Patient-rated unmet needs and quality of life improvement.
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Health Services Needs and Demand↗
Biomedical subjects
D McQueen
Publications and source records attributed to D McQueen.
Global priority setting for Cochrane systematic reviews of health promotion and public health research.
BACKGROUND: Systematic reviews of health promotion and public health interventions are increasingly being conducted to assist public policy decision making. Many intra-country initiatives have been established to conduct systematic reviews in their relevant public health areas. The Cochrane Collaboration, an international organisation established to conduct and publish systematic reviews of healthcare interventions, is committed to high quality reviews that are regularly updated, published electronically, and meeting the needs of the consumers. AIMS: To identify global priorities for Cochrane systematic reviews of public health topics. METHODS: Systematic reviews of public health interventions were identified and mapped against global health risks. Global health organisations were engaged and nominated policy-urgent titles, evidence based selection criteria were applied to set priorities. RESULTS: 26 priority systematic review titles were identified, addressing interventions such as community building activities, pre-natal and early infancy psychosocial outcomes, and improving the nutrition status of refugee and displaced populations. DISCUSSION: The 26 priority titles provide an opportunity for potential reviewers and indeed, the Cochrane Collaboration as a whole, to address the previously unmet needs of global health policy and research agencies.
Evidence-Based Medicine↗
Spontaneous follicular and luteal function in infertile women with oligomenorrhoea: role of luteinizing hormone.
OBJECTIVE: There is a paucity of longitudinal endocrine studies of infertile patients with oligomenorrhoea. We have assessed the frequency and quality of spontaneous follicular development and luteal function in patients with oligomenorrhoea and infertility (PCOS), and have related the observed criteria to circulating LH activity. DESIGN: Prospective detailed investigations in a cohort of unselected patients. PATIENTS: Infertile women with oligomenorrhoea (PCOS, n = 131) presenting to the infertility clinic at the Royal Infirmary, Glasgow. MEASUREMENTS: Patients were monitored with frequent plasma oestradiol (E2) concentration assessments over a minimum period of 3 weeks, starting more than 2 weeks after a menstrual bleed. When follicular maturation was identified the patient provided daily blood samples through to her ensuing menstrual bleed, and E2, progesterone, total testosterone, FSH and LH were assessed in these samples. Luteal phase progesterone profiles were assessed between the days LH surge +2 and LH surge +6 by means of a progesterone index. RESULTS: Forty-eight per cent of the patients showed evidence of follicular development. The oestradiol profiles in the patients showing follicular growth were normal, but the progesterone curve was sub-normal in the early luteal phase, due to a high proportion of deficient luteal phases. The mean LH concentrations were elevated in the whole group, but no difference was observed between the mean LH values for those patients showing spontaneous follicular development and those who did not, and the incidence of ovulation was similar in the normal LH and elevated LH groups. Similarly, no relation was established between LH and the quantitative assessment of luteal phase progesterone profiles (progesterone index), and the distribution of progesterone indices was similar in the normal LH and elevated LH groups. Testosterone concentrations were positively correlated with LH (p = 0.008) but not with the incidence of spontaneous follicular growth. There was no significant difference in the incidence of spontaneous ovulation between the patients with elevated or normal mean follicular phase testosterone concentrations. CONCLUSION: The data indicate that both LH and testosterone secretion in PCOS were closely linked, but that neither was directly linked to the incidence or inhibition of spontaneous follicular development in PCOS, or to the disturbance in luteal phase progesterone profiles.
Adult↗
Self-reported long-term effects of diving and decompression illness in recreational scuba divers.
The aim of this study was to examine the long-term effects of neurological decompression illness (NDCI) on recreational divers. Thirty-seven divers who had been treated for neurological decompression illness at least 2 years previously, and a control group of 50 divers with no history of decompression illness, responded to a postal questionnaire. Divers in the accident group reported more symptoms of neurological damage, were more likely to believe that diving had a deleterious effect on their health and were more likely to indicate symptoms of psychiatric morbidity. The quantity of diving in the year preceding the survey was associated with reports of neurological damage in both groups and with symptoms of psychiatric morbidity in the accident group. Although requiring confirmation from a longitudinal study, these results suggest that recreational diving can have negative long-term consequences for health, particularly after decompression illness.
Adult↗
Radionuclide migration through the genital tract in infertile women with endometriosis.
The migration of radionuclide through the genital tract was observed, comparing 20 patients with endometriosis and infertility with a control group of 23 infertile patients who had a normal pelvis. All patients had patent tubes at laparoscopy and chromopertubation, performed in both groups for the investigation of infertility and to diagnose the presence and extent of endometriosis. A radionuclide tubal test, using human albumin microspheres labelled with 99m-technetium (99mTc) was subsequently undertaken to observe the extent of genital tract migration of radionuclide to uterus, Fallopian tube and peritoneal cavity. The results show that radionuclide migration to the peritoneal cavity was impaired in patients with endometriosis, compared with the control group (30 versus 83%, respectively; P < 0.001). There was no relationship between migration and the severity of endometriosis. We conclude that impaired tubal function may be a cause of infertility in some patients with endometriosis.
Adult↗
Understanding sexual behaviour.
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Acquired Immunodeficiency Syndrome↗
Investigation of tubal infertility by radionuclide migration.
Investigation of the tubal factor in infertility is limited to an assessment of anatomical structure and tubal patency. No test of ascendant tubal function is currently available. The migration of radionuclide (99mTc-labelled human albumin microspheres) through the genital tract in 96 infertile women was compared with pelvic findings at laparoscopy and chromopertubation. The radionuclide test correlated with laparoscopy in the diagnosis of patency or blockage in 83 cases (86%). In nine patients, where 'blockage' was diagnosed on the radionuclide test but patency found at laparoscopy, a higher prevalence of pelvic abnormality was found, compared to the 78 patients where both tests demonstrated patency (P less than 0.02). The radionuclide test may facilitate detection of diseased but patent tubes and, as an adjunct to laparoscopy and chromopertubation, may provide useful information about tubal function.
Endometriosis↗
Luteinization to oocyte retrieval delay in women in whom multiple follicular growth was induced as part of an in vitro fertilization/gamete intrafallopian transfer program.
Different luteinization-to-oocyte-retrieval delays were examined in 64 IVF/GIFT patients. Multiple follicular stimulation was induced with combined therapy of hMG and GnRH-a to create continuous pituitary suppression and thus eliminate endogenous gonadotropin fluctuations. The results demonstrated that with this induction regime, the time interval can be extended to 39 hours without preoperative ovulation and with improved oocyte maturity.
Buserelin↗
Using a "lifestyle" perspective to understand toothbrushing behaviour in Scottish schoolchildren.
Using data from a wider survey of health related behaviour in 4,935 Lothian schoolchildren, 11, 13, and 15 yr old, this paper analysed toothbrushing frequency and its relation to "lifestyle" factors. Analysis of the results showed that girls brush more frequently than boys and that children with higher social class background brushed more frequently than children with low social class background. Further toothbrushing frequency was significantly related to the subjects' health perception, smoking and drinking habits, eating habits, bedtimes, and video-watching. Moreover, all these lifestyle factors were inter-related. The paper reinforced the concept of lifestyle as a meaningful descriptive term. The results demonstrated that the bivariate associations are pieces in a more complex mosaic. Toothbrushing thus seems to be an integrated part of a child's lifestyle and should be regarded as such in future health promotion efforts.
Adolescent↗
The effects of conjugated equine estrogens plus cyclical dydrogesterone on serum lipoproteins and apoproteins in postmenopausal women.
Serum lipoprotein and apoprotein concentrations were monitored for 24 weeks in 26 postmenopausal women treated with conjugated equine estrogens (0.625 mg/day) with the addition of dydrogesterone (10 mg/day) for the last 12 days of each 28 day cycle. The women had had no previous hormone replacement therapy. The estrogen plus dydrogesterone regimen caused significant (P less than 0.05) increases in triacylglycerol and HDL cholesterol concentrations. Both HDL2 and HDL3 cholesterol were increased. There were no other significant changes in lipoprotein concentrations. Both apoprotein AI and apoprotein AII concentrations increased significantly (P less than 0.05) over the study period. The ratios of apoprotein AI to apoprotein AII, apoprotein AI to HDL cholesterol and apoprotein AII to HDL cholesterol did not change. At the doses employed in this study, the use of dydrogesterone as a progestogen alters the effects of conjugated equine estrogens on lipoproteins and reinforces the view that the effects of a combined HRT regimen cannot be predicted from a consideration of the effects of the individual components.
Apoproteins↗
Computer corner #13. Computerized examinations in orthopaedics.
Computerized examinations can play an important role in the evaluation and education of trainees in orthopaedics. Several centers in the United States and Canada are currently using these, thus allowing an exchange of examination questions. Once a system is set up, only minimal involvement on the part of the instructor and office staff is required. All participants--trainees and instructors--can benefit from computerized examinations.
Computer-Assisted Instruction↗
Polyarticular pigmented villonodular synovitis in children: evidence for a genetic contribution.
Pigmented villonodular synovitis rarely occurs in multiple joints, and only once has been noted in siblings. We identified this disorder in 2 generations and found evidence for its presence in a third. It occurred in 2 sibling children at multiple sites. All affected individuals also had a rare autosomal dominant disorder, the multiple lentigines syndrome. Among the developmental abnormalities in this kindred were fibrous dysplasia, hypertelorism, pectus excavatum, high arched palate, and primary lymphedema. The etiology of pigmented villonodular synovitis is uncertain, and suggested causes include trauma, inflammation, neoplasia, and repeated hemorrhage. Our observations suggest genetic factors might also be important in the development of pigmented villonodular synovitis.
Adolescent↗
Thermal injury to bone. A vital-microscopic description of heat effects.
A titanium implant, the thermal chamber, allowing vital microscopic observations of bone tissue during heating and bone temperature measurements to be made simultaneously is described. The tissue reactions to a defined heat trauma may be followed and registered on slides and ciné film. The thermal chamber technique allows repeated observations of the same bone tissue compartment for indefinite follow-up period. In the present experiment, the chamber was inserted in the rabbit tibia and heating to 53 degrees C was applied for 1 min. During heating to the assigned temperature, the blood-flow velocity initially increased. At 53 degrees C the blood flow stopped in some vessels and became sluggish in others. 2 days after heating the blood flow in the pre-existing vessels had stopped. Gradually thereafter, all original vessels became replaced with ingrowing newly-developed vascular pathways. Fat cells seen before burning became resorbed and bone remodelling started 3-5 weeks after the heat injury. A temperature of 53 degrees C, i.e. below the denaturation point of alkaline phosphatase, caused an irreversible bone injury, after which healing occurred from the surrounding tissues.
Animals↗
The significance of cytoplasmic chondrocyte inclusions in multiple osteochondromatosis, solitary osteochondromas, and chondrodysplasias.
Lesions from two patients with multiple osteochondromas and from three patients with solitary osteochondromas were studied. The histologic and ultrastructural features in both conditions were identical. The chondrocyte population in osteochondromas resembled those in normal hyaline cartilage but the cells in osteochondromas exhibited an accumulation of granular and filamentous materials within markedly dilated cisterns of ergastoplasm. These accumulations formed eosinophilic cytoplasmic inclusions which did not stain with Alcian blue, but were PAS positive after diastase digestion. Chondrocytic inclusions of similar or diverse morphology are found in a number of chondrodysplasias. The findings suggest that the solitary osteochondromas, like the lesions of multiple osteochondromatosis, share a common morphologic feature with the chondrodysplasias.
Cartilage↗
Mechanisms of mitral valve motion during diastole.
To examine the mechanisms of mitral valve motion in mid diastole and at closure, we simultaneously measured mitral flow (electromagnetic), valve motion (echo), and atrioventricular pressures (micromanometer). Peak valve excursion (E point) occurs early 46 +/- 7 ms) after opening and always precedes peak flow; therefore, mid-diastolic closing motion (EF slope) is not due to flow deceleration or vortex formation. Large variations in peak flow are accompanied by small variations in valve excursion (coefficient of variation 41 vs. 12%, respectively). We conclude that the valve overshoots its equilibrium position and that the chordae produce tension on the valve during diastole. This approach is supported by data from papillary muscle rupture, prolonged P-R interval, and mathematical modeling. We offer a valve-closure theory unifying chordal tension, flow deceleration, and vortices, with chordal tension as a necessary condition for the proper function of the other two. Nevertheless, prolonged periods of diastasis and ventricular premature contractions indicate that competent valve closure may occur in the absence of vortices and flow deceleration.
Animals↗
Bilateral suprascapular-nerve entrapment syndrome. Case report and review of the literature.
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Aged↗
Applications of a simple theory of the acoustic motion of fibrous networks in viscous media.
The rupture of blood capillaries in the spinal chords of rats by pulsed ultrasound and the motion of fibrils in the corneal stroma are analysed in detail in terms of a simple theory of wave propagation in a fibrous network permeated by a viscous medium. The advantages of inelastic light scattering experiments in connection with studies of ultrasound are emphasized.
Animals↗
The effects of prostaglandin E1 and sodium meclofenamate on blood pressure in renal hypertensive rats.
Conflicting evidence exists regarding the ability of PGE1 to normalize blood pressure in renal hypertensive rats. We performed experiments to determine the effect of PGE1 (15 mug/kg i.p. daily for 3 weeks) in renal hypertensive Wistars and found no significant change in systolic pressure. A higher dose (150 mug/kg i.p.) lowered pressure after 14 days of treatment, but not back to control levels. Further investigations are required to establish the mechanism whereby PGE1 evokes this fall. To test the hypothesis that endogenous prostaglandins have a hypotensive function in renal hypertension, experiments were performed using sodium meclofenamate to inhibit prostaglandin biosynthesis. In chronic hypertensive rats the drug had no significant effect, while in the acute phase of renal hypertension there was a dose-dependent inhibition of the pressure rise. The possibility is suggested that prostaglandins may initiate or sustain the acute phase of renal hypertension in rats.
Animals↗