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PubMed1983

What's new in administration.

The author reviews some of the trends and issues that have emerged in mental health administration over the past 20 years. They include the growing awareness of the need for clinicians to receive training in administration, the expanding body of knowledge in the management field, the availability of statistical methods to help manage uncertainty, and advances in treatment techniques and management information systems. Other developments are changes in the delivery of services, external controls on institutions and professionals, scarcity of resources, the important role of politics and public relations in ensuring adequate services, and sensitization to the social responsibility of the mental health system.

Community Mental Health Services↗

PubMed2004

Preparing psychiatry residents for the certification exam: a survey of residency and exam experiences.

OBJECTIVE: To determine which methods best prepare psychiatry residents for the certification exam, and ultimately for practice, to facilitate appropriate residency program curriculum changes. METHOD: We sent an anonymous survey to all final year (that is, PGY5) Canadian university-affiliated psychiatry residents, regarding frequency and diversity of observed interviews, form of feedback delivery, research and other training experiences, self-perception of preparedness and knowledge base, and management strategies for exam anxiety 6 months before and immediately after the certification exam. RESULTS: There was a 52% response rate. Residents from across Canada identified the following factors as enabling successful exam completion: regular mock orals supervised by Royal College examiners, clinical experience with exposure to a wide spectrum of pathologies, individual and group study time, and appropriate anxiety management. Preparation for the oral exam involving sample case vignettes with presentation and formulation skills training was considered to be essential but was identified as an area of educational and experiential weakness in some programs. CONCLUSIONS: To prepare psychiatry residents for successful completion of their certification exam, programs should incorporate regular mock orals observed by Royal College examiners throughout residency training (not just in PGY2 and PGY5). Programs should also incorporate training in case vignettes, training in oral exam skills, and teaching of anxiety-management strategies.

Adult↗

PubMed1994

Quality assurance of a diarrhoea control programme in northeastern Brazil.

In this study quality assurance methods were used in an evaluation of a programme for Control of Diarrhoeal Diseases (CDD) in northeastern Brazil. Seventy-eight randomly selected public primary care facilities in four states were assessed by trained surveyors. Problems observed in the facilities were lack of information on target population and coverage, lack of equipment to permit rehydration in the premises, and frequent unavailability of trained professionals. Health workers showed deficiencies in history taking, physical examination and knowledge on diarrhoea management. Many caretakers had difficulties in recalling information given to them in the health facilities. Eighty-four percent of the cases were treated with oral rehydration, but 90% were sent home immediately and not kept in the facilities to practice rehydration under guidance as recommended by the national CDD programme. An overuse of the medical treatment was observed. More than two-thirds of health professionals gave wrong indications for use of antibiotics. The study showed that oral rehydration therapy is well established in the government health services in the region but that the CDD programme needs to take early action to correct deficiencies in logistics, case management and health education.

Brazil↗

PubMed2002

A clinical review of micronutrients in HIV infection.

This article reviews current literature on the role of micronutrients in human immunodeficiency virus (HIV) infection. Deficiencies of micronutrients are common in HIV-infected persons. They occur due to malabsorption, altered metabolism, gut infection, and altered gut barrier function. There is a compelling association of deficiencies of micronutrients in HIV-infection with immune deficiency, rapid disease progression, and mortality. Also, there is increased risk of vertical HIV transmission from mother to child with deficiency of vitamin A, and of neurological impairment with vitamin B12. The last five years have been exciting in micronutrient research, and there is promise that some micronutrients may be key factors in maintaining health in HIV immunodeficiency, and in reducing mortality. Selenium appears important in reducing virulence of HIV and slowing disease progression. Vitamin A supplementation in pregnant women with HIV may reduce maternal mortality and improve birth outcomes. Supplementation in children with HIV may accelerate growth. Carotenoid supplementation is being evaluated. Vitamin B12 may slow HIV immune deficiency disease progression, and reverse neurological compromise. Clinical benefit of supplementation with some micronutrients may be measurable in the presence of pre-existing deficiency. Apart from improved general nutrition, the impact of micronutrient supplements on health and their optimal use in HIV infection is controversial because there are so few controlled clinical trials. Further research is needed to elucidate the role of micronutrient deficiencies on the course of HIV infection, and the preventive and therapeutic role of supplementation in its clinical management. Nevertheless, current knowledge supports the use of routine multivitamin and trace element supplementation as adjuvant to conventional antiretroviral drug treatment as a relatively low-cost intervention.

Antioxidants↗

PubMedDate not supplied

A primer of drug safety surveillance: an industry perspective. Part I: Information flow, new drug development, and federal regulations.

OBJECTIVE: To place the fundamentals of clinical drug safety surveillance in a conceptual framework that will facilitate understanding and application of adverse drug event data to protect the health of the public and support a market for pharmaceutical manufacturers' products. Part I of this series provides a background for the discussion of drug safety by defining the basic terms and showing the flow of safety information through a pharmaceutical company. The customers for adverse drug event data are identified to provide a basis for providing quality service. The development of a drug product is briefly reviewed to show the evolution of safety data. Drug development and safety are defined by federal regulations. These regulations are developed by the FDA with information from pharmaceutical manufacturers. The intent of the regulations and the accompanying guidelines is described. An illustration from the news media is cited to show an alternative, positive approach to handling an adverse event report. DATA SOURCES: This review uses primary sources from the federal laws (regulations), commentaries, and summaries. Very complex topics are briefly summarized in the text and additional readings are presented in an appendix. Secondary sources, ranging from newspaper articles to judicial summaries, illustrate the interpretation of adverse drug events and opportunities for drug safety surveillance intervention. STUDY SELECTION: The reference materials used were articles theoretically or practically applicable in the day-to-day practice of drug safety surveillance. DATA SYNTHESIS: The role of clinical drug safety surveillance in product monitoring and drug development is described. The process of drug safety surveillance is defined by the Food and Drug Administration regulations, product labeling, product knowledge, and database management. Database management is subdivided into the functions of receipt, retention, retrieval, and review of adverse event reports. Emphasis is placed on the dynamic interaction ;of the components of the process. Suggestions are offered to facilitate communication of a review of adverse event data for various audiences. CONCLUSIONS: Careful drug safety surveillance is beneficial to the health of the public and the commercial well-being of the manufacturer. Attention to basic principles is essential and, as illustrated, may be sufficient to resolve some problems.

Adverse Drug Reaction Reporting Systems↗

PubMed2002

Age-related differences in perceived asthma control in childhood: guidelines and reality.

Current guidelines specify the goals of asthma treatment in children and propose a stepwise approach to achieve them. The authors sought to determine whether these goals were attained in children of different age groups in the community and to assess treatment in those with unsatisfactory asthma control. A cross-sectional postal questionnaire survey was performed in 1998 in all members of the major Swiss parents organisation for childhood asthma. With a response rate of 85%, data from 572 Swiss-German children aged 4-16 yrs with wheeze were analysed. Asthma control was excellent in 18% of the children, satisfactory (only episodic symptoms) in 33%, and unsatisfactory in 49% with disturbed sleep, restricted activities and school absences. When stratified by age, excellent or satisfactory control was attained by 66% of children aged 13-16 yrs, but only by 56%, 44%, and 38% of those aged 10-12, 7-9 and 4-6 yrs, respectively. Although the majority were followed-up by a doctor (95%) and were receiving beta2-agonists (82%) and inhaled corticosteroids (68%), intensity and duration of treatment were not sufficiently matched to asthma severity. In virtually all children there was scope to improve medical treatment, preventive measures and knowledge of asthma management, with very few if any children with therapy-resistant asthma. Even in children with poor asthma control, 89% of parents were satisfied with the results of treatment. The goals of asthma treatment were attained in one-half of the children, particularly in younger age groups. Although inhaler use was common, detailed assessment showed evidence for undertreatment, especially in the youngest age group, and insufficient adherence to preventive measures. Parental expectations of asthma control, which were lower than those outlined in guidelines, might be an important but underestimated factor in paediatric asthma management.

Administration, Inhalation↗

PubMed2006

Health Research Profile to assess the capacity of low and middle income countries for equity-oriented research.

BACKGROUND: The Commission on Health Research for Development concluded that "for the most vulnerable people, the benefits of research offer a potential for change that has gone largely untapped." This project was designed to assess low and middle income country capacity and commitment for equity-oriented research. METHODS: A multi-disciplinary team with coordinators from each of four regions (Asia, Latin America, Africa and Central and Eastern Europe) developed a questionnaire through consensus meetings using a mini-Delphi technique. Indicators were selected based on their quality, validity, comprehensiveness, feasibility and relevance to equity. Indicators represented five categories that form the Health Research Profile (HRP): 1) Research priorities; 2) Resources (amount spent on research); 3) Production of knowledge (capacity); 4) Packaging of knowledge and 5) Evidence of research impact on policy and equity. We surveyed three countries from each region. RESULTS: Most countries reported explicit national health research priorities. Of these, half included specific research priorities to address inequities in health. Data on financing were lacking for most countries due to inadequate centralized collection of this information. The five main components of HRP showed a gradient where countries scoring lower on the Human Development Index (HDI) had a lower capacity to conduct research to meet local health research needs. Packaging such as peer-reviewed journals and policy forums were reported by two thirds of the countries. Seven out of 12 countries demonstrated impact of health research on policies and reported engagement of stakeholders in this process. CONCLUSION: Only one out of 12 countries indicated there was research on all fronts of the equity debate. Knowledge sharing and management is needed to strengthen within-country capacity for research and implementation to reduce inequities in health. We recommend that all countries (and external agencies) should invest more in building a certain minimum level of national capacity for equity-oriented research.

Africa↗

PubMed2004

Empirical support for a treatment program for families of young children with externalizing problems.

We evaluated the efficacy of a manualized multimodal treatment program for young externalizing children. Families were assigned randomly to an immediate 12-week parent and child treatment condition (n = 24) or to a delayed-treatment condition (n = 23). Parents had high attendance, high satisfaction with treatment, and increased knowledge of behavior management principles. Relative to the waitlist condition, treatment parents reported statistically and clinically significant reductions in child behavior problems, improved parenting practices (i.e., increased consistency, decreased power assertive techniques), an increased sense of efficacy, and reduced parenting stress. There was a trend toward parents improving their attitudes toward their children. In considering the process of change, we found evidence that improved parenting practices mediated reductions in child behavior problems and that child improvements mediated changes in parent attitudes and stress. Five months following treatment, teachers reported significant improvements in child behaviors, whereas parents reported that reductions in child behavior problems and parenting stress were maintained.

Adult↗

PubMed2006

Optimizing treatment of epilepsy during pregnancy.

Freedom from seizures is the ultimate goal in treatment of patients with epilepsy. At the same time, the side effects of antiepileptic drugs (AEDs) should not outweigh the benefits of treatment. This is particularly important in women with epilepsy who wish to become pregnant. These women and their partners should be made aware of the risks associated with uncontrolled seizures as well as the teratogenicity of some AEDs. Recent studies have indicated a higher risk for birth defects and possibly also adverse cognitive effects associated with exposure to valproate compared with carbamazepine. Although further studies are needed, it appears reasonable to use valproate with caution in women with epilepsy who are planning to become pregnant and to consider whether other equally effective and safer AEDs are available. However, women who need valproate to control their seizures should continue the drug and not be discouraged from pregnancy, provided that they receive counseling with the best available knowledge. With proper management before conception, during pregnancy, and after birth, the vast majority of pregnancies in women with active epilepsy will have a favorable outcome.

Abnormalities, Drug-Induced↗

PubMed2005

A quantitative model of tumor-induced angiogenesis in the nude mouse.

OBJECTIVE: Novel animal models allowing for the quantification of tumor-induced angiogenesis and cell migration may offer significant insight into the characterization and multidisciplinary treatment of brain tumors. In this study, we seek to establish such a model in tumor-bearing brain, allowing for a clear demarcation of primary and satellite tumor tissue in conjunction with precise quantification of cerebral microvasculature. METHODS: We used green fluorescent protein-transfected 9L-gliosarcoma cells stereotactically injected into the brain parenchyma of nude mice perfused with tetramethylrhodamine-dextran immediately before they were killed. New three-dimensional analytical software developed in our laboratory provided a quantitative analysis of laser-scanning confocal microscopy images of dextran-labeled cerebral microvessels. RESULTS: Our data confirm significant angiogenesis in tumor and brain adjacent to tumor. CONCLUSION: Because these highly infiltrative malignant brain tumors interdigitate with normal brain parenchyma through finger-like projections at the periphery of the solid tumor boundary, therapeutic options targeting tumor blood flow--combined with novel three-dimensional imaging to localize and track such interventions--may offer new hope for glioma management. To our knowledge, this system represents the first animal brain tumor model allowing for the precise colocalization and quantification of angiogenesis and tumor cell invasion, which may play an important role in the development of future therapy for brain tumors.

Animals↗

PubMed2001

Writing your curriculum vitae.

Your curriculum vitae (CV) is your gateway to shortlisting. A good CV takes a long time to prepare. It should not only record your training but, more importantly, should reflect your 'physicianly' qualities, management skills and knowledge of health-care systems.

Career Mobility↗

PubMed2005

Development of acute gouty attack in the morbidly obese population after bariatric surgery.

BACKGROUND: Gout is associated with increased body weight. We evaluated the prevalence of gout and acute gouty attacks in the morbidly obese population who underwent bariatric surgery. METHODS: The medical records and operative reports of 1,240 patients who underwent bariatric surgery were reviewed retrospectively for weight parameters, BMI, weight loss, medical history of gout, and onset of acute gouty attacks. RESULTS: Of the 1,240 patients, 5 (0.4%) had been previously diagnosed with gout. 2 of these 5 had acute attacks during the postoperative period, and responded successfully to intravenous colchicine. CONCLUSION: Although rare, gout must be considered a co-morbid illness in obese and morbidly obese patients. Surgeons should be familiar with the signs and symptoms of attacks in the postoperative period, and be knowledgeable in the management.

Acute Disease↗

PubMed2004

Factors associated with emergency department visits due to acute asthma.

It is important to identify characteristics related to poor disease control and frequent visits to the emergency department (ED). The objective of the present study was to compare the characteristics of patients attending the adult ED for treatment of asthma exacerbation with those attending an asthma specialist clinic (AC) in the same hospital, and to determine the factors associated with frequent visits to the ED. We conducted a cross-sectional survey of consecutive patients (12 years and older) attending the ED (N = 86) and the AC (N = 86). Significantly more ED patients than AC patients reported ED visits in the past year (95.3 vs 48.8%; P < 0.001) and had difficulty performing work (81.4 vs 49.4%; P < 0.001. Significantly more AC than ED patents had been treated with inhaled corticosteroids (75.6 vs 18.6%; P < 0.001) used to increase or start steroid therapy when an attack was perceived (46.5 vs 20.9%; P < 0.001) and correctly used a metered-dose inhaler (50.0 vs 11.6%; P < 0.001). The history of hospital admissions (odds ratio, OR, 4.00) and use of inhaled corticosteroids (OR, 0.27) were associated with frequent visits to the ED. In conclusion, ED patients were more likely than AC patients to be dependent on the acute use of the ED, were significantly less knowledgeable about asthma management and were more likely to suffer more severe disease. ED patients should be considered an important target for asthma education. Facilitating the access to ambulatory care facilities might serve to reduce asthma morbidity.

Acute Disease↗

PubMed2000

The gut at war: the consequences of enteropathogenic Escherichia coli infection as a factor of diarrhea and malnutrition.

Diarrheal disease is still the most prevalent and important public health problem in developing countries, despite advances in knowledge, understanding, and management that have occurred over recent years. Diarrhea is the leading cause of death in children under 5 years of age. The impact of diarrheal diseases is more severe in the earliest periods of life, when taking into account both the numbers of episodes per year and hospital admission rates. This narrative review focuses on one of the major driving forces that attack the host, namely the enteropathogenic Escherichia coli (EPEC) and the consequences that generate malnutrition in an early phase of life. EPEC serotypes form dense microcolonies on the surface of tissue-culture cells in a pattern known as localized adherence (LA). When EPEC strains adhere to epithelial cells in vitro or in vivo they cause characteristic changes known as Attaching and Effacement (A/E) lesions. Surface abnormalities of the small intestinal mucosa shown by scanning electron microscopy in infants with persistent diarrhea, although non-specific, are intense enough to justify the severity of the clinical aspects displayed in a very young phase in life. Decrease in number and height of microvilli, blunting of borders of enterocytes, loss of the glycocalyx, shortening of villi and presence of a mucus pseudomembrane coating the mucosal surface were the abnormalities observed in the majority of patients. These ultrastructural derangements may be due to an association of the enteric enteropathogenic agent that triggers the diarrheic process and the onset of food intolerance responsible for perpetuation of diarrhea. An aggressive therapeutic approach based on appropriate nutritional support, especially the utilization of human milk and/or lactose-free protein hydrolyzate-based formulas and the adequate correction of the fecal losses, is required to allow complete recovery from the damage caused by this devastating enteropathogenic agent.

Acute Disease↗

PubMed2004

Laryngeal sensitivity evaluation and dysphagia: Hospital Sírio-Libanês experience.

CONTEXT: Laryngeal sensitivity is important in the coordination of swallowing coordination and avoidance of aspiration. OBJECTIVE: To briefly review the physiology of swallowing and report on our experience with laryngeal sensitivity evaluation among patients presenting dysphagia. TYPE OF STUDY: Prospective. SETTING: Endoscopy Department, Hospital Sírio-Libanês. METHODS: Clinical data, endoscopic findings from the larynx and the laryngeal sensitivity, as assessed via the Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) protocol (using the Pentax AP4000 system), were prospectively studied. The chi-squared and Student t tests were used to compare differences, which were considered significant if p < or = 0.05. RESULTS: The study included 111 patients. A direct association was observed for hyperplasia and hyperemia of the posterior commissure region in relation to globus (p = 0.01) and regurgitation (p = 0.04). Hyperemia of the posterior commissure region had a direct association with sialorrhea (p = 0.03) and an inverse association with xerostomia (p = 0.03). There was a direct association between severe laryngeal sensitivity deficit and previous radiotherapy of the head and neck (p = 0.001). DISCUSSION: These data emphasize the association between proximal gastroesophageal reflux and chronic posterior laryngitis, and suggest that decreased laryngeal sensitivity could be a side effect of radiotherapy. CONCLUSIONS: Even considering that these results are preliminary, the endoscopic findings from laryngoscopy seem to be important in the diagnosis of proximal gastroesophageal reflux. Study of laryngeal sensitivity may have the potential for improving the knowledge and clinical management of dysphagia.

Adolescent↗

PubMed2004

Survival of exotic Newcastle disease virus in commercial poultry environment following removal of infected chickens.

During the first weeks of 2003, after exotic Newcastle disease (END) was confirmed in commercial layer flocks in Southern California, it became apparent that the virus survival information in the literature varied widely and was difficult to extrapolate to current local conditions. The END Task Force used the information available in the literature and the recommendations of research scientists to establish protocols for safely handling manure from infected and depopulated premises. In an attempt to gain more applicable knowledge in the management of contaminated poultry manure in the course of the END outbreak, this virus survival study was designed and implemented. Environmental drag swabs were tested for END virus from two of the early-infected commercial ranches that consisted of several houses following immediate removal of the infected flocks. A total of 293 samples, composed of 168 manure drag swab pools, 72 dropping board swab pools, and 38 compost swab pools from 3 houses (ranch 1), and 180 manure belt scraper swab pools from ranch 2 were analyzed for ND virus isolation and characterization for 21 consecutive days postdepopulation. Thirteen manure drag swab pools (from houses 1 and 3) and two manure dropping board swab pools (from house 3) collected from ranch 1 were positive for END virus at 0, 1, 2, 3, 4, 7, 10, 12, and 16 days postdepopulation. No END virus was isolated after the 16th day following depopulation from any of the samples. All samples from ranch 2 were negative during the entire observation period.

Animals↗

PubMedDate not supplied

Highly active antiretroviral therapy in neonates and young infants.

As techniques for early diagnosis of HIV-infected neonates and young infants become more sophisticated, neonatal nurses will be responsible for administering a variety of antiretroviral agents. Infants infected with HIV are likely to be placed on combination therapy, with the goal of suppressing viral replication and stabilizing the immune system. Combination therapy also reduces the risk of resistance mutations associated with monotherapy. The pharmacokinetics of antiretroviral agents in neonates is under study in a variety of PACTG protocols. However, the pharmacokinetics of most antiretroviral agents in premature infants has not been studied. With the exception of zidovudine, specific dosing for these agents in the preterm population is not known. The long-term effects of antiretroviral agents on growth and development also require further study. Knowledge of the management of HIV in all populations is expanding rapidly. Access to and utilization of HIV/AIDS-related resources are essential. The reader is encouraged to check for updated recommendations for the management of HIV-infected infants on the Internet at http://AIDSinfo. nih.gov.

Anti-HIV Agents↗

PubMed2002

Designing decoys for chemokine-chemokine receptor interaction.

Aberrant expression of chemokines and their receptors play causative roles in the pathophysiology of numerous autoimmune and inflammatory disease processes. Moreover, an integral step in HIV infection involves binding to chemokine receptors, and hence chemokines are intimately linked to HIV-related diseases. Therefore, chemokines and their receptors are excellent targets for developing drugs that are more specific and may be of benefit in the management of disease. Knowledge of the chemokine and chemokine receptor structures, and an understanding of the structural basis of their function are essential for structure-aided design of receptor decoys. Chemokine ligands bind their receptors with nanomolar (nM) affinity, and successful design of a small molecule antagonist should bind the receptor with similar high affinity and specificity. Chemokines bind receptors that belong to the 7-transmembrane class on leukocytes, and highly negatively charged proteoglycans that are present on the cell surface. Structure-function studies have identified regions in both the ligand and the receptor that mediate binding and activation. Structures of numerous chemokines have been solved though very little is known regarding receptor structures. This review will summarize the current knowledge on the structures, structure-function, and the efficacy of chemokine derivatives and functional domain peptides as antagonists, and discuss strategies for exploiting this information for designing decoys for inflammatory, autoimmune, and HIV-related diseases.

Animals↗