A pilot study was carried out to assess the value of a radiolabeled antibody against epidermal growth factor receptor (EGFR1) in localizing tumors in patients with squamous carcinomas of the head and neck. Positive images of large tumours (greater than 3 cm diameter) were obtained in 8 of 11 patients after intravenous administration of 111indium-labeled EGFR1. Two patients gave equivocal results, while negative scans were obtained from the patient with the smallest tumor (1 cm diameter). There were no false-positive images. The success of this study in localizing relatively large squamous carcinomas indicates that the antibody should be evaluated in patients with smaller tumors to establish the limits of detection of the technique.

Adult↗

PubMedDate not supplied

Diagnostic judgments of nurse practitioners providing primary gynecologic care: a quantitative analysis.

OBJECTIVES: To determine the accuracy of experienced nurse practitioners' judgments of the probability of chlamydial infection of the cervix, to identify the clinical factors ("cues") related to the judgments, and to discern likely sources of judgment error. DESIGN: Cross-sectional study with prospective data collection. SETTING: Urban hospital-based clinic. PATIENTS: 492 nonpregnant women receiving primary gynecologic care. INTERVENTIONS: Four nurse practitioners recorded clinical data, tested women for chlamydial infection, and judged the probability of chlamydial infection using six categories: less than 1%, 1-4%, 5-9%, 10-24%, 25-50%, and greater than 50%. MEASUREMENTS AND MAIN RESULTS: Chlamydial infection was detected by immunofluorescent assay in 31 (6%) of the 492 women. Although the median probability judgment was 5-9%, judgments were only weakly related (p = 0.08) to actual rates of infection. In a multivariate analysis, eight clinical cues were independently (p less than 0.05) related to nurse practitioners' probability judgments: age less than 20 years; past chlamydial or gonococcal infection; new sex partner; partner with suspected genital infection; genito-urinary symptoms; cervicitis, purulent vaginal discharge; and malodorous vaginal discharge. A linear model based on the eight cues, weighted according to their regression coefficients, predicted chlamydial infection more accurately than did the nurse practitioners' actual judgments (ROC curve areas 0.69 vs. 0.58, respectively; p less than 0.05). However, only two of the eight cues (age less than 20 years and purulent vaginal discharge) were actually related to chlamydial infection in a second multivariate model; this model bad accuracy similar to that of an empirically derived prediction rule (ROC curve areas 0.77 and 0.80, p = 0.27). CONCLUSIONS: Nurse practitioners were often inaccurate in their diagnostic judgments. Our analyses suggest that this inaccuracy stemmed from both the inconsistent use of clinical cues and the use of cues that were not related to chlamydial infection. Therefore, interventions such as algorithms that promote consistency and accuracy in diagnostic use of relevant cues would be likely to improve their diagnostic judgments.

Adult↗

PubMedDate not supplied

A new diagnostic index for predicting cervical infection with either Chlamydia trachomatis or Neisseria gonorrhoeae.

OBJECTIVE: To develop and test a diagnostic index for estimating the probability of cervical infection with either Chlamydia trachomatis or Neisseria gonorrhoeae. DESIGN: Prospective, cross-sectional study in two phases: 1) to develop a diagnostic index based on independent predictors of cervical infection; 2) to test the index. SETTINGS: A hospital-based clinic and a student health service. PATIENTS: Development phase: 190 nonpregnant women seen in the gynecology clinic; testing phase: 588 women seen in the gynecology clinic (n = 372) or the student health service (n = 216). INTERVENTIONS: Experienced clinicians recorded historical, physical, and microscopic findings on standard forms and tested women for chlamydial and gonococcal infections. RESULTS: Three independent predictors of cervical infection were identified and weighted: age (two points if less than 20 years and one point if 20-29 years); a new sex partner or one suspected of having a genital infection (one point); purulent vaginal discharge (one point). In the testing groups, cervical infection was present in none of 62 women with no points, seven of 269 (3%) with one point, 14 of 188 (7%) with two points, and 19 of 69 (28%) with three or four points (p less than 0.001). The index estimated the probability of infection more accurately (p less than 0.01) than did clinicians, performed well in each site, and remained accurate when C. trachomatis and N. gonorrhoeae were considered separately. CONCLUSION: The diagnostic index accurately estimates the probability of cervical infection with either C. trachomatis or N. gonorrhoeae and may be useful in selecting women for definitive diagnostic testing.

Adult↗

PubMedDate not supplied

Opiate-related deaths in Dublin.

BACKGROUND: Intravenous drug misuse, principally heroin, occurs primarily in the Greater Dublin area. Methadone maintenance treatment has been an important part of the response to opiate misuse in Dublin since 1992. AIMS: To determine the number of opiate-related deaths in Dublin City and County during 1999, to establish the number of methadone-related deaths and determine the proportion of deaths associated with methadone prescribed according to guidelines. METHODS: A retrospective review of all coroners' inquest files in Dublin City and County during 1999 was undertaken. RESULTS: There were 84 opiate-related deaths. Seventy-eight (92.9%) were male. Seventy-three (86.9%) had two or more drugs identified toxicologically. There were 45 methadone-related deaths, of which 15 (33.3%) were receiving methadone prescribed according to guidelines. CONCLUSION: Opiate-related deaths occur primarily in males in the 25-34 year age group and are associated with a high level of polydrug use. Diverted methadone accounted for the majority of deaths involving

Adolescent↗

PubMedDate not supplied

Self-report of Guardians Ad Litem: provision of information to judges in child abuse and neglect cases.

Reporting patterns of Guardians Ad Litem to judges in cases on child abuse and neglect were studied. Guardians indicated which information they had included in reports to judges in recently adjudicated cases of child abuse and neglect. Information reported in child abuse cases was compared with information reported in neglect cases, and the pattern of reporting was found to be the same in both types of cases. Guardians most frequently included information concerning the child's physical safety, the interaction between the parent(s) and the child, and personality characteristics of the parent(s). Less frequently reported was information regarding conflict in the home and family enmeshment.

Adult↗

PubMedDate not supplied

Supplemental low flow oxygen prevents hypoxia during endoscopic cholangiopancreatography.

Administration of continuous oxygen during ERCP may prevent hypoxia. Oxygen saturation was recorded using pulse oximetry in 50 consecutive patients undergoing ERCP. Patients were randomly allocated to receive no oxygen or low flow oxygen (2 liters/min) via nasal prongs or nasopharyngeal cannula. Oxygen saturation fell below 90% in 47% of patients not receiving oxygen compared with 0% in those administered oxygen (p less than 0.001). No difference existed in oxygen saturations between those groups receiving supplemental oxygen via nasal prongs or nasopharyngeal cannula. Continuous administration of low flow oxygen is recommended during ERCP.

Aged↗

PubMedDate not supplied

Pretransplant MLC in the presence of cyclosporine may predict renal allograft survival.

Explore the source record for details and available documents.

Adolescent↗

PubMedDate not supplied

A weekend camp for bereaved siblings.

PURPOSE: The purpose of this article is to describe a weekend bereavement camp for children age 6 to 18 years who have lost a brother or sister to cancer. A description of the planning for the camp and the weekend program is included. OVERVIEW: Camp New Horizons is a weekend camp for children age 6 to 18 years who have lost a sibling to cancer. At the camp, the children are divided into age-appropriate groups and spend time, through various activities, learning about the grief process to reduce their feelings of isolation, to express grief appropriately, and to move forward in the grief process. Similar programs, as well as the uniqueness of this program, are discussed. CLINICAL IMPLICATIONS: Camp New Horizons has met many of the educational and support needs of bereaved siblings. Networks of support and friendship have formed that allow the children to reach out to one another when needed. Parents and children have increased their communication about the death in their family, thus accepting their feelings and increasing support in the family system. Continued collaboration between centers will create ongoing support for the healthcare professionals and the programs they provide.

Adaptation, Psychological↗

PubMedDate not supplied

Evaluation of endoscopic sclerotherapy of esophageal varices in children.

Sixteen children (3.5-14.7 years) with portal hypertension and variceal hemorrhage were treated by direct endoscopic variceal sclerotherapy. Follow-up clinical and endoscopic evaluations have been carried out over a 1-6-year period (mean, 2.3 years). Prior to sclerotherapy, three patients had undergone unsuccessful surgical approaches, and the mean transfusional requirement from the time of the first hemorrhage was 12.3 units of blood per child per year for those with extrahepatic portal vein obstruction (n = 10) and 3.8 units for those with primary liver disease. Following sclerotherapy, transfusional requirements were significantly reduced in both groups, to 1.8 units and 2.2 units (85% and 43% reduction, respectively). Re-bleeding in four patients was due to the occurrence of gastric varices. One patient with extrahepatic portal hypertension has required subsequent shunt surgery for this complication, 5 years after sclerotherapy. Two patients have died, one with cystic fibrosis and hemorrhage from gastric varices and one from liver failure due to progressive biliary cirrhosis. Complications of sclerotherapy included transient retrosternal pain (eight occasions), esophageal ulceration with bleeding (n = 1) and esophageal stricture (n = 1). We conclude that sclerotherapy is an effective technique in obliterating esophageal varices and reducing the risk of hemorrhage in children with portal hypertension, with an acceptably low complication rate. We favor its use over more invasive surgical measures for control of acute and recurrent variceal hemorrhage, particularly for cases of extrahepatic portal hypertension in which a favorable natural history is likely.

Adolescent↗