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PubMed2006

Novel strategies of aerosolic pharmacotherapy.

The pulmonary administration of drugs plays a crucial role in the management of various respiratory and systemic diseases. While the cellular properties of airway epithelial cells offer a great potential to deliver drugs into the lungs or the circulation, only little is known about the exact transport pathways. Recently, the high-affinity proton-coupled drug and peptide transporter PEPT2 was identified in the human respiratory tract. The expression of transporter mRNA and protein was localized to the airway epithelium and alveolar type II pneumocytes. In addition, transport studies revealed transporter-mediated uptake of substrates into epithelial cells indicating that the transporter is the molecular basis for the transport of peptides and peptidomimetic drugs in pulmonary epithelial cells. Since genotype analysis revealed no significant differences amongst different transporter genotypes concerning expression and function, the transporter displays an interesting novel target for pulmonary delivery of drugs.

Administration, Inhalation↗

PubMed2003

Views of nursing staff on the use of physical restraint.

A postal questionnaire survey was employed in regional secure and psychiatric intensive care units in England and Wales, in respect of mental health nurses' training in the use of physical restraint. The nurses' views were sought relating to their last experience of implementing the procedure. Whilst most nurses (n = 259, 96.3%) reported positive outcomes in so far that the incident was brought under control, the views of the aftereffects of the procedure were of concern and ambivalence. The literature suggests that service users did not necessarily hold the same positive views. A range of alternatives, which were consistent with the literature, was made by staff to improve intervention in the management of violence. Negative aspects relating to the use of physical restraint were also highlighted. They included procedural, injury, clinical and management issues. Some respondents also expressed concerns about the negative attitudes of their colleagues. The findings of this aspect of the survey highlights that the therapeutic value of physical restraint can only be achieved with appropriate monitoring and with emphasis on psychological intervention in the prevention and management of violence.

Attitude of Health Personnel↗

PubMed2002

Researching drug information needs in Australia.

National research about drug information needs and access strategies from a cross-section of professionals and community respondents was undertaken in conjunction with the development of the Australian Drug Information Network (ADIN). Many professionals who have an active concern about drug and alcohol issues experience frustration with their access to high quality and relevant drug information. Although the Internet is widely perceived to be the answer to disseminating information, it remains the least favoured source of drug information among professionals, especially in regional and remote locations. Limited access to technology and doubts about the quality of web-based information were expressed concerns. Community differences about where and how to access information were also apparent, with the Internet being a more feasible resource for metropolitan and younger respondents.

Australia↗

PubMed1993

Aesthetic concerns of children and parents in relation to different classifications of the Tooth Surface Index of Fluorosis.

Increasing prevalence of dental fluorosis for children both from fluoridated and non-fluoridated communities are now well documented. Along with recent studies purporting possible adverse health effects from fluorides, this proven public health intervention is again being challenged. This study was undertaken to determine the prevalence of dental fluorosis for children from fluoridated and non-fluoridated areas in British Columbia. In addition, children and parents were provided with an opportunity to express concerns about the aesthetics of the child's anterior teeth. Children from representative schools in two communities were surveyed using the Tooth Surface Index of Fluorosis (TSIF). Questionnaires were sent home to parents to detail their child's use of various fluoride preventive practices and residence histories. Completed questionnaires were returned and exams were performed on 1131 children. Of those examined, 60% had dental fluorosis on at least two tooth surfaces, only 8% had scores ranging from "2" to "6", and 52% were classified with a score of "1". Parental and child ratings on the aesthetics or color of the child's teeth suggests that there are few children with aesthetic problems in the TSIF category of "1". While concerns of parents were more common, the actual source of those concerns was not assessed in the questionnaire. Not unexpectedly, children with fluorosis on anterior teeth ranging between TSIF scores of "2" to "6" appear to have increased concerns about tooth color. Data from children with confirmed residence histories from fluoridated communities suggest that the occurrence of aesthetic problems in these children is rare.

Adult↗

PubMed2003

Genetic analysis of capsular status of meningococcal carrier isolates.

The meningococcal capsule is the primary virulence factor with systemic isolates requiring full expression of the capsule but with capability to down-regulate the capsule in order to invade. The meningococcal capsular operon is composed of a number of genes that are involved in capsular synthesis and transport. Differences in capsular synthesis genes may allow discrimination between meningococcal serogroups whereas absence of genes for either synthesis or transport imply that the meningococcus is unencapsulated. Although mechanisms such as slipped-strand mispairing and acquisition of insertion sequences have been demonstrated to be involved in regulation of capsular expression, few studies have addressed the mechanisms of capsular expression in carrier isolates. Following a community-based intervention programme for an outbreak of meningococcal disease, we collected meningococcal carrier isolates from the intervention area and control areas. We undertook genetic analysis of the capsular operon and the mechanisms of capsular regulation, together with an investigation of the potential of capsular genes to identify the genogroup of non-serogroupable isolates. Use of the siaD gene allowed the discrimination of 30/89 (34%) non-serogroupable isolates into B, C, W135 and Y with a siaA gene PCR permitting the characterization of a further 6 isolates whose capsules contained sialic acid. Slipped-strand mispairing was evident in only 4 of 13 genogroupable B isolates and the insertion sequence IS1301 was found in 2 of 36 siaA-positive isolates. Of 51 non-genogroupable isolates 25 (49%) were shown to be ctrA negative. There was a higher percentage of ctrA-positive isolates (P<0.001) amongst meningococcal strains obtained from those sampled in non-intervention schools than those sampled at intervention schools. The ctrA-negative isolates warrant further investigation of their genotypic organization since such avirulent strains may be important in conferring natural protection against invasive disease. We found that after mass antibiotic prophylaxis, recolonization occurs preferentially with non-pathogenic meningococcal strains. This as implications for assessment of the benefits of mass antibiotic and vaccination programmes for outbreak control. Previously expressed concerns of increased risk due to removal of protective ora may have been overstated.

Bacterial Capsules↗

PubMed2000

Variation in rates of electroconvulsive therapy use among consultant teams in Edinburgh (1993-1996).

BACKGROUND: Critics of electroconvulsive therapy (ECT) have expressed concern about variations in ECT use among consultant teams within the same hospital. The aim was to establish whether or not there was a significant variation in rates of ECT use among consultant teams in the same hospital when in-patient workload was taken into account. METHODS: A computerised database was used to calculate annual and aggregate rates of ECT use by consultant team, expressed as the number of individual in-patients treated per 100 in-patients discharged between 1993 and 1996. RESULTS: The variation in aggregate rates of ECT use varied approximately 18-fold among the 11 general adult psychiatric teams (P<0.001), and twofold among the three sector old-age psychiatric teams (P<0.05). CONCLUSIONS: Substantial variation in the rates of ECT use was confirmed, but only among general adult psychiatric teams. LIMITATIONS: The extent to which findings from one teaching hospital can be generalised was unknown. Possible explanations of the variations were not assessed.

Adult↗

PubMed2003

Type 1 growth factor receptor expression in node positive breast cancer: adverse prognostic significance of c-erbB-4.

BACKGROUND: There is a clear need to define biological markers that will predict the response to treatment in breast cancer, and several recent studies suggest that the expression of type 1 growth factor receptors may prove important in this regard. The type 1 growth factor receptors are a family of transmembrane receptors comprising epidermal growth factor receptor (EGFR), c-erbB-2, c-erbB-3, and c-erbB-4. Both EGFR and c-erbB-2 are associated with poor prognosis in certain tumours. AIMS: There is very little information concerning expression patterns of the full range of type 1 growth factor receptors, especially with respect to c-erbB-3 and c-erbB-4. Therefore, this study was designed to compare the expression of each, and to assess whether expression of any of the factors was related to patient survival in a clinical series. METHODS: Type 1 growth factor receptor expression was investigated by means of immunohistochemistry in a series of node positive patients with breast cancer (n = 66), and statistical analysis was carried out to determine associations between variables and survival analysis for each variable. RESULTS: There were several correlations between variables, and overexpression of EGFR, c-erbB-2, and c-erbB-4 was found to be associated with adverse clinical outcome, although the results were significant only for c-erbB-4 (p = 0.002). CONCLUSION: Although patient numbers are small, this is the first report describing c-erbB-4 as an adverse prognostic marker. These findings are in contrast to previous investigations and may relate to the fact that the patients studied all had advanced stage disease and had undergone similar chemotherapy regimens in the context of a clinical trial.

Biomarkers, Tumor↗

PubMed2004

Public attitudes towards the use of primary care patient record data in medical research without consent: a qualitative study.

OBJECTIVES: Recent legislative changes within the United Kingdom have stimulated professional debate about access to patient data within research. However, there is currently little awareness of public views about such research. The authors sought to explore attitudes of the public, and their lay representatives, towards the use of primary care medical record data for research when patient consent was not being sought. METHODS: 49 members of the public and four non-medical members of local community health councils in South Wales, UK gave their views on the value and acceptability of three current research scenarios, each describing access to data without patient consent. RESULTS: Among focus group participants, awareness of research in primary care was low, and the appropriateness of general practitioners as researchers was questioned. There was general support for research but also concerns expressed about data collection without consent. These included lack of respect and patient control over the process. Unauthorised access to data by external agencies was a common fear. Current data collection practices, including population based disease registers elicited much anxiety. The key informants were equally critical of the scenarios and generally less accepting. CONCLUSIONS: This exploratory study has highlighted a number of areas of public concern when medical records are accessed for research without patient consent. Public acceptability regarding the use of medical records in research cannot simply be assumed. Further work is required to determine how widespread such views are and to inform those advising on confidentiality issues.

Access to Information↗

PubMed1997

Fertility therapy and the risk of very low birth weight.

OBJECTIVE: To test the hypothesis of an association between maternal infertility therapy and the risk of very low birth weight (VLBW), defined as birth weight less than 1500 g, independent of the risk of multiple births, and to estimate the contribution of infertility therapy to the national incidence of VLBW. METHODS: The National Maternal and Infant Health Survey conducted in 1988 was used to develop statistics describing outcomes among this birth cohort and to construct logistic regression models evaluating fertility therapy as an independent risk factor for VLBW. RESULTS: An estimated 10.1% of live births and 18.2% of VLBW births nationally were associated with either maternal subfertility or infertility therapy (6.8% and 11.4%, respectively). The risk of VLBW among women concerned with subfertility (i.e., receiving diagnostic testing or advice on timing intercourse) was 1.4 (95% confidence interval [CI] 1.1, 1.9), whereas that for women undergoing therapeutic interventions (ie, ovarian stimulation, surgery, in vitro fertilization, or artificial insemination) was 2.6 (95% CI 2.1, 3.2). Accounting for effects of multiple gestation, maternal age, and a history of miscarriage, the odds ratios for the concerned and therapy groups were 1.5 (95% CI 1.1, 1.9) and 2.0 (95% CI 1.5, 2.5), respectively. Black women were less likely to use fertility therapy but more likely to experience a therapy-related VLBW. CONCLUSION: Fertility therapy is associated with an important portion of all VLBW and with an elevated risk of VLBW, related only in part to an increased risk of multiple gestations. Women expressing concern about subfertility but not receiving therapy are also at increased risk of VLBW, suggesting that a history of infertility may mediate part of the risk associated with fertility therapy.

Adult↗

PubMed2002

Distance learning project--information skills training: supporting flexible trainees in psychiatry.

This one-year project was designed to investigate the skills training needs of a group of 12 specialist registrars in psychiatry working as flexible trainees (part time) in the NHS. They had expressed concerns about their lack of information technology skills at training assessment seminars. A part-time project officer, was appointed to support the group giving information skills training to each flexible trainee on an individual basis, through a series of home visits. The project officer worked under the supervision of the London Library & Information Development Unit (LLIDU) from a home base, to identify with the insular feelings expressed by the project group. Project funding purchased a laptop computer with modem and a printer for each participant to use during the project. The training covered: basic search skills and developing search strategy techniques using quality filters particularly in relation to the MEDLINE database; how to search the Cochrane Library and PubMed and exploiting Internet information resources. The group asked for help with word processing and presentation software use. These needs were met in a series of half-day workshops. Experience and insight gained during the project will feed into future planning of information skills training for larger numbers of flexible trainees.

Education, Distance↗

PubMedDate not supplied

Mood disorders in the female patient.

Disruptive changes in mood and low energy level are among the most common reasons women consult a physician. Usually no clear physiological explantation for these changes can be found. Many physicians feel uncomfortable dealing with patients with these complaints. The purpose of this paper is to discuss a practical approach to helping women with such conditions. A variety of terms have been utilized to refer to the situation in which a female patient has decreased energy or labile mood. Premenstrual Syndrome (PMS) and chronic fatigue syndrome (CFS) are currently popular terms. An association of low mood with menstrual cycle phase is undoubted, with the late luteal-early premenstrual phase most commonly associated with depression and irritability. It seems likely that women with PMS and those without it do not differ in circulating hormone levels during their cycles but rather in the brain response to these. Estrogen and progesterone receptors exist in the brain and change during the cycle. Elaborate diagnostic efforts are rarely rewarding in managing mood and energy disorders. Of more value is a careful history particularly concerned with the pattern of mood changes and with life stresses, accompanied by a thorough physical examination and laboratory tests. In most cases, changes in mood and energy are a variant of clinical depression. Changes in energy and sleep may be more evident than low affect. Treatment with an appropriate antidepressant, usually a selective serotonin re-uptake inhibitor (SSRI), benefits most of these patients. Allowing the patient to express concerns about stressful life situations is often of great value.

Female↗

PubMedDate not supplied

Left-handed surgeons: are they left out?

BACKGROUND: Left-handedness has been considered a simple inconvenience by some or something as convoluted as "the sinister," the Latin word for the left, by others. One in ten medical personnel is left-handed. The perceptions of left-handed surgeons regarding their laterality related inconveniences are unknown. OBJECTIVES: To determine the perceptions of left-handed surgeons and the way it has affected their surgical training and career. DESIGN AND SETTING: Web-based survey of left-handed surgeons. PARTICIPANTS: Left-handed surgeons in 2 boroughs of New York City, Manhattan and Brooklyn. METHODS: Distribution and completion of the survey. MAIN OUTCOME MEASURE: Career-oriented concerns of left-handed surgeons. RESULTS: Three percent of left-handed surgeons received laterality related mentoring during medical school. Ten percent of the programs mentored left-handed surgical residents, and 13% of the programs provided left-handed instruments during surgical residency. Laparoscopy and laparoscopic instruments did not eliminate the problems associated with instrument handling to left-handed surgeons. Ten percent of the left-handed surgeons expressed concerns when asked whether they would be comfortable being treated by another left-handed surgeon when they are the patients themselves. CONCLUSIONS: This study reveals the perceptions of left-handed surgeons in adapting to a right-handed world. Early laterality related mentoring in medical school and during surgical residency with provision of left-handed instruments might reduce the inconveniences of left-handed surgeons learning.

Attitude of Health Personnel↗

PubMed2006

In whose best interests? Nurses' experiences of the administration of sedation in general medical wards in England: an application of the critical incident technique.

BACKGROUND: Despite concern expressed in recent government documents in the UK about the inappropriate use of sedation when a patient is agitated or confused and cannot consent, there is little nursing literature on the topic. The general legal and ethical principles apply that a patient who is unable to consent should be given care that is in his or her 'best interests'. AIM: The aim of this paper is to report on qualitative data concerning nurses' use of sedation which were obtained as part of a larger study to explore the way in which nurses obtain consent prior to nursing care procedures. METHOD: A purposive sample of 30 qualified nurses in two teaching hospitals in England was obtained. One hundred critical incidents were collected through 30 in-depth interviews as a means of focusing on specific incidents concerning informed consent prior to nursing care procedures in clinical practice. FINDINGS: The administration of sedation to patients who cannot consent was a major theme to emerge. Sedation was sometimes given in the interests of other patients or staff rather than the patient and before alternative strategies had been considered. Nurses were uneasy about the use of sedation in such circumstances, and lacked knowledge as to when it may be appropriate to do so. CONCLUSIONS: Nurses need to be familiar with the relevant ethical and legal principles and professional guidance in their own countries for caring for people who cannot consent, and need to be confident in their understanding and application of these principles to ensure that sedation is administered appropriately.

Aggression↗

PubMed2006

Reproductive concerns of women treated with radical trachelectomy for cervical cancer.

OBJECTIVE: To report the reproductive concerns of women treated for stage I cervical cancer with fertility-preserving surgery. MATERIALS AND METHODS: Newly diagnosed cervical cancer patients undergoing radical trachelectomy were enrolled in this study preoperatively and assessed over time. Preliminary data from the preoperative analysis and 3-month and 6-month assessment points addressing reproductive concerns are presented. RESULTS: Between February 2004 and June 2006, 29 patients were enrolled in the study. Three patients were excluded because they did not undergo the planned surgery and 6 patients were excluded because they required adjuvant therapy. Future childbearing was the main reason most women chose to undergo the procedure; however, treatment choice was also guided by conversations with their doctors (41%, n=12). Twenty-six (90%) initially expressed concern over future conception and childbearing, but this increased to all patients by 6 months. At enrollment, the majority of the patients had high expectations for future conception and childbearing but this declined over time. Despite this, patients' distress gradually decreased over time. CONCLUSIONS: Our results show that many women who have undergone a radical trachelectomy present with distress and reproductive concerns that persist for up to 6 months postoperatively. Concerns about conception appear to decrease following surgery; however, concerns about pregnancy appear to increase post trachelectomy itself. This pilot study reflects the first preliminary data from an active ongoing study prospectively collecting information over 2 years from newly diagnosed stage I cervical cancer patients undergoing radical trachelectomy.

Adolescent↗

PubMed1993

Concern for dental appearance among young adults in a region with non-specialist orthodontic treatment.

With limited orthodontic manpower in an area, treatment resources may be allocated to deal with a restricted number of patients, e.g. those with the most severe malocclusions, or to treat a greater number of patients by letting the specialist supervised treatment delivered by non-specialists. The purpose of the present study was to examine orthodontic concern among young adults in a region where orthodontic treatment was mainly delivered by non-specialists. The material comprised 100 individuals born in 1971 and 1972 (mean age 18.0 years) who were consecutively examined and interviewed during their annual routine dental visits. Forty subjects (19 females, 21 males) had previous orthodontic treatment. In all but four individuals treatment was delivered by general dental practitioners. Impressions for dental study casts and standardized photographs (Polaroids) were taken. The individual's occlusion was classified according to two methods: the Need for Orthodontic Treatment Index (NOTI) and Anterior Occlusal Traits (AOT). Interviews concerning the subjects' perception of their occlusion were performed with the use of questionnaires. From the answers a composite measure representing orthodontic concern was constructed. Awareness of their own dental arrangement was assessed by comparing the respondents' reports with occlusal recordings from the study casts, and by a photo-identification test. Frequencies of NOTI and AOT scores demonstrated that more than 50 per cent of the treated individuals were still assessed to be in need of treatment and exhibited deviations in the anterior region. Furthermore, 30 per cent of the treated subjects expressed concern about their occlusal appearance, and dissatisfaction was generally based on a realistic perception of their own dental appearance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1998

Results of the 1997 survey of the American Association of Academic Chief Residents in Radiology.

RATIONALE AND OBJECTIVES: The American Association of Academic Chief Residents in Radiology annually surveys residency programs on a variety of issues related to residency training. The survey results allow individual programs to compare features of their programs with national averages and to gauge trends in radiology residency training. MATERIALS AND METHODS: Questionnaires were mailed to the chief residents in 180 accredited radiology residency programs in the United States. A variety of demographic and common-interest questions were asked. The 1997 survey focused on American Board of Radiology (ABR) examination preparation, residency curriculum, and socioeconomic issues relevant to graduating radiology residents. RESULTS: Completed surveys from 73 programs (41%) were returned. Areas of curriculum concern among chief residents reflected primarily current turf issues. A higher than expected percentage of residents considered their training to be inadequate in nonneurologic magnetic resonance imaging and chest, musculoskeletal, and genitourinary radiology. Job security is a major emerging concern for radiology residents who are considering careers in private practice. The practice of remembering and transcribing questions from the ABR written examination is common, and these questions are a valued resource in preparing for the diagnostic section of the written examination. Most residents attend a commercial review course before the oral examination, and the majority of programs also provide internal review courses. CONCLUSION: A higher than expected percentage of chief residents expressed concern regarding training in subspecialties of radiology that are neither areas of turf dispute nor areas where certificate of additional qualification examinations are offered. Radiology programs and residents expend substantial resources on preparation for the ABR examinations in addition to the usual 4-year curriculum. The most valued resource for the diagnostic section of the examination is almost certainly not equally available. Radiology residents are increasingly concerned about future job security.

Attitude of Health Personnel↗

PubMed1991

Personality characteristics of a community sample of adolescents with conduct disorders.

The Millon Adolescent Personality Inventory (MAPI) was used to compare the personality styles, expressed concerns, and behavioral correlates of a community sample of conduct-disordered (n = 13) and non-conduct-disordered (n = 137) adolescents. Structured interviews with adolescents and parents were used to classify subjects using DSM-III criteria. Significant differences were found between groups. Conduct-disordered youth reported being very critical, harsh, and not respectful of others. They tended to seek out the unpredictable and to be moody and pessimistic. They expressed a lack of confidence in school performance and dissatisfaction with family life. These results support the usefulness of self-report measurements with troubled adolescents in general, and the validity of the MAPI in particular. Implications for diagnosis and treatment are discussed.

Adaptation, Psychological↗

PubMed1987

Progress towards control of the acute respiratory viral diseases of childhood.

Many of the common respiratory illnesses of infancy and childhood are caused by viruses of the Paramyxoviridae family, in particular measles virus, respiratory syncytial (RS) virus and parainfluenzavirus type 3 (PI3). Effective measles vaccine was developed by classical methods, but these same methods have failed to provide vaccines to control RS and PI3 virus infections. The WHO Programme for Vaccine Development was initiated in 1983 to encourage the application of the new biotechnologies to continuing problems, such as the acute virus-induced respiratory diseases of childhood. At a meeting of research workers held in July 1986 under the auspices of this programme, renewed optimism was expressed concerning the prospects for immunoprophylaxis of RS virus-induced disease. Animal models are now available for evaluation of the immunogenic potential of candidate vaccines. Vaccinia/RS recombinant viruses have been produced which have allowed the immunogenic properties of individual RS virus proteins to be defined. Complete protection without the exacerbation of disease, which earlier had accompanied the use of formalin-inactivated vaccines, has been achieved in animals immunized with vaccinia virus recombinants expressing the F protein; partial protection was obtained using G protein gene vectors. PI3 appears to be an inherently stable virus and evidence from animal experiments suggests that bovine PI3 might be suitable for use as a live vaccine in man.

Acute Disease↗