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At least 1,243 records · Page 69Linked to original sources

PubMed1996

Cardiac event recorders yield more diagnoses and are more cost-effective than 48-hour Holter monitoring in patients with palpitations. A controlled clinical trial.

OBJECTIVE: To compare the diagnostic yield and cost-effectiveness of transtelephonic event monitors with those of Holter monitoring in patients with intermittent palpitations. DESIGN: Randomized crossover trial. SETTING: Diagnostic service of a teaching hospital and surrounding primary care practices. PATIENTS: 43 patients with previously uninvestigated palpitations who were referred for Holter monitoring. MEASUREMENTS: Patients were randomly allocated to receive an event monitor or 48-hour Holter monitor and then to receive the other device. Event monitors were used for 3 months or until two recordings were obtained while symptoms occurred. The main end point was an electrogram recorded during symptoms. The incremental cost-effectiveness of obtaining a diagnostic rhythm strip from event monitors was compared with that of Holter monitoring. RESULTS: The mean (+/- SD) patient age was 45 +/- 19 years; 37 patients (88%) were women. Event monitors were twice as likely to provide a diagnostic rhythm strip electrocardiogram during symptoms as 48-hour Holter monitoring (29 patients [67%] and 15 patients [35%], respectively; P < 0.001). Event monitors detected 8 patients (19%) with clinically important arrhythmias (6 patients with supraventricular tachycardia and 2 with atrial fibrillation or flutter), whereas the Holter monitors detected no significant arrhythmia (P < 0.005). With the event monitors, most patients transmitted an electrocardiogram recording by 6 weeks. Event monitors were dominant and therefore more cost-effective than 48-hour Holter monitoring, resulting in a cost savings of $213 for each additional diagnostic rhythm strip obtained during symptoms. CONCLUSIONS: Holter monitoring is a poor diagnostic test for intermittent palpitations. Event recorders provide better data and are more cost-effective.

Adult↗

PubMed1999

[Validity of different classifications of unstable angina].

The classification of the unstable angina syndrome has represented one of the main objectives of the cardiologists in the two last decades. The ambiguous definition of this syndrome has led to the phenomenon that numerous classifications have been achieved, based especially in the different clinical presentations of this syndrome, that are neither clearly matched with a different physiopathology nor with the prognosis. On the other hand, the validation of the majority of the classifications have been attempted through studies of selected populations with an insufficient number of patients in a syndrome with a wide spectrum of clinical presentation, pathophysiology and prognosis. On this basis, the existing classifications do not fully satisfy the scientific community, which is confirmed by the periodical appearance of new proposals. In our setting, the classifications which are most applied are those of the Spanish Society of Cardiology and Braunwald's Classification. Both offer the usefulness of their simplicity, since they only consider clinical aspects, but sustain the previously mentioned inconveniences. A more practical classification could possibly be based exclusively on physiopathological or prognostic characteristics, which allow a more adequate management of these patients.

Angina, Unstable↗

PubMed2001

Features of primary care associated with variations in process and outcome of care of people with diabetes.

BACKGROUND: There is now clear evidence that tight control of blood glucose and blood pressure significantly lowers the risk of complications in both type I and type II diabetes. Although there is evidence that primary care can be as effective as secondary care in delivering care for people with diabetes, standards in primary care are variable. Previous studies have shown that practice, patient or organisational factors may influence the level of care of patients with diabetes. However, these studies have been conducted in single geographical areas and involved only small numbers of practices. AIM: To determine the standard of diabetes care in general practice and to determine which features of practices are associated with delivering good quality care. DESIGN OF STUDY: A questionnaire survey and analysis of multi-practice audit data. SETTING: Three health authorities in England, comprising 169 general practices. METHOD: This study was conducted with a total population of 1,182,872 patients and 18,642 people with diabetes. Linkage analysis was carried out on data collected by a questionnaire, routinely collected health authority data, and multi-practice audit data collected by primary care audit groups. Practice annual compliance was measured with process and outcome measures of care, including the proportion of patients who had an examination of their fundi, feet, blood pressure, urine, glycated haemoglobin, and the proportion who had a normal glycated haemoglobin. RESULTS: Median compliance with process and outcome measures of care varied widely between practices: fundi were checked for 64.6% of patients (interquartile range [IQR] = 45.3-77.8%), urine was checked for 71.4% (IQR = 49.7-84.3%), feet were checked for 70.4% (IQR = 51.0-84.4%), blood pressure for 83.6% (IQR = 66.7-91.5%), and glycated haemoglobin was checked for 83.0% of patients (IQR = 69.4-92.0%). The glycated haemoglobin was normal in 42.9% of patients (IQR = 33.0-51.2%). In multiple regression analysis, compliance with measures of process of care were significantly associated with smaller practices, fundholding practices, and practices with a recall system. Practices with more socioeconomically deprived patients were associated with lower compliance with most process measures. Practices with a greater proportion of patients attending hospital clinics had lower compliance with process and outcome measures. Being a training practice, having a diabetes mini-clinic, having more nurses, personal care, and general practitioner or nurse interest in diabetes were not associated with compliance of process or outcome of care. CONCLUSIONS: Despite recent evidence that complications of diabetes may be delayed or prevented, this study has highlighted a number of deficiencies in the provision of diabetes care and variations in care between general practices. Provision of high quality diabetes care in the United Kingdom will present an organisational challenge to primary care groups and trusts, especially those in deprived areas.

Delivery of Health Care↗

PubMed2001

Preventive dental care for children and adolescents.

Preventive dental care for children and adolescents requires a good understanding of the dental caries process and the particular relationships that exist throughout childhood and young adulthood. Only when these relationships are understood can they be used to diagnose dental caries risk and apply appropriate preventive therapies and restorative care that is effective. The need to diagnose risk when applying preventive care is as important for individual patients as it is for population groups. At the individual level, the aim is to aid the development of a healthy functioning dentition for life. This applies in the population group level but the cost benefits also become important in justifying the funding to carry out preventive practices. Risk can be determined by general factors including the socioeconomic status, access to optimally fluoridated drinking water and age. Specific factors include the microbiology of the dental plaque, dietary practices, oral hygiene practices, individual fluoride use and previous dental caries history. Once the risk has been diagnosed and the related factors identified, the best preventive approach can be selected. This may include oral hygiene, dietary change, fluoride recommendations, restorative care using fluoride releasing materials or antibacterial mouthwashes. The dentist may play several roles in preventive dental care. The first is as the giver of advice and care for the individual child patient; the second is as an advocate to help the child get the care by getting the consent and support of the parents; and the third may be to lobby for the appropriate funding to obtain this care in publicly funded programs.

Adolescent↗

PubMedDate not supplied

Are North American nephrologists biased against peritoneal dialysis?

OBJECTIVE: To examine possible bias against peritoneal dialysis (PD) by nephrologists less familiar with it. DESIGN: Secondary analysis of a previously reported survey. PARTICIPANTS: All practicing Canadian nephrologists (n = 290, response rate 66.2%) and a subgroup of American nephrologists who were members of the National Kidney Foundation Council on Dialysis (n = 507, response rate 47.3%). Responses were then subdivided by type of dialysis practice: mainly or only hemodialysis (HD, n = 117), mainly or only PD (n = 16), or both HD and PD (n = 232). INTERVENTION: Self-administered mailed questionnaire. MAIN OUTCOME MEASURES: Opinions and attitudes of nephrologists concerning patient characteristics favoring one dialysis modality over the other, as well as the relative utilization of HD and PD currently and in a hypothetical ideal situation. RESULTS: The main differences were present between physicians practicing mainly HD and physicians practicing mainly PD, with those practicing both giving answers usually intermediate to the others. The maximum weight suitable for PD was 10 kg less according to HD-oriented nephrologists compared with PD-oriented nephrologists (97.8 kg vs 108.5 kg). All nephrologists agreed that, ideally, 40% of prevalent end-stage renal disease patients should be on PD to optimize cost-effectiveness, whereas the proportion should be between 32% and 45% when one optimizes survival, wellness, and quality of life. In general, differences between groups were small. CONCLUSIONS: Most nephrologists favored a proportion of PD higher than the current prevalence seen in either Canada or the U.S.A. If physicians' biases are contributing to the distribution of dialysis modalities, they are not likely to be major factors. Unknown but important factors, external to the physician, may shape modality distribution more than the opinions and attitudes of physicians. If a more balanced and cost-effective dialysis delivery system is desired, more understanding and manipulation of these non physician-related factors will be required.

Attitude of Health Personnel↗

PubMedDate not supplied

[The relationship between intestinal metaplasia and gastric carcinoma: a study of 722 biopsies].

Intestinal metaplasia has been shown by many investigators to be a premalignant state. Considering this fact, 722 gastric biopsies were studied, a 24% of association was found between gastric carcinoma and intestinal metaplasia and 27% of the cases with metaplasia were found in "apparently normal" or with benign stomach lesions. The group most affected was males over 61 years. Control endoscopy and biopsy was practiced in 17 patients with previously diagnosed intestinal metaplasia and in 11.7% gastric carcinoma with metaplasia was found. Therefore, it cannot be concluded that intestinal metaplasia is a premalignant condition, but its frequent association with gastric adenocarcinoma advises periodical examination by endoscopy in every patient over 40 years in which it is determined by biopsy.

Adenocarcinoma↗

PubMed1955

TUBERCULIN reaction size on five consecutive days.

The present paper gives the results of a study on tuberculin reaction size-erythema and induration-at different intervals after intradermal testing with 1 TU.In the course of tuberculin-testing some 18,000 textile workers in Mehalla el Kobra, Egypt, the tuberculin reactions of 417 men were read daily for five days after the tests had been given. The successive readings were made by the same observer without reference to his previous readings.No difference of any practical significance was found between the results of readings made on the second through the fifth day. Almost all the reactions of over 6 mm of induration on any one day (except the first) remained above 6 mm on the subsequent days, and those measuring 0-6 mm did not exceed 6 mm on the later days. Thus, whether the reactions had been read on the second, third, fourth, or fifth day, essentially the same persons would have been classified as positive and negative according to the induration-reaction size.Erythema could have served as well as induration for separating the study population into the same two groups, had 0-8 mm of erythema been defined as negative and erythema of 9 mm or more as positive for reactions read on the second through the fifth day.In tuberculin surveys of the population under study there would thus have been no need to adhere to a fixed reading interval.The material included in the present paper illustrates how the results of a relatively small and inexpensive preliminary study may serve to simplify and rationalize subsequent large-scale work.

Egypt↗

PubMedDate not supplied

[Multidisciplinary investigations in dead persons suspicious of AIDS].

The background of AIDS is the deregulation of the cellular immune system caused by HIV infection. AIDS has proved to be entirely different from any previous known diseases. It affects practically all the tissues and organs of the human body. Clinical and autopsy diagnoses are confronted with an incomparable diversity of inflammatory, vascular, degenerative and neoplastic changes. Thanks to clinical and pathological researshes, the medical knowledge of AIDS has rapidly progressed. The Institute of Forensic Medicine is, for now, the unique medical institution organized to perform obligatory autopsies of drug-addicts, to detect the other cases suspect of HIV infection or some AIDS indicative diseases. The aim of this study is to establish the basis for multidisciplinary investigations of AIDS and to solve very important problems such as: a) to accept the diagnostic criteria for correct diagnosis of AIDS, with or without laboratory evidence of HIV infection; b) to recognize the early stadium of clinico-pathological entities associated with HIV infection; c) to improve the "indicator" of AIDS disease for daily medical practice.

Acquired Immunodeficiency Syndrome↗

PubMed2005

[Do women demand to be assisted at medical clinics more often than men?].

BACKGROUND: Different features of the users of the Spanish Public Health System have been previously assessed, specially in General Practice and Hospital Emergency Departments. Nevertheless, the epidemiological characteristics of those patients who attend to specialised clinics have not been so thoroughly evaluated. PATIENTS AND METHODS: The referee of the demand, the place of residence, the age and the sex of patients were all analysed for the ,first visits, at the Medical Department clinics (Internal Medicine, Cardiology, Gastroenterology, Pneumology) in our hospital, during 2002. RESULTS: A total of 7,486 demands for attention (53.3% were women) were asked for by 5,841 patients (52.8%) were women. When analysing the variable, place of residence, we find women asked for more frequently than men, in the categories of General Practice Department and age less than 60 years. Those patients coming from urban areas were more in percentage than those coming from rural areas. Whereas the, index of frequency, was higher in women than in men, however, there were no differences between urban and rural areas. CONCLUSION: In our targeted population we have observed a higher demand for medical clinics in women, though the actual demand will depend on factors such as age, place of residence and the referee.

Adolescent↗

PubMedDate not supplied

Determinants of musculoskeletal frailty and the risk of falls in old age.

Neuromuscular parameters that describe locomotion are indispensable variables for the diagnosis and treatment of frailty, fall risk and osteoporosis. A scientifically-based standardized locomotor assessment should be an essential part of medical examinations in research and clinical practice. There has been no previous consensus regarding which test procedures should be included in a locomotor assessment. The goal of this article is to provide a rationale for the selection of appropriate locomotor tests in a comprehensive locomotor assessment for elderly patients. We propose that a locomotor assessment should comprise the parameters that have been proven predictive for both falls and impending disability. The parameters should be measured in the standard units of physics. Therefore, we propose the following tests for a standardized locomotor assessment: (1) Self-selected gait velocity as the single best measure of general locomotor status and a good predictor of age-related adverse events; (2) Chair rise test (timed 5 chair rises) which measures power on vertical movement and the hip surrounding muscles as the most important neuromuscular risk factor for falls and fall-related fractures; (3) Tandem standing and tandem walking to measure postural capacity (balance) to the side; (4) Timed up and go test as a global screening procedure; (5) Clinical gait analysis with special focus on regularity; and (6) At least on a research level, movement must be measured referring to the terms of physics by mechanography. Mechanography (Leonardo force plate system, Novotec Pforzheim, Germany) records the time course of ground reaction forces, velocity of the vertical movements of the center of mass and power during unrestricted physiological movements. In the mechanogram the eccentric and concentric phases of movements can be differentiated and the storage of energy in the elastic elements of the body can be examined. The kinetics of human movement is explained by mechanograms of a two-legged jump. The ground reaction forces resulting from a jump down from a height of 0,46 m are demonstrated as a performance that is representative for human coordination. One goal of this text is to underline the insights that arise if the rules of physics are applied to human movement. A deeper understanding enables us to create more effective treatments for disorders of the muscle-bone unit. Bringing physics and cybernetics into the field of osteoporosis is a great heritage of Harold Frost.

Accidental Falls↗

PubMedDate not supplied

[The evaluation of noncompliance in an anti-influenza vaccination program].

The article presents an evaluation of an anti-influenza vaccination programme in a population at risk, with a special study of the general characteristics of the group of non-complying patients, and the possible relation of these characteristics with their conduct. Moreover, a study was made of the possible motives for not complying with the vaccination programme by means of a survey carried out by post and telephone in a representative sample of 108 individuals. A 34.77% of the registered population did not receive the anti-influenza vaccine, corresponding largely with the youngest age group (15 to 44 years) and there were no significant differences determined by sex or risk factor or doctor. A positive response was received from 75% of those surveyed, and the basic conclusions drawn were a low proportion of information error attributable to the programme (2.94%), and patient refusal as the principal cause of non-compliance (54.41%), followed by "other reasons" (hospitalisation, absence from home, etc.) (32.35%). The strategies that may be followed in the face of this problem require definition of the group of non-compliers, further understanding of the motives for their conduct, and educational measures to change their attitude. 95.9%). Incidence of hypertension and hyperlipemia was 56.2% and 47.3%. Late vascular events varied between 2.6% (nephropathy) and 19.5% (retinopathy). A total of 101 patients (44.6%) were unaware of the existence of diabetic health education programmes. Moreover, 68 (30.3%) declared that they had never received any previous information about their diabetes. Practical skills were evaluated on an individual basis.

Age Factors↗

PubMedDate not supplied

[A clinical evaluation of an improved copper amalgam].

The author presents the results of physicochemical trials and preliminary clinical assessment of modified copper amalgam, carried out to master the optimal method for its preparation. The optimal conditions for the preparation of a filling from modified copper amalgam consist in mixing 0.42 +/- 0.02 g of the alloy powder and 0.3 g of mercury within 25-35 sec. Clinical trials have demonstrated the advantages of this modification vs. the filling manufactured in this country previously, this recommending it for practical pedodontics.

Child↗

PubMed1991

Cost-effectiveness evaluation of measles immunization strategies on a college campus.

Since live rubeola vaccine became available in 1963, routine immunization of children at age 15 months has been the recommended strategy for eliminating measles in the United States. However, due to increasing measles outbreaks, especially among previously immunized populations, the Immunization Practices Advisory Committee (ACIP) recently recommended modifying the one-dose measles vaccination policy to a two-dose schedule, one at 15 months and one at age 5 or 6 years. To address the present college population, ACIP recommended vaccinating all college students who lack proof of immunity. We used the methods of decision analysis to examine the cost effectiveness of implementing such a program in a specific college population, namely, students at the University of California at Los Angeles (UCLA). We developed a model to examine three possible vaccination strategies: "wait," "screen," and "vaccinate all." Estimates of probabilities and cost were derived from several outbreaks at UCLA as well as statewide data. In the baseline case, the least expensive strategy is to wait until an outbreak occurs before implementing a vaccination program. The additional cost incurred by screening per measles case avoided is $122,871. However, using sensitivity analysis, we found that the overall cost of elective vaccination strategies is driven by the cost of the vaccine itself. If vaccine could be provided at a nominal cost to the university, a strategy of vaccinating all students without proof of immunity (by either history of two vaccinations or positive titer) would provide the high level of immunity needed to prevent outbreaks and still be most cost effective ($16,644 per measles case avoided).

Cost-Benefit Analysis↗

PubMed1990

Feasibility of in-center staff-assisted cycler dialysis.

Many debilitated elderly patients are not currently considered for peritoneal dialysis because they cannot perform the procedure themselves and they lack adequate back-up support in the family or extended care facility. They often tolerate hemodialysis poorly, and may exhaust their vascular access sites. We have provided intermittent in-center staff-assisted cycler dialysis to two debilitated elderly patients for a total of 12 patient months. Initial peritoneal equilibration tests indicated high solute transport rates in both patients, and led us to evolve a regimen based on frequent cycles. We use a 4 days a week regimen, cycling 12-14 liters during a 7.5 hour period each day. The patients tolerated the treatment well, with improved control of fluid balance and maintenance or improvement in appetite compared to baseline periods of CAPD. Mean pre-treatment BUN is 87 mg/dl. This is 29% higher than during CAPD, and has been stable. The requirement for additional nursing care has been variable but not disruptive of other activities once we established a dedicated space and routine. Current cycler technology permits consideration of in-center cycling as a practical alternative for many patients previously excluded from peritoneal dialysis.

Aged↗

PubMed1986

[The main etiologic groups of congenital developmental defects and the problems of diagnosis and thanatogenesis].

The proportion of congenital developmental defects (CDD) in children decreased in perinatal or early age is increasing. According to national and foreign data this figure is in the range of 21-41%. The etiologic structure of CDD for the last 5 years (1980-1984) basing on the data from the Minsk Teratologic Center has not practically changed. As in the previous 5 years, 50.8% of CDD belong to multifactorial ones, 14.3% are due to single gene mutations (8.4% of them are inherited according to dominant type and 5.9%--according to recessive type). Chromosome and gene mutations caused 7.9% of CDD. About 2% of CDD are induced by the effect of environmental factors on the embryo (less frequently on the fetus). Etiology of 25.1% of CDD is not clear.

Congenital Abnormalities↗

PubMed1987

Urticaria associated with antigonadotropin-releasing hormone antibody in a female Kallman's syndrome patient being treated with long-term pulsatile gonadotropin-releasing hormone.

The administration of pulsatile gonadotropin-releasing hormone (GnRH) has received increasing attention as a method of inducing ovulation or initiating puberty. Few side effects have been reported, although urticarial allergic reactions have been reported in the male. An 18-year-old female with hypogonadotropic hypogonadism and anosmia due to lack of endogenous GnRH was treated for 230 days using subcutaneous GnRH in an attempt to induce physiologic puberty. Just before anticipated menarche, therapy was discontinued because of the appearance of an urticarial reaction at the injection site as well as at previous injection sites. The presence of immunoglobulin G (IgG) antibodies against GnRH were subsequently identified in the patient's serum. These results further confirm the potential for antibody production to this small natural peptide in the female not previously exposed to GnRH. Some practical considerations for this form of therapy are highlighted.

Adolescent↗

PubMedDate not supplied

Induced abortion in a rural area of Bangladesh.

Mortality rates from indigenous abortion practices have not been described previously. From September 1982 to August 1983, traditional birth attendants, under medical supervision, collected data on all identifiable pregnant women and pregnancy outcomes in a geographically defined population in rural Bangladesh. Of 9,906 pregnancies, 9,317 ended in live birth, 412 in induced abortion, and 177 in spontaneous abortion. All abortions were induced by indigenous health practitioners. The abortion-to-live-birth ratio was 44.2 per 1,000. Ten women died after induced abortion, yielding a death-to-case rate of 2.4 percent. The death-to-case rate was highest for women 35 and older and women of parity five and higher. The authors conclude that improved distribution of safe, acceptable means of fertility regulation may save many mothers' lives.

Abortion, Induced↗

PubMed1979

[Soluble high molecular weight derivatives of pancreatic trypsin inhibitor. Effect of electrostatic interaction of protein with the carrier on covalent binding and some physico-chemical properties of modified preparations of pancreatic inhibitor].

Modification of pancreatic trypsin inhibitor by carboxymethyl dextran with the aid of carboxyl groups of the carrier activated by water-soluble carbodiimide has been carried out. A special role of electrostatic interactions of protein with the carrier during inhibitor modification has been shown. This modification results in active preparations with high protein concentration on the carrier; their molecular weight is practically equal to that of previously used carrier. A comparison of the thermal stability of high molecular weight preparations of pancreatic inhibitor with respect to protein concentration on the carrier and the number of links between protein and carrier has been carried out.

Binding Sites↗