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Routine Practice (routine + practice)
Selected AbstractsThe effect of ranitidine versus proton pump inhibitors on gastric secretions: a meta-analysis of randomised control trialsANAESTHESIA, Issue 6 2009K. Clark Summary Aspiration of acid into the lungs is an infrequent but potentially devastating complication of general anaesthesia. Routine practice often includes use of pharmacological agents to reduce gastric volume and increase gastric pH. The aim of this study was to compare the net benefit of proton pump inhibitors with histamine 2 blockers in a meta-analysis. Electronic databases were searched for trials that compared ranitidine vs proton pump inhibitors in their effect on volume and pH of gastric fluid aspirates. We identified nine trials of which seven were suitable for meta-analysis. Pooled outcomes suggest that premedication with ranitidine is more effective than proton pump inhibitors in reducing the volume of gastric secretions (by an average of 0.22 ml.kg,1; 95% confidence interval 0.04,0.41) and increasing gastric pH (by an average of 0.85 pH units; 95% confidence interval ,1.14 to ,0.28). [source] Infant feeding in the neonatal unitMATERNAL & CHILD NUTRITION, Issue 4 2010Rhona J. McInnes Abstract Infants admitted to a neonatal unit (NNU) are frequently unable to feed by breast or bottle because of ill health or prematurity. These infants require nutritional support until they can start oral feeding. Breastfeeding is advocated for these infants, and mothers are frequently encouraged to express breast milk to be fed via the enteral tube. However, by discharge, breastfeeding rates tend to be low. Oral feeding requires careful management, and although practices may vary because of clinical need, some may be informed by unit norms. There is limited evidence for effective breastfeeding support in this environment and little exploration of the effect of routine feeding decisions. This study aimed to explore feeding decisions and considered how these might affect outcomes. The staff in the two large urban NNUs who participated in the feeding decisions were interviewed and the data were analysed using a theoretical framework. Feeding decisions were made mainly by the unit staff, with limited parental involvement. Subsequent management varied, with differences being related to staff experience and beliefs, unit norms, parent's expectations and physical constraints within the unit. The staff were overtly supportive of breastfeeding, but the need to monitor and quantify milk intake may undermine breastfeeding. Furthermore, feeding breastfed infants during the mothers' absence was controversial and provoked debate. There is a need for clear guidelines and increased parental involvement in feeding decisions. Routine practices within the system may discourage mothers from initiating and persisting with breastfeeding. A change in unit culture is required to fully support the parent's feeding choices. [source] Usefulness of skin testing in cutaneous drug eruptions in routine practiceCONTACT DERMATITIS, Issue 3 2009Tatiana Tchen Background: Cutaneous drug eruptions are common side-effects. The imputation score combining intrinsic (chronology, clinical and paraclinical signs) and extrinsic criteria used in Pharmacovigilance Centres is insufficient alone to identify with certainty a responsible drug. Objective: To evaluate the imputation score before and after performing skin testing in patients with cutaneous drug eruptions. Patients/Methods: A single-centre retrospective study was performed on 339 patients tested between 2001,2006. Imputation scores were calculated before and after skin tests for each cutaneous drug eruption according to the clinical type of skin eruption and the type of drug. Results: Among 121 patients meeting inclusion criteria, 46% showed an increase of the imputation score as shown by 25/41 cases of maculo-papular exanthema, 4/11 cases of acute generalized exanthematous pustulosis and 17/41 cases of urticaria/anaphylaxis. The imputation score increased in 25/70 cases of the tested antibiotic drugs, in 14/56 cases of cardiovascular drugs, and it increased in 19 patients (34%) with I1 or I2 imputation scores before skin testing and in 29 (52%) with an I3 imputation score before skin testing. Conclusions: Drug skin testing appeared useful in investigating cutaneous drug eruptions in routine practice, including not only drugs with a high imputation score (I3) but also those with a lower score (I1, I2). Drug skin testing should lead to oral rechallenge of drugs with negative tests in order to determine which drugs may be used safely. [source] Rapid (partial) prescreening of cervical smears: the quality control method of choice?CYTOPATHOLOGY, Issue 4 2002D. BROOKE Rapid rescreening of all negative and inadequate smears is the quality control method of choice in the UK. The sensitivity of primary screening of laboratory and individual screeners are major indicators of screening quality and are dependent on the number of false negative smears found by rapid screening for their calculation. High sensitivity may indicate good quality primary screening or poor quality rapid review. Quantifiably high quality rapid rescreening is essential if these sensitivity figures are to be meaningful. A 12-month study was undertaken in routine practice using the prescreening mode to ascertain the sensitivity of rapid (partial) screening in our department . The final results of smears were compared with those of rapid prescreening. The calculated sensitivity ranged from 92,54% for high-grade abnormalities and 75,33% for all grades, revealing a wide range of performance between individual prescreeners. Rapid prescreening can identify individuals best suited to rapid screening in routine practice. By using these prescreeners only, the sensitivity of cervical screening could be raised. Rapid (partial) prescreening should be considered as the quality control method of choice. [source] A 12-month follow-up study of treating overweight schizophrenic patients with aripiprazoleACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2008S. G. Schorr Objective:, To investigate the feasibility of switching overweight schizophrenic patients to aripiprazole and to assess the impact of 12 months of aripiprazole treatment on weight in routine practice. Method:, This was a non-controlled cohort study in overweight schizophrenic patients. Data were collected before treatment with aripiprazole was started and at 12-month follow-up. Results:, A total of 53 patients were included; of these 55% continued using aripiprazole for 12 months. Aripiprazole treatment for 12 months (P = 0.027) and stopping clozapine or olanzapine treatment (P = 0.038) predicted weight loss (,3 kg). Patients receiving aripiprazole monotherapy (n = 16, mean ,3.0 kg) had similar weight loss than patients receiving aripiprazole in addition to another antipsychotic drug (n = 13, mean ,4.4 kg). Conclusion:, In routine practice once aripiprazole treatment was started, more than half of the patients remained on aripiprazole and most of them lost weight. Adding aripiprazole to clozapine gave similar weight loss as monotherapy with aripiprazole. [source] Randomized controlled trials in schizophrenia: a critical perspective on the literatureACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2002S. Gilbody Objective:,The randomized trial provides an opportunity to minimize the inclusion of biases in the evaluation of interventions in psychiatry. Difficulties arise, however, when applying their results to `real world' clinical practice and decision-making. We, therefore, examined the real world applicability of schizophrenia trials. Method:,A narrative overview of the content and quality of the randomized trials relevant to the care of those with schizophrenia is provided. Results:,Complex, explanatory, under-powered randomized drug trials dominate evaluative research in schizophrenia. Conclusion:,Explanatory designs are a necessary but insufficient step in establishing the true worth of interventions in schizophrenia. Research from other spheres of mental health and wider health care suggest that pragmatic trials are feasible. This design allows large scale trials to be conducted which include patients which we would recognize from routine practice and which record outcomes which are of genuine interest to decision-makers. [source] Standardized health check data from community-dwelling elderly people: the potential for comparing populations and estimating needHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2000Peter Bath PhD Abstract The main aim of this study was to compare EASY-Care data obtained during nurse-administered annual health checks in two populations of older people. A secondary aim was to determine whether a standardized assessment system administered as part of routine practice by a trained nurse during the over-75 health check could generate useful information for comparing population health and functional status of community-dwelling-older people. One hundred and seventy-nine elderly people (aged 75 years and over) from the Woodstock ward, Belfast, having relatively high deprivation; and 238 elderly people from south Hampshire, ranging from affluent wards in New Forest to inner city wards, were assessed using the EASY-Care assessment system as part of their annual health check. There was a high response rate to the standardized assessment in both populations (75% and 79%). Compared to people in south Hampshire, the people in Belfast had higher relative risk of having fair/poor self-rated health, and lower relative risk of having good/sufficient accommodation and of having difficulty chewing. People in Belfast had a higher relative risk of being dependent for six of the seven IADL items and for continence of urine, bathing, grooming, use of the stairs and dressing among the ADL items. The results demonstrate the ability of data generated by assessment system to discriminate between populations of older people when used as part of routine practice. Differences in health and functional status may be associated with deprivation. Data collected during the annual health check about the health and functional status of older people could provide a useful adjunct to census and survey data to measure population needs and to support locality planning. [source] Inside the black box of shared decision making: distinguishing between the process of involvement and who makes the decisionHEALTH EXPECTATIONS, Issue 4 2006Adrian Edwards MRCGP MRCP PhD Abstract Background, Shared decision making has practical implications for everyday health care. However, it stems from largely theoretical frameworks and is not widely implemented in routine practice. Aims, We undertook an empirical study to inform understanding of shared decision making and how it can be operationalized more widely. Method, The study involved patients visiting UK general practitioners already well experienced in shared decision making. After these consultations, semi-structured telephone interviews were conducted and analysed using the constant comparative method of content analysis. Results, All patients described at least some components of shared decision making but half appeared to perceive the decision as shared and half as ,patient-led'. However, patients exhibited some uncertainty about who had made the decision, reflecting different meanings of decision making from those described in the literature. A distinction is indicated between the process of involvement (option portrayal, exchange of information and exploring preferences for who makes the decision) and the actual decisional responsibility (who makes the decision). The process of involvement appeared to deliver benefits for patients, not the action of making the decision. Preferences for decisional responsibility varied during some consultations, generating unsatisfactory interactions when actual decisional responsibility did not align with patient preferences at that stage of a consultation. However, when conducted well, shared decision making enhanced reported satisfaction, understanding and confidence in the decisions. Conclusions, Practitioners can focus more on the process of involving patients in decision making rather than attaching importance to who actually makes the decision. They also need to be aware of the potential for changing patient preferences for decisional responsibility during a consultation and address non-alignment of patient preferences with the actual model of decision making if this occurs. [source] Decision aids in routine practice: lessons from the breast cancer initiativeHEALTH EXPECTATIONS, Issue 3 2006Kerry A. Silvia BA Abstract Background, Many decision aids have been developed to help patients make treatment and screening decisions; however, little is known about implementing them into routine clinical practice. Objective, To assess the feasibility of implementing a patient decision aid (PtDA) for the early stage breast cancer surgical decision into routine clinical care. Design, Structured individual interviews. Setting and participants, A convenience sample of providers from nine sites, including two community resource centres, a community hospital and six academic centres. Main outcome measures, Usage data, barriers to and resources for implementing the PtDAs. Results, Six of the nine sites were using the PtDAs with patients. Two sites were primarily using a scheduling system and four sites relied on a lending system. For the academic centres, the keys to successful implementation included integrating the PtDA into the flow of patients through the centre and having physicians who recommended it to patients. At the community centres, the keys to successful implementation included an informed staff and the flexibility to get the PtDAs to patients in different ways. Barriers that limited or prevented sites from using the PtDA included a lack of clinical support, a lack of system support, competing priorities and scheduling problems. Conclusions, It is feasible to implement a breast cancer PtDA into routine clinical care at academic centres and community resource centres. Future research should assess the effectiveness of PtDAs in routine clinical care as well as resources and barriers to their implementation in community hospitals. [source] Stratification of foot ulcer risk in patients with diabetes: a population-based studyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2006G. P. Leese Summary This trial assessed whether a simple clinical tool can be used to stratify patients with diabetes, according to risk of developing foot ulceration. This was a prospective, observational follow-up study of 3526 patients with diabetes (91% type 2 diabetes) attending for routine diabetes care. Mean age was 64.7 (range 15,101) years and duration of diabetes was 8.8 (±1.5 SD) years. Patients were categorised into ,low' (64%), ,moderate' (23%) or ,high' (13%) risk of developing foot ulcers by trained staff using five clinical criteria during routine patient care. During follow-up (1.7 years), 166 (4.7%) patients developed an ulcer. Foot ulceration was 83 times more common in high risk and six times more in moderate risk, compared with low-risk patients. The negative predictive value of a ,low-risk score' was 99.6% (99.5,99.7%; 95% confidence interval). This clinical tool accurately predicted foot ulceration in routine practice and could be used direct scarce podiatry resources towards those at greatest need. [source] Automated counting of white and red blood cells in the cerebrospinal fluidINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 4 2000M.W. Aune Summary The objective of this study was to examine to what extent the automated method of the Bayer H*2 instrument could replace the visual counting of white and red blood cells in cerebrospinal fluid. The number of white blood cells as well as the percentage of mononuclear and polymorphonuclear cells were counted in the ,Baso channel' (Research screen 3) whereas the number of red cells were registered as the ,R-count' (Research screen 1). All automated cell counts were compared to visual estimates. The automated count yielded reliable results down to 5 × 106 white blood cells/l and 5 × 108 red blood cells/l. In some samples ,noise' was present in the Baso channel. A correct white blood cell count could then be obtained by counting the cells directly as dots on the screen. It was possible to differentiate between polymorphnuclear cells and mononuclear cells at all WBC concentrations. The automated counting of cerebrospinal fluid can be performed without changing thresholds or sample volumes of the instrument. Thus, in the routine practice it will be possible to alternate between automated counting of whole blood samples and cerebrospinal fluid samples. [source] Conveying caring: Nurse attributes to avert violence in the EDINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 3 2009Dr Lauretta Luck RN BA MA(Psy) PhD Violence towards nurses in Emergency Department's is a world wide problem that some contend is increasing in severity and frequency, despite the many strategies implemented to prevent violent events. This paper presents the findings of an instrumental case study in a busy rural Emergency Department. Twenty Registered Nurses participated in the study and data from 16 unstructured interviews, 13 semi-structured field interviews, and 290 h of participant observation were thematically analysed. In addition, 16 violent events were observed, recorded via a structured observation tool and analysed using frequency counts. Thematically there were five attributes rural emergency nurses were observed to use to avert, reduce and prevent violence. The five attributes were being safe, being available, being respectful, being supportive and being responsive. We argue that these attributes were embodied in the emergency nurses routine practice and their conceptualization of caring. [source] Outpatient care and medical treatment of children and adults with atopic eczemaJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 4 2009Jochen Schmitt Summary Background: Despite the high prevalence, morbidity and economic burden of atopic eczema (AE), data on outpatient care of affected patients are missing. Methods: Utilizing a population-based administrative health care database from Saxony, Germany, this study describes outpatient care and medical treatment of AE by different medical disciplines in 2003 and 2004 by means of a representative sample of 11,555 patients with AE. Results: About 60% of all patients with AE seeking outpatient care were adults. Of the adults 66% and among children 51% consulted a dermatologist at least once within the study period. More than 50% of patients in all age groups received potent topical steroids. Of all patients 8% and 3% received topical pimecrolimus and topical tacrolimus, respectively. More than 10% of patients received systemic steroids, while less than 0.1% was given cyclosporine. The mean annual amount of topical anti-inflammatory treatment per patient was about 40 grams. Conclusions: Unexpectedly high proportions of patients with AE received potent topical and systemic steroids. The average total amount of prescribed medications was low. This study suggests insufficient care and medical treatment of patients with AE in routine practice. [source] Evaluation of the alkaline wash/lysis procedure for the molecular diagnosis of a positive bacterial blood culture in clinical routine practiceJOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 3 2010Sheng-Chuan Hsi Abstract Blood culture is commonly used to detect microorganisms in patients with a suspected blood infection. This study evaluated the alkaline wash/lysis procedure to extract DNA of microorganisms in a clinical blood culture. A multiplex polymerase chain reaction (PCR) targeting the 16S rDNA (ribosomal DNA) gene and the fungal ITS (internal transcribed spacer) gene was used as a reliable indicator for the presence of microorganism DNA in the extracts. A total of 535BacT/ALERT positive blood culture bottles were evaluated. Multiplex PCR showed positive results in 530 DNA extracts, but 5 DNA extracts gave negative results. We conclude that the alkaline wash/lysis procedure in combination with the multiplex PCR is a simple and sensitive method, which can be used in a standard diagnostic laboratory to detect microorganisms in blood culture material. J. Clin. Lab. Anal. 24:139,144, 2010. © 2010 Wiley-Liss, Inc. [source] Literature review: should antipyretic therapies routinely be administered to patient fever?JOURNAL OF CLINICAL NURSING, Issue 17-18 2010Jane V Carey Aims and objectives., To determine whether the practices of routinely treating fever with antipyretic medications or physical cooling methods are supported by the literature. Background., Fever is one of the commonest symptoms presented to caregivers. Previous research suggests that treating fever with antipyretic medications or physical cooling methods is often routine practice. This article considers that fever and the febrile response may have been preserved through evolution because of its advantage for host defences and that fever may have an adaptive value. It is questioned whether the administration of antipyretic therapies could prolong the duration of illness, as interventions to lower body temperature are acting against the body's natural response to infection. Design., Literature review. Method., Electronic databases and the Internet were searched, supplemented by citation tracking. Articles were eligible if the participants studied had received pharmacological or physical cooling interventions to reduce their body temperature during fever. The interventions were evaluated in regard to whether they prolonged duration of illness. Results., Results were inconsistent. None of the studies found that antipyretic therapies reduced duration of illness in patients with fever. Evidence suggests that antipyretic therapies do not reduce the duration of illness, but can prolong it. Conclusions., The evidence on which to base recommendations for practice is weak but does not support the current practice of administering antipyretic therapies routinely to patients with fever. Physical cooling methods alone should never be used. Nurses should assess patients with fever on an individualised basis and use antipyretic therapies selectively. Relevance to clinical practice., The administration of antipyretics to patients with fever is an important issue, and nurses are at the forefront of decision-making. Evidence-based care delivery is expected by the NMC. A protocol to assist decision-making when caring for patients with pyrexia is suggested. [source] Training psychiatric teams to do family systems acute psychiatryJOURNAL OF FAMILY THERAPY, Issue 1 2007Jochen Schweitzer This article presents an account of a comprehensive eighteen-day, multi-team, multidisciplinary training approach to family systems inpatient acute psychiatry. It has been developed and tested as part of the SYMPA project (systems therapy in acute psychiatry), which aims to establish systemic case conceptualizations and interventions as routine practice in acute psychiatry. Content, didactic characteristics and specifications of this training are discussed. To illustrate the practical implementation of the training, specifically designed exercises are described and a clinical case is included. The article concludes by presenting first results of the research on implementation indicating that the training had a significant impact on the quantity and quality of conversations with patients. [source] Routine colonic mucosal biopsy and ileoscopy increases diagnostic yield in patients undergoing colonoscopy for diarrheaJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 3 2002IAN F YUSOFF Abstract Background and Aims: In patients undergoing colonoscopy for diarrhea, when the examination is normal, the role of routine mucosal biopsy remains controversial, particularly in the open-access setting. It is uncertain whether routine ileoscopy adds anything to colonoscopy alone. We aimed to assess the yield of mucosal biopsy and ileoscopy in patients with diarrhea. Methods: We retrospectively reviewed all colonoscopies performed for diarrhea over a 9-year period in a tertiary referral center with an open-access service. We then selected cases where the examination was normal and biopsies were performed. The histopathology reports of these selected cases were then reviewed. Results There were 1131 cases identified. The mucosal examination was normal in 465 cases (41%); 362 of these had colonic biopsies performed. Histology was normal in 316 cases (87%) and was non-specific in 28 cases (8%). Significant histopathology was present in 18 cases (5%) with a significantly higher prevalence of microscopic colitis in patients above 60 years old. Ileoscopy was performed in 508 cases and was abnormal in 26 cases (5%). The abnormality on ileoscopy was the sole abnormality in 13 cases (3%). Conclusions Routine colonic mucosal biopsy and ileoscopy each identify significant additional pathology in 5% of cases when investigating patients with diarrhea, and are recommended as routine practice in this setting. We found ileal biopsy unhelpful when ileoscopy was normal. © 2002 Blackwell Science Asia Pty Ltd [source] Consulting the source code: prospects for gene-based medical diagnosticsJOURNAL OF INTERNAL MEDICINE, Issue S741 2001U. Landegren Abstract. Landegren U (Rudbeck Laboratory, Uppsala, Sweden) Gene-based diagnostics (Internal Medicine in the 21st Century). J Intern Med 2000; 248: 271,276. Gene-based diagnostics has been slow to enter medical routine practice in a grand way, but it is now spurred on by three important developments: the total genetic informational content of humans and most of our pathogens is rapidly becoming available; a very large number of genetic factors of diagnostic value in disease are being identified; and such factors include the identity of genes frequently targeted by mutations in specific diseases, common DNA sequence variants associated with disease or responses to therapy, and copy number alterations at the level of DNA or RNA that are characteristic of specific diseases. Finally, improved methodology for genetic analysis now brings all of these genetic factors within reach in clinical practice. The increasing opportunities for genetic diagnostics may gradually influence views on health and normality, and on the genetic plasticity of human beings, provoking discussions about some of the central attributes of genetics. [source] Focal Cortical Dysplasia: Improving Diagnosis and Localization With Magnetic Resonance Imaging Multiplanar and Curvilinear ReconstructionJOURNAL OF NEUROIMAGING, Issue 3 2002Maria Augusta Montenegro MD ABSTRACT Objective. To establish the contribution of multiplanar reconstruction (MPR) and curvilinear reformatting (CR) to the MRI investigation of focal cortical dysplasia (FCD). Methods. From a group of patients with intractable frontal lobe epilepsy, we selected patients with neuroimaging diagnosis of FCD. The diagnosis of FCD was based on the neuroimaging findings after a three step evaluation, always in the same order: (a) plain MRI films, (b) MPR, and (c) CR. After the selection of patients, the process of reviewing all the images in the three stages described above was performed by one of us, who did not take part on the selection of patients nor on the initial evaluation, and who was blind to the clinical and EEG findings of the patients. For data analysis, we first assessed the contribution of the additional findings of MPR analysis compared to the results of the evaluation using only plain MRI films, as is usually done in routine practice. Second, we assessed the contribution of CR to the findings of plain MRI films plus MPR. After completing the multistep evaluation, we all went back to review the plain MRI films with knowledge of lesion topography, in order to identify possible subtle features associated with FCD. Results. Seventeen patients met the inclusion criteria. Twelve had imaging diagnosis of FCD and were included in the second step of this project. Plain films of high resolution MRI showed the lesion in 6 (50%) of the 12 patients. By adding MPR to the plain MRI films, we identified lesions in all 12 patients. Furthermore, we found that MPR provided a better lesion localization and ascertainment of its relationship to other cerebral structures in 5 of 6 (83%) patients who had a lesion identified on plain films. By adding CR to the plain MRI films plus MPR analysis, we observed that (a) CR also allowed the identification of the dysplastic lesion in all patients, (b) CR improved lesion localization in one patient, and (c) CR provided a better visualization of the lesion extent in 4 patients (33%), showed a larger lesion in 3, and demonstrated that part of the area suspected as abnormal was more likely volume averaging in 2. Conclusion. MPR and CR analysis add to the neuroimaging evaluation of FCD by improving the lesion diagnosis and localization. CR helps to establish the extent of the lesion more precisely, allowing the visualization of some areas not shown on high resolution MRI and MPR. These techniques are complementary and do not replace the conventional wisdom of MRI analysis. [source] Systematic review of the role of pre-oxygenation for tracheal suctioning in ventilated newborn infantsJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2003MA Pritchard Abstract: Pre-oxygenation for endotracheal suctioning for mechanically ventilated infants is routine practice in many neonatal intensive care units. In the present systematic review the evidence to support its use is discussed and the authors conclude that no confident recommendations can be made from the results of this review. [source] Computerized cognitive,behaviour therapy for anxiety and depression: a practical solution to the shortage of trained therapistsJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 5 2004S. VAN DEN BERG bsc Computerized cognitive,behaviour therapy (CCBT) programmes have been developed to help meet the enormous need for evidence-based psychological treatment of common mental health problems in the context of a severe shortage of trained therapists to meet that need. Randomized controlled trials have confirmed the efficacy of such programmes. We present the experience of a community mental health team (CMHT) resource centre with one such programme, Beating the Blues, together with outcome data on a small sample of its clients. We conclude that experience and data, taken together, demonstrate the practical benefits of CCBT in routine practice. [source] Public Good, Private Protections: Competing Values in German Transplantation LawLAW & POLICY, Issue 2 2002Linda Hogle Organ transplantation has become almost routine practice in many industrialized countries. Policy, ethical, and legal debates tend to center on fairness of allocation rules or alternatives to promote greater numbers of donations. There are also certain beliefs about the use of bodily materials that are often presumed to be homogenous across Euro,American societies. In Germany, however, the idea of using the bodies of some for the good of others, and the right to proclaim some bodies dead for large,scale medical and political purposes is highly charged. This is due to the historical context of medical experimentation, selection, and euthanasia under National Socialism, and the former East German socialist policies which intervened in the private lives and bodies of citizens. This article is based on an ethnography of organ procurement practices during the period when German policymakers struggled with writing a transplant law. Active public resistance revealed deep concern about state intervention in private matters and amplified the growing unrest over definitions of moral community in a changing, post,reunification society. The article shows how public disputes about health policy become a way through which societies deal with other social conflicts. [source] Relation between inflammation and symptoms in asthmaALLERGY, Issue 3 2009I. Tillie-Leblond Asthma symptoms are the main reason for healthcare utilization and are a fundamental parameter for the evaluation of asthma control. Currently, asthma is defined as a chronic inflammatory disease. A French expert group studied the association between inflammation and asthma symptoms by carrying out a critical review of the international literature. Uncontrolled asthmatics have an increased number of polynuclear eosinophils in the induced sputum and an increased production of exhaled NO. Control by anti-inflammatory treatment is accompanied by a reduction in bronchial eosinophilia and exhaled NO. Asthma symptoms are the result of complex mechanisms and many factors modify their perception. Experimental data suggest that there is a relationship between the perception of symptoms and eosinophilic inflammation and that inhaled corticoid therapy improves this perception. Although they are still not applicable in routine practice, follow-up strategies based on the evaluation of inflammation are thought to be more effective in reducing exacerbations than those usually recommended based on symptoms and sequential analysis of respiratory function. Inhaled corticosteroid therapy is the reference disease-modifying therapy for persistent asthma. Recent studies demonstrated that adjustment of anti-inflammatory treatment based on symptoms is an effective strategy to prevent exacerbations and reduce the total number of doses of inhaled corticosteroids. [source] Nuclear DNA analyses in genetic studies of populations: practice, problems and prospectsMOLECULAR ECOLOGY, Issue 3 2003De-Xing Zhang Abstract Population-genetic studies have been remarkably productive and successful in the last decade following the invention of PCR technology and the introduction of mitochondrial and microsatellite DNA markers. While mitochondrial DNA has proven powerful for genealogical and evolutionary studies of animal populations, and microsatellite sequences are the most revealing DNA markers available so far for inferring population structure and dynamics, they both have important and unavoidable limitations. To obtain a fuller picture of the history and evolutionary potential of populations, genealogical data from nuclear loci are essential, and the inclusion of other nuclear markers, i.e. single copy nuclear polymorphic (scnp) sequences, is clearly needed. Four major uncertainties for nuclear DNA analyses of populations have been facing us, i.e. the availability of scnp markers for carrying out such analysis, technical laboratory hurdles for resolving haplotypes, difficulty in data analysis because of recombination, low divergence levels and intraspecific multifurcation evolution, and the utility of scnp markers for addressing population-genetic questions. In this review, we discuss the availability of highly polymorphic single copy DNA in the nuclear genome, describe patterns and rate of evolution of nuclear sequences, summarize past empirical and theoretical efforts to recover and analyse data from scnp markers, and examine the difficulties, challenges and opportunities faced in such studies. We show that although challenges still exist, the above-mentioned obstacles are now being removed. Recent advances in technology and increases in statistical power provide the prospect of nuclear DNA analyses becoming routine practice, allowing allele-discriminating characterization of scnp loci and microsatellite loci. This certainly will increase our ability to address more complex questions, and thereby the sophistication of genetic analyses of populations. [source] New prognostic histological parameter of invasive ductal carcinoma of the breast: Clinicopathological significance of fibrotic focusPATHOLOGY INTERNATIONAL, Issue 4 2000Takahiro Hasebe Immunohistochemistry, DNA ploidy analysis and molecular genetics have made it possible to predict the outcome of breast cancer more precisely than routine histological examination alone. However, in routine practice, it is difficult to incorporate these methodologies in all cases. If certain histological parameters can accurately predict the outcome of patients with breast cancer, they would be more practical for routine use. We showed that the presence of fibrotic focus (FF) in invasive ductal carcinoma (IDC) is closely associated with c-erbB-2 or p53 protein expression, high proliferative activity, and high angiogenesis of the tumors. Furthermore, multivariate analyses with well-known prognostic parameters for IDC demonstrated that the presence of FF is the most useful independent parameter to predict IDC patient outcome. In addition, our data suggested that the interaction between tumor cells and stromal fibroblasts may play an important role in the formation of FF in IDC based on growth factor and growth factor receptor protein expression in the tumor cells and fibroblasts forming FF. Based on the results of our clinicopathological studies, we propose a new prognostic classification scheme for the prediction of IDC patient outcome, which consists of FF, nuclear atypia, and fat invasion. This classification has superior predicting power to existing prognostic classifications. [source] Intraoperative extracorporeal membrane oxygenation and survival of pediatric patients undergoing repair of congenital heart diseasePEDIATRIC ANESTHESIA, Issue 8 2008RANDALL P. FLICK MD Summary Background:, We studied the association between the introduction of extracorporeal membrane oxygenation (ECMO) into routine practice and the survival of children who failed weaning from cardiopulmonary bypass (CPB). We compare two periods, before formal introduction of ECMO in our institution (1993,1999, pre-ECMO era) and after ECMO became a formalized program (2000,2006, ECMO era). Methods:, Retrospective review of Mayo Clinic Database between 1993 and 2006 for outcomes of patients <18 years old who required ECMO during repair of congenital heart malformations. Results:, Thirty-five children during ECMO era received intraoperative ECMO, and 17 (54%) survived to hospital discharge. The frequency of ECMO use was the highest in neonates, therefore, this was the only subcohort of pediatric patients that allowed comparison of survival between the pre-ECMO and ECMO eras. When compared to pre-ECMO era, neonatal survival increased during ECMO era (P = 0.043). ECMO was mostly used in neonates with higher complexity of cardiac defects undergoing more complex repairs, and the overall improvement of survival was primarily due to better survival of these patients. During pre-ECMO era, survival was lower in patients with higher risk (P = 0.001). However, during ECMO era, no difference in survival was observed across assigned risk groups (P = 0.658). Conclusions:, The availability of ECMO for neonates failing to wean from CPB was associated with improved survival, especially in children undergoing repair of the most complex congenital heart malformations. After introduction of ECMO, survival improved and no longer depended upon the complexity of surgical repair. [source] How well do patients report noncompliance with antihypertensive medications?: a comparison of self-report versus filled prescriptionsPHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 1 2004Philip S. Wang MD Abstract Purpose To address poor patient compliance with antihypertensives, clinicians and researchers need accurate measures of adherence with prescribed regimens. Although self-reports are often the only means available in routine practice, their accuracy and agreement with other data sources remain questionable. Methods A telephone survey was conducted on 200 hypertensive patients treated with a single antihypertensive agent in a large health maintenance organization (HMO) or a Veterans Affairs medical center (VAMC) to obtain self-reports of the frequency of missing antihypertensive therapy. We then analyzed records of all filled prescriptions to calculate the number of days that patients actually had antihypertensive medications available for use. Agreement between the two data sources was measured with correlation coefficients and kappa statistics. Logistic regression models were used to identify demographic, clinical and psychosocial correlates of overstating compliance. Results There was very poor agreement between self-reported compliance and days actually covered by filled prescriptions (Spearman correlation coefficient,=,0.15; 95%CI: 0.01, 0.28). Very poor agreement was also observed between a categorical measure of self-reported compliance (ever vs. never missing a dose) and categories of actual compliance defined by filled prescriptions (<,80% vs >,80% of days covered; kappa,=,0.12, 95%CI: ,0.02, 0.26). Surprisingly, few factors were associated with inaccurate self-reporting in either crude or adjusted analyses; fewer visits to health care providers was significantly associated with overstating compliance. Conclusions Compliance was markedly overstated in this sample of patients and few characteristics identified those who reported more versus less accurately. Clinicians and researchers who rely on self-reports should be aware of these limits and should take steps to enhance their accuracy. Copyright © 2003 John Wiley & Sons, Ltd. [source] The Genetic Counseling Video Project (GCVP): Models of practice,AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 4 2006D. Roter Abstract Genetic counseling is conceptualized as having both "teaching" and "counseling" functions; however, little is known about how these functions are articulated in routine practice. This study addresses the question by documenting, on videotape, the practices of a national sample of prenatal and cancer genetic counselors (GCs) providing routine pre-test counseling to simulated clients (SCs). One hundred and seventy-seven GCs recruited at two annual conferences of the National Society of Genetic Counselors (NSGC) were randomly assigned to counsel one of six female SCs of varying ethnicity, with or without a spouse, in their specialty. One hundred and fifty-two videotapes were coded with the Roter Interaction Analysis System (RIAS) and both GCs and SCs completed evaluative questionnaires. Two teaching and two counseling patterns of practice emerged from cluster analysis. The teaching patterns included: (1) clinical teaching (31%) characterized by low psychosocial, emotional and facilitative talk, high levels of clinical exchange, and high verbal dominance; and (2) psycho-educational teaching (27%) characterized by high levels of both clinical and psychosocial exchange, low levels of emotional and facilitative talk, and higher verbal dominance. The counseling patterns included: (1) supportive counseling (33%) characterized by low psychosocial and clinical exchange, high levels of emotional and facilitative talk, and low verbal dominance; and (2) psychosocial counseling (9%) with high emotional and facilitative talk, low clinical and high psychosocial exchange, and the lowest verbal dominance. SCs ratings of satisfaction with communication, the counselor's affective demeanor, and the counselor's use of non-verbal skills were highest for the counseling model sessions. Both the teaching and counseling models seem to be represented in routine practice and predict variation in client satisfaction, affective demeanor, and nonverbal effectiveness. © 2006 Wiley-Liss, Inc. [source] Intensified Screening and Treatment of the Metabolic Syndrome for Cardiovascular Risk ReductionPREVENTIVE CARDIOLOGY, Issue 1 2005Nathan D. Wong PhD The metabolic syndrome (MetS), characterized by a clustering of risk factors associated with insulin resistance and abdominal obesity, is associated with an increased risk of coronary heart disease and cardiovascular disease mortality. Persons with MetS have a wide spectrum of coronary heart disease risk and appropriate evaluation of risk using global risk algorithms. Measurement of other risk markers and subclinical disease is potentially needed to best set treatment goals and accompanying treatment regimens. The presence of MetS risk factors should be considered in global risk assessment. Clinical management emphasizes addressing underlying risk factors predisposing to MetS-specifically overweight/obesity and physical inactivity. Further recommendations are given for clinical risk factors, including atherogenic dyslipidemia, elevated blood pressure, insulin resistance/hyperglycemia, prothrombotic state, and proinflammatory state. Clinicians are recommended to assess MetS in their routine practice and to intensify efforts to adequately treat accompanying lifestyle and clinical risk factors. [source] Optimization of Volumetric Computed Tomography for Skeletal Analysis of Model Genetic OrganismsTHE ANATOMICAL RECORD : ADVANCES IN INTEGRATIVE ANATOMY AND EVOLUTIONARY BIOLOGY, Issue 5 2008Sergio X. Vasquez Abstract Forward and reverse genetics now allow researchers to understand embryonic and postnatal gene function in a broad range of species. Although some genetic mutations cause obvious morphological change, other mutations can be more subtle and, without adequate observation and quantification, might be overlooked. For the increasing number of genetic model organisms examined by the growing field of phenomics, standardized but sensitive methods for quantitative analysis need to be incorporated into routine practice to effectively acquire and analyze ever-increasing quantities of phenotypic data. In this study, we present platform-independent parameters for the use of microscopic x-ray computed tomography (microCT) for phenotyping species-specific skeletal morphology of a variety of different genetic model organisms. We show that microCT is suitable for phenotypic characterization for prenatal and postnatal specimens across multiple species. Anat Rec, 291:475,487, 2008. © 2008 Wiley-Liss, Inc. [source] | |||||||||||||||||||||||||||||||