated. Nevertheless, a strong preference for Maieta over Tococa was observed during a subsequent bioassay, where the ants had physical contact with a domatium of each plant species. These results suggest that additional, short distance mechanisms are also necessary for host discrimination. Overall, our findings suggest that the high degree of compartmentalization observed in symbiotic ant,plant relationships is achieved, at least in part, by the relatively high degree of specificity in host selection displayed by foundress queens. [source]

Research Methods of Inquiry

ACADEMIC EMERGENCY MEDICINE, Issue 11 2006
Joel Rodgers MA
Incidents of significant consequence that create surge may require special research methods to provide reliable, generalizable results. This report was constructed through a process of literature review, expert panel discussion at the journal's consensus conference, and iterative development. Traditional clinical research methods that are well accepted in medicine are exceptionally difficult to use for surge incidents because the incidents are very difficult to reliably predict, the consequences vary widely, human behaviors are heterogeneous in response to incidents, and temporal conditions prioritize limited resources to response, rather than data collection. Current literature on surge research methods has found some degree of reliability and generalizability in case-control, postincident survey methods, and ethnographical designs. Novel methods that show promise for studying surge include carefully validated simulation experiments and survey methods that produce validated results from representative populations. Methodologists and research scientists should consider quasi-experimental designs and case-control studies in areas with recurrent high-consequence incidents (e.g., earthquakes and hurricanes). Specialists that need to be well represented in areas of research include emergency physicians and critical care physicians, simulation engineers, cost economists, sociobehavioral methodologists, and others. [source]

An Appeal to Aid Specialists

DEVELOPMENT POLICY REVIEW, Issue 1 2010
Keith Horton
The appeal I am making is (roughly speaking) for aid specialists to do more to help those of us who are not aid specialists to arrive at judgments about the effects of the work of (voluntary) aid agencies that we have at least some reason to think accurate. I argue that the fact that it is so difficult for us to arrive at such judgments at present has certain negative consequences, and that this gives those who are in a position to make it easier for us to arrive at such judgments strong reasons to do so. And I argue that (certain) aid specialists are in such a position. Hence my appeal to them to do so. [source]

The social causes of inequality in epilepsy and developing a rehabilitation strategy: A U.K.-based analysis

EPILEPSIA, Issue 10 2009
Leone Ridsdale
Summary A rehabilitation approach has been adopted for many long-term neurologic conditions, but not for epilepsy. The disabilities associated with epilepsy are cognitive, psychological, and social, which are not as readily identified by medical doctors as are physical disabilities. A rehabilitation approach moves the emphasis from a medically driven process to a focus on the personal, social, and physical context of long-term illness. It is suggested that a missed opportunity for education and support for self-management occurs after diagnosis. This results in disadvantage to those whose educational level and knowledge of epilepsy are low. People who do not achieve epilepsy control may then experience higher levels of psychological distress, and a negative cycle of loss of self-efficacy, poor epilepsy control, social disadvantage, and disability. Rehabilitation services have benefited communities surrounding centers of excellence. Not so in epilepsy. Despite centers of excellence, areas with deprivation have higher than national average levels of patients reporting a seizure in the prior year, and higher emergency hospital admissions. Specialists working in partnership with general practitioners (GPs) and practice nurses can do more to increase participation and reduce distress for people with epilepsy. When available, GPs and nurses with special interest in epilepsy promote integrated services. Primary,secondary networks are likely to be more effective in preventing downward drift. This requires evaluation. [source]

New plant protection information system in Hungary,

EPPO BULLETIN, Issue 1 2000
A. Pákozdi
Data on the occurrence and spread of pests has been supplied by the Hungarian Plant Protection Organization for over 40 years. Since the 1970s, this service has been operated by the central station and the 20 county stations of the Plant Protection Organization. Data recorded on pest occurrence and developmental stage of pests and plants has been used to run a forecasting system at local and national levels. However, because of significant staff reductions in the Plant Protection Organization and the disappearance of independent forecasting groups, the reliability of the system, which was based on very specific data, has decreased. It has become necessary to develop a more reliable and flexible computer-aided system (Plant Protection Information System, PPIS), better adjusted to the political and economic changes that have occurred. A major element of the new system, introduced in 1997, is that excessively detailed recording was replaced by a more practical general approach with fewer subjective errors. Specialists from the county stations of the Plant Protection Organization monitor infestation levels of 73 pests in 20 crops using five qualification categories. The results obtained are input into the PPIS program, which processes them into user-friendly charts and maps showing the plant health situation in each county and in the country as a whole, as a basis for taking decisions on plant protection measures. [source]

European AIDS Clinical Society (EACS) guidelines on the prevention and management of metabolic diseases in HIV,

HIV MEDICINE, Issue 2 2008
JD 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]

Shaping the future of Scandinavian anaesthesiology: a position paper by the SSAI

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2010
E. SØREIDE
Traditionally, Scandinavian anaesthesiologists have had a very broad scope of practice, involving intensive care, pain and emergency medicine. European changes in the different medical fields and the constant reorganising of health care may alter this. Therefore, the Board of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) decided to produce a Position Paper on the future of the speciality in Scandinavia. The training in the various Scandinavian countries is very similar and provides a stable foundation for the speciality. The Scandinavian practice in anaesthesia and intensive care is based on a team model where the anaesthesiologists work together with highly educated nurses and should remain like this. However, SSAI thinks that the role of the anaesthesiologists as perioperative physicians is not fully developed. There is an obvious need and desire for further training of specialists. The SSAI advanced educational programmes for specialists should be expanded and include formal assessment leading to a particular medical competency as defined by the European Union of Medical Specialists (UEMS). In this way, Scandinavian anaesthesiologists will remain leaders in perioperative, intensive care, pain and critical emergency medicine. [source]

All Pediatric Nurses are Specialists

JOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 1 2002
Roxie L. Foster PhD
No abstract is available for this article. [source]

Acute and Critical Care Clinical Nurse Specialists: Synergy for Best Practices

JOURNAL OF CLINICAL NURSING, Issue 14 2008
Janice Rattray
[source]

Impact of primary tumour stage on survival in dogs with solitary lung tumours

JOURNAL OF SMALL ANIMAL PRACTICE, Issue 2 2008
G. A. Polton
Objectives: The objective of this study was to determine simple prognostic criteria for differentiation of canine solitary lung tumour cases into those that will and will not benefit from thoracic surgery. Methods: This was a retrospective study using the records of cases presented to Davies Veterinary Specialists, Hitchin, UK, from December 1998 to December 2005. Survival analyses were performed using the Kaplan-Meier and logrank methods. Potentially significant variables were evaluated by multivariate Cox analysis. Results: Forty-two patients met the inclusion criteria. Primary tumour stage T1, absence of neoplastic lymph nodes and metastases, and papillary tumour type were statistically significant favourable prognostic indicators on univariate analysis. Multivariate analysis attributed significance to primary tumour stage T1 and papillary type only. Median survival times were 555 days for T1N0M0 tumours of papillary type and 72 days for the remainder. Clinical Significance: Survival time following surgery in dogs with primary lung tumours was poor except in clinical stage T1N0M0 cases. These data support use of clinical techniques to dichotomise cases as T1N0M0 or other, improving decision making in thoracic surgery. These data validate initiation of prospective studies examining the role of chemotherapy in the management of advanced cases. [source]

A Configuration Typology for Involving Purchasing Specialists in Product Development

JOURNAL OF SUPPLY CHAIN MANAGEMENT, Issue 4 2001
Nicolette Lakemond
SUMMARY This article develops a configuration typology for purchasing's involvement in product development projects. Six configurations are identified and analyzed, varying in degree of coordination and level of purchaser integration. The configurations are illustrated by five case studies performed in different companies operating in different industries. Enabling factors, such as the purchasing organization and the competencies and skills of the purchasers, can facilitate the involvement of purchasers in a development project. Project size and project complexity can be identified as driving factors influencing the appropriateness of the purchaser involvement configurations. Dedicated, full-time purchasing specialists in combination with a purchasing coordinator provide the strongest degree of involvement necessary for managing large and complex projects, whereas indirect, ad hoc purchasinginvolvement provides the lowest degree of involvement sufficient for small and relatively simple projects. [source]

EAACI/GA2LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria

ALLERGY, Issue 10 2009
T. Zuberbier
This guideline, together with its sister guideline on the management of urticaria [Zuberbier T, Asero R, Bindslev-Jensen C, Canonica GW, Church MK, Giménez-Arnau AM et al. EAACI/GA²LEN/EDF/WAO Guideline: Management of urticaria. Allergy, 2009; 64:1427,1443] is the result of a consensus reached during a panel discussion at the 3rd International Consensus Meeting on Urticaria, Urticaria 2008, a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO). Urticaria is a frequent disease. The life-time prevalence for any subtype of urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria do not only cause a decrease in quality of life, but also affect performance at work and school and, as such, are members of the group of severe allergic diseases. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors, and pathomechanisms. In addition, it outlines evidence-based diagnostic approaches for different subtypes of urticaria. The correct management of urticaria, which is of paramount importance for patients, is very complex and is consequently covered in a separate guideline developed during the same consensus meeting. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). [source]

EAACI/GA²LEN/EDF/WAO guideline: management of urticaria

ALLERGY, Issue 10 2009
T. Zuberbier
This guideline, together with its sister guideline on the classification of urticaria (Zuberbier T, Asero R, Bindslev-Jensen C, Canonica GW, Church MK, Giménez-Arnau AM et al. EAACI/GA²LEN/EDF/WAO Guideline: definition, classification and diagnosis of urticaria. Allergy 2009;64: 1417,1426), is the result of a consensus reached during a panel discussion at the Third International Consensus Meeting on Urticaria, Urticaria 2008, a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO). As members of the panel, the authors had prepared their suggestions regarding management of urticaria before the meeting. The draft of the guideline took into account all available evidence in the literature (including Medline and Embase searches and hand searches of abstracts at international allergy congresses in 2004,2008) and was based on the existing consensus reports of the first and the second symposia in 2000 and 2004. These suggestions were then discussed in detail among the panel members and with the over 200 international specialists of the meeting to achieve a consensus using a simple voting system where appropriate. Urticaria has a profound impact on the quality of life and effective treatment is, therefore, required. The recommended first line treatment is new generation, nonsedating H1 -antihistamines. If standard dosing is not effective, increasing the dosage up to four-fold is recommended. For patients who do not respond to a four-fold increase in dosage of nonsedating H1 -antihistamines, it is recommended that second-line therapies should be added to the antihistamine treatment. In the choice of second-line treatment, both their costs and risk/benefit profiles are most important to consider. Corticosteroids are not recommended for long-term treatment due to their unavoidable severe adverse effects. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). [source]

Implications of the Placebo Response for Interventional Pain Specialists

NEUROMODULATION, Issue 2 2002
Peter S. Staats MD
[source]

The Daubert Standard, A Primer for Pain Specialists

PAIN MEDICINE, Issue 1 2003
Ronald J. Kulich PhD
First page of article [source]

Are We Training Future Pain Specialists?

PAIN PRACTICE, Issue 4 2003
Janice M. Livengood PhD
,,Abstract: The purpose of this study was to determine whether pain practices in Tennessee are training future pain specialists. Following IRB approval, a questionnaire designed for the study was administered to members of the TN Pain Society. Results indicate that none of the subjects are training residents at their pain practice and the majority are not training pain fellows. Few attendings reported having trained in a pain fellowship themselves and the majority are reportedly not engaged in continuing pain management education through national or international organizations, such as the American Pain Society (APS) or the International Association for the Study of Pain (IASP). Of concern is whether or not this sample reflects the nature of pain practices throughout the country. If so, will there be a shortage of pain residents and fellows in the near future? Will pain practices be opened and operated by those who are not trained to treat chronic pain?,, [source]

Variations in diagnostic criteria for carpal tunnel syndrome among Ontario specialists,

AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 1 2006
Brent Graham MD, FRCSC
Abstract Background Variations in diagnostic criteria for carpal tunnel syndrome (CTS) may result in differing reports of disease prevalence, errors in diagnosis, and variable results of treatment. The objective of this study was to determine how consistent specialists are in their ratings of the importance of clinical criteria for the diagnosis of CTS. Methods Three hundred specialist physicians and surgeons received a questionnaire containing 57 clinical criteria for the diagnosis of CTS. A visual analog scale (VAS) was used to rate the importance of each criterion in the diagnosis of CTS. Results The overall consistency both across and within specialties was poor (intraclass correlation coefficient across specialties (ICC),=,0.28; ICC range within specialties 0.27,0.37). Conclusions Specialists are relatively inconsistent in the importance they assign to clinical criteria for the diagnosis of CTS. This inconsistency may be an important source of variation in the reported prevalence and treatment of CTS. Am. J. Ind. Med. 49:8,13, 2006. © 2005 Wiley-Liss, Inc. [source]

Latest news and product developments

PRESCRIBER, Issue 7 2007
Article first published online: 11 JUL 200
Poor asthma control with off-licence prescribing Children who are prescribed off-licence medications are more likely to have poor asthma control, according to an analysis from Dundee (Br J Gen Practice 2007;57:220-2). The review of 17 163 consultations identified 1050 (6.1 per cent) who received a prescription for an unlicensed use (defined as not licensed for children or the particular age group, or dose not licensed). High doses (4.5 per cent) were more frequent than unlicensed indications (1.9 per cent). Children who received off-label prescriptions reported statistically significantly more symptoms in the day or night, symptoms during activity, and increased use of daily short-acting beta2-agonists. The authors note that off-label prescribing appears to be increasing. Atkins diet most effective over one year? The ultra low-carbohydrate, high-protein Atkins diet achieved greater weight loss than other popular diets in overweight women over one year, say US investigators (J Am Med Assoc 2007;297:969-77). The study compared the Atkins diet with three diets designed as low- or very high-carbohydrate, or based on USA nutritional guidance, in 311 women with body mass index 27-40. After one year, mean weight loss was 4.7kg with the Atkins diet , significantly greater than with the low- carbohydrate diet (1.6kg) but not compared with very high-carbohydrate (2.2kg) or the nutrition-based diet (2.6kg). Metabolic endpoints were comparable or more favourable in women using the Atkins diet. Androgen therapy linked to gum disease The majority of men treated with androgen deprivation therapy for prostate cancer are more likely to have periodontal disease (J Urol 2007;177:921-4). After controlling for risk factors, the prevalence of periodontal disease was 80.5 per cent among treated men compared with 3.7 per cent in matched controls not receiving treatment. There was no difference in bone mineral density between the groups but plaque scores were significantly higher among treated men. Food Commission rebuts MHRA on additives An independent watchdog has not accepted the MHRA's justification for including certain additives in medicines for children. The Food Commission (www.foodcomm.org.uk) found that most medicines for children contained additives, some of which , including azo dyes and benzoates , are not permitted in food. The Commission called on the pharmaceutical industry to stop using ,questionable additives'. The MHRA stated that the licensing process takes into account the likely exposure to excipients that are considered essential to make medicines palatable to children. Colouring helps children to identify the correct medicine, and preservatives ensure a reasonable shelf-life. A list of additives is included in the product's summary of product characteristics and patient information leaflet. In response, the Commission states: , , it is quite possible to flavour medicines with natural oils or extracts, and natural colourings such as beetroot and beta-carotene can be used instead of azo dyes. If parents were advised to give these medicinal products at mealtimes the manufacturers could also add a little sugar to sweeten their products, rather than relying on artificial sweeteners.' All triptans the same? There is no economic case for choosing one triptan over another and no evidence for preferring a particular triptan for adults, a systematic review has concluded. The Canadian Agency for Drugs and Technologies in Health (www.cadth.ca) found that published trials had compared most triptans with sumatriptan but not with one another, and most economic evaluations were flawed. New drug for HIV Janssen-Cilag has introduced darunavir (Prezista), a new protease inhibitor for the treatment of HIV infection. Licensed for highly pre- treated patients in whom more than one other pro- tease inhibitor regimen has failed, darunavir must be co-administered with ritonavir (Norvir). A month's treatment at the recommended dose of 600mg twice daily costs £446.70. Variation in liquid captopril for children The NHS uses a wide range of liquid formulations of captopril to treat children with heart failure , with no assurance of their bioequivalence (Arch Dis Child 2007; published online 15 March. doi: 10.1136/adc.2006.109389). Specialists in Leicester surveyed 13 tertiary paediatric cardiac centres and 13 hospitals that referred patients to them. Only three tertiary centres supplied the same liquid for-mulation of captopril as their referring hospitals. Four hospitals supplied tablets for crushing and dissolving in water; the other hospitals and centres used a total of nine different formulations. The authors say the formulations had widely varying shelf-lives, determined empirically in all but one case, and were used interchangeably despite a lack of quality control data to establish their bioequivalence. QOF CVD targets not good enough for GPs Two-thirds of GPs want Quality Outcome Framework (QOF) targets for cardiovascular disease brought into line with those of the Joint British Societies latest guidance (JBS2), according to a survey by doctor.net.uk. The survey of 1000 GPs showed that 88 per cent were aware of the JBS2 guidelines and most were already implementing the targets for lipids, blood pressure and blood glucose in some form; however, only 55 per cent were implementing the JBS2 obesity target and 14 per cent were implementing screening for the over-40s. The JBS2 target for lipids in at-risk patients is <4mmol per litre total cholesterol and <2 mmol per litre LDL-cholesterol, compared with <5 and <3mmol per litre respectively in QOF and the NSF. The survey was commissioned by Merck Sharp & Dohme and Schering- Plough. Fracture warning Following warnings in the US that rosiglitazone (Avandia) is associated with an increased risk of fractures in women, Takeda has advised prescribers that pioglitazone (Actos) carries a similar risk. An analysis of the company's clinical trials database has revealed an excess risk of fractures of bones below the elbow and knee. The incidence was similar to the excess risk associated with rosiglitazone and also confined to women. Scottish approvals The Scottish Medicines Consortium (www.scottish medicines.org.uk) has approved for use within NHS Scotland the sublingual tablet formulation buprenorphine/naloxone (Suboxone) for the treatment of opioid dependence. It has also approved the combined formulation of valsartan and amlodipine (Exforge) and the restricted use of the If inhibitor ivabradine (Procoralan). [source]

Matching a Graduate Curriculum in Public/Community Health Nursing to Practice Competencies: The Rush University Experience

PUBLIC HEALTH NURSING, Issue 2 2006
R.N.C., Susan Swider Ph.D.
ABSTRACT An evidence-based approach to Public/Community Health Nursing (P/CHN) requires that P/CHN educators prepare practitioners with the relevant skills, attitudes, and knowledge. Such education should be competency-based and have measurable outcomes to demonstrate student preparation. In 2003, the Quad Council competencies were developed to be applied at two levels of public health nursing practice: the staff nurse/generalist role and the manager/specialist/consultant role. This paper describes a process for evaluation and revision of a graduate curriculum to prepare Advanced Practice Clinical Nurse Specialists (CNS) in P/CHN, to ensure that the educational program addresses and develops knowledge and proficiency in all relevant competencies. This paper documents the process of integrating the competencies throughout the P/CHN graduate curriculum at varying levels, guiding students to achieve proficiency in each competency by the end of the program. Measurement of achievement in these competencies will be discussed, and examples provided. Advanced Practice Public Health Nurses educated via this competency-based approach will be prepared to sit for national certification as a CNS in Public/Community Health, and to assume leadership roles in public health nursing. [source]

Pain Management in Patients with Substance Abuse: Treatment Challenges for Pain and Addiction Specialists

THE AMERICAN JOURNAL ON ADDICTIONS, Issue 5 2007
Vania Modesto-Lowe MD
No abstract is available for this article. [source]

ORIGINAL RESEARCH,ERECTILE DYSFUNCTION: Journey into the Realm of Requests for Help Presented to Sexual Medicine Specialists: Introducing Male Sexual Distress

THE JOURNAL OF SEXUAL MEDICINE, Issue 3 2007
Edoardo S. Pescatori MD
ABSTRACT Introduction., The recent availability of noninvasive pharmacological remedies for male sexual function triggered an exponential increase in the number of men requesting help in the sexuality area. Aim., The Italian Society of Andrology explored requests for help, not included in formerly established clinical categories of sexual medicine. Methods., A central board of 67 andrologists identified new areas of requests for help, instrumental for a web-based questionnaire, forwarded to 912 members of the Italian Society of Andrology. Results were submitted to an independent consensus development panel. Main Outcome Measures., A questionnaire response rate of 30.8% was considered acceptable according to standard response rates of medical specialist samples. Results., The Central Board interaction identified two new domains of requests for help: sexual distress and unconventional requests for pro-erectile medications. Web-based questionnaire results suggested that such domains account for 29% and 9% respectively of all requests for help already presented by male patients at sexual medicine clinics. The Independent Consensus Development Panel issued a final consensus document; herewith, the statement defining male sexual distress: A non-transitory condition and/or feeling of inadequacy such as to impair "sexual health" (WHO working definition). Inadequacy can originate both from physiological modifications of male sexual functions, and from diseases, dysfunctions, dysfunctional symptoms and dysmorphisms, both of andrological and non-andrological origin, which do not relate to "erectile dysfunction" (NIH Consensus Development Panel definition), but that might also induce erectile dysfunction. Sexual Distress can lead to a request for help which needs to be acknowledged. Conclusion., The Italian Society of Andrology identified two new areas of requests for help concerning male sexual issues: sexual distress and unconventional requests for pro-erectile medications. These domains, which do not represent new diseases, nonetheless induce the sufferers to seek help and, accordingly, need to be acknowledged. Pescatori ES, Giammusso B, Piubello G, Gentile V, and Pirozzi Farina F. Journey into the realm of requests for help presented to sexual medicine specialists: Introducing male sexual distress. J Sex Med 2007;4:762,770. [source]