Home About us Contact
|
Home About us Contact | ||
|
|
||
Relating
Kinds of Relating Selected AbstractsENACTMENTS: MOVING FROM DEADLY WAYS OF RELATING TO THE BEGINNINGS OF MENTAL LIFEBRITISH JOURNAL OF PSYCHOTHERAPY, Issue 2 2008David Morgan abstract The author discusses the vicissitudes of working analytically with patients who present with monolithic forms of thinking. He describes an approach that emphasizes the importance of the analyst as a real object that has at first to be explored to discover whether or not what is projected corresponds to the analyst's mind. This exploration of the other often confronts the analyst with their own issues surrounding sanity and madness, life and death; it is through this exploration of these real anxieties in the mind of the object that can lead to the beginnings of thinking in severely ill patients. [source] New Considerations Relating to Class Effect With Angiotensin-Converting Enzyme Inhibitors-The PEACE StudyJOURNAL OF CLINICAL HYPERTENSION, Issue 3 2005Domenic A. Sica MD Angiotensin-converting enzyme inhibitor therapy provides positive outcome benefits in a number of cardiac scenarios including congestive heart failure, postmyocardial infarction, as well as in the hypertensive patient at cardiac risk. This benefit exists both in normotensive and hypertensive individuals and is present in those with various grades of cardiovascular risk. This beneficial cardiovascular effect has now been observed with several angiotensin-converting enzyme inhibitors, suggesting a class effect. The Prevention of Events with Angiotensin-Converting Enzyme Inhibition trial studied the effect of adding the angiotensinconverting enzyme inhibitor trandolapril to a contemporary therapeutic regimen of patients with stable coronary artery disease and preserved left ventricular function. In this study, the addition of trandolapril did not confer any additional benefit in terms of reducing the incidence of cardiovascular death, myocardial infarction, or coronary revascularization. The neutral findings in this trial add a new wrinkle to the concept of class effect for cardiovascular protection with angiotensin-converting enzyme inhibitors in patients with coronary artery disease. [source] Self-Compassion Versus Global Self-Esteem: Two Different Ways of Relating to OneselfJOURNAL OF PERSONALITY, Issue 1 2009Kristin D. Neff ABSTRACT This research examined self-compassion and self-esteem as they relate to various aspects of psychological functioning. Self-compassion entails treating oneself with kindness, recognizing one's shared humanity, and being mindful when considering negative aspects of oneself. Study 1 (N=2,187) compared self-compassion and global self-esteem as they relate to ego-focused reactivity. It was found that self-compassion predicted more stable feelings of self-worth than self-esteem and was less contingent on particular outcomes. Self-compassion also had a stronger negative association with social comparison, public self-consciousness, self-rumination, anger, and need for cognitive closure. Self-esteem (but not self-compassion) was positively associated with narcissism. Study 2 (N=165) compared global self-esteem and self-compassion with regard to positive mood states. It was found that the two constructs were statistically equivalent predictors of happiness, optimism, and positive affect. Results from these two studies suggest that self-compassion may be a useful alternative to global self-esteem when considering what constitutes a healthy self-stance. [source] A Prognostic Index Relating 24-Hour Ambulatory Blood Pressure to Cardiac Events in Ischemic Cardiomyopathy Following Defibrillator ImplantationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2008LANFRANCO ANTONINI M.D. Background:We assessed the role of left ventricular ejection fraction and of ambulatory blood pressure monitoring (ABPM) to predict cardiac death and heart failure in patients with defibrillator fulfilling MADIT II criteria. ABPM variables assessed included: mean 24 hours diastolic and systolic blood pressure, mean 24 hours heart rate, and pulse pressure. Methods:We studied 105 consecutive patients (age 67 ± 11), all with a defibrillator and ejection fraction , 30%). Results:At 1-year follow-up, there were 29 events (25%), three cardiac deaths, and 26 hospitalizations for heart failure. Age, creatinine, mean 24 hours diastolic blood pressure, and mean 24 hours systolic blood pressure (but not ejection fraction) were associated with events. A prognostic index (PI) was built by age and ABPM variables, according to the formula (120 , age) + (mean 24 hours diastolic blood pressure + mean 24 hours systolic blood pressure). Receiver operating characteristic curves showed the best cutoff for PI = 220 (sensitivity 81%, specificity 71%, positive predictive value 56%, negative predictive value 88%). Cox regression analysis confirmed the significant association between lower PI (< 220) and clinical events (HR 4.8, 95% CI 1.8,12.3, P = 0.0001 for PI). Overall, 12% of patients with high PI values (, 220 n = 71) had clinical events at 12-month follow-up, compared with 61% of patients with low PI (< 220 n = 34) (P < 0.0001). Conclusion:The PI built by mean 24 hours diastolic and systolic blood pressure and age could be a simple method to stratify risk of cardiac death and acute heart failure in MADIT II patients, in whom ejection fraction, uniformly depressed, is not predictive. [source] International Promises and Domestic Pragmatism: To What Extent will the Employment Relations Act 1999 Implement International Labour Standards Relating to Freedom of AssociationTHE MODERN LAW REVIEW, Issue 3 2000Tonia Novitz This paper explores the rhetoric and reality surrounding implementation of international labour standards in the Employment Relations Act 1999. It focuses on UK commitments relating to freedom of association and considers whether the new legislation goes any significant way towards their fulfilment. The paper begins by outlining obligations which arise from a state's membership of the International Labour Organisation (ILO) and ratification of ILO Conventions. It then goes on to examine indications that, since the change of government in 1997, there has been a significant shift in UK policy relating to such international obligations. The remainder of the paper examines reforms made by the Employment Relations Act to trade union recognition, protection of strikers from dismissal and prevention of anti-union discrimination. It emerges that the Third Way proposed by the present Labour Government entails a complicated detour from the path of full compliance with ILO standards. [source] Reliability in grid computing systems,CONCURRENCY AND COMPUTATION: PRACTICE & EXPERIENCE, Issue 8 2009Christopher Dabrowski Abstract In recent years, grid technology has emerged as an important tool for solving compute-intensive problems within the scientific community and in industry. To further the development and adoption of this technology, researchers and practitioners from different disciplines have collaborated to produce standard specifications for implementing large-scale, interoperable grid systems. The focus of this activity has been the Open Grid Forum, but other standards development organizations have also produced specifications that are used in grid systems. To date, these specifications have provided the basis for a growing number of operational grid systems used in scientific and industrial applications. However, if the growth of grid technology is to continue, it will be important that grid systems also provide high reliability. In particular, it will be critical to ensure that grid systems are reliable as they continue to grow in scale, exhibit greater dynamism, and become more heterogeneous in composition. Ensuring grid system reliability in turn requires that the specifications used to build these systems fully support reliable grid services. This study surveys work on grid reliability that has been done in recent years and reviews progress made toward achieving these goals. The survey identifies important issues and problems that researchers are working to overcome in order to develop reliability methods for large-scale, heterogeneous, dynamic environments. The survey also illuminates reliability issues relating to standard specifications used in grid systems, identifying existing specifications that may need to be evolved and areas where new specifications are needed to better support the reliability. Published in 2009 by John Wiley & Sons, Ltd. [source] Quantification of Extinction Risk: IUCN's System for Classifying Threatened SpeciesCONSERVATION BIOLOGY, Issue 6 2008GEORGINA M. MACE definición de prioridades de conservación; especies amenazadas; Lista Roja UICN; riesgo de extinción Abstract:,The International Union for Conservation of Nature (IUCN) Red List of Threatened Species was increasingly used during the 1980s to assess the conservation status of species for policy and planning purposes. This use stimulated the development of a new set of quantitative criteria for listing species in the categories of threat: critically endangered, endangered, and vulnerable. These criteria, which were intended to be applicable to all species except microorganisms, were part of a broader system for classifying threatened species and were fully implemented by IUCN in 2000. The system and the criteria have been widely used by conservation practitioners and scientists and now underpin one indicator being used to assess the Convention on Biological Diversity 2010 biodiversity target. We describe the process and the technical background to the IUCN Red List system. The criteria refer to fundamental biological processes underlying population decline and extinction. But given major differences between species, the threatening processes affecting them, and the paucity of knowledge relating to most species, the IUCN system had to be both broad and flexible to be applicable to the majority of described species. The system was designed to measure the symptoms of extinction risk, and uses 5 independent criteria relating to aspects of population loss and decline of range size. A species is assigned to a threat category if it meets the quantitative threshold for at least one criterion. The criteria and the accompanying rules and guidelines used by IUCN are intended to increase the consistency, transparency, and validity of its categorization system, but it necessitates some compromises that affect the applicability of the system and the species lists that result. In particular, choices were made over the assessment of uncertainty, poorly known species, depleted species, population decline, restricted ranges, and rarity; all of these affect the way red lists should be viewed and used. Processes related to priority setting and the development of national red lists need to take account of some assumptions in the formulation of the criteria. Resumen:,La Lista Roja de Especies Amenazadas de la UICN (Unión Internacional para la Conservación de la Naturaleza) fue muy utilizada durante la década de l980 para evaluar el estatus de conservación de especies para fines políticos y de planificación. Este uso estimuló el desarrollo de un conjunto nuevo de criterios cuantitativos para enlistar especies en las categorías de amenaza: en peligro crítico, en peligro y vulnerable. Estos criterios, que se pretendía fueran aplicables a todas las especies excepto microorganismos, eran parte de un sistema general para clasificar especies amenazadas y fueron implementadas completamente por la UICN en 2000. El sistema y los criterios han sido ampliamente utilizados por practicantes y científicos de la conservación y actualmente apuntalan un indicador utilizado para evaluar el objetivo al 2010 de la Convención de Diversidad Biológica. Describimos el proceso y el respaldo técnico del sistema de la Lista Roja de la IUCN. Los criterios se refieren a los procesos biológicos fundamentales que subyacen en la declinación y extinción de una población. Pero, debido a diferencias mayores entre especies, los procesos de amenaza que los afectan y la escasez de conocimiento sobre la mayoría de las especies, el sistema de la UICN tenía que ser amplio y flexible para ser aplicable a la mayoría de las especies descritas. El sistema fue diseñado para medir los síntomas del riesgo de extinción, y utiliza cinco criterios independientes que relacionan aspectos de la pérdida poblacional y la declinación del rango de distribución. Una especie es asignada a una categoría de amenaza si cumple el umbral cuantitativo por lo menos para un criterio. Los criterios, las reglas acompañantes y las directrices utilizadas por la UICN tienen la intención de incrementar la consistencia, transparencia y validez de su sistema de clasificación, pero requiere algunos compromisos que afectan la aplicabilidad del sistema y las listas de especies que resultan. En particular, se hicieron selecciones por encima de la evaluación de incertidumbre, especies poco conocidas, especies disminuidas, declinación poblacional, rangos restringidos y rareza; todas estas afectan la forma en que las listas rojas deberían ser vistas y usadas. Los procesos relacionados con la definición de prioridades y el desarrollo de las listas rojas nacionales necesitan considerar algunos de los supuestos en la formulación de los criterios. [source] Evaluation of the skin sensitizing potency of chemicals by using the existing methods and considerations of relevance for elicitationCONTACT DERMATITIS, Issue 1 2005David A. Basketter The Technical Committee of Classification and Labelling dealing with harmonized classification of substances and classification criteria under Directive 67/548/EEC on behalf of the European Commission nominated an expert group on skin sensitization in order to investigate further the possibility for potency consideration of skin sensitizers for future development of the classification criteria. All substances and preparations should be classified on the basis of their intrinsic properties and should be labelled accordingly with the rules set up in the Directive 67/548/EEC. The classification should be the same under their full life cycle and in the case that there is no harmonized classification the substance or preparation should be self-classified by the manufacturer in accordance with the same criteria. The Directive does not apply to certain preparations in the finished state, such as medical products, cosmetics, food and feeding stuffs, which are subject to specific community legislation. The main questions that are answered in this report are whether it would be possible to give detailed guidance on how to grade allergen potency based on the existing methods, whether such grading could be translated into practical thresholds and whether these could be set for both induction and elicitation. Examples are given for substances falling into various potency groups for skin sensitization relating to results from the local lymph node assay, the guinea pig maximization test, the Buehler method and human experience. [source] Erratum: MR imaging in assessing cardiovascular interventions and myocardial injuryCONTRAST MEDIA & MOLECULAR IMAGING, Issue 2 2007Alexis Jacquier Contrast Media and Molecular Imaging, MR imaging in assessing cardiovascular interventions and myocardial injury, Alexis Jacquier, Charles B. Higgins and Maythem Saeed, published in CMMI 2:1, DOI: 10.1002/cmmi122, pp1,15. Contract/Grant Sponsor information relating to Dr. A. Jacquier was absent from the published article. It should be noted that Dr. A. Jacquier was supported by the Société Française de Radiologie, Paris, as a research fellow. [source] The Disclosure of UK Boardroom Pay: the March 2001 DTI proposalsCORPORATE GOVERNANCE, Issue 4 2001Martin J. Conyon In March 2001 the government announced that new disclosure rules relating to UK boardroom pay would be introduced. This paper critically evaluates these proposals. The new proposals emerged from the government's Directors Remuneration consultative document issued in July 1999. The current paper makes the following contributions to the governance literature. First, the new disclosure proposals are reviewed. I suggest that they are incomplete both in their detail and scope. I also suggest that the government has conceded that more US style executive compensation disclosure is required. Second, I describe US executive compensation disclosure practices. If convergence in disclosure practice is potentially desirable then a more systematic comparison and analysis of current disclosure policies in the two economies is warranted. [source] Alcohol use and negative affect in the offence cycleCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2003Andrew Day Introduction It is commonly acknowledged that, for many offenders, alcohol use is strongly associated with criminal behaviour. The belief held by many professionals that the two phenomena are associated, probably in a causal way, has led to the inclusion of alcohol use as a ,criminogenic need' in many settings where rehabilitation programmes are used to reduce recidivism. However, the mechanisms and pathways involved in the alcohol,crime link remain poorly understood. Argument and conclusion This paper reviews the literature relating to alcohol,offending links and draws some inferences about the role of alcohol use as a criminogenic need in offender rehabilitation. It is proposed that the bi-directional relationship between alcohol use and negative affective states is important in understanding the offence cycle, and that deficits in self-regulation not only characterize both alcohol misuse and negative affect but are also implicated in the offending behaviour itself. Copyright © 2003 Whurr Publishers Ltd. [source] Decision Sciences Research in China: A Critical Review and Research Agenda,Foundations and Overview,DECISION SCIENCES, Issue 4 2006Xiande Zhao ABSTRACT This article focuses on decision sciences research in China, providing an overview of current research and developing a foundation for future China-based research. China provides a unique research opportunity for decision sciences researchers, owing to its recent history, rapid economic development, and strong national culture. We examine recent economic reforms and their impact on the development of research questions in the decision sciences, as well as discuss characteristics of the diverse regions in China and their potential as sites for various types of research. We provide a brief overview of recent China-based research on decision sciences issues relating to national culture, supply chain management, quality management, production planning and control, operations strategy, and new product development and discuss some of the unique methodological challenges inherent in China-based research. We conclude by looking forward to emerging research opportunities in China. [source] Physician and emergency medical technicians' knowledge and experience regarding dental traumaDENTAL TRAUMATOLOGY, Issue 3 2006Shaul Lin Abstract,,, The purpose of the present study was to evaluate the knowledge of physicians and emergency medical technicians (EMT) regarding primary treatment for dental trauma and to assess the experience they have in treating dental injuries. The study population consisted of 70 military physicians and EMT during their military service. A questionnaire was distributed relating to demographic data, such as age, gender, position, and type of military service, as well as the following issues: past experience in treating or witnessing dental trauma, former education regarding diagnosis and treatment of dental trauma, assessment of knowledge regarding dental trauma, etc. Of all participants, only 4 (5.9%), all physicians, received education regarding dental trauma. Nevertheless, 42 (61.8%) reported they witnessed such an injury during their military service. Dental injuries were first seen by the EMT in 41.2% of the cases, by the physician in 25%, and by a dentist in only 7.3%. Overall, 58 (85.3%) of the physicians and EMT stated that it was important to educate the primary health care providers regarding diagnosis and treatment of dental trauma. Special emphasis should be given to providing primary caregivers with the relevant education to improve their knowledge and ability of dealing with diagnosis and treatment of dental trauma. [source] ,Salience syndrome' replaces ,schizophrenia' in DSM-V and ICD-11: psychiatry's evidence-based entry into the 21st century?ACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2009J. Van Os Objective:, Japan was the first country to abandon the 19th century term of ,mind-splitting disease' (schizophrenia). Revisions of DSM and ICD are forthcoming. Should the rest of the world follow Japan's example? Method:, A comprehensive literature search was carried out in order to review the scientific evidence for the validity, usefulness and acceptability of current concepts of psychotic disorder. Results:, The discussion about re-classifying and renaming schizophrenia and other psychotic disorders is clouded by conceptual confusion. First, it is often misunderstood as a misguided attempt to change societal stigma instead of an attempt to change iatrogenic stigma occasioned by the use of misleading and mystifying terminology. Second, the debate is misunderstood as purely semantic, whereas in actual fact it is about the core concepts underlying psychiatric nosology. Third, it has been suggested that the debate is political. However, solid scientific evidence pointing to the absence of nosological validity of diagnostic categories lies at the heart of the argument. Fourth, there is confusion about what constitutes a syndrome (a group of symptom dimensions that cluster in different combinations in different people and for which one or more underlying diseases may or may not be found) and a disease (a nosologically valid entity with specific causes, symptoms, treatment and course). Conclusion:, Scientific evidence favours a syndromal system of classification combining categorical and dimensional representations of psychosis. The concept of ,salience' has the potential to make the public recognize psychosis as relating to an aspect of human mentation and experience that is universal. It is proposed to introduce, analogous to the functional-descriptive term ,Metabolic syndrome', the diagnosis of ,Salience syndrome' to replace all current diagnostic categories of psychotic disorders. Within Salience syndrome, three subcategories may be identified, based on scientific evidence of relatively valid and specific contrasts, named Salience syndrome with affective expression, Salience syndrome with developmental expression and Salience syndrome not otherwise specified. [source] International Trade Theory and Policy: What is Left of the Free Trade Paradigm?DEVELOPMENT AND CHANGE, Issue 6 2005Sunanda Sen Free trade doctrines have been questioned from the angle of their logical validity as well as relevance. Their replacement by New Trade Theories has been matched by important policy moves on strategic trade and industrial policy in advanced countries. These are defended by the advanced nations, both at inter-governmental levels and in multilateral institutions, largely in the interest of big capital in industry and finance. However, the theoretically discarded principles of free trade are still in use to push trade liberalization in developing countries. An uneven power relation between the rich and poor nations of the world has generated this asymmetric combination of policies in the world economy. Neglect of the macroeconomic issues relating to the national as well as the world economy has led these theories and the related policies to ignore the concerns for growth as well as development. [source] The subjective experience of taking antipsychotic medication: a content analysis of Internet dataACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2009J. Moncrieff Objective:, We explored the subjective effects associated with olanzapine, risperidone and older antipsychotics. Method:, We conducted a content analysis of an Internet database of comments about prescribed medications. Results:, We analysed 223 comments on risperidone, 170 on olanzapine and 46 relating to three older antipsychotics. The predominant subjective effects produced by all drugs consisted of sedation, cognitive impairment and emotional flattening or indifference. Connections appeared between these effects and Parkinsonian-like symptoms with the older drugs, sexual impairment with risperidone and metabolic effects with olanzapine. The experience of akathisia was frequently linked to suicidal thoughts. Some respondents described how the drugs' subjective effects helped to reduce symptoms of mania, psychosis and anxiety. Conclusion:, The generalisability of Internet data is uncertain. However, the data suggest that adverse subjective effects play a central role in the experience of taking antipsychotic drugs and may be related to the drugs' desired benefits. [source] Attention deficits, Attention-Deficit Hyperactivity Disorder, and intellectual disabilitiesDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 4 2008Curtis K. Deutsch Abstract Attention-Deficit Hyperactivity Disorder (ADHD) and its earlier nosologic classifications have been extensively investigated since the 1960s, with PubMed listings alone exceeding 13,000 entries. Strides have been made in the diagnosis and treatment of ADHD in individuals with intellectual function in the normal range, as described in companion reviews in this special issue. In contrast, comparatively little is known about ADHD in intellectual developmental disabilities (IDD) despite the possibility that ADHD is statistically overrepresented among individuals with IDD (Pearson et al. 1997 Attention-deficit/hyperactivity disorder in mental retardation: nature of attention deficits. In: Burack J, Enns J, editors. Attention, development, and psychopathology. New York: Guilford Press. p 205,229; Pearson et al. 2000 Am. J. Ment. Retard. 105:236,251). Here, we provide a review of diagnostic controversies in ADHD with IDD, and discuss several topics that are currently attracting research efforts in the field. These include behavioral phenotyping and attempts to come to grips with problems of behavioral and etiological heterogeneity. Additionally, we consider issues relating to methodologically sound assessment of attention disorders and evidence-based intervention procedures that may clarify and/or ameliorate attention deficits in individuals with IDD. © 2008 Wiley-Liss, Inc. Dev Disabil Res Rev 2008;14:285,292. [source] Language and communication development in down syndromeDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 1 2007Joanne E. Roberts Abstract Although there is considerable variability, most individuals with Down syndrome have mental retardation and speech and language deficits, particularly in language production and syntax and poor speech intelligibility. This article describes research findings in the language and communication development of individuals with Down syndrome, first briefly describing the physical and cognitive phenotype of Down syndrome, and two communication related domains,hearing and oral motor skills. Next, we describe language development in Down syndrome, focusing on communication behaviors in the prelinguistic period, then the development of language in children and adolescents, and finally language development in adults and the aging period. We describe language development in individuals with Down syndrome across four domains: phonology, semantics, syntax, and pragmatics. Wethen suggest strategies for intervention and directions for research relating to individuals with Down syndrome. © 2007 Wiley-Liss, Inc. MRDD Research Reviews 2007;13:26,35. [source] A review of studies describing the use of acetyl cholinesterase inhibitors in Parkinson's disease dementiaACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2005I. D. Maidment Objective:, To review the literature relating to the use of acetyl cholinesterase inhibitors in Parkinson's disease dementia (PDD). Method:, MEDLINE (1966 , December 2004), PsychINFO (1972 , December 2004), EMBASE (1980 , December 2004), CINHAL (1982 , December 2004), and the Cochrane Collaboration were searched in December 2004. Results:, Three controlled trials and seven open studies were identified. Efficacy was assessed in three key domains: cognitive, neuropsychiatric and parkinsonian symptoms. Conclusion:, Cholinesterase inhibitors have a moderate effect against cognitive symptoms. There is no clear evidence of a noticeable clinical effect against neuropsychiatric symptoms. Tolerability including exacerbation of motor symptoms , in particular tremor , may limit the utility of cholinesterase inhibitors. [source] Gender-specific care of diabetes mellitus: particular considerations in the management of diabetic womenDIABETES OBESITY & METABOLISM, Issue 12 2008Szalat Auryan In the past 30 years, the all-cause mortality and cardiovascular mortality rates for women with diabetes mellitus (DM), in contrast to men, have not declined. Furthermore, the difference between all-cause mortality rates in women with DM and those without DM has more than doubled. This urgently needs addressing. This review will analyse published medical literature relating to the specific management of DM in women and try to identify areas where gender affects care. We have identified specific gender differences in the pathophysiology of glucose homeostasis disorder, diabetes-related complications and any female gender-specific features of women with diabetes, such as contraception and the menopause. These gender-specific features of DM may offer a route to improved care for women and new therapeutic possibilities. [source] Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment,DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S1 2008A. R. Berendt Abstract The International Working Group on the Diabetic Foot appointed an expert panel to provide evidence-based guidance on the management of osteomyelitis in the diabetic foot. Initially, the panel formulated a consensus scheme for the diagnosis of diabetic foot osteomyelitis (DFO) for research purposes, and undertook a systematic review of the evidence relating to treatment. The consensus diagnostic scheme was based on expert opinion; the systematic review was based on a search for reports of the effectiveness of treatment for DFO published prior to December 2006. The panel reached consensus on a proposed scheme that assesses the probability of DFO, based on clinical findings and the results of imaging and laboratory investigations. The literature review identified 1168 papers, 19 of which fulfilled criteria for detailed data extraction. No significant differences in outcome were associated with any particular treatment strategy. There was no evidence that surgical debridement of the infected bone is routinely necessary. Culture and sensitivity of isolates from bone biopsy may assist in selecting properly targeted antibiotic regimens, but empirical regimens should include agents active against staphylococci, administered either intravenously or orally (with a highly bioavailable agent). There are no data to support the superiority of any particular route of delivery of systemic antibiotics or to inform the optimal duration of antibiotic therapy. No available evidence supports the use of any adjunctive therapies, such as hyperbaric oxygen, granulocyte-colony stimulating factor or larvae. We have proposed a scheme for diagnosing DFO for research purposes. Data to inform treatment choices in DFO are limited, and further research is urgently needed. Copyright © 2008 John Wiley & Sons, Ltd. [source] Are clinical practical guidelines (CPGs) useful for health services and health workforce planning?DIABETIC MEDICINE, Issue 5 2010A critique of diabetes CPGs Diabet. Med. 27, 570,577 (2010) Abstract Aims, Chronic disease management is increasingly informed by clinical practice guidelines (CPGs). However, their implementation requires not only knowledge of guideline content by clinicians and practice processes that support implementation, but also a health workforce with the capacity to deliver care consistent with CPGs. This has a health services planning as well as a health workforce dimension. However, it is not known whether CPGs are described in a way that can inform health services and health workforce planning and potentially drive better quality care. This study aimed to ascertain whether CPGs are useful for health service and health workforce planning. Methods, This question was explored taking diabetes mellitus as a case study. A systematic search of Medline, EMBASE, CINAHL and Scopus was carried out to identify all CPGs relating to the management of diabetes mellitus in the primary healthcare setting. The search was limited to guidelines published in the English language between 2003 and 2009. The quality of guidelines was assessed against a subset of criteria set by the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration. Results, Seventy-five diabetes-related CPGs were identified, of which 27 met the inclusion criteria. In terms of quality, many guidelines adopted evidence-based recommendations for diabetes care (59%) and most were endorsed by national authorities (70%). With regards to coverage of 17 identified subpopulations, guidelines were generally selective in the populations they covered. Whilst many provided adequate coverage of common complications and comorbidities, approaches to management for those with reduced capacity for effective diabetes self-care were largely absent, except for indigenous populations. Conclusions, Clinical practice guidelines are potentially useful for health services and health workforce planning, but would be more valuable for this purpose if they contained more detail about care protocols and specific skills and competencies, especially for subpopulations who would be expected to have reduced capacity for effective self-care. If service planning ignores these subgroups that tend to require more resource-intensive management, underprovision of services is likely. [source] Improving glycaemic control in children and adolescents: which aspects of therapy really matter?DIABETIC MEDICINE, Issue 4 2010T. C. Skinner Diabet. Med. 27, 369,375 (2010) Abstract In paediatric diabetes, the concept of intensive therapy in the post-Diabetes Control and Complications Trial period has become subverted by a pharmaco-technological paradigm at the expense of other aspects of care such as goal-setting and psychosocial support. This review examines which patients benefit most from intensive therapy in terms of glycaemic control (HbA1c). It also reviews published controlled trial and observational data relating to the impact of various insulin types and delivery systems on glycaemic control and canvasses the literature dealing with the impact of patient support, philosophy of care, goal setting and treating team dynamic on HbA1c. Taking into account the characteristics of those patients who benefit most from intensive therapy, the quantum of HbA1c change and the persistence of changes that have been reported in selected and non-selected patient groups, it appears that there is a clear hierarchy in aspects of therapy that improve glycaemic control for children and adolescents with Type 1 diabetes. Prime issues appear to be patient support, team cohesion and goal setting. The reported glycaemic benefits achieved by an isolated emphasis upon a pharmaco-technological paradigm are limited in children and adolescents. It appears that only after the prime issues have been first considered will the potential benefits of the insulin types and regimens then be realized. [source] Familial factors in diabetic nephropathy: an offspring studyDIABETIC MEDICINE, Issue 3 2006E. Agius Abstract Aims Familial clustering of diabetic nephropathy in patients with Type 2 diabetes suggests that inherited factors predispose to diabetic nephropathy, but the nature of these factors is uncertain. The aim of the study was to compare the prevalence of known risk factors for nephropathy in non-diabetic offspring of Type 2 diabetic patients with and without nephropathy and in control subjects. Methods Three groups of patients were recruited with 40 or 41 subjects in each group. These were subjects having one Type 2 diabetic parent with nephropathy (DN); subjects having one parent with Type 2 diabetes without nephropathy (DnoN), and non-diabetic unrelated control subjects with no personal or parental history of diabetes (Control subjects). Results The median (interquartile range) albumin/creatinine ratio (ACR) was 1.40 (0.96,2.90) mg/mmol in DN; 0.94 (0.50,1.46) mg/mmol in DnoN and 1.22 (0.66,1.83) mg/mmol in Controls (anova: P = 0.03). ACR was higher in group DN than in DnoN (P < 0.006) and in Control subjects (P < 0.03), but there was no difference between DnoN and Control subjects. Twenty-four-hour ambulatory blood pressure monitoring showed mean daytime systolic blood pressure to be significantly higher in group DN than in DnoN (P < 0.02) or Control subjects (P < 0.01) (anova: P = 0.004). Fasting insulin, HOMA-IR, interleukin-6 (IL-6) and C-reactive protein (CRP) were similar in the three groups. Conclusion Our data provide further evidence that genetic factors are important in determining urinary albumin excretion and renal disease associated with Type 2 diabetes and suggest that genes that affect systemic arterial blood pressure but not those relating to insulin resistance or inflammation are likely to be implicated. [source] A qualitative investigation of the views and health beliefs of patients with Type 2 diabetes following the introduction of a diabetes shared care serviceDIABETIC MEDICINE, Issue 10 2003S. M. Smith Abstract Aims A qualitative research approach was adopted in order to explore the views and health beliefs of patients with Type 2 diabetes who had experienced a new structured diabetes shared care service. Methods Patients from 15 general practices were randomly selected and invited to attend three focus groups. Two independent researchers adopted the ,Framework' technique to analyse the transcribed data and identify key themes expressed by patients. Results Themes relating to diabetes included frustration, victimization and powerlessness in relation to living with diabetes, controlling blood sugar, medication and economic barriers to care. Differences in emphases between patients and healthcare providers emerged. Patients were generally positive about shared care and largely identified it with the nurses involved. Conclusion This research highlights the importance of an in-depth exploration of patients' views during changes in diabetes care delivery to identify service delivery failures and gaps in patient knowledge such as lack of awareness of the extent of macrovascular risk. [source] Insulin-treated diabetes and driving in the UKDIABETIC MEDICINE, Issue 6 2002G. Gill Abstract Diabetes, and particularly insulin-treated diabetes, has important implications for motor vehicle driving, largely because of its association with potential hypoglycaemia. For this reason, most countries operate some driving restrictions on insulin-treated diabetic patients, as well as systems of intermittent reassessment of hypoglycaemic risk. In the UK, regulations are operated by the Driver and Vehicle Licensing Agency (DVLA), which is an agency of the Department of the Environment, Transport and the Regions (DETR). They are supported by an Expert Panel which advises the Secretary of State on diabetes-related issues relating to fitness to drive. The patient organization Diabetes UK is also concerned with diabetes and driving issues, largely from a position of lobbying policy-influencers and supporting individual cases. All parties involved with diabetes and driving issues recognize the need for more research on the subject, as the current literature is flawed in design, though no convincing excess of accidents amongst diabetic drivers has been conclusively demonstrated. Currently in the UK, Class 2 vehicles (large trucks and passenger vehicles) are barred to diabetic drivers on insulin. European law has recently extended this to so-called C1 (large vans and small lorries) and D1 (minibuses) vehicles, though the law has recently been revised to allow individual consideration for potential diabetic C1 drivers on insulin treatment. Diabetes and insulin-treated diabetes is an emotive and difficult issue, for which a stronger evidence base is urgently needed. [source] Patient-assessed health outcome measures for diabetes: a structured reviewDIABETIC MEDICINE, Issue 1 2002A. M. Garratt Abstract Aims To identify available disease-specific measures of health-related quality of life (HRQL) for diabetes and to review evidence for the reliability, validity and responsiveness of instruments. Methods Systematic searches were used to identify instruments. Instruments were assessed against predefined inclusion and exclusion criteria. Letters were sent to authors requesting details of further instrument evaluation. Information relating to instrument content, patients, reliability, validity and responsiveness to change was extracted from published papers. Results The search produced 252 references. Nine instruments met the inclusion criteria: Appraisal of Diabetes Scale (ADS), Audit of Diabetes-Dependent Quality of Life (ADDQoL), Diabetes Health Profile (DHP-1, DHP-18), Diabetes Impact Measurement Scales (DIMS), Diabetes Quality of Life Measure (DQOL), Diabetes-Specific Quality of Life Scale (DSQOLS), Questionnaire on Stress in Diabetic Patients-Revised (QSD-R), Diabetes-39 (D-39) and Well-being Enquiry for Diabetics (WED). The shortest instrument (ADS) has seven items and the longest (WED) has 50 items. The ADS and ADDQoL are single-index measures. The seven multidimensional instruments have dimensions covering psychological well-being and social functioning but vary in the remainder of their content. The DHP-1 and DSQOLS are specific to Type 1 diabetes patients. The DHP-18 is specific to Type 2 diabetes patients. The DIMS and DQOL have weaker evidence for reliability and internal construct validity. Patients contributed to the content of the ADDQoL, DHP-1/18, DQOL, DSQOLS, D-39, QSD-R and WED. The authors of the ADDQoL, DHP-1/18, DQOL, DSQOLS gave explicit consideration to content validity. The construct validity of instruments was assessed through comparisons with instruments measuring related constructs and clinical and sociodemographic variables. None of the instruments has been formally assessed for responsiveness to changes in health. Conclusions Five of the diabetes-specific instruments have good evidence for reliability and internal and external construct validity: the ADDQoL, DHP-1/18, DSQOLS, D-39 and QSD-R. Instrument content should be assessed for relevance before application. The instruments should be evaluated concurrently for validity and responsiveness to important changes in health. [source] Atypical antipsychotics and weightgain , a systematic reviewACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2000D. M. Taylor Objective: To review systematically data relating to weight changes with atypical antipsychotics. Method: We conducted a Medline search on October 29 1999 and covered the period 1980,99. All recovered papers were examined for further relevant reports. In addition, we wrote to pharmaceutical manufacturers and 10 practising clinicians to ask them to provide other relevant reports known to them. Results: Eighty reports mentioning change in body weight were retrieved. Data relating to weight changes were of variable quality. Weight changes were indicated by a variety of measures. The majority of reports related to short-term changes. Conclusion: All atypical drugs, with the exception of ziprasidone, have been associated with weight increases. Clozapine seems to have the highest risk of weight gain, followed by olanzapine and quetiapine. There is probably a lower risk with risperidone, sertindole and zotepine and a still lower risk with amisulpride. Ziprasidone appears not to be associated with weight gain. In the absence of more compelling data, these rankings must be considered approximate and preliminary. Longer, more robust trials are needed. [source] Early diagnosis of schizophrenia , the first step towards secondary preventionACTA PSYCHIATRICA SCANDINAVICA, Issue 400 2000M. Davidson Objective: To review current knowledge of risk factors associated with schizophrenia and the development of diagnostic markers aimed at the delay or attenuation of the first psychotic episode. Method: Studies relating to the development of disease and the risk factors that could inform predictive markers are reviewed, including high-risk studies, birth-cohort studies, and retrospective and follow-back studies. Results: Future schizophrenic patients present with delayed developmental milestones, speech and behavioural difficulties, and lower IQ scores than non-cases. Conclusion: Results are consistent with the notion that schizophrenia is a developmental disease and that such antecedents are present; further research is required to improve the specificity of diagnostic markers and predictive power before these can be used to prevent or delay psychotic episodes of schizophrenia. [source] Review of Policies and Guidelines on Infant Feeding in Emergencies: Common Ground and GapsDISASTERS, Issue 2 2001Andrew Seal Recent crises in regions where exclusive breastfeeding is not the norm have highlighted the importance of effective policies and guidelines on infant feeding in emergencies. In 1993, UNICEF compiled a collection of policy and guideline documents relating to the feeding of infants in emergency situations. In June 2000 Save the Children, UK, UNICEF and the Institute of Child Health undertook a review of those documents, updating the list and identifying the common ground that exists among the different policies. The review also analysed the consistency of the policy framework, and highlighted important areas where guidelines are missing or unclear. This article is an attempt to share more widely the main issues arising from this review. The key conclusions were that, in general, there is consensus on what constitutes best practice in infant feeding, however, the lack of clarity in the respective responsibilities of key UN agencies (in particular UNICEF, UNHCR and WFP) over issues relating to co-ordination of activities which affect infant-feeding interventions constrains the implementation of systems to support best practice. Furthermore, the weak evidence base on effective and appropriate intervention strategies for supporting optimal infant feeding in emergencies means that there is poor understanding of the practical tasks needed to support mothers and minimise infant morbidity and mortality. We, therefore, have two key recommendations: first that the operational UN agencies, primarily UNICEF, examine the options for improving co-ordination on a range of activities to uphold best practice of infant feeding in emergencies; second, that urgent attention be given to developing and supporting operational research on the promotion of optimal infant-feeding interventions. [source] | ||||||||||||||||||||||||||||||||||||||||||||||||||||