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At least 199 records · Page 11Linked to original sources
PubMed1999

[The 'Diabetes mellitus type 2' guideline (first revision) of the Dutch College of General Practitioners: response from internal medicine].

The corrections in the revised standard 'Diabetes mellitus type 2' of the Dutch College of General Practitioners are in accordance with the recent revision of DM classification, the notion that many DM patients remain undiagnosed and the finding in the UK prospective diabetes study (UKPDS) that strict blood glucose control and hypertension control are advantageous regarding microangiopathy. However, despite the UKPDS evidence, diuretics are still recommended as first treatment for hypertension. In addition the criteria for hyperlipidaemia treatment will probably have to be revised shortly. The only severe point of criticism is the referral to a dietician and control after three months in a patient diagnosed with DM. The reviewer recommends earlier control and consideration of the height of the blood glucose level before initiating therapy.

Diabetes Mellitus, Type 2↗
PubMed2001

Reliability, validity, and responsiveness of general and disease-specific quality of life measures in a clinical trial for cytomegalovirus retinitis.

The objective of this study was to evaluate a questionnaire for assessing general and disease-specific quality of life among people with cytomegalovirus (CMV) retinitis. Cross-sectional and longitudinal analyses of data from 279 people enrolled in the CMV Retinitis Retreatment Trial were used. At baseline, Cronbach's alpha and multitrait analysis were used to assess internal consistency and discriminant construct validity for scales of general health, vision, and treatment impact. Associations of scales with clinical measures of health and vision were assessed at baseline with Pearson correlations and t tests, and over time with generalized estimating equations regression. Internal consistency coefficients ranged from .68 to.88. Criteria for discriminant validity were fulfilled for most scales; however, the general health perceptions and energy scales were highly correlated. Scales were moderately correlated with clinical measures at baseline. Over time, scale scores were associated with Karnofsky scores and clinical measures of CMV retinitis and vision. General and CMV retinitis-specific quality of life measures appear reliable, valid, and responsive.

AIDS-Related Opportunistic Infections↗
PubMed1984

Metabolic effects of infection.

The metabolic effects of infection influence a wide variety and number of host biochemical pathways and molecular mechanisms. These responses function in support of the many diverse defense systems used by the body to control or eliminate invading microorganisms. Despite their complexity and diversity, these responses develop in relatively consistent, almost stereotypic pattern of progression during the course of generalized febrile infections caused by many kinds of different agents. If an infection localizes within an organ system, derangements of function of that organ may be superimposed upon the generalized responses. These general metabolic responses are initiated and modulated by the release of endogenous mediators, hormones, and by central nervous system stimuli as well. The magnitude of these metabolic changes can be influenced by the severity and duration of the illness. Clinically, the most visible metabolic effects of an infectious disease are catabolic. They can be documented by measurable losses of body constituents and nutrients. However, it must be kept in mind that equally important anabolic processes are taking place at the same time. It is these latter anabolic events that are of importance in host defensive mechanisms.

Acid-Base Equilibrium↗
PubMed2006

The response of general practitioners to the threat of violence in their practices: results from a qualitative study.

BACKGROUND: Violence directed towards GPs has been recognized as a significant problem in the UK. In Australian urban general practice, no study has previously examined this topic. OBJECTIVE: The objective of this study was to investigate the responses of Australian urban GPs to experiences of violence and to perceptions of risk of violence. METHODS DESIGN: A qualitative study of data collected from two sources-focus group discussions and qualitative questionnaire responses. Focus group discussions were audiotaped and transcribed. Questionnaires offered the opportunity for respondents to make qualitative comments. The focus group transcripts and qualitative questionnaire responses were coded independently by members of the research team and subjected to thematic analysis. SETTING: Three urban Divisions of General Practice in New South Wales, Australia. SUBJECTS: Focus groups were conducted with male and female GPs comprising a range of ages, socio-economic practice catchments and practice structures. Questionnaires were distributed to all GPs in the three divisions. RESULTS: The GPs in this study perceived themselves as being at significant risk of occupational violence. Despite responses to violence being largely ad hoc and uncoordinated, a coherent schema of GPs' responses to the threat of violence is apparent in the data. This has been characterized as encompassing primary, secondary and tertiary responses, and reflects a continuum of proactive to reactive responses. CONCLUSION: The findings will have implications for further research and for policy in the area.

After-Hours Care↗
PubMed1980

The mechanisms of differential control in the sympathetic system studied by hypothalamic stimulation.

In an attempt to study the mechanisms of differential action observed in the autonomic nervous system, response patterns evoked in two sympathetic nerves by stimulation of the hypothalamus were investigated. Recordings were made from inferior cardiac and vertebral nerves (mainly vasoconstrictors of the forearm muscles), both originating from stellate ganglia, in chloralose anesthetized cats. Repetitive stimulation of various hypothalamic regions produced 4 types of responses often in single preparations: (1) a response in which differential action between cardiac and vertebral nerves was characterized by an increase in vertebral nerve activity and a decrease in cardiac nerve discharges; (2) a response in which the activities of these two nerves were opposite to that described above; (3) a generalized response of the two nerves; both vertebral and cardiac nerve activity being greatly augmented. This response was accompanied by a great increase in forearm blood flow and could be classified as a part of "defense reaction"; and (4) another type of generalized response in which augmented activity of both nerves was accompanied by a decrease in muscle blood flow. Stimulation of the same hypothalamic area with a single or a short train of pulses evoked in sympathetic neurons an excitation of a short duration, followed by a long-lasting "silent period". The magnitude and duration of these two phases of responses of cardiac and vertebral nerves differed, depending on the site of stimulation. Stimulation of certain hypothalamic points could affect discharges of the left and the right cardiac nerves differently in some animals. The mechanism of differential control in the sympathetic system and some conditions which alter this pattern was discussed.

Animals↗
PubMed1999

[The 'Osteoporosis' guideline of the Dutch College of General Practitioners; response from family practice].

The guideline gives a well considered view of the management of osteoporosis. According to the characteristics of general practice the guideline emphasises good information to patients about lifestyle and nutrition. There is a strong advice against screening for osteoporosis. Case-finding of high risk patients in general practice meets a reticent attitude. The guideline indicates precisely the conditions to consider interventions by drugs. The decision to start drug therapy can only be made after adequate information in consultation with the patient. The management of osteoporosis needs much more reserve than most physicians and patients (want to) know.

Family Practice↗
PubMed1986

Bias of morphine generalization to cyclazocine by drug history.

Pigeons trained to discriminate morphine from saline under a color tracking procedure received cumulative doses of cyclazocine after various regimens of daily morphine or saline administration. Cyclazocine generalization curves were obtained after zero, one, two, or six completely drug-free days. In four or five animals, cyclazocine produced more response generalization to morphine after six drug free days than after no drug free days. In two animals the cyclazocine dose-effect generalization curves were generally shifted to the left with increased time from last drug exposure. Morphine response generalization to cyclazocine was also related to the degree of stimulus control evident in the non-drug (saline) condition during early portions of the subjects' experimental histories. The less stimulus control evident in the non-drug (saline) condition (i.e., the more morphine-appropriate responses made after saline injections and the greater variability of such responding), the more likely it was to obtain morphine-appropriate responding after cyclazocine administration.

Animals↗
PubMed1987

Role and responsibilities of general practitioner organisers of continuing medical education.

A total of 359 general practitioner organisers of continuing medical education in England and Wales were sent a questionnaire on their role and responsibilities in 1985; 206 with relevant duties replied. The results of the survey showed that they were playing an effective part in planning, organising, and evaluating educational activities at district level, that many were highly qualified and experienced general practitioners, and that many had previously been concerned in vocational training. Less than half had undergone formal training for their continuing education role. Only 105 (51%) were appointed district general practitioner tutors. They were more active in postgraduate centres than in practice based education. Almost a quarter (49) spent three to five hours a week on their educational duties, but 111 (54%) spent fewer hours. Although well provided with educational resources, few had any control over district educational funds, and over half lacked office space. As to remuneration, 161 (78%) received 500 pounds or less a year and almost two thirds received no reimbursement for expenses. Most had no job description. Attention is drawn to the case for appointing general practitioner organisers of continuing medical education ("district general practice tutors") in all districts of England and Wales, to their role in improving the participation of general practitioners in continuing medical education, and to the urgent need for a national agreement on their job description, preparation, support, and remuneration.

Education, Medical, Continuing↗
PubMed2006

Refractory generalized seizures: response to corpus callosotomy and vagal nerve stimulation.

PURPOSE: The vagal nerve stimulator (VNS) and corpus callosotomy can reduce seizure frequency when seizures are refractory to medications. However, the efficacy and safety of these two procedures have not been compared. This study evaluates the two procedures for generalized seizures. METHODS: All patients with refractory generalized seizures (generalized tonic-clonic, tonic, or atonic) who underwent a corpus callosotomy (anterior or complete) (n = 53) without other forms of epilepsy surgery and those who underwent VNS placement (n = 25) were evaluated for this study. Seizure response and procedure complications were evaluated. RESULTS: For those with a corpus callosotomy and generalized tonic-clonic seizures (n = 50), 79.5% had >or=50% decrease in the frequency of generalized tonic-clonic seizures, and 60% had >or=80% seizure reduction. For those with a VNS and generalized tonic-clonic seizures (n = 21), 50% had >or=50% seizure reduction, and 33% had >or=80% seizure reduction. Tonic and atonic seizures decreased after either VNS or a corpus callosotomy. The complication rate for corpus callosotomy was higher (21% all complications, 3.8% permanent) than that for VNS (8%; none permanent), but complications for both corpus callosotomy and VNS were rarely permanent. CONCLUSIONS: Both corpus callosotomy and VNS are effective in reducing generalized seizures. Corpus callosotomy is associated with greater efficacy but higher risk for complications, although these were generally transient.

Adolescent↗
PubMedDate not supplied

Improving social interaction in chronic psychotic using discriminated avoidance ("nagging"): experimental analysis and generalization.

Three social-interaction behaviors of a withdrawn chronic schizophrenic were increased using a discriminated avoidance ("nagging") procedure. The three behaviors were: (a) voice volume loud enough so that two-thirds of his speech was intellibible at a distance of 3m; (b) duration of speech of at least 15 sec; (c) placement of hands and elbows on the armrests of the chair in which he was sitting. "Nagging" consisted of verbal prompts to improve performance when the behaviors did not meet their criteria. A combined withdrawal and multiple-baseline design was used to evaluate the effectiveness of the procedure, and the contingency was sequentially applied to each of the three behaviors in each of four different interactions to determine the degree of stimulus and response generalization. Results indicated that the contingency was the effective element in increasing the patient's appropriate performance, and that there was a high degree of stimulus generalization and a moderate degree of response generalization. After the patient's discharge from the hospital, the durability of improvement across time and setting was determined in followup sessions conducted at a day treatment center and at a residential care home. Volume and duration generalized well to the new settings, while arm placement extinguished immediately.

Adult↗
PubMed1999

Responsiveness of general health status in chronic low back pain: a comparison of the COOP charts and the SF-36.

The objective of this study was to compare the responsiveness and assess the concurrent validity of two functional health status instruments, the Dartmouth COOP charts and the SF-36 in chronic low-back pain (CLBP) patients. The data came from 129 of 174 patients who participated in a randomized clinical trial of the therapeutic management of CLBP. Reliable and valid disease-specific outcomes, patient-rated low-back pain and disability, were used as external criteria (EC) to identify improved and non-improved patients. Unpaired t-statistics and receiver operating characteristic (ROC) curve calculations were used to quantify responsiveness. The two instruments had sufficient and very similar responsiveness using both EC. Comparisons between improved and non-improved patients for the COOP charts and SF-36, respectively, using pain as EC, yielded differences which translated into large effect sizes (0.8 and 0.7) (P=0.0008 and 0.003). Using disability as EC, differences of moderate effect size were found (0.5 and 0.6) (P=0.02 and 0.002). The ROC curve calculations using pain as EC resulted in areas under the curve of 0.76 (95% CI: 0.64, 0.88) for the COOP charts, and 0.74 (95% CI: 0.60, 0.88) for the SF-36. The corresponding areas using disability as EC were 0.67 (95% CI: 0.55, 0.79) and 0.72 (95% CI: 0.60, 0.84). The best cut-off point in both instruments for differentiating between improved and non-improved patients was approximately six percentage points. The constructs of functional health status, as reflected in the global scores of the two instruments, are highly correlated (r=0.82). Six of the instruments' nine dimensions are moderately to highly correlated (r=0.52 to 0.86), and the overall canonical correlation was high (R=0.9). In conclusion, both instruments seem equally suitable for use as outcome measures in clinical trials on CLBP. The COOP charts are faster to fill out and score.

Adult↗
PubMed2000

Induction of the mitochondrial permeability transition in vitro by short-chain carboxylic acids.

We recently reported that acrylic acid (AA) induces the MPT in vitro, which we suggested might be a critical event in the acute inflammatory and hyperplastic response of the olfactory epithelium. The purpose of the present investigation was to determine if induction of the MPT is a general response to short-chain carboxylic acids or if there are critical physical chemical parameters for this response. Freshly isolated rat liver mitochondria were incubated in the presence of varying concentrations of selected carboxylic acids. All of the acids that we tested caused a concentration-dependent induction of the MPT, which was blocked by cyclosporine A. Although the C4 carboxylic acids were slightly more potent than the C5 acids, there was no correlation with the degree of saturation, the octanol/water coefficient (log P), or the dissociation constant (pK(a)) of the acids that we tested. We conclude that induction of the MPT in vitro is a general response to short-chain carboxylic acids having a pK(a) of 4 to 5.

Acrylates↗
PubMed1980

Cell kinetics of the initial response to orthodontically induced osteogenesis in rat molar periodontal ligament.

Initial cell kinetics (15 min-20 h) of mechanically induced osteogenesis was studied with 3H-thymidine (3H-Tdr) autoradiography. Continuous orthodontic force elicited a three-stage cell proliferative reaction within rat molar periodontal ligament (PDL): (a) brief, generalized response, characterized by a burst of mitotic activity from 75 min to 2 h and a cyclic change (decrease, increase and return to control levels) in percent labeled cells from 15 to 2 h; (b) transient, generalized response, involving an increased mitotic index (MI) from 2 to 13 h, associated with elevated labeling index (LI) from 6 to 12 h; and (c) sustained, localized osteogenic response (12 h to several days) in which cell proliferation was confined primarily to the immediate area of new bone formation. These results suggest that the initial effect of mechanical perturbation on relatively quiescent adult bone progenitor cells is a generalized, transient release of G1 and G2 blocked cells. This response may correlate clinically with the regional acceleration phenomenon (RAP), which follows bone trauma, fracture, or surgical injury.

Animals↗
PubMed1989

Inpatient psychiatric units in nonteaching general hospitals. Response to public mental health policy or hospital economics?

The purpose of the study was to determine the extent to which the existence of inpatient psychiatric units (IPU) in general hospitals is related to patient service "needs," to certain economic and organizational characteristics of general hospitals, or to both. Area and institutional characteristics of general hospitals in Massachusetts were analyzed with multivariate techniques. Interviews were also conducted with representatives from hospitals and the Massachusetts Department of Mental Health in three mental health catchment areas. Most of the teaching hospitals in the state have IPUs. The study indicated that a statistical difference exists between characteristics of IPU and non-IPU nonteaching general hospitals. The probability that a nonteaching general hospital will have an IPU is related to both market conditions and institutional characteristics of the hospital. Nonteaching general hospitals with IPUs were more likely to be located in areas with higher incomes but fewer office-based psychiatrists per capita. IPU hospitals were also more likely to be larger and to receive a higher percent of their revenues from Medicaid than their non-IPU counterparts. The study did not provide evidence that "need" as defined by traditional indicators was an influential factor in IPU existence.

Community Mental Health Services↗
PubMed2003

PprI: a general switch responsible for extreme radioresistance of Deinococcus radiodurans.

Deinococcus radiodurans exhibits an extraordinary ability to withstand the lethal and mutagenic effects of DNA damaging agents, particularly, ionizing radiation. Available evidence indicates that efficient repair of DNA damage and protection of the chromosomal structure are mainly responsible for the radioresistance. Little is known about the biochemical basis for this phenomenon. We have identified a unique gene, pprI, as a general switch for downstream DNA repair and protection pathways, from a natural mutant, in which pprI is disrupted by a transposon. Complete functional disruption of the gene in wild-type leads to dramatic sensitivity to ionizing radiation. Radioresistance of the disruptant could be fully restored by complementation with pprI. In response to radiation stress, PprI can significantly and specifically induce the gene expression of recA and pprA and enhance the enzyme activities of catalases. These results strongly suggest that PprI plays a crucial role in regulating multiple DNA repair and protection pathways in response to radiation stress.

Blotting, Western↗
PubMed1993

Electroencephalogram spectral edge frequency, lower esophageal contractility, and autonomic responsiveness during general anesthesia.

Both the electroencephalogram (EEG) spectral edge frequency (SEF) and lower esophageal contractility (LEC) indices have been reported to be useful indicators of anesthetic depth. We designed a prospective study to evaluate the relationship between changes in these two variables and objective measurements of physiologic responsiveness to surgical stress (i.e., changes in hemodynamic variables and plasma levels of norepinephrine, epinephrine, total catecholamines, and vasopressin). Eighty-nine consenting adult males undergoing radical prostatectomy procedures under a standardized general anesthetic technique were studied according to a randomized, single-blinded protocol. General anesthesia was induced with 30 micrograms/kg intravenous (i.v.) alfentanil, 2.5 mg/kg i.v. thiopental, and 0.1 mg/kg i.v. vecuronium, and subsequently maintained with 0.5 microgram/kg/min alfentanil, nitrous oxide (N2O) 67% in oxygen, and 0.8 microgram/kg/min vecuronium. Following retropubic dissection, 81 patients (92%) manifested acute hypertensive responses, with mean arterial pressure increasing from 90 +/- 14 to 122 +/- 14 mm Hg (mean +/- SD). This acute hypertensive response was treated with one of three different treatment modalities (20 to 60 micrograms/kg i.v. alfentanil, 0.5 to 2.0% inspired isoflurane, or 0.05 to 0.15 mg/kg i.v. trimethaphan) to return the mean arterial pressure to within 10% of the preincisional (baseline) value within 5 to 10 minutes. Although the mean arterial pressure, heart rate, and plasma levels of catecholamines and vasopressin significantly increased following the surgical stimulus, and decreased after adjunctive therapy, the EEG-SEF and LEC index (LECI) values did not significantly change during these study intervals. Furthermore, using a logistic regression analysis, we observed that preincision EEG-SEF and LECI values could not predict whether patients would manifest a hypertensive response. Therefore, the EEG-SEF and LECI were unreliable indicators of anesthetic depth.

Aged↗