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Surgical gastrostomy has been a widely accepted method for introducing a percutaneous feeding tube for many years. However, complications are frequent, and many children who need them are not good surgical candidates. This study examines imaging guided percutaneous placement of feeding gastrostomy catheters as a safe and effective alternative to surgery.
The factors that contribute to continued use of contraception are examined through a multivariate analysis of data gathered in the course of the Philippine 1974 National Acceptor Survey. Twenty-five independent variables were utilized in the analysis, of which only three were found to have an appreciable effect upon continuation: the method accepted, age, and husband's attitude regarding family planning. When the sample was divided into method subgroups, several features of the service process explained variance in pill continuation, and fecundability explained variance in rhythm continuation. The findings suggest that there is considerable potential for improving the effectiveness of the Philippine program through administrative action. Better IUD services and information, more emphasis on the needs of husbands, and improvements in the ongoing support of pill users could substantially improve the amount of contraceptive protection offered by the program.
A method is described for the determination of cardiac volume with the subject in a sitting position. The results correspond with those of other accepted methods, but there are several significant advantages: 1. The position is easily maintained by the subject and the method is therefore acceptable for patients with cardiac disease. 2. The risks connected with a Valsalva effect are reduced. 3. There is no need to change the position of the x-ray tube during the examination. 4. Contrary to the traditional technique, the x-ray room does not require a very high ceiling. 5. Because of even blood distribution, the cardiac volume determinations also provide information regarding the lungs.
A modification is described for the method of ultramicroelectrophoretic fractioning of proteins in polyacrylamide gel in capillaries 400--100 microns in diameter. The original construction of the assembly of apparatuses is offered which can be assembled from details made in the USSR. The operation of dosed filling of capillaries is significantly facilitated. The optimal quantity of protein in one sample reaches 1.5--0.1 mkg (depending on the capillary diameter). The reproducability and sharpness of protein fractions by the offered method are not worse compared with the generally accepted method of macro-disc electrophoresis.
This study compared the accuracy of two accepted methods of inserting lag screws. The ability of the two techniques to produce concentrically drilled holes between the inner and outer cortices, the ability to accurately overdrill a small hole, and the displacement of the cortices following application and tightening of the lag screw were investigated using an experimental model of bony cortices. The results indicate that when the gap between the cortices is large, both methods of lag screw insertion are equally inaccurate. For smaller gaps between the cortices, the drill guide technique is more accurate than the other.
A strictly controlled field trial was designed to assess the value of an iodophorpost-milking teat disinfectant in the prevention of new mastitis infections in a 132 cow herd. The disinfectant was applied by a hand spray, a method acceptable, effective, and less costly than conventional teat dipping methods. Only the left side of the udder was treated, the right quarters acting as controls. Dry-cow therapy and other methods of mastitis control were already practised, and no change in routine was introduced apart from half-udder teat spraying. Fifty-eight new cases of mastitis were found to occur on the teat-sprayed side, compared with 91 in the untreated quarters; 35 and 23, respectively, were clinical. No Group B streptococci existed in the herd, and the principal reductions were in Group C streptococci and coagulase-negative staphylococci, the percentages of which were halved. The percentage of coliform infections on the teat-sprayed side was, in contrast, doubled. The incidence of new clinical and subclinical disease without infection was in reverse ratio to that of infections, being 29-9 per cent higher in the quarters which were teat-sprayed. Analysis of cumulative CMT reactions from regular monthly surveys indicated that exponential cell-count values on each side of the udder were identical. Thus, while new infections were significantly reduced, overall cell counts were not, and there is clearly a need for further research into factors other than bacteria which may initiate teat damage and inflammatory changes in the udder.
This report reviews animal and human studies undertaken to develop simpler, safer, and more acceptable methods of female sterilization. Animal studies revealed inadequate prevention of pregnancy by tubocclusive methods from within the uterus, and the laparoscopic route was chosen. A series of clips were evaluated, and a clip was designed which would have a spring load, be wide enough to cause true tissue necrosis, have a firm grip on the tube to prevent dislodgement, and have a smooth external surface. Extensive human trials of the clip and applicator have resulted in over 1,000 patients with clips applied by 27 physicians in 10 centers throughout the world. Six pregnancies appear to have been due so far to application onto structures other than the isthmic portion of the tube. Complications due to the clip itself appear to be minimal, and the feasibility of performing this operation under local anesthesia in a hospital facility other than the operating room is currently under evaluation.
Research is reported concerning an acceptable method for sampling and analyzing samples for carbon disulfide. Test atmospheres of carbon disulfide were generated dynamically using the syringe injection method, ant the theoretical concetnration verified by a liquid absorbent, colorimetric method. The CS2 was adsorbed on charcoal tubes, eluted with benzene, and quantitated with a gas chromatography equipped with a sulfer flame photometric detector. The results compared with the colorimetris analysis. The sensitivity of this method is 1 mug on a charcoal tube. The charcoal tubes were also tested for breakthrough volumes, holding power vs time, and the effect of air transport and temperature cycles.
The purpose of this paper is to show that the currently accepted methods for the determination of implant stability are unpredictable. It describes those techniques that are currently utilized for the assessment of implant success and discusses the problems they present. The paper will propose the Periotest method as a reliable and reproducible alternative to the methods currently available to the clinician for determining implant stability.
OBJECTIVES: Diagnostic disclosure is a key therapeutic moment in Functional Neurological Disorder (FND). This systematic review aimed to evaluate quantitative evidence on diagnostic acceptance, understanding, satisfaction, symptom outcomes, and healthcare utilisation following diagnostic disclosure in FND, and to conduct a meta-analysis of diagnostic acceptance. METHODS: Systematic searches of PubMed, Scopus, PsycINFO, and Web of Science identified quantitative studies in adults with FND. Screening followed predefined inclusion criteria. Data were extracted using a structured template and risk of bias was assessed using the Newcastle-Ottawa Scale. A random-effects meta-analysis of proportions was conducted using the Freeman-Tukey transformation. RESULTS: Fifteen studies were included, four of which contributed to the meta-analysis (n = 481). Reported diagnostic acceptance rates ranged from 38.7% to 90%, although the timing and method of assessment varied across studies. Pooled acceptance was 0.68 (95% CI 0.44-0.88), with substantial heterogeneity. Structured or reinforced communication was frequently associated with improved understanding and satisfaction, although its superiority for diagnostic acceptance was not established. In some studies, diagnostic acceptance was associated with more favourable clinical outcomes, although findings were inconsistent. Some studies reported reductions in healthcare utilisation or costs following satisfactory diagnostic explanation, whereas others found no sustained overall reduction. CONCLUSIONS: Diagnostic communication in FND is associated with differences in acceptance, understanding, and downstream clinical and healthcare outcomes. Approximately two-thirds of patients were reported as accepting the diagnosis following disclosure, although the timing and method of assessment varied substantially across studies. Empathic and evidence-informed communication may enhance understanding and engagement, although its effects on healthcare use and recovery remain uncertain. PRACTICE IMPLICATIONS: Diagnostic disclosure should be delivered clearly, empathically, and with reinforcement over time. Written information, reputable educational resources, and opportunities for follow-up clarification may support patient understanding and engagement, although stronger comparative evidence is needed.
In order to reduce the racial disparities in cancer death rates, prevention programs designed for minorities must concentrate on the cancer sites and intervention methods which offer the greatest promise for closing the mortality gap. Generally accepted methods to achieve these results were recently published by the U.S. Preventive Services Task Force. Effective intervention recommendations will be increased when researchers understand the cultural differences of minorities, communicate clearly, collaborate with other programs, and treat the program participants with respect.
The surveys of the College of American Pathologists indicate a consistent bias between the manual "reference" method for hemoglobin determinations and the Coulter S measurements. The Coulter S hemoglobin values are invariably lower; the difference averages 0.3 g/dl. The commonly used calibration methods for the Coulter appear to be subobtimal. The hemoglobin calibration and quality assurance method proposed by Bull and colleagues is advocated as the presently most acceptable method. Commercial hemoglobin control materials should not be used for hemoglobin calibration.
This chapter has reported the findings of acceptability of prostaglandin pessaries compared with vacuum aspiration as methods for inducing abortion in a very early stage of pregnancy. Acceptability has been defined by the WHO as the degree with which a treatment method has attributes that make it perceived by a user or potential user to be consonant with his or her own sense of well-being and therefore will be used or preferred. The acceptability of the medical and surgical procedures for inducing abortion was studied in Swedish abortion patients using a pre- and post-abortion design for obtaining observations. Methods used included interview schedules, questionnaires, rating scales and attitude measuring techniques. Patients consenting to take part in the acceptability study had agreed to be randomly assigned to prostaglandin treatment, given at the clinic or self-administered by the patient at home, or to vacuum aspiration. A high degree of acceptability for the prostaglandin treatment was obtained in this group of patients who had applied for an abortion very soon after one missed menstrual period. This was indicated from the finding that the very high preference for this procedure remained unchanged in the group randomly assigned to it. Other measures of attitudes to prostaglandin treatment also indicated the unchanged positive attitude. There was a significant change in the attitude to vacuum aspiration among those assigned to this treatment, indicating that post-abortion it was more acceptable to these patients. However, 30% of them would still prefer the prostaglandin treatment, especially self-administered, in the event of another abortion. There were consistent and significant relationships found between the degree of negative emotional arousal before and after abortion and preference for the medical or surgical procedure and also the amount of complaints after abortion. Those patients who pre-abortion had preferred the self-administered procedure were, regardless of which treatment they had been assigned to, those who were least emotionally upset both before and after the treatment and also complained the least. This chapter also reported on findings of how acceptable the medical and surgical procedures can be inferred to be from comparisons of preferences and attitude measures obtained from abortion patients before treatment and from women in the same age group (who would not exclude an abortion if pregnant) in samples from outside the clinical setting. In the non-patient groups about half the subjects would prefer the medical alternative.(ABSTRACT TRUNCATED AT 400 WORDS)
The use of varicocelectomy for the treatment of subfertility seems to be incontrovertible. However, there is a difference of opinion as to the proper surgical method of varicocele ablation. The inguinal and high retroperitoneal approaches are the most commonly accepted methods to date. However, significant postoperative morbidity is common and return to normal activity often is prolonged. Also, bilateral operations are being performed more commonly. These considerations have prompted many to search for alternative techniques. We developed a laparoscopic procedure that is as simple and effective as more traditional methods. In addition, it offers lower morbidity, allows for microscopic dissection with preservation of the spermatic artery and is amenable to bilateral ligation without a second incision. Ten patients 16 to 54 years old underwent laparoscopic ligation of the spermatic veins at the internal inguinal ring. The diagnosis was based on physical examination. Indications for the operation were infertility with a stress sperm pattern in 5 patients, testicular atrophy in 4 and scrotal pain in 1. Four patients underwent bilateral ligation. Preliminary followup showed resolution of the varicocele in all patients and disappearance of pain in the patient treated for this symptom. No morbidity related to this procedure has been encountered and all patients resumed normal activity within 2 days. We believe that this new method is a viable alternative for varicocelectomy.
Pulsimetry proved to be the most acceptable method for estimating energy requirements of miners working under extreme conditions with constantly changing ergometric parameters. It has been established that the mean daily energy requirements of miners working in deep coal mines under conditions of high temperature comprise 3500 kcal. Energy requirements for the main types of the physical activity of workers in deep mines have been calculated, basing on basal metabolism, metabolic constants for varying activities have been determined.
The many treatment methods in current use for every known complaint only seem to aggravate the difficulty of treating ocular herpes simplex virus (HSV) infections, which are generally self-limited in the immunocompetent host. The cornea is already a somewhat immune-deficient tissue since its lack of blood vessels separates it partially from the host, and treatment with glucocorticoids, which are immunosuppressive, increases the risk of damaging complications such as scarring, prolonged morbidity, bacterial or fungal superinfection, and the occasional corenal perforation. Accepted methods of treatment of specific lesions, are discussed, as are some methods that are not yet accepted, but which seem promising. Herpes zoster may result in scarring and significant loss of vision even without the use of glucocorticoids, the disease often manifesting itself in the already compromised host. The major complication is postherpetic neuralgia. None of the available treatment methods has been fully satisfactory, and every effort should be made to prevent eye lesions in patients with early infection of the ophthalmic branch of the trigeminal nerve. Stimulation of cellular immunity by various means appears to offer some new promise for control of the disease. Management of varicella, cytomegalovirus, and infectious mononucleosis are also discussed.
Injuries to the portal vein are associated with a high mortality because of a high incidence of concomitant injury to surrounding structures and refractory shock. Repair of the portal vein injury is often difficult or impossible because of massive hemorrhage. The key to successful management of a portal vein injury is rapid blood volume resuscitation and obtaining rapid and adequate exposure. The optimal exposure for repair consists of reflection of the hepatic flexure of the colon with mobilization of the root of the mesentery, pancreas, and duodenum. Lateral venorrhaphy is the preferred method of management, but in hemodynamically unstable patients, ligation of the portal vein is an acceptable method of treatment.
Multiplex polymerase chain reaction (PCR) and gene probe detection of target lacZ and uidA genes were used to detect total coliform bacteria and Escherichia coli, respectively, for determining water quality. In tests of environmental water samples, the lacZ PCR method gave results statistically equivalent to those of the plate count and defined substrate methods accepted by the U.S. Environmental Protection Agency for water quality monitoring and the uidA PCR method was more sensitive than 4-methylumbelliferyl-beta-D-glucuronide-based defined substrate tests for specific detection of E. coli.