Leiomyomatosis peritonealis disseminata-is a different approach needed?
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Diagnosis, Differential↗
Biomedical subjects
A Tapp
Publications and source records attributed to A Tapp.
The legal risks of e-mail.
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Computer Communication Networks↗
Occupational health transfer of records.
Corporate mergers, downsizing and buy-outs can have an impact on the practice of occupational health nurses. With these changes, occupational health departments are frequently transferred to a new corporation, or existing occupational health services may be eliminated. This can create multiple dilemmas for the employer, employee and for the occupational health nurse who is the custodian of the employee's health records.
Canada↗
Defamation actions.
Registered nurses working in today's fast paced, high-tech health care environments are aware of their professional accountability and that, at some point, they may be involved in legal proceedings related to their practice. A civil lawsuit alleging negligence is the predominant concern nurses have when they turn their minds to this issue.
Canada↗
A timely risk management resource.
The Hospital Information Services program and the work of the HLC members has resulted in a significant increase in the number of physicians and institutions willing to co-operate with bloodless treatment of patients. Over a five-year period the number of physicians willing to co-operate in this matter has increased from 5,000 to more than 50,000 in 65 countries. This dramatic increase in the number of informed co-operative clinicians has also resulted in the development of more than 80 bloodless surgery and medical centres in various countries.
Blood Transfusion↗
Supervision of psychiatric patients.
Nurses are frequently part of a health care team providing services to psychiatric patients. From a health care and legal perspective, one of the pressing issues that must often be addressed is the amount of supervision or intervention required to protect the patient from self-harm or from injuring others.
Canada↗
Release of confidential information to the police.
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Canada↗
Schizophrenia, narcolepsy, and HLA-DR15, DQ6.
A strong association between HLA-DR2, DQ1 and narcolepsy-cataplexy has been known since 1986. In 1990 a subdivision (HLA-DR15, DQ6) was shown to be equally associated. Narcolepsy symptoms include rapid eye movement (REM)-sleep intrusion hallucinations during the day. Some narcoleptics may be so hallucinated that they become delusional and receive a diagnosis of schizophrenia. Fifty-six inpatient schizophrenics and 56 normal controls were compared to see if there was an excess of the narcolepsy-associated antigens (NAA) among schizophrenics. Patients had frequency of the NAA 3.89 times higher than controls. After a subset was studied by night (n = 9) and day (n = 7) polysomnography, two patients were found to be true narcoleptics. Their psychosis improved with treatment for narcolepsy. When NAA(+) and NAA(-) schizophrenics were compared, the NAA(+) subgroup had significantly higher Brief Psychiatric Rating Scale (BPRS) scores and more hospitalizations. There were no effects attributable only to gender or race. We conclude that narcolepsy can simulate schizophrenia in some cases, and that even in nonnarcoleptic patients, the HLA-DR15,DQ6 antigens mark a group of severe schizophrenics that merits further study.
Adult↗
Oestriol in the treatment of postmenopausal urgency: a multicentre study.
UNLABELLED: Oestrogen deficiency in postmenopausal women is thought to be important in the genesis of lower urinary tract symptoms, in particular the 'urge syndrome'. Evidence to support the use of oestrogen therapy in symptomatic postmenopausal women is, however, limited. Oestriol is a weak, naturally occurring oestrogen that may be beneficial to the urogenital tissues without stimulating the endometrium. We have investigated the use of oestriol in the treatment of postmenopausal sensory and motor urge incontinence. MATERIALS AND METHODS: A double-blind, placebo-controlled, randomised, multicentre study of 3 mg oral oestriol/day for 3 months in the treatment of women with urge incontinence was undertaken. RESULTS AND CONCLUSIONS: Sixty-four women were recruited into the study. Although oestriol produced both subjective and objective improvement in lower urinary tract function, it was not significantly better than placebo. Some of the difficulties of running a multicentre study were encountered.
Double-Blind Method↗
Age disorientation in Kraepelinian schizophrenia: frequency and clinical correlates.
Many schizophrenic patients exhibit significant neuropsychological impairment, and age disorientation is considered to be one of the more extreme manifestations. To evaluate clinical correlates of age disorientation with reference to the course of schizophrenic illness, we compared 39 deteriorated chronic Kraepelinian schizophrenic patients and 39 nondeteriorated schizophrenic patients early in the course of illness. Age disorientation was observed in 36% of patients in the Kraepelinian group, but in no patient in the non-Kraepelinian group. In the Kraepelinian group, age disorientation was unrelated to positive/negative symptoms or illness duration. Our data suggest that age disorientation may be a function of aging in schizophrenia, but is not merely a function of chronicity.
Adult↗
Listeriosis revisited: the role of the obstetrician.
The clinical course and outcome is described of three pregnancies complicated by listeriosis encountered during a 6-month period. All three ended in preterm labour characterized by the passage of meconium by the fetus. Two babies died in the early neonatal period and the third survived with neurological handicap. Although the diagnosis of listeriosis was made only after delivery, all the mothers had a pyrexial illness before delivery. A high index of suspicion is needed for the early detection and prompt treatment of this life-threatening perinatal infection. Effective advice concerning prevention of listeriosis by avoidance of high-risk foods must be given to women during pregnancy.
Adult↗
The influence of nipple stimulation at term on the duration of pregnancy.
The influence of nipple stimulation (NS) at term on the duration of pregnancy was investigated among low-risk gravidas in a randomized prospective study. A significant inverse relationship was found between the duration of pregnancy and both gestational age at recruitment and cervical (Bishop) score, although the influence of cervical score was quantitatively small. Nipple stimulation did not influence either the duration of pregnancy or the probability of having a cesarean section or an instrumental delivery. Patient compliance was, however, poor, which may in part account for these findings, as there was an inverse trend between the daily average duration of NS and the duration of pregnancy.
Adult↗
Terodiline: a dose titrated, multicenter study of the treatment of idiopathic detrusor instability in women.
Idiopathic detrusor instability is a common cause of lower urinary tract symptoms at all ages and in both sexes. Treatment initially is conservative and often includes drug therapy. Terodiline has the theoretical advantage of being a drug with anticholinergic and calcium channel blocking effects. Theoretically, by using a drug with dual action the beneficial effect of reduced detrusor overactivity might occur at a dosage below that likely to lead to the troublesome side effects experienced by patients who take pure anticholinergic agents. A total of 70 female patients completed a study characterized by extremely strict inclusion criteria and a tight protocol. Other novel elements to the study were the extensive use of urinary diaries for symptom evaluation, standardized urodynamic studies agreed upon by the participating centers and the dose titration design of the trial. Terodiline has been demonstrated to be a safe, well tolerated and effective drug in the treatment of idiopathic detrusor instability. Drug treatment led to significant decreases in urinary frequency and incontinence episodes. Pre-micturition symptoms, such as urgency, were markedly reduced and the voided volume was significantly increased. Although there were consistent trends towards greater improvement in the urodynamic measurements, when the terodiline and placebo groups were compared these did not reach statistical significance, partly due to a large improvement in the placebo group. Nevertheless, terodiline has been shown to be a useful drug for conservative management of patients with detrusor instability.
Adult↗
The effect of vaginal delivery on the urethral sphincter.
To investigate the aetiological role of vaginal delivery in genuine stress incontinence we compared two groups of women who underwent full urodynamic assessment in our department. The women in the first group had competent urethral sphincter mechanisms and those in the second group had genuine stress incontinence. There were no differences between the two groups in respect of parity, number of vaginal deliveries or birthweight of the heaviest baby. The group with competent urethral sphincter mechanisms did show some evidence to implicate an increased number of vaginal deliveries in poor function of the distal part of the urethral sphincter mechanism.
Birth Weight↗
Affective cycling in thyroid disease.
Depression in an elderly man with primary recurrent unipolar depression responded to radioactive iodine treatment of a thyrotoxic nodule, without the addition of psychotropic medications. Two months later, manic symptoms developed concomitant with the termination of the hyperthyroid state secondary to the radioactive iodine treatment. Clinical implications of these findings in relation to the possible mechanism of action of thyroid hormones on affective cycling are discussed.
Aged↗
Effect of oestrogen and testosterone implants on psychological disorders in the climacteric.
In a double-blind trial oestradiol, oestradiol/testosterone, or placebo implants were assessed for their effects on psychological symptoms in women attending a menopause clinic. After two months, women receiving active treatment scored better than the placebo group on a self-rating scale of distress, on anxiety, and on depression (p less than 0.05). Postmenopausal but not perimenopausal women improved after placebo, and at 4 months the scores in the three groups no longer differed significantly.
Adult↗
Frequency of neuropathology in a brain bank from a long-term, domiciliary population.
Postmortem analysis of brain chemistry and anatomy in the study of psychiatric disorders has enjoyed renewed interest recently. There are myriad difficulties in establishing a brain bank, including proper diagnosis and confounding neuropathology. These difficulties may become more pronounced in a long-term domiciliary facility. In order to begin to address neuropathologic considerations, we performed neuropathological examinations on each patient included in our bank of 20 brains. Forty-five per cent of all patients had significant and unexpected neuropathology. Selection of patients to be included in postmortem studies requires careful screening to enhance accurate neuropathological assessment.
Adult↗