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PubMed1977

Random mucosal biopsies in the evaluation of patients with carcinoma of the bladder.

The management of patients with recurrent transitional cell carcinoma of the bladder has posed a constant dilemma to the practicing urologist. Previously, urine cytologies have been used and have been of value only in those instances in which they have been classified as diagnostic. Cytologies that reveal atypia or a high degree of suspicion have offered little help in the management of these patients. The current procedure of doing random mucosal biopsies using the cold cup biopsy forceps provides the pathologist with a sampling of the mucosa of the involved bladder so that a tissue diagnosis of sufficient magnitude, ranging from atypia to carcinoma in situ to frank carcinoma, may be established. This information may become valuable in determining alternate forms of management in these patients and may have a greater predictive value than customary urine cytology.

Aged↗
PubMed1989

Female adolescents' compliance with contraceptive regimens.

Although today's adolescents have access to a variety of contraceptive options, they remain inconsistent and suboptimal users of these methods. A particularly frustrating problem for those caring for adolescents is the issue of noncompliance with contraceptives, which is an important antecedent of adolescent pregnancy. In the future, new fertility-related developments such as subdermal hormonal implants may reduce the likelihood of noncompliance. For the present, however, systematic monitoring rather than only when noncompliance is suspected is essential in enhancing adolescents' contraceptive compliance.

Adolescent↗
PubMed2000

Setting up a discipline: conflicting agendas of the Cambridge History of Science Committee, 1936-1950.

Traditionally the domain of scientists, the history of science became an independent field of inquiry in the twentieth century and mostly after the Second World War. This process of emancipation was accompanied by a historiographical departure from previous, 'scientistic' practices, a transformation often attributed to influences from sociology, philosophy and history. Similarly, the liberal humanists who controlled the Cambridge History of Science Committee after 1945 emphasized that their contribution lay in the special expertise they, as trained historians, brought to the venture. However, the scientists who had founded the Committee in the 1930s had already advocated a sophisticated contextual approach: innovation in the history of science thus clearly came also from within the ranks of scientists who practiced in the field. Moreover, unlike their scientist predecessors on the Cambridge Committee, the liberal humanists supported a positivistic protocol that has since been criticized for its failure to properly contextualize early modern science. Lastly, while celebrating the rise of modern science as an international achievement, the liberal humanists also emphasized the peculiar Englishness of the phenomenon, In this respect, too, their outlook had much in common with the practices from which they attempted to distance their project.

Curriculum↗
PubMed2002

Predicting disease recurrence in intermediate and high-risk patients undergoing radical prostatectomy using percent positive biopsies: results from CaPSURE.

OBJECTIVES: To determine whether percent positive biopsies could be used to predict the probability of disease recurrence in contemporary patients undergoing radical prostatectomy in community-based practice settings. Previous studies have demonstrated the importance of systematic prostate biopsy results in the risk assessment for newly diagnosed patients with prostate cancer. METHODS: We studied 1265 patients enrolled in CaPSURE (a longitudinal registry of patients with prostate cancer) who underwent radical prostatectomy as definitive local treatment of their prostate cancer. Preoperative characteristics, including age, race, prostate-specific antigen (PSA) level at diagnosis, clinical T stage, biopsy Gleason score, and percent positive prostate biopsies at the time of diagnosis, were determined for each patient. Disease recurrence was defined as PSA level of 0.2 ng/mL or greater on two consecutive occasions after radical prostatectomy or the occurrence of a second cancer treatment more than 6 months after surgery. Cox proportional regression analysis was performed to determine the significant independent predictors of disease recurrence. Patients were assigned to previously described risk groups on the basis of clinical tumor stage, PSA at diagnosis, and biopsy Gleason score. The likelihood of disease recurrence for each risk group, stratified according to the percentage of positive biopsies (0% to 33%, 34% to 66%, and more than 66%), was determined using the Kaplan-Meier method and compared using the log-rank test. RESULTS: The median follow-up was 3.3 years after surgery. The serum PSA level at diagnosis, biopsy Gleason score, percent positive biopsies, and ethnicity were significant independent predictors of disease recurrence. The percentage of positive prostate biopsies was a significant predictor of disease recurrence for low, intermediate, and high-risk patients. For patients with high-risk disease, the likelihood of disease recurrence 5 years after surgery was 24%, 34%, and 59% for patients with 0% to 33%, 34% to 66%, and more than 66% positive biopsies, respectively. CONCLUSIONS: Serum PSA, biopsy Gleason score, and percent positive biopsies were significant predictors of disease recurrence in this population. The percent positive biopsies may be useful in identifying high-risk patients suitable for definitive local therapy.

Biopsy, Needle↗
PubMed1988

Peer reviewer agreement for major anesthetic mishaps.

In a study of peer reviewer agreement for major anesthetic mishaps, 42 anesthesiologists performed a standardized peer review of 48 reports of anesthetic mishaps obtained from a national data base. The peer review group exhibited agreement (P less than 0.0001) for judgments on the appropriateness of clinical care, the presence or absence of human error, and the role of better monitoring in prevention of the mishap. Personal attributes of the reviewers (eg, type of practice, length of time in practice, and previous experience with mishap review) did not appear to influence agreement. The study findings suggest a highly favorable environment for the development of broadly recognized standards of care in anesthesiology.

Anesthesia↗
PubMed1998

Management-related risk factors for M. paratuberculosis infection in Michigan, USA, dairy herds.

A cross-sectional study was conducted from June through December 1996 to identify management-related risk factors for herd-level M. paratuberculosis infection. Data were collected from 121 participating herds. A two-part questionnaire was administered to gather data on current and previous management practices and herd productivity. A random sample of cows aged > or = 24 months was selected from each herd and tested for antibodies to M. paratuberculosis using the IDEXX Antibody ELISA (sensitivity 64%, specificity 96%). A positive herd was one in which > or = 2 animals tested positive for antibodies to M. paratuberculosis. A negative herd was one in which no animal tested positive. Herds in which only one animal tested positive were dropped from statistical analysis to reduce the risk of including false-positive herds in the statistical analyses. There were 80 herds with one or more positive animals and 41 herds with no positive animals in the sample (66% herd-level prevalence). Twenty-six herds (21%) were dropped from further analyses because they had only one positive cow. Twelve herds (10%) were dropped from analysis because of missing data. The resulting sample used for statistical modeling included 46 positive herds and 37 negative herds (55% herd-level prevalence). A multi-variable logistic-regression model was used to evaluate the results. The variable 'use of an exercise lot for lactating cows' was associated with a three-fold increase in odds of a herd being positive for M. paratuberculosis infection (O.R. = 3.01, C.I. = 1.03-8.80); 'cleaning of maternity pens after each use' was associated with a three-fold reduction in odds of a herd being positive for M. paratuberculosis infection (O.R. = 0.28, C.I. = 0.08-0.89); 'application of lime to pasture areas in 1993' resulted in a ten-fold decrease in odds of a herd being positive for M. paratuberculosis infection (O.R. = 0.10, C.I. = 0.02-0.56).

Analysis of Variance↗
PubMed2000

Development of a clinical instrument to measure heel pad indentation.

OBJECTIVE: To provide an accurate, reliable, non-invasive, portable instrument to measure heel pad indentation in a clinical setting. DESIGN: A novel instrument was applied to assess heel pad indentation. BACKGROUND: For the lack of quantitative biomechanical tools for in vivo assessment, palpation is used to evaluate heel pad stiffness subjectively in everyday clinical practice. Furthermore, previous studies have evaluated heel pad stiffness using non-portable instrumentation. METHODS: Cylindrical probe was attached to an electronic force gauge unit that passed through a Perspex plate for placement on heel pad. Displacement of the plate was connected to a linear variable differential transformer. A laptop PC allowed for portability and storage of data. An exponential curve described the force-displacement data. Ten healthy subjects (mean 21. 7; SD, 1.7 years) were assessed on ten separate occasions. The procedure was standardised for subject position and placement. RESULTS: Accuracy and reliability of each device component was established. An intraclass correlation (2,1) of 0.90 and 0.88 demonstrated curve coefficients b1 and b0 respectively. A paired t-test demonstrated no significant difference between the left and right foot coefficients. CONCLUSION: The results demonstrated that each system component could be measured accurately and reliable. Reproducible results were obtained over separate occasions. The study has described a method to analyse the force-displacement curve. RelevanceThe development of a hand-held device may help the clinician to assess heel pad stiffness in the clinical setting. Heel pad stiffness may be associated in the development of plantar heel pain in athletes.

Adolescent↗
PubMed2003

Activation of host constitutive immune defence by an intestinal trypanosome parasite of bumble bees.

Many parasites, including important species that affect humans and livestock, must survive the harsh environment of insect guts to complete their life-cycle. Hence, understanding how insects protect themselves against such parasites has immediate practical implications. Previously, such protection has been thought to consist mainly of mechanical structures and the action of lectins. However, recently it has become apparent that gut infections may interact with the host immune system in more complex ways. Here, using bumble bees, Bombus terrestris and their non-invasive gut trypanosome, Crithidia bombi, as a model system we investigated the effects of parasitic infection, host resources and the duration of infections on the host immune system. We found that infection doubled standing levels of immune defence in the haemolymph (the constitutive pro-phenoloxidase system), which is used as a first, general defence against parasites. However, physical separation of the parasite from the haemolymph suggests the presence of a messenger system between the gut and the genes that control the pro-phenoloxidase system. Surprisingly, we found no direct effect of host resource-stress or duration of the infection on the immune system. Our results suggest a novel and tactical response of insects to gut infections, demonstrating the complexity of such host-parasite systems.

Animals↗
PubMed1998

The tacit-explicit connection: Polanyian integrative philosophy and a Neo-Polanyian medical epistemology.

The purpose of this paper is to introduce an approach to clinical practice aiming to resolve the dilemma of choosing between a mechanistic and a phenomenological model. The approach is an extension of Polanyi's epistemology. Michael Polanyi (1891-1976), devised an epistemology of science which overcomes the problem of detachment, inherent in the "mechanistic" approach, and resolves the problem of subjectivity troubling phenomenologists. His epistemology is known as Personal Knowledge. An extension of this epistemology, a Neo-Polanyian proposal, is offered as a more successful model for clinical practice than previous suggestions addressing the dilemma.

Ethics, Medical↗
PubMed2004

Brain mechanisms for the formation of new movements during learning: the evolution of classical concepts.

Current concepts hold that the role of the motor cortex is limited to the control of the appropriate motoneurons on the "point-to-point" principle during the performance of specialized movements of the distal parts of the limbs. However, the last decade has seen the appearance of many data on the plasticity of the motor cortex and its active participation in the process of motor learning. Expression of fos genes has been observed in the motor cortex during the formation of specialized movements. Increases in intracortical horizontal connections in layers II-III during learning fine movements has been seen. The cholinergic input to layers II-III of the motor cortex plays a significant role in this. At the same time, data obtained by functional brain mapping have provided evidence that the activity of the motor cortex also increases during the practice of previously learned movements. This raises the question of the specific function of the motor cortex in the process of motor learning. During the formation of new movements during motor training, a number of previously used synergies interfere with the performance of newly formed coordinations and must be inhibited. The central mechanisms of interference of coordinations in humans have only just started to receive study. At the same time, there is an experimental model for the reorganization and inhibition of interfering synergies in animals. Reorganization of coordinations and inhibition of synergies interfering with the performance of a new movement have been shown to be a specific function of the motor area of the cortex. Cortical control persists during the automation of these synergies, which is not the case in other types of learned movements, though this in itself does not mean that conscious control of their performance also persists.

Animals↗
PubMed1989

Risk factors for ovarian cancer: a case-control study.

A hospital-based case-control study of ovarian cancer was conducted in London and Oxford between October 1978 and February 1983. Menstrual characteristics, reproductive and contraceptive history and history of exposure to various environmental factors were compared between 235 women with histologically diagnosed epithelial ovarian cancer and 451 controls. High gravidity, hysterectomy, female sterilisation and oral contraceptive use were associated with a reduced risk of ovarian cancer. Infertility and late age at menopause were associated with an increase in risk. While these factors were related, they were each found to be independently associated with ovarian cancer risk after adjusting for the effect of the other factors.

Adult↗
PubMed2003

Qualitative research: implications for description and assessment.

As clinical speech-language pathologists seeking different ways to understand the complexity of communication within naturalistic and social contexts, we are progressively adapting the qualitative research methods of the social sciences for our assessment purposes. This article discusses some basic principles and practices discussed previously in this forum on qualitative research and demonstrates how they can be employed to provide effective and sufficient clinical communicative assessment.

Anthropology, Cultural↗
PubMed2003

Usefulness of the free alpha-subunit to diagnose hypogonadotropic hypogonadism.

OBJECTIVE: Differentiating constitutional delay of growth and puberty from hypogonadotropic hypogonadism is still a problem in clinical practice. Our previous study demonstrated that the peak/basal ratio of the free alpha-subunit of the glycoprotein hormones is higher in normal prepubertal boys than in male adults with hypogonadotropic hypogonadism. The objective of this study was to assess the performance of this ratio in normal male patients at different ages and levels of pubertal development, and in patients with hypogonadotropic hypogonadism, both isolated and combined with other pituitary hormone deficiencies. DESIGN: Cohort study. PATIENTS: Twenty-eight normal prepubertal males between 6 and 8 years; 20 normal prepubertal males between 9 and 13 years; 18 males with constitutional delay of growth and puberty; 26 normal pubertal males; 13 adult men with isolated hypogonadotropic hypogonadism; 21 adult men with complete hypogonadotropic hypogonadism combined with other hormone deficiencies; and 11 adult men with partial hypogonadotropic hypogonadism combined with other hormone deficiencies. MEASUREMENTS: Serum levels of free alpha-subunit immediately before (basal), and 30 and 60 min after 100 micro g intravenous GnRH were measured by immunofluorimetry. Median and P25-P75 range of the peak/basal ratio of the free alpha-subunit was determined for each group. A receiver operating characteristics curve was calculated. Results were compared using the Kruskal-Wallis test. RESULTS: The peak/basal ratio of the free alpha-subunit was higher in patients with constitutional delay of growth and puberty (7.46) than in those with isolated hypogonadotropic hypogonadism (2.73), complete combined hypogonadotropic hypogonadism (1.58), and partial combined hypogonadotropic hypogonadism (2.61; P < 0.001). A peak/basal ratio < 3.26 identified hypogonadotropic hypogonadism with 93.2% sensitivity and 94.4% specificity when compared to constitutional delay of growth and puberty. There was no statistical difference between the peak/basal ratio of prepubertal patients between 6 and 8 years (7.20), patients between 8 and 13 years (8.71), normal pubertal males (8.10) and those with constitutional delay of growth and puberty (7.46). In a group of boys with delayed puberty, a cut-off point of 3.69 defined hypogonadotropic hypogonadism with 95.6% sensitivity and 94.4% specificity. A cut-off point of 4.81 gave 100% sensitivity (88.9% specificity), and 3.09 gave 100% specificity (86.7% sensitivity). CONCLUSIONS: The peak/basal ratio of the free alpha-subunit can be used for the differential diagnosis of constitutional delay of growth and puberty and hypogonadotropic hypogonadism, irrespective of age. This distinction allows early investigation and treatment of patients with hypogonadotropic hypogonadism and reassurance for those with constitutional delay of growth and puberty.

Adolescent↗
PubMed2003

Changing Childbirth: a pilot project.

OBJECTIVE: To compare the outcomes of an adapted pilot Changing Childbirth initiative providing continuity of care by a group of known midwives with traditional maternity care. DESIGN: Between-groups trial to compare levels of satisfaction and clinical outcomes for two groups of women, cared for either under this Changing Childbirth scheme or the traditional model of care. METHOD: Of the 200 women who agreed to participate in the project, 100 were randomly allocated to the pilot scheme and 100 to the traditional care package. During the postpartum period, information was collected via a questionnaire about participants' levels of satisfaction with a variety of aspects of care provided during the antenatal, delivery and postpartum periods. Data about clinical outcomes for the two groups were also obtained. RESULTS: Women in the pilot group had significantly more continuity of care throughout each of the three periods, were generally more satisfied with their care, felt that they had more choice over a variety of aspects of care and experienced no compromise in clinical outcomes (P = 0.05 or less in each case). IMPLICATIONS FOR PRACTICE: Many previous attempts to introduce the Changing Childbirth initiative have revealed significant problems, particularly with regard to the continuity of carer requirement. Taking account of local health care needs and existing provision, the present study adapted this concept to continuity of care. This did not apparently affect any of the guiding principles contained in the original document, and yet enhanced satisfaction. It would appear that the Changing Childbirth agenda can be adapted and integrated with local health care situations without sacrificing any of the overarching principles.

Adolescent↗
PubMedDate not supplied

Stress, social support and well-being of Arab mothers of children with intellectual disability who are served by welfare services in northern Israel.

BACKGROUND: The present study examined the influence of a social support system on the level of stress and the sense of personal well-being of 100 Israeli Arab mothers of young children with special needs. METHODS: Fifty mothers were served by the welfare services in the Nazareth area while 50 did not get help on a regular basis. A comparison was done between educated, urban mothers, and less-educated, rural mothers. RESULTS: The research results point to a relationship between informal support resources, and the marital and economic stress of the mothers: the higher the amount of the informal support resources, the lower the level of stress that was experienced by the mothers. A relationship between the amount of informal support and level of parental stress was not confirmed. A relationship between the amount of support resources and the personal well-being of the mothers was found: the higher the amount of informal support resources, the higher the sense of well-being of the mothers. A relationship between formal support (the welfare services), and level of stress or personal well-being was not found. Education and place of living were not related to level of stress or personal well-being. Educated mothers from urban areas used the formal support (the welfare services) less than less-educated mothers who lived in rural areas. CONCLUSIONS: The findings are interpreted with respect to practice and previous studies.

Adult↗