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PubMed2006

Recent advances in external genitalia.

In the last decade, significant progress in the knowledge and management of external genital anomalies has been achieved, including an improved understanding of epidemiology and pathophysiology of these anomalies, the identification of etiologic genetic defects, and significant improvements in surgical approaches that have decreased complications and improved cosmetic outcomes. We highlight the most clinically important advances of the commonly encountered external genital anomalies.

Bladder Exstrophy↗

PubMed2003

Assessment of veterinary needs of ruminant livestock owners in Ghana.

We assessed the needs of ruminant-livestock owners in three districts in Ghana for veterinary services, the acceptability of particular services or activities and the willingness of people to use services through public or private delivery systems. Purposive sampling was used in choosing 516, 100 and 100 ruminant-livestock owners in East Mamprusi, Savelugu-Nanton and Tamale districts, respectively, for the administration of a questionnaire. The response proportions were 87-99%. Focus-group discussions (FGDs) were done in Savelugu-Nanton and Tamale districts. Animal diseases, housing, and lack of knowledge on management practices were identified as the three most important problems in the districts. Generally, accessibility to veterinary services and drugs was not easy. Large proportions of respondents identified advice on health, bathing or spraying against ectoparasites, castration, deworming, treatment involving injectables, sale of medicines or drugs, treatment for skin diseases, vaccinations, and treatment of wounds as activities that they needed. Many used veterinary staff to meet their needs and were willing to use the services of private veterinary providers if private clinics were established in their localities.

Animals↗

PubMed2004

[MALT gastric lymphomas].

INTRODUCTION: The stomach is the most common site involved in primary gastrointestinal lymphoma. Gastric lymphoma originates from the mucosa-associated lymphoïd tissue so called MALT. It comprises a group of distinctive clinicopathological entities which are important to consider for clinical management. CURRENT KNOWLEDGE AND KEY POINTS: In recent years, new diagnostic tools and new treatment strategies have improved the overall prognosis. One of the most exciting recent discoveries is the hypothesis that an infection by a bacterium, Helicobacter pylori has a decisive role in gastric lymphoma. FUTURE PROSPECTS AND PROJECTS: Recent advances, essentially due to molecular biology and cytogenetic studies may emerge with the understanding of pathogenesis and new prognostic factors of these different types of gastric lymphomas. It is the aim of our oncoming studies together with the evaluation of the new therapeutic options such as radiotherapy and monoclonal antibodies in prospective studies.

Diagnosis, Differential↗

PubMed2003

Mucosa-associated lymphoid tissue lymphoma of the thymus resected using combined thoracoscopic and transcervical approaches.

Mucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade variant of B cell lymphoma that arises in extranodal tissue of the gastrointestinal tract, lung, salivary gland, thyroid, or other organ derived from the foregut. However, MALT lymphoma in the thymus is extremely rare. We report a case of thymic MALT lymphoma, extending to the neck, resected using combined thoracoscopic and transcervical approaches. To the best of our knowledge, thoracoscopic management of MALT lymphoma in the thymus has not previous been reported.

Biopsy, Needle↗

PubMed2002

On complexity, process ownership and organisational learning in manufacturing organisations, from an ergonomics perspective.

The paper discusses some characteristics and implications of the complexity approach as applied to manufacturing organisations and their supply chains. It then discusses the acquisition of process capability within organisations, one of the essential processes for maintaining the organisation's ability to compete in a complex environment. The paper then discusses the concept of the Process Owner, as a means of preserving and evolving the organisation's knowledge under such circumstances, and discusses the consequences of this role. Finally, the knowledge lifecycle management implications are discussed, since these are among the resources that a Process Owner will require to maintain the effectiveness of the role. Throughout the paper the point is made that complexity demands more of an organisation than technical excellence; technology alone will not overcome the effects of complexity and the organisation's people must be included in the response to its challenges.

Ergonomics↗

PubMed1993

Scaphoid fracture: a new method of assessment.

The value of colour flow Doppler ultrasound scanning in patients with suspected acute carpal scaphoid fracture has been examined. A prospective study of 78 patients with signs and symptoms of carpal scaphoid injury was undertaken over a period of 6 months. Both wrists of all patients were scanned within 12-72 h of injury. The radial artery and carpal scaphoid bone contours are visible using this type of imaging technique. The distance between the medial wall of the radial artery and the outer cortex of the scaphoid waist was measured. The scaphoid index is described and was calculated from this measurement. Patients were managed without knowledge of the ultrasound imaging result, using plain radiographs and clinical examination as the standard for determining the presence of a scaphoid fracture. All patients were followed to the resolution of symptoms. All 12 patients who were subsequently considered to have scaphoid fractures were identified using this imaging technique within 12-72 h after injury. We conclude that this imaging may be useful in the assessment of patients with carpal scaphoid fracture. It can be used early, as a supplementary investigation, in patients with suspected carpal scaphoid fracture in whom the initial plain radiographs are normal.

Adolescent↗

PubMedDate not supplied

The psychiatric perspectives of epilepsy.

Psychiatric conditions occur frequently in epilepsy, and their manifestations are diverse. Evaluation and management require knowledge of disease processes relevant to epilepsy and to psychiatry, as well as the role of other factors that affect the expression of psychiatric illnesses: behaviors, temperament, cognition, and life events. This article describes a comprehensive approach for addressing psychiatric issues in epilepsy patients.

Anticonvulsants↗

PubMed2002

Setting information priorities for remediation decisions at a contaminated-groundwater site.

Many sites of contamination due to inappropriate disposal of hazardous materials or wastes have been found. These sites have the potential of damaging the environment and human health and thus need to be evaluated as to whether and what actions should be initiated. In the decision on whether a contaminated site should be subject to management, the knowledge concerning important parameters that would influence the decision will be beneficial to planning of data collection to support the decision. This paper presents a case study of contaminated site located in northern Taiwan, where the groundwater is contaminated by chlorinated hydrocarbons including trichloroethylene (TCE) and tetrachloroethylene (PCE). A site-specific multimedia risk assessment is performed to estimate the total risk resulting from the contamination. In addition, Monte Carlo simulation, rank correlation coefficients, and decision criteria are combined to develop a methodology for assessing the important of parameters in terms of their influence on the decision. It is found that TCE concentration, vegetable yield, deposition interception fraction of vegetables, and plant surface loss constant, are the four parameters important to the decision-making of the case problem.

Algorithms↗

PubMed2001

Patterns of adherence to diabetes vision care guidelines: baseline findings from the Diabetic Retinopathy Awareness Program.

OBJECTIVES: (1) To describe baseline patterns of adherence to American Diabetes Association and American Academy of Ophthalmology vision care guidelines for diabetes in the Diabetic Retinopathy Awareness Program, and (2) to evaluate factors associated with nonadherence. This paper describes the baseline characteristics of a population enrolled in a prospective, randomized clinical trial. DESIGN: Cross-sectional study. PARTICIPANTS: Between October 1993 and May 1994, the study identified 2308 persons with diabetes, 18 years of age or older, who were residents of Suffolk County, New York, via a multimedia community-wide recruitment campaign. INTERVENTION AND METHODS: Eligibility for the trial was determined during a 20-minute phone interview, which included questions about vision care practices; diabetes management; and knowledge, attitudes, and beliefs about diabetes, vision, and diabetic retinopathy. This paper describes these patient characteristics at baseline. Eligible patients would be randomized subsequently to a 2-year diabetes educational intervention arm, which included mailed packets and newsletters focused on vision care, or to a control nonintervention arm. MAIN OUTCOME MEASURE: Nonadherence to guidelines at baseline was defined as the absence of a dilated eye examination during the year before recruitment into the study. RESULTS: Of the 2308 persons interviewed, 813 (35%) did not follow the vision care guidelines; two thirds of this group reported no eye examination in the year before the interview, and one third had an undilated examination. Ophthalmologists performed 49% of the examinations in the nonadherent group, versus 86% in the adherent group. In logistic regression analyses, factors related to nonadherence were: younger age (odds ratio [OR] = 0.97), type 2 diabetes with or without insulin use (OR = 1.62 and 1.99, respectively), shorter diabetes duration (OR = 0.97), last eye examination performed by an optometrist (OR = 5.32) or other nonophthalmologist (OR = 4.29), less practical knowledge about diabetes (OR = 1.57), and no prior formal diabetes education (OR = 1.30). CONCLUSIONS: Within this population, more than one third of participants had not been following vision care guidelines. Nonadherence was linked to several potentially modifiable factors; changes in these factors could enhance the early detection of diabetic retinopathy.

Adolescent↗

PubMed1996

New antidepressant drugs and the treatment of depression in the medically ill patient.

The advent of the SSRIs, venlafaxine, bupropion, and nefazodone, has greatly expanded pharmacologic treatment options for the depressed medically ill patient. Although the relatively benign side effects of these medications on cardiac conduction and blood pressure allow for more liberal use in the medically ill, these drugs nevertheless have different capacities for adverse drug interactions that must be considered. Nevertheless, such interactions can usually be avoided or managed by knowledgeable clinicians cognizant of the pharmacodynamic and pharmacokinetic principles outlined in this article.

Adjustment Disorders↗

PubMed1999

Medical therapy. Management of the refractory patient.

Although relatively rare, GERD patients refractory to medical therapy remain a challenge for the clinician. Refractoriness can be diagnosed only if the patient is properly studied on medication and if what should be adequate medical therapy has been given a sufficient therapeutic trial. Use of 24-hour intragastric and intraesophageal pH-metry has improved the ability to manage patients who appear to be nonresponders. Simple advice and minor adjustments to medical therapy are usually all that is needed for most patients, but in some, management requires knowledge of the principles outlined in this article. If followed, only a small group of patients should be medically refractory.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMed2002

Achievements and goals of the EORTC Invasive Fungal Infections Group. European Organisation for Research and Treatment of Cancer.

Invasive fungal infections are an increasing complication for patients with cancer. These infections still are difficult to diagnose and to treat and thus still have a high fatality rate. New strategies should include evaluation of new diagnosis tools and large-scale assessment of these new methods will need multidisciplinary collaboration. High-quality clinical trials dedicated to establish 'state-of-the-art' prevention and treatment are also directly needed. Created in 1991, the EORTC Invasive Fungal Infection Group has faced several of these challenges and significantly improved the knowledge and management of these infections in Europe.

Antifungal Agents↗

PubMedDate not supplied

[Critical care nursing and continuous renal replacement techniques in the Madrid Community].

The continuous renal replacement techniques (CRRT) aim to substitute the altered renal function during a period of time, presenting advantages compared to conventional hemodialysis (CH). This study aims to determine the situation of the CRRT in the Intensive care units (ICU) of the Madrid Community (MC) using a survey distributed to nurses (n = 131) of 14 ICU. It evaluates four aspects of the CRRT: management model, knowledge, problems and degree of satisfaction. It identified four models, the most frequent is that in which ICU nurse and intensivist participate (60%). Self-evaluation of knowledge was fair in 55.7% of the cases and the mean of correct responses in an evaluation of 10 questions was 4.19 and 5.45 in those with previous courses. A total of 84.7% think that CRRT significantly increases the workloads and 62.6% believe that they should be done by the ICU nurses. The main problem is the lack of knowledge to resolve complications during the technique. We conclude that the ICU nursing can handle the CRRT, adapting the nurse/patient ratio; training programs should be established and the role of the teaching nurse defined in critical renal cares.

Critical Care↗

PubMed2000

Health and hygiene knowledge, attitudes and behaviour.

The aim of this study was to develop and test measures of health and hygiene knowledge, attitudes and behaviour. A questionnaire was administered to 240 women: 80 from a squatter camp, 80 from an informal settlement and 80 from a formal township. Reliability of the knowledge scale was 0.73. Coefficient alpha was 0.87 for the attitude and behaviour scales. The knowledge, attitude and behaviour scales were significantly related (P<0.001). Factor analysis confirmed that domestic and personal hygiene were core components of the attitude scale, whereas the emphasis for behaviour was on personal hygiene. Stepwise regression showed that age explained 23% of the variance in knowledge and 18% in behaviour. Waste management significantly affected knowledge, attitudes and behaviour, suggesting that dustbin ownership was an important public health measure. It was concluded that these scales were useful measures of health and hygiene knowledge, attitudes and behaviour; provided baseline information for planning health promotion programmes; and could be used to evaluate the effectiveness of such programmes.

Adult↗

PubMed2000

Clinical trials update: IMPROVEMENT-HF, COPERNICUS, MUSTIC, ASPECT-II, APRICOT and HEART.

Important new studies relevant to the field of heart failure reported at the annual congress of the European Society of Cardiology (ESC), held in Amsterdam in August 2000, are reviewed. The IMPROVEMENT of Heart Failure survey investigated the knowledge and perceptions of over 1300 primary care physicians from 14 ESC member nations and the actual practice in over 11000 of their patients. Guidelines and clinical practice were compared. The survey suggested, in this large sample, that the quality of care was higher than previous smaller surveys have suggested but have also identified important deficiencies in knowledge and management that should be rectified. The COPERNICUS study demonstrated that carvedilol was remarkably well tolerated even in patients with very severe heart failure and that treatment was associated with a substantial reduction in mortality even among patients that would conventionally not be considered, by many, for beta-blocker therapy. The MUSTIC trial suggested that cardiac resynchronisation using biventricular pacing improved patients symptomatically whether or not the patient was in atrial fibrillation. Morbidity and mortality studies of cardiac resynchronisation are now underway. The ASPECT-II and APRICOT-II studies investigated the role of warfarin, aspirin and their combination for the long-term management of myocardial infarction. One interpretation of the data from these studies is that the combination of aspirin and warfarin is about as effective as warfarin alone but with a much higher incidence of side effects. Warfarin alone appeared superior to aspirin alone. In summary, the annual congress of the ESC provided important new information for clinical practice and, to date, was, by far, the most important cardiology congress in the world this year.

Adrenergic beta-Antagonists↗

PubMed2004

Mechanisms of disease: roles of nitric oxide and endothelin-1 in delayed cerebral vasospasm produced by aneurysmal subarachnoid hemorrhage.

Molecular biologic investigations in the past decades have begun to unravel the intracellular mechanisms involved in vasomotor regulation of cerebral blood vessels and their failure in delayed cerebral vasospasm produced by aneurysmal subarachnoid hemorrhage. Progress in deciphering macrovascular regulatory mechanisms and their failure in delayed cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage have revealed that there are at least two important vasoactive substances-nitric oxide and endothelin-1-that play important roles in the clinical manifestations of subarachnoid-hemorrhage-induced cerebral vasospasm. Nitric oxide is a cell-membrane-permeable free radical gas that accounts for the phenomenon of vasodilatation by a variety of vasodilator agents. Endothelin-1, a 21 amino acid peptide, is one of the most potent constricting factors. Cerebral vasospasm is thought to represent a disturbance in the cerebral vasomotor equilibrium for which these two physiologically antagonistic compounds are at least partly responsible. Advances in our understanding of the molecular responses of the cerebral vasculature to subarachnoid hemorrhage should lead to more comprehensive management as knowledge becomes translated into development of effective pharmacologic agents to reverse or prevent cerebral vasospasm following aneurysmal subarachnoid hemorrhage.

Endothelin-1↗

PubMed2006

The challenges of Proteus syndrome: diagnosis and management.

Proteus syndrome (PS) is a disorder of patchy or mosaic postnatal overgrowth of unknown etiology. The onset of overgrowth typically occurs in infancy and can involve any tissue of the body. Commonly involved tissues include connective tissue and bone, skin, central nervous system, the eye, but it apparently can affect any tissue. Diagnosing of PS is difficult and the diagnostic criteria are controversial. Our group advocates stringent diagnostic criteria to facilitate research and appropriate clinical care. The benefit of strict criteria is that they define a clinical group that is reasonably homogenous with respect to manifestations and prognosis. The overgrowth of PS is progressive and can be difficult to manage. The progressive overgrowth most commonly causes severe orthopaedic complications, but it can cause many other complications. One of the most common complications in patients with PS is deep venous thrombosis and pulmonary embolism, which can cause premature death. Effective management requires knowledge of the wide array of manifestations and complications of the disorder and a team approach that includes the geneticist, surgeons, and other specialists.

Female↗

PubMed2000

Relative accuracy of the identification of ovarian structures in the cow by ultrasonography and palpation per rectum.

Manual palpation or ultrasonographic examination of the cow's genital tract are currently used by veterinarians involved in reproductive management, but knowledge of the potential and the limitations of both methods is important to obtain an optimal accuracy in the diagnosis of physiological and pathological ovarian structures. This review presents the main features of manual and ultrasonographic characteristics of follicles, corpora lutea (with or without a cavity), follicular and lutenized cysts and the reliability of the two methods is compared. Manual diagnosis of follicles <10 mm is rather inaccurate, but ultrasound offers the possibility to diagnose follicles <5 mm and to measure their inner diameter. The predictive values of the presence or absence of a corpus luteum as determined by palpation are similar (78 vs. 75%). Manual or ultrasonographic diagnosis of the growing or regressing corpus luteum is rather difficult. The positive predictive value of a mature corpus luteum diagnosed by ultrasonography is lower (87%) than the negative predictive value (92%). Compared to manual palpation, ultrasonography permits a better estimation of the number and to determine more precisely the size of the mature corpus luteum. The positive values for follicular cysts diagnosed by palpation or by ultrasonography are 66 and 74% respectively, and for luteal cysts, the values are 66 and 85%, respectively.Manual palpation or ultrasonography are useful tools to diagnose ovarian structures in the cow. The accuracy of such methods can be enhanced by securing information on the reproductive history of the animal, palpation of uterine horns, vaginal examination or progesterone determinations.

Animals↗