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PubMedDate not supplied

The role of nurses in installing telehealth technology in the home.

Home telehealth involves the use of video conferencing or remote monitoring equipment in patients' homes. The installation of hardware and training of patients has historically been performed by nurses, typically RNs. This article examines the experience of RNs as telehealth installers in the Informatics for Diabetes Education and Telemedicine (IDEATel) project, where RNs were responsible for the installation of the Home Telemedicine Units (HTUs) and for training patients in the use of the HTUs, blood pressure cuffs, and fingerstick glucose meters. Average installation and training time was 166 minutes (SD 51 min). Structured interviews with RN installers revealed that patient education and training accounted for roughly two thirds of the in-home time. Technology-related problems, especially those related to telecommunications, were the primary cause of installation difficulties. Thematic analysis of installer interviews identified eight major themes and confirmed the importance of both clinical and technical knowledge during the telehealth installation process.

Aged↗

PubMed1995

Antifungal susceptibility testing of yeasts: evaluation of technical variables for test automation.

The technical parameters for antifungal susceptibility testing with Candida species were reexamined to determine the optimal conditions for testing with semiautomated preparations of broth microdilution cultures, automated spectrophotometric readings of the cultures, and dose-response and endpoint determinations by means of a computer spreadsheet. Tests were based on proposed standard method M27P of the National Committee for Clinical Laboratory Standards for antifungal agents. RPMI 1640 broth with extra glucose to a final concentration of 2% gave higher and more reproducible drug-free control readings without affecting susceptibility endpoint readings. An inoculum of 8 x 10(4) yeasts per ml prepared from a carbon-limiting broth culture without further standardization was found to give optimal control readings after 48 h of incubation at 37 degrees C. For flucytosine, fluconazole, itraconazole, and ketoconazole, endpoints based on 50% growth inhibition (50% inhibitory concentration) gave the minimum variation with inoculum size and the fewest endpoint differences with RPMI 1640 medium obtained from two different suppliers. The 50% inhibitory concentration was also the optimal endpoint for fluconazole and ketoconazole susceptibilities in comparison with broth macrodilution MICs determined by the method of the National Committee for Clinical Laboratory Standards. Intralaboratory reproducibility was determined by retrospective analysis of replicate results for isolates retested at random over a 2-year period. This approach showed less favorable reproducibility than has been reported from purpose-designed, prospective antifungal susceptibility studies, but it may better reflect real-life test reproducibility. Susceptibility data for 616 clinical isolates of yeasts, representing 16 Candida and Saccharomyces spp., confirmed the tendency of Candida lusitaniae isolates to show relatively low susceptibilities to amphotericin B, the tendency of Candida krusei isolates to show low flucytosine and fluconazole susceptibilities, and the presence of some isolates in the species Candida albicans, Candida glabrata, and Candida tropicalis with low susceptibilities to azole derivative antifungal agents. The study demonstrates the value of automation and standardization in all stages of yeast susceptibility testing, from plate preparation to data analysis.

Antifungal Agents↗

PubMed1994

Gastroenteritis: a waterborne outbreak affecting 1600 people in a small Danish town.

STUDY OBJECTIVE: To examine (i) the extent of illness caused by contamination of a waterworks with waste water due to overflow, and its correlation with precipitation; (ii) the potential secondary spread; (iii) economic losses due to sick leave. DESIGN: A historical follow up study with structured postal questionnaires. SETTING: A small community on the outskirts of greater Copenhagen at the end of 1991 and the beginning of 1992. PARTICIPANTS: The main study group comprised all 703 households supplied by the waterworks (response rate: 89% of households). There was a control group of 200 randomly chosen households in neighbouring communities with a different water supply source (response rate: 64% of households). A day care group of all 149 children (response rate: 78%) and 30 teachers (response rate: 83%) who lived in central Copenhagen, but spent the day in four day care centres supplied by the waterworks, and members of their household was also studied. MEASUREMENTS AND MAIN RESULTS: Altogether 1455 people (88% of respondents in the main study group) reported having had symptoms of gastroenteritis, particularly diarrhoea (83%) and vomiting (55%). In the control group, 10% had had symptoms of gastroenteritis. The onset of episodes with diarrhoea correlated well with precipitation (Spearman's correlation coefficient: 0.75; p = 0.0002). The secondary attack rate in household contacts was 12%. No pathogens were found. Affected people stayed home from work for a total of 1658 days. The cost of loss of production because of sick leave amounted to 1,600,000 Danish kroner (180,000 pounds). CONCLUSIONS: The outbreak caused extensive illness correlated with precipitation, showed secondary spread, and was associated with major economic losses. Increased awareness among local physicians and waterworks personnel of the possibility of contamination of the water could have led to earlier intervention and reduced the extent of illness. Outbreaks are often caused by several factors, many of a technical nature, which in this case acted together. It is recommended that attention be paid to each factor.

Adult↗

PubMed2005

Palliative therapy.

There are a wide variety of palliative treatments for esophageal cancer. The aim of most treatments is to maintain oral food intake, which should stabilize or even improve quality of life. Stent placement is currently the most widely used treatment modality for palliation of dysphagia from esophageal cancer. Stent placement offers a rapid relief of dysphagia, however, the rate of complications (late hemorrhage) and recurrent dysphagia (stent migration, tumor overgrowth) is relatively high. The scientific evidence to advocate the use of anti-reflux stents for the prevention of gastro-esophageal reflux is currently too low. Photodynamic therapy is mostly used in North America; however, due to the high costs of the treatment, the long-lasting side effects and the necessity of repeated treatments, it is not an ideal treatment for palliation of malignant dysphagia. Nd:YAG laser is a relatively effective and safe treatment modality, although laser treatment is also expensive, technically difficult and requiring repeated treatment sessions at 4-6 weeks intervals. Single dose brachytherapy compares favorably to stent placement in long-term effectiveness and safety. Effective treatment strategies are probably 12 Gy given in one fraction or 16 Gy given in two fractions. Palliative chemotherapy offers response rates in recent trials (including partial and complete responses) ranging from 35% to 50%. Whether palliative chemotherapy also results in a survival benefit is not established yet. For clinical trials on palliation of esophageal cancer, the measurement of quality of life is an important outcome measure. The cancer-specific EORTC QLQ-C30 and the esophageal cancer-specific EORTC-OES-18 are validated measures for establishing quality of life status. For the future, a multimodality approach with stent placement or brachytherapy in combination with chemotherapy may be indicated.

Adenocarcinoma↗

PubMed1985

Insulin appearance of subcutaneously infused insulin: influence of the basal rate pulse interval of the infusion pump.

To compare the metabolic control and the pharmacokinetics of infused insulin using an insulin pump (Auto-Syringe AS 6C) which provides the basal rate in pulses every 2-10 min with a pump (Medix Syringe Driver 209) providing the basal rate in pulses every 15-60 min, 6 C-peptide negative diabetic patients received, in random order, identical, but individual, insulin treatment during one 4-day period using the Auto-Syringe pump and another 4-day period using the Medix pump. On the fourth day of each period, blood glucose and plasma-free insulin were estimated every 30 min for 7 hr and every 5 min for the next hour. Plasma-free insulin was significantly higher on 3 time points out of the 26 possible when using the Medix pump, but this was not reflected in the blood glucose concentrations which were similar in the 2 periods. The results indicate that, from a metabolic and pharmacokinetic point of view, insulin pumps working with larger intervals between the basal rate pulses are just as good as the more technically advanced and hence often more expensive pumps which provide the basal rate in more and smaller pulses.

Adult↗

PubMedDate not supplied

The role of high-dose-rate brachytherapy in the palliation of symptoms in patients with non-small-cell lung cancer: a systematic review.

PURPOSE: This review addresses the role of high-dose-rate endobronchial brachytherapy (HDREB) for symptom palliation in patients with non-small-cell lung cancer. METHODS AND MATERIALS: Relevant trials were identified through a systematic search of the literature. RESULTS: Twenty-nine trials were eligible. Six randomized trials involved HDREB alone or with external beam radiation therapy (EBR) or laser therapy. Median and 1-year survival ranged from 4 to 10 months and from 11% to 38%, respectively. Symptoms controlled by HDREB were dyspnea, cough, chest pain, and hemoptysis. Fatal hemoptysis ranged from 7% to 22%. Better overall symptom palliation and fewer retreatments were required in previously untreated patients using EBR alone or EBR with HDREB. CONCLUSIONS: EBR alone is more effective than HDREB for symptom palliation in previously untreated patients with endobronchial non-small-cell lung cancer. HDREB with EBR seems to provide better symptom relief than EBR alone. HDREB is recommended for symptomatic patients with recurrent endobronchial obstruction previously treated by EBR, providing it is technically feasible.

Brachytherapy↗

PubMed2002

Percutaneous treatment for carotid stenosis.

Stroke is the leading cause of serious long-term disability in the United States. A substantial portion of strokes are caused by atherosclerotic carotid artery disease. The conventional risk factors for coronary atherosclerosis are also responsible for carotid atherosclerosis. Carotid stenosis is encountered in medical practice in either symptomatic or asymptomatic states. In symptomatic patients, medical management with antiplatelet agents does not provide adequate protection against stroke. Carotid endarterectomy can help reduce the risk of a subsequent stroke. Asymptomatic patients with severe carotid stenosis can also benefit from surgical intervention if endarterectomy can be performed at a low operative risk. In recent years, percutaneous carotid stenting using self-expanding stents has become popular for the treatment of carotid stenosis. Although this initial experience has been reported from a high-risk patient population, the results are encouraging, with acceptable periprocedural stroke rates. Moreover, emboli protection devices, modern adjuvant pharmacotherapy, and modern self-expanding stents were not utilized in these studies. With rapidly expanding technology and advances in interventional pharmacology, improvement of clinical outcome is likely. Table 3 summarizes current recommendations for carotid stenting based on a panel of cardiologists, radiologists, and vascular surgeons. At this stage, randomized trials to compare endarterectomy with carotid stenting are underway. Cautious optimism is necessary until the optimal equipment, emboli protection devices, and adjuvant pharmacotherapies are fully investigated. Until then, carotid stenting should be restricted to high-risk candidates for carotid endarterectomy, including patients with severe cardiac comorbidities, previous neck surgeries or radiation, restenosis after endarterectomy, or other technical contraindications for surgery.

Angioplasty↗

PubMed2006

A simple parallel analytical method of prenatal screening.

Protein microarray has progressed rapidly in the past few years, but it is still hard to popularize it in many developing countries or small hospitals owing to the technical expertise required in practice. We developed a cheap and easy-to-use protein microarray based on dot immunogold filtration assay for parallel analysis of ToRCH-related antibodies including Toxoplasma gondii, rubella virus, cytomegalovirus and herpes simplex virus type 1 and 2 in sera of pregnant women. It does not require any expensive instruments and the assay results can be clearly recognized by the naked eye. We analyzed 186 random sera of outpatients at the gynecological department with our microarray and commercial ELISA kit, and the results showed there was no significant difference between the two detection methods. Validated by clinical application, the microarray is easy to use and has a unique advantage in cost and time. It is more suitable for mass prenatal screening or epidemiological screening than the ELISA format.

Dose-Response Relationship, Drug↗

PubMed2002

Isolated liver perfusion for non-resectable liver tumours: a review.

Many treatments have been proposed for non-resectable primary or secondary hepatic cancer but the results have generally been disappointing. Isolated Hepatic Perfusion (IHP) was first attempted four decades ago but it gained acceptance only recently, after spectacular tumour responses were obtained by isolated limb perfusion with melphalan and tumour necrosis factor (TNF) for melanomas and sarcomas. Surgical isolation of the liver is a technically demanding operation that allows the safe administration of high doses of chemotherapeutics and TNF. Percutaneous techniques using balloon occlusion catheters are simpler but result in higher leakage rates from the perfusion circuit into the systemic circulation. Several phase I-II trials indicate that IHP can yield high tumour response rates, even when there is resistance to systemic chemotherapy. However, no significant advantage in overall survival has been demonstrated so far. IHP offers unique pharmacokinetic advantages for locoregional chemotherapy and biotherapy. It might also allow gene therapy with limited systemic exposure and toxicity. At present, IHP nevertheless remains an experimental treatment modality which should therefore be used in controlled trials only.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2000

Optimizing radiation parameters for cervical cancer.

The treatment of cervical cancer has become increasingly sophisticated with evidence-based guidelines generated from randomized trials directing combined modality programs. The radiotherapeutic guidelines have been derived largely from single institutional experiences coupled with data from the Patterns of Care Studies. The design of external-beam fields has improved because of a better understanding of the anatomy of the cervix, uterus, parametrium, and draining lymph nodes from surgical, lymphangiogram, computed tomography scan, and magnetic resonance imaging series. An improvement in survival and local control with dose intensity (a reduction in overall treatment time and increase in overall dose) has been shown for cervical cancer, especially for locally advanced disease, and these series are highlighted. The use of intracavitary radiation, which is technically accurate, dramatically improves outcome and allows for dose intensity. Alternative brachytherapy techniques, such as high-dose-rate, and interstitial, are discussed. Ways to improve the therapeutic ratio for radiation, including biological factors, are reviewed. More research is necessary to understand the complex dose distribution of external-beam and intracavitary brachytherapy and its relationship to tumor control.

Brachytherapy↗

PubMed2000

Initial extractions and tooth loss during supportive care in a periodontal population seeking comprehensive care.

BACKGROUND/AIMS: This retrospective survey was aimed at determining the prevalence of tooth extractions and the dental pathologies associated with them during both the active and maintenance phase of periodontal therapy in a periodontal population seeking comprehensive dental care. METHODS: A total of 273 randomly selected subjects from the oral prophylaxis clinic of the University of Berne were included. All subjects had received comprehensive care consisting of periodontal and restorative treatment and participated in a supervised maintenance program for an average of 67+/-46 months (range 5 to 278 months). The population consisted of 39.6% current smokers and 27.8% previous smokers. 6.2% of the patients had gingivitis, 20.5% mild periodontitis, 48.4% moderate and 24.9% severe periodontitis. The average frequency of the recall visits was 4.4+/-1.5 appointments/year (range 1.7-12 appointments/year). RESULTS: Results indicated that 574 out of a total of 6503 teeth were extracted; 311 teeth were extracted during active therapy and 263 during the supportive periodontal care (SPC) phase of therapy. 46% of patients received tooth extractions as part of their active treatment and 41% during their participation in the secondary prevention program. In the subgroup whose treatment plan included extractions the average number was 2.5+/-1.6 teeth per patient. Likewise, the patients who received extractions during recall lost an average of 2.35+/-1.9 teeth per subject with an incidence of 0.4+/-0.37 teeth per patient per year. These data reinforce the concept that a minority of the population is responsible for the majority of tooth extractions, both during active therapy and SPC. Periodontal disease was the only pathology observed at 57% of the extracted teeth; while caries, endodontic pathology and technical problems in the absence of periodontitis were observed in 29% of cases. CONCLUSIONS: These observations indicate that the rendered treatment was effective in the long-term maintenance of the dentition of these subjects and suggest that advanced periodontal disease represented the major cause of tooth loss in this population.

Adolescent↗

PubMed2007

A clinical development paradigm for cancer vaccines and related biologics.

Therapeutic cancer vaccines are a heterogeneous group of complex biologics with distinctly different clinical characteristics than cytotoxic agents. The current clinical development paradigm used for oncology drug development is based on criteria developed for cytotoxic agents. More flexible and focused developmental guidelines are needed to address the unique characteristics of therapeutic cancer vaccines. Over the course of 1 year, the Cancer Vaccine Clinical Trial Working Group, representing academia and the pharmaceutical and biotechnology industries with participation from the US Food and Drug Administration, defined in a consensus process the cornerstones of a new clinical development paradigm for cancer vaccines and related biologics. Four major topics were addressed: (1) end points for clinical trials, (2) trial designs and statistical methods, (3) technical and developmental challenges, and (4) combination therapy. The proposed paradigm suggests therapeutic cancer vaccines to be investigated in 2 general types of clinical studies: proof-of-principle trials and efficacy trials. Proof-of-principle trials, which introduce a novel cancer vaccine into humans, should include a minimum of 20 or more patients in a homogenous, well-defined population in an adjuvant setting or without rapidly progressive disease in a metastatic setting to allow vaccines adequate time to induce biologic activity and should incorporate immune and molecular markers. Objectives should include initiation of a safety database, determination of dose and schedule, and demonstration of biologic activity as proof-of-principle. Biologic activity is defined as any effect of the vaccine on the target disease or host immune system using biologic markers as study end points, for example, clinical, molecular, or immune response. Immune response is demonstrated if determined in 2 separate, established and reproducible assays at 2 consecutive follow-up time points after the baseline assessment. If proof-of-principle trials show such immune response, or other biologic or clinical activity, efficacy trials may be initiated. If none of these end points is met, the clinical development plan should be reevaluated to decide if further development is warranted. Efficacy trials formally establish clinical benefit either directly or through a surrogate and are encouraged to be randomized studies. This is in contrast to single-arm phase 2 trials used for cytotoxic agents, which often use tumor response rate as the primary end point and historical controls as a comparator. Efficacy trials may use prospectively planned adaptive designs to expand from randomized phase 2 into phase 3 studies if well-defined trigger-point criteria are met, but the cost of incorporating such design elements should be carefully evaluated. Efficacy trials can also be exploratory randomized phase 2 trials or conventional phase 3 trials. In addition, conventional clinical end points can be adjusted to account for biologic features of cancer vaccines. The concept of efficacy trials allows for an early assessment of vaccine efficacy based on credible prospective data. This 2-phase developmental paradigm supports a more flexible, expeditious, and focused clinical developmental process with early and informed decision making. In addition, this report addresses clinical development challenges and issues for combination therapies.

Cancer Vaccines↗

PubMed2003

A paclitaxel-eluting stent for the prevention of coronary restenosis.

BACKGROUND: Intimal hyperplasia and resulting restenosis limit the efficacy of coronary stenting. We studied a coronary stent coated with the antiproliferative agent paclitaxel as a means of preventing restenosis. METHODS: We conducted a multicenter, randomized, controlled, triple-blind study to evaluate the ability of a paclitaxel-eluting stent to inhibit restenosis. At three centers, 177 patients with discrete coronary lesions (<15 mm in length, 2.25 to 3.5 mm in diameter) underwent implantation of paclitaxel-eluting stents (low dose, 1.3 microg per square millimeter, or high dose, 3.1 microg per square millimeter) or control stents. Antiplatelet therapies included aspirin with ticlopidine (120 patients), clopidogrel (18 patients), or cilostazol (37 patients). Clinical follow-up was performed at one month and four to six months, and angiographic follow-up at four to six months. RESULTS: Technical success was achieved in 99 percent of the patients (176 of 177). At follow-up, the high-dose group, as compared with the control group, had significantly better results for the degree of stenosis (mean [+/-SD], 14+/-21 percent vs. 39+/-27 percent; P<0.001), late loss of luminal diameter (0.29+/-0.72 mm vs. 1.04+/-0.83 mm, P<0.001), and restenosis of more than 50 percent (4 percent vs. 27 percent, P<0.001). Intravascular ultrasound analysis demonstrated a dose-dependent reduction in the volume of intimal hyperplasia (31, 18, and 13 mm3, in the high-dose, low-dose, and control groups, respectively). There was a higher rate of major cardiac events in patients receiving cilostazol than in those receiving ticlopidine or clopidogrel. Among patients receiving ticlopidine or clopidogrel, event-free survival was 98 percent and 100 percent in the high-dose and control groups, respectively, at one month, and 96 percent in both at four to six months. CONCLUSIONS: Paclitaxel-eluting stents used with conventional antiplatelet therapy effectively inhibit restenosis and neointimal hyperplasia, with a safety profile similar to that of standard stents.

Angiogenesis Inhibitors↗

PubMed2000

Local control of prostate cancer by transrectal HIFU-therapy.

Transrectal high intensity focused ultrasound (HIFU) as a minimal invasive treatment approach of localized prostate cancer was evaluated concerning its efficacy and security. Post-operative monitoring included PSA-levels and histological results of control random biopsies. Seventy-three HIFU sessions were performed on 62 patients during the period from November 1997 to April 2000. Patients were classified in 4 indication groups: 1) localized prostate cancer, T1-T2, initial PSA < 15 ng/ml, Gleason score < 7, volume < 30 cc, no more than 4 of 6 random biopsies affected by cancer, not suitable for radical prostatectomy; 2) localized prostate cancer, T1-T3, no PSA or Gleason score limitation; 3) local recurrence after first line therapy (RPE, radiation, hormonal ablation); 4) for local debulking. Mean plus or minus standard deviation for patient age was 67.5 +/- 7.48 years, for PSA was 7.64 +/- 5.26 ng/ml and for prostate volume was 21.3 +/- 7.9 cc. Median follow up was 15 months (range 5-29) and included PSA development, control sextant biopsies and transrectal color coded duplex sonography (TCCDS) at 1, 3, 6, 12 and 24 months. At least 1 control biopsy result was available in 48 patients. We evaluated the therapy in 3 categories: 1) group 1 (complete response) included 33/48 patients (68.7%) with no residual cancer and PSA < 4 ng/ml; 2) group 2 (biochemical control) 8/48 patients (16.7%) with small residual cancer and PSA < 4 ng/ml; 3) group 3 (failure) 7/48 patients (14.6%) with residual cancer and PSA > 4 ng/ml (4 of them received hormone therapy). As major complications 2 urethrorectal fistulas occurred, both in post-radiation patients, 3 stress-incontinences II-III after TUR post HIFU. In 20 patients (32.3%) transurethral manoeuvres were necessary to remove obstructive necrotic tissue or because of bladderneck or urethral strictures. 11 of these patients were among the first 20 treated patients. Regarding the individual learning curve about technique, indication and the technical developments HIFU treatment can currently be considered as a valid alternative treatment strategy for patients with localized prostate cancer, who are not suitable for radical surgery. HIFU treatment can be repeated depending on biopsy result and PSA development. Local control of the localized prostate cancer was observed in group 1 and 2 (85%).

Aged↗

PubMed2006

The effects of fatigue on decision making and shooting skill performance in water polo players.

The aim of this study was to assess the effects of fatigue on decision making and goal shooting skill in water polo. Fourteen junior elite male players (age 17.2 +/- 0.5 years; mass 84.2 +/- 7.6 kg; height 1.85 +/- 0.05 m) completed four sets of eight repetitions of an approximately 18 s maximal water polo specific drill. Progressively declining rest ratios for each successive set of the drill were employed to induce increasing fatigue and reflect the demands of match-play. A video-based temporally occluded decision-making task (verbalized response to various tactical situations) or goal shooting skill test (qualitative and quantitative analysis of goal shooting) was performed after each set. Heart rate, rating of perceived exertion (RPE) and blood lactate concentration were recorded. Heart rate (159 +/- 12, 168 +/- 13, 176 +/- 12, 181 +/- 12 Deats min-1; P < 0.001) and RPE (13.1 +/- 2.2, 15.5 +/- 1.7, 17.3 +/- 1.6, 19.1 +/- 1.1; P < 0.001) increased with declining rest ratios. At very high fatigue, decision-making accuracy was 18.0 +/- 21.8% better than at low fatigue (P = 0.008). Shooting accuracy and velocity were unaffected by incremental fatigue; however, skill proficiency (technique) decreased by 43 +/- 24% between the pre-test and high-fatigue conditions (P < 0.001). In conclusion, incremental increases in fatigue differentially influenced decision making (improved) relative to the technical performance (declined), accuracy and speed of the ball (unchanged) of a water polo goal shot.

Adolescent↗

PubMed2002

Level ground and uphill cycling efficiency in seated and standing positions.

PURPOSE: This study was designed to examine the effects of cycling position (seated or standing) during level-ground and uphill cycling on gross external efficiency (GE) and economy (EC). METHODS: Eight well-trained cyclists performed in a randomized order five trials of 6-min duration at 75% of peak power output either on a velodrome or during the ascent of a hill in seated or standing position. GE and EC were calculated by using the mechanical power output that was measured by crankset (SRM) and energy consumption by a portable gas analyzer (Cosmed K4b(2)). In addition, each subject performed three 30-s maximal sprints on a laboratory-based cycle ergometer or in the field either in seated or standing position. RESULTS: GE and EC were, respectively, 22.4 +/- 1.5% (CV = 5.6%) and 4.69 +/- 0.33 kJ x L(-1) (CV = 5.7%) and were not different between level seated, uphill seated, or uphill standing conditions. Heart rate was significantly ( < 0.05) higher in standing position. In the uphill cycling trials, minute ventilation was higher ( < 0.05) in standing than in seated position. The average 30-s power output was higher ( < 0.01) in standing (803 +/- 103 W) than in seated position (635 +/- 123 W) or on the stationary ergometer (603 +/- 81 W). CONCLUSION: Gradient or body position appears to have a negligible effect on external efficiency in field-based high-intensity cycling exercise. Greater short-term power can be produced in standing position, presumably due to a greater force developed per revolution. However, the technical features of the standing position may be one of the most determining factors affecting the metabolic responses.

Adolescent↗

PubMedDate not supplied

Long-term outcome in hemodialysis: morbidity and mortality.

Despite technical and pharmacological improvements achieved over the past years, long-term prognosis of patients undergoing chronic hemodialysis is still rather poor. Cardiovascular disease is the leading cause of both morbidity and mortality in these patients, mostly because of their severely compromised cardiovascular conditions already at the time of starting hemodialysis. A proper management of factors involved in the development of cardiovascular abnormalities is therefore a basic pre-requisite for improving their clinical outcome. Hypertension and anemia should be adequately evaluated and corrected, in light of their primary involvement in the pathogenesis of left ventricular hypertrophy, whereas treatment of calcium and phosphate metabolism disorders, particularly of high serum phosphorus levels, is needed to prevent the development of severe secondary hyperparathyroidism and mainly vascular calcifications, whose detrimental pathophysiologic consequences on cardiovascular structures are huge. At the same time, the prescription of the hemodialytic treatment should be optimised, with a satisfactory removal of uremic toxins through the delivery of an adequate dialysis dose and with the use of biocompatible membranes, where possible, thus minimizing the inflammatory response secondary to the interaction between blood and the artificial material of the hemodialysis system. The clinical superiority of high-flux membranes, although suggested by all studies performed so far, has still to be demonstrated by well-conducted clinical studies; on-line convective treatments and daily hemodialysis, although promising, also need to be confirmed in randomized trials. In conclusion, long-term outcome of hemodialysis patients may only be improved by a complex, multi-factorial therapeutical approach.

Anemia↗

PubMed1992

Dental health care workers' response to the HIV epidemic.

Random samples of Minnesota DHCWs were surveyed in late 1989 regarding HIV-related and infection control KAPs. Response rates were: dentists 69% (438/631); hygienists 73% (439/603); and assistants 56% (384/691). More than 50% of DHCWs said they did not have sufficient information to safely and effectively provide care for HIV-infected patients. Use of infection control techniques varied considerably. Parenteral injuries were relatively high, but only 5% of DHCWs believed they could have been exposed to HIV from these occurrences, and few DHCWs sought medical evaluation. Less than 45% of offices had a blood/body fluid exposure staff protocol, and few offices had a policy for HIV-infected staff. Nearly twice as many DHCWs said offices have an ethical versus a legal duty to treat HIV-infected persons. Low percentages of DHCWs believed the private practice dental office is the best place to treat HIV-infected patients, but approximately 50% said they would provide care. Twenty percent indicated that a diagnosed HIV-infected person had been seen at their office. Seventy-six percent said staff had been uncomfortable treating HIV-infected patients, 14% said staff had refused to treat, and 10% said referrals were difficult. DHCWs exhibited substantial improvements in their HIV-related KAPs compared to previous surveys. Nevertheless, additional cognitive and behavioral changes are necessary to ensure that all DHCWs provide care with the highest technical, legal, and ethical standards for all patients.

Acquired Immunodeficiency Syndrome↗