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PubMed1999

Who coordinates infection control programs in Australia?

BACKGROUND: Australian infection control practitioners (ICPs) have not been previously profiled. Knowledge of their practice is limited, making support and evaluation of their programs difficult. To investigate the current role, function, and attributes of this group, we undertook a national survey of members of the Australian Infection Control Association. METHODS: In 1996 a questionnaire was sent to all 1078 nonmedical and nonindustry members of the Australian Infection Control Association. More than half (65%) of the membership responded to the questionnaire, which measured demographics, experience, infection control training and education, staffing levels, perceived deficits, and managerial support. RESULTS: Our results indicate that the typical Australian ICP works in a public acute-care facility with fewer than 251 beds, has 6 years experience in the field, and has completed hospital-based nursing training. Surveillance was the activity that consumed most of the ICPs' time. The majority of ICPs had responsibilities in addition to infection control, and although they considered management to be supportive, additional clerical support was identified as an area for program improvement. CONCLUSIONS: We have provided the first comprehensive profile of Australian ICPs and their practices. Our findings compel professional associations, such as the Australian Infection Control Association, to address the following: standardization in practice and surveillance, provision of appropriate training and ongoing education, and encouragement of research initiatives by infection control staff. These strategies are the key to future evidence-based infection control and will ensure survival of this specialty in Australia.

Adult↗

PubMed2000

Oral hygiene, dentition, sexual habits and risk of oral cancer.

In an Italian case-control study of oral cancer, number of missing teeth and other aspects of dental care were similar, but the general condition of the mouth, as indicated by gum bleeding, tartar deposits and mucosal irritation, was worse among oral cancer cases than controls. No differences were detected in sexual practices (including oral sex) and (previous) sexually transmitted infections.

Adult↗

PubMed2000

Oncology patients' and oncology nurses' perceptions of nurse caring behaviours.

Previous research on patients' and nurses' perceptions of nurse caring behaviours has documented significant differences in the ranking of important behaviours. However, these samples have included a variety of medical-surgical patients and nurses and different types of institutional settings, all of which may have affected the results. The present study sought to determine if patients and nurses from one subspecialty area and one institution would have more concordant perceptions of caring. Forty-four oncology patients and 49 oncology nurses completed the Respondents Perceptions of Caring Behaviour Scale (RPCBS). Results showed that overall mean patient rankings were highly correlated with mean nurse rankings (Spearman's correlations coefficient 0.94, P<0.0001). The Wilcoxon two-sample rank sum test was used to test the difference in rank of the 20 items between the patients and nurses. There was a significant difference in rank in only six of the 20 items. These data suggest that oncology patients and nurses have more concordant perceptions of caring than previously investigated groups. Implications for practice and further research are discussed.

Journal Article↗

PubMed1985

[Sonographic diagnosis of severe fetal malformations].

The present paper reports on results of ultrasonographic examination in the identification of severe congenital malformations in the period between 1975 and 1982. The incidence of severe congenital malformations in relation to the total number of births during this period was 159 out of 11,372 (1.4%). In 144 cases with severe malformations at least one antenatal ultrasonographic examination had been performed. According to their topographic location, 42% of these were head/neural tube defects, 38% trunk/organ defects, only 2% were severe defects of the extremities and 18% were rare fetal malformations. As a result of previous ultrasonographic examinations at specialists' practices 60% of the cases were referred to the authors' clinic for further clarification with a correct diagnosis or a suspected fetal malformation. Of all the sonographically demonstrable structural defects of the fetus, 81% of all severe fetal defects seen at the authors' clinic during the period in question were identified correctly. If the observation period is divided into the years 1975 to 1979 and 1980 to 1982, there is a striking rate of increase in the number of antenatal ultrasonographic diagnoses which were correct, from 71% in the first period to 86% between 1980 and 1982. Most of the false-negative ultrasonographic findings were congenital cardiac abnormalities, since up to that point no special fetal echocardiographic examinations had been performed. In the entire period covered by the investigation there was only one false-positive finding ("Potter's syndrome"). Forty-six per cent of the ultrasonographically demonstrated severe fetal malformations were diagnosed before the end of the 24th week of pregnancy, and 54% after the end of the 24th week of pregnancy. Only in 60 out of 141 cases (43%) with severe fetal malformations was the quantity of amniotic fluid found to be normal; 26% of the cases had hydramnios and 31% oligohydramnios. Pathologic movement behaviour had been registered ultrasonographically in 43% of the cases with severe fetal malformations; biometric dimensions of the biparietal cranial diameter and the transverse diameter of the thorax (greater than 10th percentile to 90th percentile, according to the percentile growth curves of Schmidt, 1982) corresponding to gestational age had only been measured in 30% and 50%, respectively, of the cases with fetal malformations. During the entire period covered by the investigation, from 1975 to 1982, only 16 children born at term (between the 38th and 42nd weeks) had severe malformations which had not already been diagnosed.(ABSTRACT TRUNCATED AT 400 WORDS)

Amniotic Fluid↗

PubMed1990

A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures.

BACKGROUND: Antiepileptic drugs are commonly used to prevent seizures that may follow head trauma. However, previous controlled studies of this practice have been inconclusive. METHODS: To study further the effectiveness of phenytoin (Dilantin) in preventing post-traumatic seizures, we randomly assigned 404 eligible patients with serious head trauma to treatment with phenytoin (n = 208) or placebo (n = 196) for one year in a double-blind fashion. An intravenous loading dose was given within 24 hours of injury. Serum levels of phenytoin were maintained in the high therapeutic range (3 to 6 mumol of free phenytoin per liter). Follow-up was continued for two years. The primary data analysis was performed according to the intention to treat. RESULTS: Between drug loading and day 7, 3.6 percent of the patients assigned to phenytoin had seizures, as compared with 14.2 percent of patients assigned to placebo (P less than 0.001; risk ratio, 0.27; 95 percent confidence interval, 0.12 to 0.62). Between day 8 and the end of year 1, 21.5 percent of the phenytoin group and 15.7 percent of the placebo group had seizures; at the end of year 2, the rates were 27.5 percent and 21.1 percent, respectively (P greater than 0.2 for each comparison; risk ratio, 1.20; 95 percent confidence interval, 0.71 to 2.02). This lack of a late effect could not be attributed to differential mortality, low phenytoin levels, or treatment of some early seizures in patients assigned to the placebo group. CONCLUSIONS: Phenytoin exerts a beneficial effect by reducing seizures only during the first week after severe head injury.

Adult↗

PubMed2002

Can patient reactions to the first chiropractic treatment predict early favorable treatment outcome in persistent low back pain?

OBJECTIVE: To investigate whether 3 distinct patterns of reactions to chiropractic care predict early favorable treatment outcome in patients with persistent low back pain. DESIGN AND SETTING: Multicenter, clinic-based prospective outcome study with standardized interview questionnaires conducted in private chiropractic practices in Sweden. STUDY SUBJECTS: Previously compliant chiropractors were invited to participate in the study. A maximum of 20 consecutive patients (per chiropractor) who sought chiropractic care for low back pain with or without sciatica with a duration of more than 2 weeks at the time of consultation and for a minimum of 30 days total during the past year. INTERVENTION: Chiropractic management as decided by the treating chiropractor. OUTCOME AND PREDICTOR VARIABLES: Improvement was defined at the 4th visit as self-reported "definitely improved" (the best of 5 choices). The hypothesized most favorable prognostic group had immediate improvement reported on the 1st visit, reduced pain intensity reported on the 2nd visit, reduced disability reported on the 2nd visit, and a common reaction or no reaction reported on the 2nd visit. The hypothesized least favorable prognostic group had no immediate improvement on the 1st visit, no reduction of pain intensity on the 2nd visit, no reduced disability on the 2nd visit, and no reaction or an uncommon reaction reported on the 2nd visit. The hypothesized intermediate prognostic group included all patients who did not fit into the hypothesized most favorable or least favorable groups. COVARIABLES: Age, sex, pain intensity during past 24 hours, description of disability, duration and pattern of pain during present attack, duration and pattern of pain during past 12 months. ANALYSIS OF DATA: The 3 predictor-groups were cross-tabulated against the outcome variable and the other covariates. RESULTS: Of the 115 patients in the most favorable prognostic group, 84% (95% confidence interval, 77-91) reported to be "definitely improved" by the 4th visit versus 63% (59-67) of the 384 patients in the intermediate prognostic group, and 30% (22-38) of the 116 patients in the least favorable prognostic group. No major interactions from the covariates could explain these results. CONCLUSION: Among chiropractic patients with persistent low back pain, it is possible to predict which patients will report definite improvement early in the course of treatment.

Adult↗

PubMed1975

Chitin synthetase zymogen is attached to the yeast plasma membrane.

Pretreatment of yeast protoplasts with concanavalin A, according to the method used by G. A. Scarborough for Neurospora (J. Biol. Chem. 250, 1106-1111, 1975), reinforced the plasma membranes, and helped to maintain their integrity during subsequent lysis of the protoplasts. After purification by centrifuging on a Renografin density gradient, practically intact membranes were obtained. Previous labeling of the protoplasts with 125I or with [3H]concanavalin A resulted in recovery of the radioactivity in the membrane fraction. The bulk of the chitin synthetase (chitin synthase; UDP-2-acetamido-2-deoxy-D-glucose:chitin 4-beta-acetamidodeoxyglucosyltransferase; EC 2.4.1.16) recovered in the gradient was also found In this fraction; in the zymogen form. About 20% of the activity sedimented in a plasma-membrane-free fraction at lower density. Glutaraldehyde inactivated chitin synthetase when it was added to a lysate, but not when applied to intact protoplasts. It is concluded that chitin synthetase is so oriented in the membrane that it is only accessible from the inside of the cell. These results confirm our previous hypothesis that the chitin synthetase zymogen is associated with the plasma membrane, a basic assumption for the explanation of localized activation of the enzyme and initiation of septum formation.

Cell Fractionation↗

PubMed2006

Preparation for practice: how can medical schools better prepare PRHOs?

There is growing evidence that new PRHOs feel unprepared for their first post. This study compared three cohorts of graduates, the first from a traditional systems-based curriculum, the second from the same systems-based curriculum, who had also taken an intercalated degree, and the third from a PBL curriculum who had not intercalated. Subjective reports of confidence in clinical skills, anxiety and feelings of preparedness for practice were assessed using a previously published instrument. Graduates from the PBL curriculum who had not intercalated felt significantly better prepared, less anxious and more confident than equivalent graduates from the systems-based curriculum. Systems-based curriculum graduates who had taken an additional intercalated degree scored as highly in these criteria as the PBL graduates who had not intercalated. Despite these improvements, absolute levels of anxiety remained high and feelings of preparedness and confidence in clinical skills remained poor.

Anxiety↗

PubMed1991

Termination of transcription in an 'in vitro' system is dependent on a polyadenylation sequence.

Using HeLa cell nuclear extract as a source of the different transcription and polyadenylation factors and reverse transcription to analyze the levels of RNA 5' and 3' to the cleavage-polyadenylation site, an in vitro assay has been established to study polyadenylation coupled to transcription directed by different adenovirus promoters. The levels of transcription 5' and 3' to the cleavage site in the L3 polyadenylation region are practically the same as described previously, however, the level of transcription 3' to the cleavage site in the SV40 early polyadenylation region decreases immediately after the cleavage site indicating a termination of the transcription.

Adenoviridae↗

PubMed2001

The potential for reduction of radiation doses to patients undergoing some common X ray examinations in Tanzania.

The potential for patient dose reduction in diagnostic radiology was investigated in five major Tanzanian hospitals. The aim of this study was to follow up previously reported suggestions for improved practices to achieve dose reductions. The suggestions were implemented and entrance surface dose measurement repeated by using well-calibrated LiF thermoluminescence dosemeters. The results show that dose reductions in chest PA X ray examinations ranged from 15% to 50%. For abdomen AP and pelvis AP X ray examinations, the dose reductions ranged from 24% to 73% and from 25% to 72%, respectively. The respective dose reductions for lumbar spine AP and LAT projections ranged from 4% to 58% and from 16% to 77%. Interestingly, the majority of radiographs obtained after the implementation of dose reduction measures were useful for intended diagnosis according to the opinion of radiologists. It is concluded that significant dose reductions can be achieved in the country without loss of diagnostic information. Such dose reductions also predict reductions of radiation risk to patients.

Humans↗

PubMed2004

Correlates of the affective impact of auditory hallucinations in psychotic disorders.

While many who hear auditory hallucinations (AHs) experience them as unpleasant, some do not. Little is known about the correlates of AHs that are not unpleasant, or of the characteristics of those who hear them. To better understand this symptom, we used a comprehensive structured interview schedule to study 199 subjects who had experienced AHs. Subjects' responses to AHs were combined into two indexes: one assessing total affective impact and the other assessing the affective direction (positive or negative). Subjects who had grandiose delusions experienced their AHs more positively. AHs that were more frequent, lasted longer, and were louder were experienced more negatively. AHs heard in the second person and those related to people with whom the subjects had personal relationships were more positive than those heard in the third person. Many other aspects of AHs were unrelated to total affective impact or direction. It is argued that the positive evaluation of voices by subjects requires greater attention than it has received previously. Implications for assessment, clinical practice, and research are discussed.

Adolescent↗

PubMed1986

Antihypertensive treatment with bopindolol alone or combined with a diuretic in general practice.

beta blockers are now well established as alternative first-line drugs for treating hypertension. Bopindolol is a new beta blocker with a long duration of action and antihypertensive properties at low dosage. To assess the blood pressure (BP) lowering effect and tolerance of bopindolol, 590 hypertensive patients with diastolic BP greater than or equal to 100 mm Hg (age 22-78 years; mean +/- SD, 51 +/- 10) were evaluated prospectively by a study group of 248 practicing physicians. Following discontinuation of previous antihypertensive drugs for 4 weeks and/or a 2-week placebo phase, bopindolol 1 mg/day was given for 12 weeks. Bopindolol dose was decreased to 0.5 mg/day if diastolic BP after 8 weeks was less than or equal to 85 mm Hg; chlorthalidone 12.5-25 mg/day was added if diastolic BP was greater than or equal to 95 mm Hg after 4 or 8 weeks of bopindolol monotherapy. Compared to placebo, BP was lowered (p less than 0.0001) by bopindolol monotherapy (n = 273) from 159/104 +/- 14/4 to 139/89 +/- 12/6 mm Hg, by combination treatment (n = 288) from 165/108 +/- 16/6 to 145/95 +/- 16/7 mm Hg. Diastolic BP was reduced to less than 95 mm Hg by bopindolol 0.5 or 1 mg/day in 241 patients, by combination treatment in 150 patients. Bopindolol-induced absolute or percentage decreases in systolic or diastolic BP correlated with pretreatment BP (r = 0.22-0.51, p less than 0.001), but not with age (r = -0.05 to 0.08).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗

PubMed1997

Lower extremity alignment and risk of overuse injuries in runners.

A group of 304 runners enrolling in a marathon training program had alignment measurements performed and completed a questionnaire on training practices and injuries over the previous 12 months. The alignment measures consisted of arch index (AI), heel valgus (HV), knee tubercle-sulcus angle (TSA), knee varus (KV), and leg-length difference (LLD). Results indicated few consistent statistical associations between these alignment measures and risk of injuries, either bivariately or multivariately: left AI with hamstring injuries; right AI with shin injuries; right HV with back injuries; left TSA with ankle injuries; KV with hip injuries; and LLD with back, ankle, and foot injuries. A few statistically significant relationships were also found between other training and anthropometric factors and injuries: mileage with hamstring injuries; interval training with shin injuries; hard surfaces with back and thigh injuries; shoe use patterns with foot and overall injuries; and body mass index with heel injuries. We conclude that lower-extremity alignment is not a major risk factor for running injuries in our relatively low mileage cohort; however, prospective studies are necessary to confirm or refute these findings.

Adult↗

PubMed1986

Essential thrombocythemia and leukemic transformation.

Alkylating agents and 32P have been widely employed in the treatment of patients with essential thrombocythemia (ET). During a four-month period, we observed 3 cases of ET that had transformed into leukemia. Two patients had been treated with uracil mustard: One developed acute myelogenous leukemia 79 months after institution of therapy, and the other patient developed chronic myelomonocytic leukemia 24 months after the start of therapy. The third patient had been treated with busulfan, and ET evolved into myelofibrosis and eventually into acute undifferentiated leukemia with myelofibrosis. The patient who developed acute myelogenous leukemia was asymptomatic at the time of diagnosis of ET but was treated because his platelet count was greater than 1,000,000/mm3. He died 1 month after leukemic transformation, during induction chemotherapy. The other 2 patients presented with symptoms referable to their thrombocythemia. Review of the English literature revealed 12 other definite or probable cases of ET with leukemic transformation, all but 1 having been treated with alkylating agents and/or 32P. We propose that the natural history of ET may be similar to that of polycythemia vera, with evolution into leukemia being an unusual occurrence except in the setting of previous chemotherapy. Therefore, the current practice of treating asymptomatic patients with ET may not be justified, since administration of alkylating agents or 32P may increase the risk of subsequent development of leukemia.

Adult↗

PubMed1998

Intravenous cyclosporin as rescue therapy in severe ulcerative colitis: time for a reappraisal?

BACKGROUND: Intravenous cyclosporin is the only new therapy in recent years to have made a significant impact on the management of acute severe ulcerative colitis (UC). It is increasingly recommended for use in patients who prove refractory to the standard regimen of intravenous (i.v.) and rectal hydrocortisone but do not warrant immediate surgery. This practice is based on uncontrolled and controlled studies which suggest a short-term efficacy of 80% and long-term efficacy of 60% in avoiding colectomy. AIM: The aim of this study was to assess the short- and long-term efficacy of i.v. cyclosporin in patients admitted to our hospital with acute severe ulcerative colitis refractory to i.v. steroids, over a 6-year period. METHOD: A retrospective survey of patients admitted to the John Radcliffe Hospital, Oxford, with acute severe UC over a 6-year period (1991-97) was performed. Truelove and Witts criteria for acute severe UC were satisfied by 216 patients. RESULTS: The standard regimen achieved remission in 132 patients (61%). Of the 84 patients who failed to respond, 34 (40%) proceeded directly to colectomy whilst 50 received cyclosporin (4 mg/kg by continuous slow infusion). Remission was achieved by i.v. cyclosporin in 28/50 (56%) patients who were subsequently transferred to oral cyclosporin (5 mg/kg). However, 8/28 (29%) who initially responded later relapsed after discharge from hospital and underwent colectomy. The short-term efficacy of 56% therefore falls to 40% in the longer term (mean follow-up of 19 months). CONCLUSION: This is the largest survey to date of patients with refractory severe UC treated with i.v. cyclosporin. The findings confirm the potential value of i.v. cyclosporin in severe UC but its effectiveness in clinical practice is less dramatic than previously reported.

Acute Disease↗

PubMed2002

Potential carbon mitigation and income in developing countries from changes in use and management of agricultural and forest lands.

The many opportunities for mitigating atmospheric carbon emissions in developing countries include reforesting degraded lands, implementing sustainable agricultural practices on existing lands and slowing tropical deforestation. This analysis shows that over the next 10 years, 48 major tropical and subtropical developing countries have the potential to reduce the atmospheric carbon burden by about 2.3 billion tonnes of carbon. Given a central price of $10 per tonne of carbon and a discount rate of 3%, this mitigation would generate a net present value of about $16.8 billion collectively for these countries. Achieving these potentials would require a significant global effort, covering more than 50 million hectares of land, to implement carbon-friendly practices in agriculture, forest and previously forested lands. These estimates of host-country income potentials do not consider that outside financial investment may or may not be available. Our calculations take no account of the additional benefits of carbon sequestration in forest soils undergoing reforestation, increased use of biomass and reduced use of fossil-fuel inputs and reduced agricultural emissions. In all events, realizing these incomes would necessitate substantially greater policy support and investment in sustainable land uses than is currently the case.

Africa↗

PubMed2004

Clinical holistic medicine: holistic adolescent medicine.

The holistic medical approach seems to be efficient and can also be used in adolescent medicine. Supporting the teenager to grow and develop is extremely important in order to prevent many of the problems they can carry into adulthood. The simple consciousness-based, holistic medicine--giving love, winning trust, giving holding, and getting permission to help the patient feel, understand, and let go of negative beliefs--is easy for the physician interested in this kind of practice and it requires little previous training for the physician to be able to care for his/her patient. A deeper insight into the principles of holistic treatment and a thorough understanding of our fellow human beings are making it work even better. Holistic medicine is not a miracle cure, but rather a means by which the empathic physician can support the patient in improving his/her future life in respect to quality of life, health, and functional capacity--through coaching the patient to work on him/herself in a hard and disciplined manner. When the patient is young, this work is so much easier. During our lifetime, we have several emotional traumas arranged in the subconscious mind with the smallest at the top, and it is normal for the person to work on a large number of traumatic events that have been processed to varying degrees. Some traumas have been acknowledged, some are still being explored by the person, and yet others are still preconscious, which can be seen for example in the form of muscle tension. Sometimes the young dysfunctional patient carries severe traumas of a violent or sexual nature, but the physician skilled in the holistic medical toolbox can help the patient on his/her way to an excellent quality of life, full self-expression, a love and sex life, and a realization of his/her talents--all that a young patient is typically dreaming about. Biomedicine is not necessary or even recommended when the physical or mental symptoms are caused by disturbances in the personal development that can be corrected with love and understanding. If possible, biomedicine must be avoided, even if this means suffering for the young person, who needs to confront the tough realities of life in order to grow into an able and sound adult.

Adolescent↗

PubMed1999

Two-phase flow through porous media in the fixed-contact-line regime.

The complete set of equations controlling immiscible two-phase flow through porous media are derived from first principles under the sole restriction that contact lines between the two fluids and the grain surfaces are not allowed to migrate irreversibly. Because rough grain surfaces have the ability to trap contact lines over significant ranges of capillary-pressure variation, such laws are of practical interest. As distinct from previous coarse-graining work, we explicitly allow for the stretching of the fluid interface, which results in considerable nonlinearity at the macroscopic scale. The laws are obtained through an asymptotic analysis and have several new features compared to the standard laws conventionally used in two-phase flow modeling. These include the need to (i) distinguish between measurable fluxes and the volume-averaged flow; (ii) allow for flow induced by the time rate of change of the capillary pressure; and (iii) include quadratic-force terms in the generalized Darcy laws when macroscopic-pressure diffusion is slow (as defined herein).

Journal Article↗