ECONOMIC PAPERS: A JOURNAL OF APPLIED ECONOMICS AND POLICY, Issue S1 2008
RIC SIMES
The practice of financial regulation in Australia has drifted away from the lighted-handed principles articulated in the Wallis Report. The burden of regulatory compliance has steadily grown. The inconsistency between regulatory principle and practice is explained as the result of perverse incentives facing regulators, an absence of effective consultation with industry regarding the cost burden of regulation, and a failure to properly assess the social benefits and costs of regulatory intervention. The paper argues for the creation of a Bureau of Financial Sector Regulation to improve the accountability of regulators and publish independent social cost,benefit analyses of financial regulation. The paper also calls for a further inquiry into Australia's financial system ten years on from the Wallis Inquiry. [source]

BARRIERS AND CHALLENGES IN CLINICAL ETHICS CONSULTATIONS: THE EXPERIENCES OF NINE CLINICAL ETHICS COMMITTEES

BIOETHICS, Issue 8 2009
REIDAR PEDERSEN
ABSTRACT Clinical ethics committees have recently been established in nearly all Norwegian hospital trusts. One important task for these committees is clinical ethics consultations. This qualitative study explores significant barriers confronting the ethics committees in providing such consultation services. The interviews with the committees indicate that there is a substantial need for clinical ethics support services and, in general, the committee members expressed a great deal of enthusiasm for the committee work. They also reported, however, that tendencies to evade moral disagreement, conflict, and ,outsiders' are common in the hospitals. Sometimes even the committees comply with some of these tendencies. The committees agree that there is a need to improve their routines and procedures, clarify the committees' profile and field of responsibility, to make the committees well-known, to secure adequate operating conditions, and to develop organizational integration and support. Various strategies to meet these challenges on a local, regional or national level are also explored in this paper. [source]

The Efficacy of Third-Party Consultation in Preventing Managerial Escalation of Commitment: The Role of Mental Representations,

CONTEMPORARY ACCOUNTING RESEARCH, Issue 1 2004
KATHRYN KADOUS
Abstract Avoiding continued investment in poorly performing projects is an important function of management control systems. However, prior research suggests that managers fail to use accounting information indicating that a project is performing poorly to discontinue it; that is, they escalate commitment to the project. We perform two experiments to investigate the efficacy of a potential control mechanism, third-party consultation, in preventing managerial escalation of commitment. We hypothesize that the information-processing objective (that is, purpose) assigned to consultants influences the mental representations they construct to process and store information, which ultimately influences their recommendations regarding the continuation of a poorly performing project. Results suggest that consultants will not construct mental representations amenable to making high-quality project-continuation recommendations unless they are assigned that specific purpose. Results further suggest that applying additional effort likely will not overcome the adverse effects of having inappropriate mental representations when making project-continuation recommendations. An implication of our study is that third-party consultants likely will not prevent managerial escalation of commitment unless consultants have a specific mandate of making a project-continuation recommendation in mind when they encounter relevant accounting information. [source]

Social Networks and the Elderly: Conceptual and Clinical Issues, and a Family Consultation

FAMILY PROCESS, Issue 3 2000
Carlos E. Sluzki M.D.
After a general introduction to the construct "social networks," this article discusses the progressive transformation of the personal social network,family, friends and acquaintances, work and leisure relationships, et cetera,as individuals reach an advanced age. This is followed by a summary and discussion of a clinical consultation, with an emphasis on the reciprocal influence between individual and social network. [source]

A cool response to the ICE Regulations?

INDUSTRIAL RELATIONS JOURNAL, Issue 5 2006
Employer, consultation, trade union approaches to the new legal framework for information
ABSTRACT One year on from the introduction of the Information and Consultation of Employees Regulations, this article reviews the emerging patterns of implementation in the light of the legislation's ,reflexive' design. The available evidence suggests considerable employer-led activity in terms of reviewing, modifying and introducing information and consultation arrangements but a relative paucity of formal ,pre-existing agreements', despite the protection they offer against the Regulations' statutory procedures being invoked by employees. This picture is consistent with a ,risk assessment' rather than a ,compliance' approach by management, facilitated by union ambivalence towards the legislation and low use of its provisions by employees. [source]

The Reality of Faith in Theology: Studies on Karl Barth: Princeton,Kampen Consultation, 2005 , Edited by Bruce L. McCormack and Gerrit Neven

INTERNATIONAL JOURNAL OF SYSTEMATIC THEOLOGY, Issue 1 2009
James R.A. Merrick
No abstract is available for this article. [source]

Night-time frequency, sleep disturbance and general health-related quality of life: Is there a relation?

INTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2009
Koji Yoshimura
Objectives: We conducted a community-based study to determine the relationship among night-time frequency, sleep disturbance and general health-related quality of life (GHQL). Methods: A total of 2271 participants, men and women, aged 41,70 and randomly selected in three Japanese towns completed a postal questionnaire survey. This questionnaire included: the International Prostate Symptom Score, the overall incontinence score of the International Consultation of Incontinence Questionnaire Short Form for lower urinary tract symptoms, the Pittsburg Sleep Quality Index for sleep problems, the Medical Outcome Study Short Form-8 for GHQL, and medical history of disease, cigarette smoking, and alcohol consumption. A multiple regression model was used for statistical analysis, and P < 0.05 was considered significant. Results: Although night-time frequency by itself was closely associated with most aspects of GHQL, this association disappeared in four domains (general health perception, vitality, mental health and emotional role) and in the two summary scores of the Medical Outcome Study Short Form-8 after inclusion of the influence of sleep problems represented by the total score on the Pittsburg Sleep Quality Index. However, three domains (physical function, physical role, and social function) remained significantly associated with night-time frequency. Sleep problems were by far the worst risk factor for the deterioration of GHQL. Conclusions: Night-time frequency appeared to be associated with GHQL mainly by affecting sleep conditions, a symptom that independently influenced some aspects of GHQL. [source]

Urinary incontinence in men with chronic obstructive pulmonary disease

INTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2008
Fumi Hirayama
Abstract: This study investigated urinary incontinence in men with chronic obstructive pulmonary disease (COPD). A total of 244 community-dwelling men (mean age 66.5 years) diagnosed with COPD within the past 4 years were recruited from six hospital outpatient departments in central Japan. The prevalence of urinary incontinence was 10% according to the International Consultation on Incontinence criterion. Urine leakage among the 24 incontinent men was typically a small amount (75%) and occurred once a week or less often (58%). Fifteen (63%) of them reported urge incontinence while only two men experienced stress incontinence. On average they had urine leakage for 2.5 (SD 2.3) years and the majority (n = 19, 79%) developed the condition after diagnosis of COPD. The finding of higher prevalence of urge incontinence challenges the conventional view that COPD is associated with stress incontinence due to high pressure coughs. [source]

The legendary beginning of the International Consultation on Interstitial Cystitis

INTERNATIONAL JOURNAL OF UROLOGY, Issue 2003
TOMOHIRO UEDA
No abstract is available for this article. [source]

Just and Inclusive Communities: Report of the Theological Consultation, La Paz, Bolivia, April 29-May 3, 2007

INTERNATIONAL REVIEW OF MISSION, Issue 384-385 2008
Article first published online: 25 MAR 200
First page of article [source]

Collaborative Childcare Health Consultation: A Conceptual Model

JOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 2 2008
Angela A. Crowley PhD
PURPOSE.,This study explored the nature of consultation between childcare providers and nurse childcare health consultants and identified factors that promote a collaborative relationship. DESIGN AND METHODS.,A qualitative study using semistructured, individual interviews of five collaborative and five conflicted pairs of nurse childcare health consultants and childcare center directors. Data were analyzed following principles of grounded theory and applying the constant comparative method of analysis. RESULTS.,Establishing a collaborative relationship was influenced by previous experiences and four themes in the relationship: open and active communication, commitment, respect, and congruent philosophies. PRACTICE IMPLICATIONS.,Preparation in developing collaborative relationships should be incorporated into the education of nurse consultants and childcare directors and providers. [source]

Computer Imaging versus Conventional Esthetic Consultation: A Prospective Clinical Study

JOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 2 2000
OLGA S. PAPASOTIRIOU DMD
ABSTRACT Computer imaging can be helpful in demonstrating to patients the potential outcome of esthetic dental procedures. The current clinical study assesses the effectiveness of computer imaging by comparing the reactions of patient and dentist to conventional consultations versus the use of computer imaging. The responses from 35 subjects show that computer imaging consultations are more effective in helping patients decide to accept treatment. Patient satisfaction was higher (93.75%) with computer consultations than with conventional methods (83.3%). Computer imaging consultations were easier to conduct but significantly (p < .05) more time consuming. CLINICAL SIGNIFICANCE This experiment confirms the role of computer imaging as an effective aid in esthetic dentistry consultations and treatment planning. Imaging facilitates communication between patient and practitioner and provides a more realistic view of anticipated treatment outcomes. [source]

Nursing leadership and management effects work environments

JOURNAL OF NURSING MANAGEMENT, Issue 1 2009
ANN MARRINER TOMEY PhD
Aim, The aim of this literature search was to identify recent research related to nursing leadership and management effects on work environment using the 14 forces of magnetism. Background, This article gives some historical perspective from the original 1983 American Academy of Nursing study through to the 2002 McClure and Hinshaw update to 2009 publications. Evaluation, Research publications were given a priority for references. Key issues, The 14 forces of magnetism as identified by Unden and Monarch were: ,1. Quality of leadership,, 2. Organizational structure,, 3. Management style,, 4. Personnel policies and programs,, 5. Professional models of care,, 6. Quality of care,, 7 Quality improvement,, 8. Consultation and resources,, 9. Autonomy,, 10. Community and the hospital,, 11. Nurse as teacher,, 12. Image of nursing,, 13. Interdisciplinary relationships, and 14. Professional development,.'. Conclusions, Correlations have been found among positive workplace management initiatives, style of transformational leadership and participative management; patient-to-nurse ratios; education levels of nurses; quality of patient care, patient satisfaction, employee health and well-being programmes; nurse satisfaction and retention of nurses; healthy workplace environments and healthy patients and personnel. Implications for nursing management, This article identifies some of the research that provides evidence for evidence-based nursing management and leadership practice. [source]

Systematic review: frequency and reasons for consultation for gastro-oesophageal reflux disease and dyspepsia

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2009
A. P. S. HUNGIN
Summary Background, Upper gastrointestinal symptoms impose a substantial illness burden and management costs. Understanding perceptions and reasons for seeking healthcare is a prerequisite for meeting patients' needs effectively. Aim, To review systematically findings on consultation frequencies for gastro-oesophageal reflux disease (GERD) and dyspepsia and patients' reasons for consultation. Methods, Systematic literature searches. Results, Reported consultation rates ranged from 5.4% to 56% for GERD and from 26% to 70% for dyspepsia. Consultation for GERD was associated with increased symptom severity and frequency, interference with social activities, sleep disturbance, lack of timetabled work, higher levels of comorbidity, depression, anxiety, phobia, somatization and obsessionality. Some consulted because of fears that their symptoms represented serious disease; others avoided consultation because of this. Inconsistent associations were seen with medication use. Patients were less likely to consult if they felt that their doctor would trivialize their symptoms. Few factors were consistently associated with dyspepsia consultation. However, lower socio-economic status and Helicobacter pylori infection were associated with increased consultation. Conclusion, Patients' perceptions of their condition, comorbid factors and external reasons such as work and social factors are related to consultation rates for GERD. Awareness of these factors can guide the clinician towards a more effective strategy than one based on drug therapy alone. [source]

Pediatric Travel Consultation in an Integrated Clinic

JOURNAL OF TRAVEL MEDICINE, Issue 1 2001
John C. Christenson
Background: In May 1997, a pediatric travel service was created within a larger integrated University-County Health Department international travel clinic. The purpose of the service was to further enhance the travel advice and care provided to children and their parents or guardians. The current study was designed to describe the care of children in this setting and to compare the care of children seen in the Pediatric Travel Service with that of children seen by other providers. Methods: All pediatric patients (defined as individuals , 18 years of age) receiving care in the travel clinic were considered candidates for inclusion in the analysis. Patients seen by the Pediatric Travel Service were compared to those seen by other staff members in the travel clinic (referred to as Regular Clinic). The following information was noted: basic demographic data, medical history including allergies, prior immunization records, intended place and duration of travel, and immunizations and medications prescribed at the time of visit. Travel advice covering water and food precautions, preventive measures against insect bites, injury prevention, malaria prevention, prevention of parasitic infections, and environmental-related problems was provided to all patients in both groups when necessary. Results: Between May 1997 and December 1999, 287 pediatric age individuals were given pretravel care by the Pediatric Travel Service (median age, 6 years; range, 1 month-18 years). During the same time period, 722 pediatric age travelers (median age, 14 years; range, 8 months-18 years) were evaluated in the Regular Clinic by other staff members. Travel destinations most commonly traveled by both groups in descending order were: Africa, Central America and Mexico, South America, and Southeast Asia. When compared to travelers seen in the Regular Clinic, individuals in the Pediatric Travel Service group were more likely to travel for humanitarian work, and for parental work relocation. Persons in the Regular Clinic were more likely to travel to Mexico and Central America. They were also more likely to travel on vacation and for missionary work or study. Hepatitis B and tetanus-diphtheria booster vaccinations were given more frequently to travelers seen in the Regular Clinic. Also, ciprofloxacin and antimotility agents were more commonly prescribed in this group. No differences were noted in the duration of travel or in the time interval between clinic visit and departure. Conclusions: While general travel advice was considered to be similar in both clinic groups, some differences were observed in the frequency of administration of certain vaccines and prescriptions of medications. These differences were likely due to a difference in age in the two study groups. The high volume and success of the clinic suggest that integrated pediatric and adult travel services in a coordinated setting can be effective. [source]

THE FAO PRECAUTIONARY APPROACH AFTER ALMOST 10 YEARS: HAVE WE PROGRESSED TOWARDS IMPLEMENTING SIMULATION-TESTED FEEDBACK-CONTROL MANAGEMENT SYSTEMS FOR FISHERIES MANAGEMENT?

NATURAL RESOURCE MODELING, Issue 4 2006
ANDRÉ E. PUNT
ABSTRACT. It is almost ten years since the FAO Technical Consultation on the Precautionary Approach to Capture Fisheries took place in Lysekil, Sweden. One outcome from this Technical Consultation was a set of guidelines on the precautionary approach to capture fisheries and species introductions. These guidelines include the need to incorporate harvest control rules in management plans. Harvest control rules should specify what action is to be taken when specified deviations from the operational targets and constraints are observed. The specification should include minimum data requirements for the types of assessment methods to be used for decision-making. Combinations of harvest control rules, assessment methods and data collection schemes are referred to as management procedures. It is now well-recognized that using management procedures is likely to lead to improved conservation of fishery resources, and that they should be evaluated to assess whether they are likely to achieve the goals for fishery management given the types of uncertainties that are likely to frustrate this venture. In general, evaluation of management procedures has been based on simulation modeling. This paper reviews the progress that has been made in various fisheries jurisdictions in terms of implementing management procedures, and why and where it has proved difficult or even impossible to implement management procedures. [source]

Comparison between reduction in 24-hour pad weight, International Consultation on Incontinence-Short Form (ICIQ-SF) score, International Prostate Symptom Score (IPSS), and Post-Operative Patient Global Impression of Improvement (PGI-I) score in patient evaluation after male perineal sling

NEUROUROLOGY AND URODYNAMICS, Issue 1 2007
Christian O. Twiss
Abstract Aims We assessed the utility of three self-assessment instruments: the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the post-operative Patient Global Impression of Improvement (PGI-I) score, and the International Prostate Symptom Score (IPSS) by correlating them with an objective outcome, the change in 24-hr pad weight, after a male perineal sling. Methods Twenty-six men with urodynamically confirmed stress incontinence underwent a male perineal sling. Patients were evaluated pre-operatively and post-operatively with a 24-hr pad test, IPSS and ICIQ-SF. Patients also completed the PGI-I post-operatively. Changes in study parameters were compared via the paired t -test, and correlations were performed using Spearman's rho. Results There were significant reductions in 24-hr pad weight (,274 g, P,<,0.001), percentage 24-hr pad weight (54.2%), ICIQ-SF score (,6.3, P,<,0.001), and the three ICIQ-SF subscores (,1.2, ,1.7, ,3.4 for Questions 3, 4, and 5, respectively, P,<,0.001 for all). The change in total ICIQ-SF score and the post-operative PGI-I score correlated strongly with percentage reduction in 24-hr pad weight (r,=,,0.68, P,<,0.001; r,=,,0.81, P,<,0.001, respectively) and with each other (r,=,0.79, P,<,0.001). The change in all three ICIQ-SF subscores correlated significantly with percentage reduction in 24-hr pad weight and with post-operative PGI-I score. There was no significant change in the IPSS or the voiding or storage subscores, and none correlated with any other study parameter. Conclusions This study validates the construct validity of the ICIQ-SF and PGI-I in the assessment of treatment for male stress incontinence and should make clinicians confident in comparing studies of incontinence treatment utilizing the change ICIQ-SF score, the post-operative PGI-I score, and percentage reduction in 24-hr pad weight as outcome measures. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source]

The Arabic ICIQ-UI SF: An alternative language version of the English ICIQ-UI SF

NEUROUROLOGY AND URODYNAMICS, Issue 3 2006
H. Hashim
Abstract Aims Urinary incontinence (UI) is a common and distressing condition. A variety of questionnaires are currently available to assess UI and its impact on patients' lives. However, most have not been adapted for international use. Following a systematic review of the literature and existing questionnaires the International Consultation on Incontinence short form questionnaire (ICIQ-UI SF) was developed, and has since been translated into many languages for local use. This paper reports the development and validation of the first UI questionnaire in the Arabic language. The development of this questionnaire will facilitate the assessment of UI in both clinical practice and research in the Middle-East. Methods Translation and validation of the Arabic version of the ICIQ-UI is described. Standard methods of translation by native Arabic and English speakers (including translation and back translation) are followed. The psychometric properties of the questionnaire, including its validity, reliability and sensitivity to change, are examined. The validation of the questionnaire involved patients attending urology outpatient clinics in two Middle-Eastern countries. Results The Arabic ICIQ-UI SF was found to be valid, reliable and responsive, indicating that the psychometric properties of the questionnaire have remained constant throughout the adaptation process. Furthermore, the findings of the psychometric testing confirm those found for the UK-English ICIQ-UI SF. Conclusions The development of this questionnaire will allow the study of Arabic speaking groups with UI in many countries around the world. This may act as an example to initiate the translation and validation of other patient reported outcomes into the Arabic language, thereby enabling more multinational and cross-cultural research into diseases in given areas. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source]

Multiple Relationships in Nursing Consultation

NURSING FORUM, Issue 2 2008
Deborah W. Wilson DNS
In a consultation relationship, when boundaries are blurred or blended individuals become overinvested and overinvolved with each other. Therefore, nurse consultants must be wary of engaging in overinvolvement in consultation that leads to multiple relationships with their clients that can jeopardize the efficacy of their consultation practice. This article examines the nature of the consultation process, practice, and ethical standards that relate to nursing consultation and multiple relationships in consultation. Emphasis is placed on exploring the particularly problematic multiple relations that occur in nursing consultation and recommendation for dealing with them in practice. Clearly, engaging in multiple relationships in consultation is problematic because of the possibility of exploitation and harm. Nurse consultants must exercise caution before entering into a multiple relationship even when they feel that there is little potential for harm. They must learn how to effectively manage multiple relationships and be prepared to respond to the challenges that they present. [source]

Depression and Anxiety Status of Patients with Implantable Cardioverter Defibrillator and Precipitating Factors

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2006
AHMET KAYA BILGE
Background: Implantable cardioverter defibrillators (ICDs) are life-saving devices in treatment of life-threatening arrhythmia. We evaluate the emotional status of Turkish patients with ICD and try to explain factors that affect emotional status of the patients. Methods: Ninety-one patients with previously implanted ICD were included in the study. Follow-up periods, presence of ICD shock, shock frequency, time of the recent shock, age, and gender were noted. Depression and anxiety scores were evaluated according to Hospital Anxiety and Depression (HAD) chart. Results: Mean anxiety and depression scores were found as 9.1 ± 5.3 and 7.2 ± 5.1, respectively. According to HAD charts, 42 patients (46%) had anxiety and 37 patients (41%) had depression. Depression scores indicated significant difference between subgroups divided on the basis of follow-up periods (P = 0.026) and on the basis of time of recent shock (P = 0.028). There was significant difference in anxiety scores (P = 0.016) between patients with ICD shocks and patients with no shocks. When the patients were divided into subgroups according to shock frequency, both depression (P = 0.024) and anxiety (P = 0.016) scores presented significant difference. In female patients, depression and anxiety scores were found significantly higher compared to male patients (P = 0.046 and P = 0.016, respectively). In multivariate analysis, gender and shock frequency were found as predictors for anxiety scores (P = 0.019 and P = 0.044, respectively). However same analysis revealed no predictive factor for depression score. Conclusion: Our study indicates presence of depression and anxiety in nearly half of the patients with ICD. Consultation with psychiatry should be a part of the treatment for patients with ICD, especially for those who constitute high-risk groups. [source]

Four Perspectives on Public Participation Process in Environmental Assessment and Decision Making: Combined Results from 10 Case Studies

POLICY STUDIES JOURNAL, Issue 4 2006
Thomas Webler
Knowing how people think about public participation processes and knowing what people want from these processes is essential to crafting a legitimate and effective process and delivering a program that is widely viewed as meaningful and successful. This article reports on research to investigate the nature of diversity among participants' perceptions of what is the most appropriate public participation process for environmental assessment and decision making in 10 different cases. Results show that there are clearly distinct perspectives on what an appropriate public participation process should be. We identified four perspectives: Science-Centered Stakeholder Consultation, Egalitarian Deliberation, Efficient Cooperation, and Informed Collaboration. The literature on public participation tends to presume that there are clear and universal criteria on how to "do" public participation correctly or that context is the critical factor. This study has revealed that even within a specific assessment or decision-making effort, there may be different perspectives about what is viewed as appropriate, which poses a challenge for both theorists and practitioners. Among the active participants in these 10 case studies, we found limited agreement and strong differences of opinions for what is a good process. Points of consensus across these cases are that good processes reach out to all stakeholders, share information openly and readily, engage people in meaningful interaction, and attempt to satisfy multiple interest positions. Differences appeared about how strongly to emphasize science and information, how much leadership and direction the process needs, what is the proper behavior of participants, how to tackle issues of power and trust, and what are the outcome-related goals of the process. These results challenge researchers and practitioners to consider the diversity of participant needs in addition to the broad context when conceptualizing or carrying out participatory processes. [source]

Public Consultation for Sustainable Development Policy Initiatives

POLICY STUDIES JOURNAL, Issue 4 2002
Manitoba Approaches
Involving the public in government decision making regarding sustainable development is a complex and difficult problem. This article suggests that weak public consultation, occurring at the operational planning level, is in part responsible for the lack of policy innovation in this realm. A case study technique considers approaches to public consultation in the development of sustainable development policy in the Canadian province of Manitoba. Using document reviews and qualitative interviews, two specific periods of policy development are traced with the outcomes of each being measured against creative consultative approaches established in the literature. It is revealed that using more complex consultative approaches at the normative policy planning level results in a number of positive implications, including mutual education and learning, participant satisfaction, policy innovation that has broad-based support, and results that have lasting implications on consultative proceshes. [source]

Latest news and product developments

PRESCRIBER, Issue 8 2007
Article first published online: 23 JUL 200
Lamotrigine for partial, valproate for generalised A large UK trial has shown that lamotrigine is the most effective choice in the treatment of partial epilepsy (Lancet 2007;369: 1000-15). The SANAD trial, commissioned by the National Institute for Health Research's Health Technology Assessment programme, randomised 1721 patients (for whom carbamazepine monotherapy would have been the treatment of choice) to treatment with carbamazepine, gabapentin, lamotrigine, oxcarbazepine (Trileptal) or topiramate (Topamax). Lamotrigine was associated with a longer time to treatment failure, though time to 12-month remission favoured carbamazepine. Over four years' follow-up, lamotrigine was numerically but not significantly superior. The authors concluded lamotrigine is clinically superior to carbamazepine for partial epilepsy A second arm of the trial, yet to be published, evaluated the treatment of generalised epilepsy and found valproate to be clinically most effective, though topiramate was cost effective for some patients. Chronic pain common in nursing homes Most residents in nursing homes say they have long- term pain but only one in seven say a health professional has ever discussed its treatment with them, according to a report by the Patients' Association (www.patients-association.org.uk). Pain in Older People ,A Hidden Problem was a qualitative study of 77 older residents in care homes in England. Most were frail and suffered long-term illness. The study found that 85 per cent of residents said they were often troubled by aches or pains and these lasted over a year in 74 per cent. Most described their pain as moderate (33 per cent) or severe (38 per cent) but 8 per cent said it was excruciating. Many reported limitations on mobility and social activities despite a high level of stoicism. All but one were taking medication to relive pain; one-third experienced adverse effects but 78 per cent believed drugs offered the most effective treatment. One-quarter said a doctor or nurse had discussed how to stop their pain worsening, and 15 per cent said they had discussed how to treat their pain. Visits from GPs appeared to be uncommon. Atherothrombotic events despite treatment Between one in five and one in seven of high-risk patients experience atherothrombotic events despite evidence-based treatment, the REACH study has shown (J Am Med Assoc 2007;297:1197-1206). REACH (REduction of Atherothrombosis for Continued Health) is an international observational study involving 68 236 patients with atherothrombotic disease or at least three risk factors. Most were taking conventional evidence-based medication. After one year, the incidence of the combined endpoint of cardiovascular death, myocardial infarction, stroke or hospitalisation for atherothrombotic events was approximately 15 per cent for patients with coronary artery disease or cardiovascular disease, and 21 per cent in patients with peripheral artery disease and established coronary disease. Event rates increased with the number of vascular beds affected, rising to 26 per cent in patients with three symptomatic arterial disease locations. Extended CD prescribing by nurses and pharmacists The Medicines and Healthcare products Regulatory Agency (MHRA) is consulting on expanding the prescribing of controlled drugs (CDs) by nonmedical prescribers. Currently, nurse independent prescribers can prescribe 12 CDs, including diamorphine and morphine, but pharmacist independent prescribers may not prescribe any CDs. The proposal is to allow both professions to prescribe any CDs within their competence, with the exception of cocaine, diamorphine or dipipanone for the management of addiction. The closing date for consultation is 15 June. Consultation is also underway on expanding the range of CDs nurses and pharmacists can prescribe under a patient group direction (PGD), and their use for pain relief. The closing date for consultation is 20 April. Intrinsa: transdermal testosterone for women A transdermal formulation of testosterone has been introduced for the treatment of low sexual desire associated with distress in women who have experienced an early menopause following hysterectomy involving a bilateral oophorectomy and are receiving concomitant oestrogen therapy. Manufacturer Procter & Gamble says that Intrinsa, a twice-weekly patch, delivers testosterone 300µg every 24 hours, achieving premenopausal serum testosterone levels. Clinical trials showed that Intrinsa reduced distress in 65-68 per cent and increased satisfying sexual activity in 51-74 per cent of women. A month's treatment (eight patches) costs £28.00. Fish oil for secondary ,not primary ,prevention of CHD Supplementing statin therapy with eicosapentaenoic acid (EPA) reduces the risk of major coronary events in patients with coronary heart disease (CHD) ,but not in patients with no history of CHD Lancet 2007;369:1090-8). The five-year study in 18 645 patients with total cholesterol levels of 6.5mmol per litre or greater found that the incidence of sudden cardiac death, fatal and nonfatal myocardial infarction in CHD patients treated with EPA plus a statin was 8.7 per cent compared with 10.7 per cent with a statin alone (relative risk reduction 19 per cent). A similar relative risk reduction in patients with no CHD was not statistically significant. There was no difference in mortality between the groups but EPA did reduce unstable angina and nonfatal coronary events. Department pilots information prescriptions The Department of Health has announced 20 sites to pilot information prescriptions prior to a nationwide roll-out in 2008. The prescriptions will guide people with long-term conditions such as diabetes and cancer to sources of support and information about their condition. The Department hopes the project will increase patients' understanding of their discussions with health professionals, empower them to locate the information they need, and provide long-term support. NPSA guidelines for safer prescribing The National Patient Safety Agency (www.npsa.nhs.uk) has published five guidelines to improve medication safety in the NHS. Targeting ,high-risk issues', the guidance covers anticoagulant prescribing, liquid medicines for oral or enteral administration, injectable medicines, epidural injections and infusions, and paediatric intravenous infusions. The implementation of each guide is supported by additional tools and resources. Better adherence not matched to outcomes A systematic review has found that interventions can increase adherence to prescribed medication but there is no evidence that clinical outcomes also improve (Arch Intern Med 2007;167:540-9). The review of 37 trials identified 20 reporting increased adherence. The most effective interventions were behavioural changes to reduce dose demands and those involving monitoring and feedback. Improvements in clinical outcomes were variable and did not correspond to changes in adherence. Antidepressant plus mood stabiliser no better US investigators have found that combining a mood stabiliser with an antidepressant is no more effective than a mood stabiliser alone in preventing mood changes (N Engl J Med 2007; published online 28 March, doi.10.1056/NEJMoa064135). The study found durable recovery occurred in 23.5 per cent of patients treated with a mood stabiliser and adjunctive antidepressant therapy for six months compared with 27.3 per cent of those taking a mood stabiliser plus placebo. [source]

Erectile Dysfunction in the Community: Trends over Time in Incidence, Prevalence, GP Consultation and Medication Use,the Krimpen Study: Trends in ED

THE JOURNAL OF SEXUAL MEDICINE, Issue 7 2010
Boris W.V. Schouten MD
ABSTRACT Introduction., In the general population, erectile dysfunction (ED) is surrounded by a "taboo." Epidemiologists studying this problem have to be aware of the phenomenon of the "tip-of-the-iceberg." Aims., Our aim is to describe the iceberg phenomenon for ED and their help-seeking behavior in the general population during a period when public interest in ED heightened and waned after the introduction of the drug sildenafil. Methods., The data were obtained as part of a large longitudinal community-based study, i.e., the Krimpen study. With four rounds of data collection with an approximate 2.1 years interval, the local pharmacists provided data on medication use, whereas abstracts from the medical record and history were provided by the local general practitioners (GPs). The data from the questionnaires were entered into the Krimpen study database but were not communicated to the GPs. Main Outcome Measures., ED: according to the ICS-questionnaire, GP consultation: search of electronic medical dossier for ED or reports from any specialist, use of ED medication as delivered by the pharmacy. Results., The age-standardized prevalence of ED is stable, i.e., around 40%. During the period 1995 to 2000, the incidence increased from 5% to 6.5%, then it stabilizes around 5% per year. The first-time use of ED medication increases exponentially between 1995 and 2000, then it stabilizes at about 3.5% per year. The number of GP consultations by men with ED increases up to 1999, after which it stabilizes at about 1.8% per year. Conclusion., We suggest that the availability and awareness of a new pharmacological option induced a change of behavior among GPs and their patients. Schouten BWV, Bohnen AM, Groeneveld FPMJ, Dohle GR, Thomas S, and Ruun Bosch JLH. Erectile dysfunction in the community: Trends over time in incidence, prevalence, GP consultation and medication use,the krimpen study: Trends in ED. J Sex Med 2010;7:2547,2553. [source]

Priapism: Pathogenesis, Epidemiology, and Management

THE JOURNAL OF SEXUAL MEDICINE, Issue 1pt2 2010
Gregory A. Broderick MD
ABSTRACT Introduction., Priapism describes a persistent erection arising from dysfunction of mechanisms regulating penile tumescence, rigidity, and flaccidity. A correct diagnosis of priapism is a matter of urgency requiring identification of underlying hemodynamics. Aims., To define the types of priapism, address its pathogenesis and epidemiology, and develop an evidence-based guideline for effective management. Methods., Six experts from four countries developed a consensus document on priapism; this document was presented for peer review and debate in a public forum and revisions were made based on recommendations of chairpersons to the International Consultation on Sexual Medicine. This report focuses on guidelines written over the past decade and reviews the priapism literature from 2003 to 2009. Although the literature is predominantly case series, recent reports have more detailed methodology including duration of priapism, etiology of priapism, and erectile function outcomes. Main Outcome Measures., Consensus recommendations were based on evidence-based literature, best medical practices, and bench research. Results., Basic science supporting current concepts in the pathophysiology of priapism, and clinical research supporting the most effective treatment strategies are summarized in this review. Conclusions., Prompt diagnosis and appropriate management of priapism are necessary to spare patients ineffective interventions and maximize erectile function outcomes. Future research is needed to understand corporal smooth muscle pathology associated with genetic and acquired conditions resulting in ischemic priapism. Better understanding of molecular mechanisms involved in the pathogenesis of stuttering ischemic priapism will offer new avenues for medical intervention. Documenting erectile function outcomes based on duration of ischemic priapism, time to interventions, and types of interventions is needed to establish evidence-based guidance. In contrast, pathogenesis of nonischemic priapism is understood, and largely attributable to trauma. Better documentation of onset of high-flow priapism in relation to time of injury, and response to conservative management vs. angiogroaphic or surgical interventions is needed to establish evidence-based guidance. Broderick GA, Kadioglu A, Bivalacqua TJ, Ghanem H, Nehra A, and Shamloul R. Priapism: Pathogenesis, epidemiology and management. J Sex Med 2010;7:476,500. [source]

Premature Ejaculation: On Defining and Quantifying a Common Male Sexual Dysfunction

THE JOURNAL OF SEXUAL MEDICINE, Issue 2006
Gregory A. Broderick MD
ABSTRACT Introduction., Premature ejaculation (PE) and its individual and relationship consequences have been recognized in the literature for centuries. PE is one of the most common male sexual dysfunctions, affecting nearly one in three men worldwide between the ages of 18 and 59 years. Until recently, PE was believed to be a learned behavior predominantly managed with psychosexual therapy; however, the past few decades have seen significant advances in understanding its etiology, diagnosis, and management. There is, as yet, no one universally agreed upon definition of PE. Aim., To review five currently published definitions of PE. Methods., The Sexual Medicine Society of North America hosted a State of the Art Conference on Premature Ejaculation on June 24,26, 2005 in collaboration with the University of South Florida. The purpose was to have an open exchange of contemporary research and clinical information on PE. There were 16 invited presenters and discussants; the group focused on several educational objectives. Main Outcome Measure., Data were utilized from the World Health Organization, the American Psychiatric Association, the European Association of Urology, the Second International Consultation on Sexual Dysfunctions, and the American Urological Association. Results., The current published definitions of PE have many similarities; however, none of these provide a specific "time to ejaculation," in part because of the absence of normative data on this subject. While investigators agree that men with PE have a shortened intravaginal ejaculatory latency time (IELT; i.e., time from vaginal penetration to ejaculation), there is now a greater appreciation of PE as a multidimensional dysfunction encompassing several components, including time and subjective parameters such as "control,""satisfaction," and "distress." Conclusion., There is a recent paradigm shift away from PE as a unidimensional disorder of IELT toward a multidimensional description of PE as a biologic dysfunction with psychosocial components. Broderick GA. Premature ejaculation: On defining and quantifying a common male sexual dysfunction. J Sex Med 2006;3(suppl 4):295,302. [source]

Endocrine Aspects of Sexual Dysfunction in Men

THE JOURNAL OF SEXUAL MEDICINE, Issue 1 2004
Alvaro Morales MD
ABSTRACT Introduction., Endocrine disorders of sex steroid hormones may adversely affect men's sexual function. Aim., To provide expert opinions/recommendations concerning state-of-the-art knowledge for the pathophysiology, diagnosis and treatment of endocrinologic sexual medicine disorders. Methods., An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a scientific and debate process. Concerning the Endocrine committee, there were eight experts from seven countries. Main Outcome Measure., Expert opinions/recommendations are based on grading of evidence-based medical literature, extensive internal committee discussion over 2 years, public presentation and deliberation. Results., Hypogonadism is a clinical and biochemical syndrome characterized by a deficiency in serum androgen levels which may decrease sexual interest, quality of erections and quality of life. Biochemical investigations include testosterone and either bioavailable or calculated free testosterone; prolactin should be considered when hypogonadism has been documented. If clinically indicated, androgen therapy should maintain testosterone within the physiological range avoiding supraphysiologic values. Digital rectal examination and determination of serum prostate specific antigen values are mandatory prior to therapy and regularly thereafter. Androgen therapy is usually long-term requiring regular follow-up, frequent monitoring of blood levels and beneficial and adverse therapeutic responses. Conclusions., Safe and effective treatments for endocrinologic sexual medicine disorders examined by prospective, placebo-controlled, multi-institutional clinical trials are needed. [source]

Endocrine Aspects of Female Sexual Dysfunction

THE JOURNAL OF SEXUAL MEDICINE, Issue 1 2004
Susan R. Davis MD
ABSTRACT Introduction., Various endogenous hormones, including estrogen, testosterone, progesterone and prolactin, may influence female sexual function. Aim., To provide recommendations for the diagnosis and treatment of women with endocrinologic sexual difficulties. Methods., The Endocrine Aspects of Female Sexual Dysfunction Committee was part of a multidisciplinary International Consultation. It included four experts from two countries and several peer reviewers. Main Outcome Measure., Expert opinion was based on committee discussion, a comprehensive literature review and evidence-based grading of available publications. Results., The impact of hormones on female sexual function and their etiological roles in dysfunction is complex. Research data are limited as studies have been hampered by lack of precise hormonal assays and validated measures of sexual function in women. Sex steroid insufficiency is associated with urogenital atrophy and may also adversely affect central sexual thought processes. Systemic estrogen/estrogen progestin therapy alleviates climacteric symptoms but there is no evidence that this therapy specifically improves hypoactive sexual desire disorder (HSDD) in premenopausal or postmenopausal women. Exogenous testosterone has been shown in small randomized controlled trials (RCT) to improve sexual desire, arousal and sexual satisfaction in both premenopausal and postmenopausal women. However, as there is no biochemical measure that clearly identifies who to treat, use of exogenous testosterone should be considered only after other causes of HSDD have been excluded, such as depression, relationship problems and ill health. The clinical assessment of HSDD should include detailed medical, gynecologic, sexual and psychosocial history and physical examination including the external/internal genitalia. Hormonal therapy should be individualized and risks/benefits fully discussed, and all treated women should be carefully followed up and monitored for therapeutic side effects. Conclusions., There is a need for prospective, multi-institutional clinical trials to define safe and effective endocrine treatments for female sexual dysfunction. [source]

Organ Trafficking and Transplant Tourism: A Commentary on the Global Realities

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 5 2008
D. A. Budiani-Saberi
The extent of organ sales from commercial living donors (CLDs) or vendors has now become evident. At the Second Global Consultation on Human Transplantation of the World Health Organization's (WHO) in March 2007, it was estimated that organ trafficking accounts for 5,10% of the kidney transplants performed annually throughout the world. Patients with sufficient resources in need of organs may travel from one country to another to purchase a kidney (or liver) mainly from a poor person. Transplant centers in ,destination' countries have been well known to encourage the sale of organs to ,tourist' recipients from the ,client' countries. [source]

Introduction: Community Consultation and the Policy Process

AUSTRALIAN JOURNAL OF PUBLIC ADMINISTRATION, Issue 1 2002
Patrick Bishop
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