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PubMed2003

The yield of UGIE: a study of a ten-year period in the 'Zaanstreek'.

BACKGROUND: Study of the occurrence of abnormalities in the oesophagus, stomach and duodenum, and of changes in specific diagnoses. METHODS: All consecutive upper gastrointestinal endoscopies (UGIEs) carried out in a period of ten years were included. RESULTS: In ten years 14,927 diagnostic UGIEs were performed (7335 men (49%) and 7592 women (51%)). These procedures were done at the request of the general practitioner in 4995 (33%) cases. A steady yearly increase in the number of open-access UGIEs was noted. Each year a mean of 796 abnormalities was seen in the oesophagus, a mean of 437 in the stomach, and of 162 in the duodenum. The presence of hiatal hernia and reflux oesophagitis significantly increased in the ten years (p < 0.001). The numbers of Barrett's oesophagus and oesophageal cancer remained constant. Gastritis showed a gradual increase (p < 0.001), while the number of gastric ulcers found per year decreased significantly in the ten-year period (p < 0.001). Gastric malignancy remained constant. Presence of duodenal ulcers and bulbitis significantly decreased (p = 0.01 and p = 0.06, respectively). CONCLUSIONS: The number of UGIEs carried out at the request of the general practitioner has significantly increased. Peptic ulcer disease shows a significant decrease, while reflux disease increases.

Endoscopy, Gastrointestinal↗
PubMed2003

Spectrum of congenital heart defects associated with Down Syndrome in high consanguineous Omani population.

OBJECTIVE: To identify the pattern of congenital heart defects (CHD) in children with Down Syndrome (DS) in an Omani population, and compare it with CHD in children without DS and with historical cohorts from populations with low prevalence of consanguinity. SETTING: Open-access Paediatric Echocardiography Clinic at Sultan Qaboos University Hospital, Muscat, Oman. DESIGN: Prospective study. METHODS: All children with DS referred to the Clinic from 1995-1998 formed the subjects (Group I). Children without DS or other known associations of CHD seen at the clinic during the same period served as controls (Group II). Two-dimensional echo-Doppler studies were performed on both groups and the results compared. RESULTS: CHD were detected in 54/90 (60%) children in Group I, compared to 698/2122 (32.9%) in Group II (P<0.001). The common CHD in Group I included secundum atrial septal defect (ASD; 18/54), atrioventricular septal defect (AVSD; 15/54) and ventricular septal defect (VSD; 14/54), and in Group II included ASD (175/698), VSD (175/698), patent ductus arteriosus (123/698), pulmonary stenosis (PS; 76/698) and AVSD (35/698). AVSD was more common (P <0.001) and PS less common (P = 0.03) in Group I. Aortic stenosis, coarctation of aorta, transposition of great arteries and complex heart diseases were not detected. Compared to several studies from populations with low prevalence of consanguineous marriages, our study showed a higher frequency of CHD in DS (P <0.05). CONCLUSION: A high frequency of CHD was documented in DS-children from a population with widely prevalent consanguinity. AVSD was most frequent in DS. An interesting observation was the relative rarity of some CHD in the DS population studied.

Child↗
PubMed2003

[Crisis of the scientific communication].

Scientific communication is undergoing radical changes. The increasingly high prices of scientific journals and other barriers limiting their accessibility are important reasons. On the internet, it is possible to archive and publicize articles with open access, thereby speeding up scientific communication and achievements. Thousands of researchers around the world and many institutions are in favour of open access, while commercial publishers fear losing their profits. The new open-access journals have a low impact factor, which is impending the transformation of the publication system.

Communication↗
PubMed2005

Economic valuation for sustainable development in the Swedish coastal zone.

The Swedish coastal zone is a scene of conflicting interests about various goods and services provided by nature. Open-access conditions and the public nature of many services increase the difficulty in resolving these conflicts. "Sustainability" is a vague but widely accepted guideline for finding reasonable trade-offs between different interests. The UN view of sustainable development suggests that coastal zone management should aim at a sustainable ecological, economic, and social-cultural development. Looking closer at economic sustainability, it is observed that economic analyses about whether changes in society imply a gain or a loss should take into account the economic value of the environment. Methods used for making such economic valuation in the context of the Swedish coastal zone are briefly reviewed. It is noted that the property rights context matters for the results of a valuation study. This general background is followed by a concise presentation of the design and results of four valuation studies on Swedish coastal zone issues. One study is on the economic value of an improved bathing water quality in the Stockholm archipelago. The other studies are a travel cost study about the economic value of improved recreational fisheries in the Stockholm archipelago, a replacement cost study on the value of restoring habitats for sea trout, and a choice experiment study on the economic value of improved water quality along the Swedish westcoast.

Animals↗
PubMed2005

Changes in the prosthodontic literature 1966 to 2042.

PURPOSE: To describe the growth and content of the prosthodontic literature over the last 4 decades, to make a prognosis on its probable development in the coming 4 decades and to discuss changes in the content of the International Journal of Prosthodontics (IJP) from its start in 1988 to 2004. METHODS: MEDLINE was searched for articles on prosthodontics published between 1966 and April 2004. All volumes of IJP were examined with respect to type, subject area and geographic origin of articles. RESULTS: Using the term "prosthodontics," the MEDLINE search produced 66,600 hits. The proportion of clinical studies increased from 1% during the first 10-year period to 13% since 2001. Articles on removable dentures decreased during the period reviewed, whereas those on implant prosthodontics increased. Randomized controlled trials were rare and often of inadequate quality. Literature reviews have become popular, but many do not follow current guidelines for systematic reviews. A marked change in geographic origin of articles in IJP has occurred, with a decrease in material from North America and an increase in that from Europe and Asia. The Internet and open-access publishing will probably have a great impact on the future development of the prosthodontic literature. CONCLUSIONS: Substantial changes have occurred in the prosthodontic literature between 1966 and 2004, and they can be expected to continue with the rapid development of information technology and increased use of the Internet.

Bibliometrics↗
PubMed2005

[Examination of patients with dyspepsia in areas with a low prevalence of Helicobacter pylori infection].

Examination of patients with dyspepsia is quantitatively a major task in gastroenterology. Several strategies have been used. In recent years the "test and treat strategy" has gained wide acceptance, because it is easy and without discomfort to the patient. The primary step in this strategy is a 13C-urea breath test for Helicobacter pylori. If the test is positive, the Helicobacter pylori must be eradicated. Only patients with alarm symptoms or refractory symptoms are offered gastroscopy. This strategy has been found useful in clinical trials performed in areas with a high prevalence of Helicobacter pylori infection. To examine whether these results are valid in clinical practice in a low-prevalence country, we performed a one-year retrospective study of our modified strategy of 666 patients, in which gastroscopy is offered to patients who test negative--an "open access test and scope strategy". In all, 576 patients were referred and examined according to the strategy; 90 patients, of whom 43 had alarm symptoms, were referred erronously. We performed 322 breath tests, of which 66 were positive--49 in patients without alarm symptoms. Of the latter, 39 were improved by Helicobacter pylori eradication therapy. These were the patients who really benefitted from the strategy. Of the 230 patients with a negative breath test, 197 agreed to have a gastroscopy done, and 31 cases of oesophagitis and 3 idiopathic ulcers were found. It is concluded that the strategy is advantageous but complicated in an open-access setting.

Adolescent↗
PubMed2005

How do clinicians manage vaginal complaints? An Internet survey.

INTRODUCTION: Although vaginal symptoms are among the most common presentations in primary care, little is known about how clinicians manage them. QUESTION: We undertook an Internet survey to determine how clinicians decided what was normal, how they evaluated vaginal complaints, and what happened when a diagnosis could not be reached. METHODS: A 27-question anonymous survey was conducted using the Medscape Internet publication platform and Medscape General Medicine , an online, peer-reviewed, open-access general medical journal. The study was targeted at physicians and nurse practitioners. RESULTS: There were 556 nurse practitioner and 608 physician respondents. Clinicians generally agreed that a midcycle increase in discharge and discharge seen at the introitus were normal; itching/irritation, odor, and a green discharge were not. There was less agreement concerning the value of a yellow discharge and "self-diagnosis" of abnormality. Eighty-two percent of MDs and 77% of NPs reported examining patients prior to treatment always or often. Only about 30% performed pH testing always or often. Ninety percent of NPs and 92% of MDs reported not making a diagnosis rarely or sometimes. When offered 4 different management strategies for patients in whom no diagnosis was made (watch and wait, symptomatic therapy, empiric antibiotics, referral), there was no clear preference. There was a weak correlation between performance of a wet mount and reports of less non-diagnosis. There was no correlation between pH and whiff testing and reports of less non-diagnosis. CONCLUSIONS: Clinicians do not always agree about what constitutes a vaginal symptom. Although most providers usually examine patients with vaginal complaints, pH and whiff testing are performed less frequently. Our data suggest the latter 2 maneuvers are not diagnostically helpful. There is no consensus regarding what to do when no diagnosis is made. Our findings suggest that the traditional approach to the evaluation of vaginal symptoms may have limited relevance for clinicians.

Female↗
PubMed2005

Sustained virological response rate to pegylated interferon plus ribavirin for chronic hepatitis C in African Americans: results in treatment-naïve patients in a university liver clinic.

OBJECTIVE: The sustained virological response (SVR) to non-pegylated interferon-based regimens for chronic hepatitis-C virus (HCV) has been lower among African Americans compared to Caucasians, a finding attributed to the high proportion of genotype-1 infections in African Americans. To determine whether such a difference in SVR is still present with pegylated interferon and ribavirin regimens, we analyzed SVR rates among treated racial groups according to genotype. METHODS: Consecutive treatment-naïve patients of multiethnic and racial backgrounds attending a university liver clinic received either Peg alfa-2a or -2b plus ribavirin 1-1.2 g based on body weight for 24-48 weeks, depending on genotype. HCV RNA titers were analyzed at 0, six or 12 months, and six months posttreatment. RESULTS: Among the first 193 patients eligible for treatment, 73 received therapy [24 African Americans (genotype 1 in 88%); 49 non-African Americans (genotype 1 in 59%)]. Of the 120 patients not treated (33% African-American and 67% non-African-American), most either had mild hepatitis on biopsy, normal ALT values, an untreated psychiatric condition or had a low expectation of treatment efficacy. SVR results for the 73 patients who completed treatment indicate that African Americans and non-African Americans with genotype 1 have similarly low rates of SVR (19% in African Americans compared with 24% in non-African Americans, p=NS). CONCLUSION: Sustained viral response rates in our open-access liver clinic are similar for genotype-1 African Americans compared to non-African Americans receiving pegylated interferon and ribavirin. The predominance of genotype 1 among African-American patients likely accounts for the lower response rates, but genotype 1 in other racial groups is associated with a proportionately lower SVR as well as a risk for delayed relapse after SVR.

Adult↗
PubMed2005

The role of optical access trocars in laparoscopic surgery.

A literature review between 2000 and 2005 has been conducted for laparoscopic access techniques. The blind insertion of a Veress needle or first trocar to create the pneumoperitoneum has been shown to cause vascular and visceral injuries. To reduce the risk of peritoneal entry, many surgeons prefer an open-access technique, like a Hasson trocar. Other trocars that can be used for laparoscopic entry are direct trocars and radially expanding trocars. No specific technique has been shown to be superior in preventing vascular and visceral complications. Optical trocars combine the advantages of the different entry techniques. This chapter describes the different entry techniques, indications, and clinical experiences of the optical trocars. An optical trocar provides a safe and feasible primary insertion method for laparoscopy in patients prone to access injuries.

Blood Vessels↗
PubMedDate not supplied

Computerized health information networks: house calls of the future?

The Cleveland Free-Net is the nation's first free open-access computer system providing health information to the public. An online survey was developed for the family medicine clinic housed within the Free-Net to study the characteristics of the users of the system and the reason they selected the Free-Net as a source of health information. Three areas were addressed: 1) user demographics; 2) content analysis of questions; and 3) reasons Free-Net was used instead of the person's own health care provider. An analysis of the initial system done in 1985 revealed that early users of the system were known to be predominantly white male professionals, generally in the 25-35 age range. In comparison to that profile, more of the users in this study were women, but the majority of users continued to be white male professionals. Questions asked can be classified in six categories: diagnosis, symptoms, treatment, medications, laboratory tests, and prevention. The main categories of medical concerns were cardiovascular, gastrointestinal, obstetrical, and gynecologic problems. Users tended to use the Free-Net for health information rather than their physician because the traditional means was not always appropriate for the life-style of this population.

Adult↗
PubMed1986

Upper gastrointestinal endoscopy--a view from general practice.

An open-access upper gastrointestinal endoscopy service for general practitioners is described. Between July 1981 and May 1985, 391 endoscopies were performed on 354 patients. In contrast to the results of other studies, demand for endoscopy and the pick-up rate for major lesions has remained steady, and the number of requests for barium meals has fallen by almost a quarter. Major lesions - cancer, gastric and duodenal ulcers and severe oesophagitis - were found in 33% of patients. Oesophagitis accounted for 28% of positive endoscopies and 18% of positive endoscopies in patients with barium negative dyspepsia. With scarce resources there may, however, be a case for ;selective' access to upper gastrointestinal endoscopy in the future.

Adult↗
PubMed1974

An appointment system in a teaching practice.

Some patients have difficulty in achieving an appointment to see a doctor in a university teaching practice. Only five per cent of patients indicated serious difficulty. Patients who discriminate in favour of seeing a particular doctor have greater difficulty. It is suggested also that some patients have the same difficulty if they are making an appointment to see a particular doctor.Clearly there is a need to explore the problem further to determine the nature of the difficulties which patients experience. It might then be expected that improvements can be made which will help patients to achieve appointments more easily. At the same time it has to be recognised that there may be some patients who will continue to have difficulty in achieving an appointment however much they are helped. Such patients may need access to community health care services in a manner entirely different from the appointment system.Most patients prefer to see their general practitioner by appointment. Both open-access surgeries and appointment systems cause difficulties for patients. The former is associated with the difficulty of long waiting periods and the second with difficulties in achieving an appointment. As some form of appointment system is likely to be continued, particularly for group practices and health centres, it is probably timely to audit patients' experience of achieving appointments.University teaching practices present general practitioners with unusual additional stresses on an appointment system. The full-time teacher's day is divided between service to patients and teaching or research. Any reduction in the availability of a particular doctor in a group may result in patients having difficulty in making an appointment. This argument could equally apply to any group of practitioners who have commitments other than to general medical services.

Appointments and Schedules↗
PubMed1984

Breast cancer: views of general practitioners on its detection and treatment.

A considerable proportion of women with breast cancer in this country present for treatment in late stages of the disease; Britain's primary health-care system means that in most cases the possible diagnosis of breast cancer is first made in general practice. This offers ample opportunity for early diagnosis and a better understanding about the way the general practitioners perceive the problems associated with the disease. With that specific aim, the present article reports on a survey conducted simultaneously in Oxford and in Edinburgh. Results show that general practitioners in the survey are deeply concerned about breast cancer and see a definite role for themselves in its early detection and long-term management. They also see a need for more health education that includes the encourgement of breast self-examination programmes. Most are in favour of open-access breast clinics for women and, in general, they feel positive about self-education programmes.

Adult↗
PubMedDate not supplied

"Céad Míle Fáilte"--an assessment of the screening of 178 Bosnian refugees to Ireland.

The number of refugees in Western Europe has risen dramatically. Such an increase poses unique challenges for all health personnel. This paper describes how the Republic of Ireland, a country with little experience of refugees, initially coped with 178 Bosnian refugees. An open-access general practitioner service was combined with a general screening protocol. Patients with significant problems tended to visit GP's, for appropriate treatment, soon after arrival. Of a total of 92 problems diagnosed at screening, general medical (14%), psychiatric (14%) and gynaecological (11%) were the most frequently encountered. Of the 30 problems referred, 80% were referred by a GP. Deficiencies in immunisation and drug history are highlighted. We make recommendations to improve the quality of future initial refugee assessment procedures.

Adolescent↗
PubMedDate not supplied

Audit of patients' experiences after endoscopy of the upper alimentary tract.

This study comprises an audit of the experiences of upper alimentary endoscopy by 400 patients examined in 15 hospitals. The patients were asked to complete a 19-section questionnaire regarding their experience of the endoscopy before, during and after the procedure. The audit was carried out in order to evaluate the patients' understanding of the investigation and to determine the impact of the findings on the patients' level of anxiety. Of the 400 patients, 304 (76.0%) returned the questionnaire; overall satisfaction was revealed with the decision to proceed with endoscopy and with the procedure itself, as well as the reassurance provided by the investigation. The study thus supports the role of open-access endoscopy.

Adolescent↗
PubMed1994

Discriminant value of symptoms in patients with dyspepsia.

BACKGROUND: Family physicians encounter many pitfalls in managing and treating dyspeptic patients, most of whom are treated in family practice based solely on their signs and symptoms. METHODS: A computer literature search followed by a systematic methodological appraisal was performed to identify studies that evaluated clinical symptomatology in dyspeptic patients. RESULTS: Ten studies, none of which took place in a family practice, fulfilled our inclusion criteria. The main conclusion drawn from outpatient populations and patients referred for open-access endoscopy was that certain clusters of symptoms have a negative predictive value for organic causes of dyspepsia. Higher age, male sex, pain at night, relief by antacids or food, and previous history of peptic ulcer disease were identified as predictors of organic causes for abdominal symptoms. CONCLUSIONS: These findings can be helpful to family physicians in determining the need for endoscopy referral. However, since the diagnostic values of tests in family practice may differ from those in referred populations, there is a need for prospective studies in primary care.

Dyspepsia↗
PubMed1997

Usefulness of anti-Helicobacter pylori and anti-CagA antibodies in the selection of patients for gastroscopy.

OBJECTIVES: Screening of dyspeptic patients with serological tests for Helicobacter pylori before open-access gastroscopy has been suggested to be worthwhile. CagA-positive H. pylori strains may be associated with major pathology more often than CagA-negative strains. The usefulness of anti-H. pylori and anti-CagA antibodies in screening for gastroscopy was evaluated in unselected dyspeptic patients. METHODS: Four hundred consecutive, unselected dyspeptic patients (mean age, 56.8 yr) in primary care were investigated with gastroscopy, ultrasonography of the upper abdomen, laboratory tests (including serological tests for H. pylori and CagA), and other examinations if needed. The patients were followed for 1 yr. RESULTS: Results of serological tests were positive for H. pylori in 56.2% of patients, of whom 64.4% also had results positive for CagA. Use of H. pylori and CagA serology-based screening combined with a history of nonsteroidal anti-inflammatory drug use would have detected only 80 and 70% of the major pathologies (peptic ulcer, moderate or severe esophagitis, celiac disease, or malignancy), respectively, in these patients. Gastroscopy would have been avoided in 30 and 41%, respectively, if only patients who had positive results on serological tests or who were nonsteroidal anti-inflammatory drug users would have been referred. In patients younger than 45 yr of age (n = 87), 60-74% of gastroscopies would have been avoided, but 50-60% of major pathologies would have been missed, by using the screening strategy studied. One of the nine malignancies (all in patients >45 yr of age) was H. pylori-negative, and two were CagA-negative. CONCLUSIONS: Anti-CagA antibodies do not offer advantages compared with anti-H. pylori antibodies in screening patients for gastroscopy. A remarkable share of major pathologies are missed by both of these screening methods. Therefore, the results of these screening tests are not recommended as selective criteria for gastroscopy.

Adolescent↗
PubMed1998

Choice words on open access.

Drawn by rates only slightly higher than traditional HMOs, consumers have hurried to sign up for open-access plans. Yet what works for patients may work against doctors who assume the financial risks.

Health Services Accessibility↗