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Little Different (little + different)

Distribution by Scientific Domains

Medical Sciences	80%

Selected Abstracts

Blood morphine levels in naltrexone-exposed compared to non-naltrexone-exposed fatal heroin overdoses

ADDICTION BIOLOGY, Issue 3 2003
DIANE ARNOLD-REED
The aim of this study was to investigate the association between prior exposure to naltrexone and increased risk of fatal heroin overdose using a review of toxicology reports for heroin-related fatalities between July 1997 to August 1999 for two groups: those treated with oral naltrexone and those who were not treated. Additional information for the oral naltrexone group was obtained from clinic files. Naltrexone-treated deaths were identified from the patient database at the Australian Medical Procedures Research Foundation (AMPRF), Perth, Western Australia (WA) through the Western Australian Department of Health, Data Linkage Project. Non-treated cases were identified from the database at the Forensic Science Laboratory, State Chemistry Centre (WA). We identified and investigated blood morphine concentrations following 21 fatal heroin overdoses with prior exposure to naltrexone and in 71 non-naltrexone-exposed cases over the same time period. The proportion of deaths where heroin use was a major contributing factor was little different in the non-naltrexone compared to the naltrexone-exposed group. Furthermore, in ,acute opiate toxicity' deaths, blood morphine levels were lower in non-naltrexone-exposed compared with naltrexone-exposed cases. Although there was a higher number of deaths designated as rapid (i.e. occurring within 20 minutes) in the naltrexone-exposed (89%) compared with the non-exposed group (72%) this was not statistically significant. Other drug use in relation to heroin-related fatalities is discussed. Findings do not support the hypothesis that prior exposure to naltrexone increases sensitivity to heroin toxicity. [source]

Service Use and Costs of Support 12 Years after Leaving Hospital

JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 4 2006
Angela Hallam
Background, There have been major changes in the provision and organization of services for people with intellectual disabilities in England over the last 30 years, particularly deinstitutionalization and the development of the mixed economy of care. The experiences of the people who participated in the Care in the Community Demonstration Programme in the mid-1980s provide evidence of the immediate and longer-term effects of the reprovision policy. Methods, Cross-sectional and longitudinal evidence was gathered on service use and costs for over 250 people 12 years after they left long-stay hospitals for community living arrangements. Comparisons were made with the situation in hospital, and 1 and 5 years after leaving. Relationships between costs after 12 years and individual characteristics assessed before people left hospital were explored. Results, Community care at the 12-year follow-up remained more expensive than hospital-based support, although the average cost was lower than at either of the 1- or 5-year community follow-up points. Service users were living in a wide variety of accommodation settings. Management responsibility fell on National Health Service (NHS) trusts, local authorities, voluntary agencies, or to private organizations or individuals. After standardizing for users' skills and abilities, costs in minimum support accommodation were significantly lower than those in residential and nursing homes, costs in staffed group homes significantly higher, and costs in hostels slightly lower. When looking at differences between individuals, no relationship was found between costs and outcomes although, overall, people were better off in the community than they had been when in hospital. Conclusions, Reprovision planning for hospital and other institutional modes of care requires major and long-term commitment of resources. Quality of life improvements can be achieved at a cost little different in the long-run from that for hospital care. The link between needs and costs (reflecting the services intended to meet those needs) would be made stronger through the individualization of care. [source]

Evaluation and Treatment of Hyperthyroidism and Hypothyroidism

JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 10 2004
ANP-C, FAANP, Mary Jo Goolsby EdD
ABSTRACT This month's clinical practice guideline (CPG) review is on the diagnosis and treatment of hyperthyroidism and hypothyroidism as provided by the American Association of Clinical Endocrinologists. An estimated 27 million Americans have thyroid disease, and about 13 million of them are undiagnosed. The risk of thyroid disease increases with age, and women are seven times more likely than men to develop thyroid problems. Unfortunately, thyroid symptoms are usually very nonspecific and should be kept in the differential diagnosis of many clinical complaints. The format of this month's column is a little different because we received two independent manuscripts, each of which had merit. We made a decision to present both points of view and deleted repetitive material. This is an example of variable approaches one can take with reviewing and critiquing CPGs. [source]

A rat model of hypereosinophilic syndrome

PATHOLOGY INTERNATIONAL, Issue 2 2001
Kenji Sano
Hypereosinophilia-occurring rats without chemical and antigen treatment have been maintained in our laboratory. The rat, Matsumoto Eosinophilia Shinshu (mes), showed hypereosinophilia at the age of 9 weeks or older and developed eosinophil-related inflammatory lesions in many organs. These lesions included: aortitis, granulomatous lesion in the mesenteric lymph node, inflammatory fibroid polyp of the stomach and pulmonary vasculitis with septal infiltration. These lesions were involved with cellular infiltration of eosinophils and macrophages, and deposition of eosinophilic crystals which immunohistologically showed major basic protein and eosinophilic peroxidase derived from eosinophilic lysosomal constituents. Although the distribution of lesions in mes is a little different from that of hypereosinophilic syndrome (HES) in humans, in that endomyocardial fibrosis appears in HES while aortitis appears in mes, mes is probably comparable with HES. The present paper describes the pathological aspects of the lesions in mes and discusses the pathogenesis of tissue injury related to eosinophilic infiltration. [source]

Preoperative localization of parathyroid adenomas: ultrasonography, sestamibi scintigraphy, or both?

CLINICAL OTOLARYNGOLOGY, Issue 5 2004
D. Hajioff
Minimal access techniques are increasingly used to remove parathyroid adenomas. Such surgery depends on accurate preoperative localization but the selection of imaging modality remains controversial. We have reviewed the accuracy of ultrasonography, sestamibi scintigraphy and their combination in 48 cases of primary hyperparathyroidism. Ultrasound had a sensitivity of 64.3% (95% confidence interval 44.1,81.4) and positive predictive value (PPV) of 100% (81.5,100) for correct lateralization. Sestamibi had a sensitivity of 83.3% (69.8,92.5) and PPV of 87.1% (73.7,95.1). The simple combination of ultrasound with sestamibi had a sensitivity of 82.1% (63.1,93.9) and a PPV of 92.0% (74.0,99.0): little different from sestamibi alone. However, if the sestamibi result was disregarded in favour of ultrasonography in discordant cases, the sensitivity reached 96.4% (81.7,99.9) and the PPV was 100% (87.2,100). These results were not dependant on a learning curve or the size of adenoma. [source]