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Selected AbstractsVisualized Sclerotherapy of Varicose VeinsDERMATOLOGIC SURGERY, Issue 2010MAMORU KIKUCHI MD BACKGROUND The spread and movement of sclerosant after injection during sclerotherapy is difficult to monitor. OBJECTIVE To develop a new visualization method that allows monitoring of sclerosant dosage and flow during sclerotherapy. METHODS We used a photodynamic eye (PDE) to perform indocyanine green (ICG) imaging. ICG produces strong fluorescence detectable using PDE and allows monitoring of sclerosant spread through blood vessels in real time. We performed visualized sclerotherapy on 50 limbs, comprising high ligation and sclerotherapy (35 limbs), stripping and sclerotherapy (10 limbs), and sclerotherapy alone (5 limbs). RESULTS In all cases, fluorescence imaging of the injected sclerosant was possible. No complications resulted from combining ICG and polidocanol in any of the patients, all of whom received follow-up evaluations at 1 week, 1 month, and 3 months after treatment. CONCLUSIONS Our new method not only avoids the risk of radiation exposure, but also allows for simple observation of sclerosant range of access, determination of the dosage for each lesion, and accurate administration of therapy to target lesions. This method will contribute to further advances in sclerotherapy, given that it allows administration of sclerosant and visual confirmation of optimal injection dosage, speed, and movement of sclerosant after injection. The authors have indicated no significant interest with commercial supporters. [source] Role of nurses in institutional ethics policies on euthanasiaJOURNAL OF ADVANCED NURSING, Issue 1 2006Chris Gastmans PhD Aim., This paper reports the findings of a survey that investigated whether Flemish Catholic hospitals and nursing homes had developed written ethics policies on euthanasia and how the role of nurses was described in these policies. Background., International research shows undeniably that nurses are confronted with patients requesting euthanasia. Euthanasia has been legal in Belgium since 2002 and in Holland since 2001. Because of the vagueness in formal documents and policies on the role of nurses in euthanasia, there is an increasing need to establish institutional ethics policies that clearly describe the role of nurses in the euthanasia process. Methods., We used a cross-sectional descriptive mail questionnaire to survey the general directors of Catholic hospitals and nursing homes in Belgium (Flanders). Data were collected between October 2003 and February 2004. Results., Of the 298 institutions targeted for survey, 81% of hospitals, 62% of nursing homes returned completed questionnaires. Of these, 79% of the hospitals and 30% of the nursing homes had a written ethics policy on euthanasia. The ethics policies of 87% of the hospitals and 77% of the nursing homes explicitly addressed the role of nurses in the euthanasia process. In the majority of hospitals and nursing homes, the ethics policies addressed the conscientious objections of nurses to euthanasia. Most hospitals and nursing homes voluntarily communicated their ethics policies to the nurses they employed. Conclusion., The written ethics policies of most Catholic healthcare institutions give explicit attention to the role of nurses in the euthanasia process. However, the meaning and content of the role of nurses, as indicated in these ethics policies, continue to be an issue. Further research is needed to verify how these policies are actually implemented within the institutions and whether they contribute to better support for nurses and to ethical care for patients. [source] Older and Younger Adults in Pain Management Programs in the United States: Differences and SimilaritiesPAIN MEDICINE, Issue 2 2006Harriėt M. Wittink PhD ABSTRACT Objectives., 1) To investigate health status of older (,60 years) and younger adults (<60 years) with chronic pain and to separately compare that with existing normative data; and 2) to examine more fully differences in health status between younger and older adults with chronic pain and explore their geographic variation across three multidisciplinary pain programs in the Pacific, Mountain, and New England regions of the United States. Design., We performed a cross-sectional analysis. Patients., Initial assessments of 6,147 patients dating from January 1998 to January 2003 were used. Outcomes Measures., We used the Treatment Outcomes of Pain Survey (TOPS), a disease-specific instrument that includes the Short Form-36. Results., The health status of the older pain patients in terms of their actual scores was comparable with that of younger pain patients across the three sites. Health status is impaired to a lesser degree in older than in younger adults with chronic pain as compared with normative adults. Statistically significant differences were found in a number of domains of the TOPS. Older adults with chronic pain present with pain intensity similar to that of younger patients with chronic pain, but report better mental health (P < 0.002), less fear-avoidance (P < 0.05), less passive coping (P < 0.0001), more life control (P < 0.05), and more lower body physical limitations (P < 0.005) than younger patients with chronic pain. Conclusions., Older adults with chronic pain differ in a number of important domains from younger adults with chronic pain: overall the former present with greater physical, and less psychosocial impairment. [source] Proposal for a Definition of Lifelong Premature Ejaculation Based on Epidemiological Stopwatch DataTHE JOURNAL OF SEXUAL MEDICINE, Issue 4 2005Marcel D. Waldinger MD ABSTRACT Introduction., Consensus on a definition of premature ejaculation has not yet been reached because of debates based on subjective authority opinions and nonstandardized assessment methods to measure ejaculation time and ejaculation control. Aim., To provide a definition for lifelong premature ejaculation that is based on epidemiological evidence including the neurobiological and psychological approach. Methods., We used the 0.5 and 2.5 percentiles as accepted standards of disease definition in a skewed distribution. We applied these percentiles in a stopwatch-determined intravaginal ejaculation latency time (IELT) distribution of 491 nonselected men from five different countries. The practical consequences of 0.5% and 2.5% cutoff points for disease definition were taken into consideration by reviewing current knowledge of feelings of control and satisfaction in relation to ejaculatory performance of the general male population. Main Outcome Measures., Literature arguments to be used in a proposed consensus on a definition of premature ejaculation. Results., The stopwatch-determined IELT distribution is positively skewed. The 0.5 percentile equates to an IELT of 0.9 minute and the 2.5 percentile an IELT of 1.3 minutes. However, there are no available data in the literature on feelings of control or satisfaction in relation to ejaculatory latency time in the general male population. Random male cohort studies are needed to end all speculation on this subject. Exact stopwatch time assessment of IELT in a multinational study led us to propose that all men with an IELT of less than 1 minute (belonging to the 0.5 percentile) have "definite" premature ejaculation, while men with IELTs between 1 and 1.5 minutes (between 0.5 and 2.5 percentile) have "probable" premature ejaculation. Severity of premature ejaculation (nonsymptomatic, mild, moderate, severe) should be defined in terms of associated psychological problems. Conclusion., We define lifelong premature ejaculation as a neurobiological dysfunction with an unacceptable increase of risk to develop sexual and psychological problems anywhere in a lifetime. By defining premature ejaculation from an authority-defined disorder into a dysfunction based on epidemiological evidence it is possible to establish consensus based on epidemiological evidence. Additional epidemiological stopwatch studies are needed for a final decision of IELT values at both percentile cutoff points. [source] | ||||||||||