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Medical Sciences	66%

Selected Abstracts

Trends in the start of the wet season over Africa

INTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 9 2009
D. R. Kniveton
Abstract A quarter of a century of daily rainfall data from the Global Telecommunications System are used to define the temporal and spatial variability of the start of the wet season over Africa and surrounding extreme south of Europe and parts of the Middle East. From 1978 to 2002, the start of the wet season arrived later in the year for the majority of the region, as time progressed. In some parts of the continent, there was an annual increase in the start date of up to 4 days per year. On average, the start of the wet season arrived 9,21 days later from 1978 to 2002, depending on the threshold used to define the start of the rains (varying from 10,30 mm over 2 days, with no dry period in the following 10 days). It is noted that the inter-annual variability of the start of the wet season is high with the range of start dates varying on average from 116 to 142 days dependent on the threshold used to determine the start date. These results may have important implications for agriculturists on all levels (from the individual farmer to those responsible for regional food supply), as knowledge of potential future climate changes starts to play an increasingly important role in the agricultural decision-making process, such as sowing and harvesting times. Copyright © 2008 Royal Meteorological Society [source]

A systematic review of studies assessing and facilitating attitudes towards professionalism in medicine

MEDICAL EDUCATION, Issue 8 2007
Vikram Jha
Objectives, An essential aspect of medical education is to facilitate the development and assessment of appropriate attitudes towards professionalism in medicine. This systematic review provides a summary of evidence for measures that have been used to assess these attitudes and their psychometric rigour. It also describes interventions that have been found to be effective in changing such attitudes. Methods, MEDLINE, EMBASE, ERIC, PsychINFO, Sociological Abstracts and CINAHL were searched from the respective start date of each database to May 2006. Three key journals and reference lists of existing reviews were also searched. Articles that were published in English and reported primary empirical research measuring medical students' attitudes towards medical professionalism were included. The findings are integrated in narrative structured in such a way as to address the research questions. Results, A total of 97 articles were included in the review. Most measures of attitudes assessed attitudes towards attributes of professionalism such as ethical issues, the patient,doctor relationship and cultural issues. Fourteen studies measured attitudes towards professionalism as a whole and 44 studies reported both the reliability and validity of measures. No interventions reported a change in attitudes over time. Conclusions, There is little evidence of reported measures that are effective in assessing attitudes towards professionalism in medicine as a whole. Likewise, there is scant evidence of interventions that influence attitude change over a period of time. Future studies should take into account the need to measure more global attitudes rather than attitudes towards specific issues in professionalism and the need to track attitudes throughout the curriculum. [source]

Duration of therapy with metoclopramide: a prescription claims data study,,§

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 8 2007
B Pharm, Sigal Kaplan PhD
Abstract Purpose Metoclopramide-induced tardive dyskinesia is associated with cumulative drug exposure, which can result from prolonged use of the drug. We estimated therapy duration with metoclopramide, and measured the extent of therapy beyond the maximum time period of 12 weeks evaluated in the clinical trials and recommended in the label. Methods Prescription claims for metoclopramide from 2002 to 2004 were extracted for participants residing throughout the US and contained within the Caremark pharmacy benefit manager (PBM) database. An episode of therapy was defined as one or a series of consecutive claims with no more than a 30-day lag between the dispensing date of a new claim and the ending date of the preceding claim. Episode duration was calculated by subtracting the start date from the end date for each episode. Results During the study period, almost 80% of participants (total,=,200,907) had only one episode of therapy. The length of the longest episode for most patients (85%) varied from 1 to 90 days, yet 15% of the patients appeared to have received prescriptions for metoclopramide for a period longer than 90 days. Cumulative therapy for longer than 90 days was recorded for almost 20% of the patients. Conclusions These results suggest that despite the known risk of tardive dyskinesia and the labeled recommendations on duration of metoclopramide use, many patients appear to use the drug for relatively long time periods beyond the labeled recommendations. Physicians should carefully consider the risk-benefit profile of the drug and, if possible, avoid increased risk of tardive dyskinesia due to prolonged exposure. Published in 2007 by John Wiley & Sons, Ltd. [source]

Use of postpartum vaginoscopic (visual vaginal) examination of dairy cows for the diagnosis of endometritis and the association of endrometritis with reduced reproductive performance

AUSTRALIAN VETERINARY JOURNAL, Issue 6 2008
DJ RUNCIMAN
Objective To assess the association between the findings from vaginoscopic examination of postpartum dairy cows with peripartum reproductive disease and their subsequent reproductive performance, and to determine the factors that might be associated with a positive vaginoscopic examination (VV). Methods Cows (n = 1325) from 17 seasonal calving dairy herds were enrolled if they had been calved at least 7 days and had at least one of the following conditions that placed them at risk of endometritis: retained fetal membranes (RFM), dystocia, a dead calf, hypocalcaemia, twin birth, calving induction or an observed vulval discharge (VD). Examination was undertaken 28,37 days before mating start date (MSD) within each herd. All cows were body condition scored (BCS) and were VV scored on a scale of 0 (clear) to 3 (purulent). The uterus and ovaries were assessed by rectal palpation. Results Cows with a positive VV score (1,3) were less likely to conceive to first service and had a lower pregnancy proportion than cows that had a negative VV score (score 0). Mean MSD to conception interval was longer in VV-positive cows. A positive VV score was associated with a low BCS, primiparity, intrapelvic uterus, poor uterine tone, large uterus, RFM, VD, dystocia, dead calf and twins. Conclusion In the present study a positive VV score was associated with reduced reproductive performance and was more common in primiparous and low BCS cows. Of the at-risk cows, those with RFM, VD, dystocia, dead calf or twins were more likely to have a positive VV score. [source]

Reported symptoms, diagnostic delay and stage of colorectal cancer: a population-based study in Denmark

COLORECTAL DISEASE, Issue 8 2006
M. Korsgaard
Abstract Objective, The primary prognostic factor for colorectal cancer (CRC) is stage. Any association between symptoms, diagnostic delay and stage may have implications for the clinical course of the disease. We examined the association between symptoms and diagnostic delay and between symptoms and stage, and assessed whether the associations differed for colon cancer (CC) and rectal cancer (RC). Patients and methods, Population-based prospective observational study based on 733 Danish CRC patients. Diagnostic delay and patients' reported symptoms were determined through questionnaire,interviews. Dukes' stage was obtained from medical records and pathology forms. Diagnostic delay was categorized into three delay groups: , 60, 61,150 and > 150 days. Stage was classified into nonadvanced (Dukes' A and B) or advanced (Dukes' C and D) cancers. We calculated the frequency of the most frequently reported initial symptom or symptom complex for CC and RC patients, and evaluated the frequency of patients with different initial symptoms/symptom complexes in the three delay groups. For the most frequent initial symptoms/symptom complexes, we calculated the frequencies according to stage, and estimated the relative risk of having an advanced stage, with 95% confidence intervals. Results, The most frequent initial symptoms/symptom complexes were very vague symptoms for CC and rectal bleeding for RC. For both CC and RC, rectal bleeding was significantly associated with nonadvanced stage. The relative risk of having an advanced cancer was 0.6 for monosymptomatic rectal bleeding and 0.7 for rectal bleeding combined with other symptoms. Conclusions, Initial symptoms of CC were often very vague, making it difficult to identify a precise start date. The most frequent initial symptom/symptom complex for RC , rectal bleeding , was better defined. Rectal bleeding was significantly associated with nonadvanced CC and RC and a significantly decreased relative risk of having an advanced cancer. [source]