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At least 487 records · Page 27Linked to original sources
PubMed1999

Pediatricians' practices and attitudes regarding breastfeeding promotion.

OBJECTIVE: Public awareness of the benefits of breastfeeding is expected to increase during and after the national, federally funded Best Start Breastfeeding Promotion Campaign. It is anticipated that this will result in more breastfeeding-based interactions between families and pediatricians. The American Academy of Pediatrics conducted a survey of its members to identify their educational needs regarding breastfeeding to assist in the design of appropriate information programs. METHOD: An eight-page, self-administered questionnaire was sent to 1602 active Fellows of the American Academy of Pediatrics. RESULTS: The response rate was 71%. Breastfeeding, as the exclusive feeding practice for the first month after birth, was recommended by only 65% of responding pediatricians; only 37% recommended breastfeeding for 1 year. A majority of pediatricians agreed with or had a neutral opinion about the statement that breastfeeding and formula-feeding are equally acceptable methods for feeding infants. Reasons given for not recommending breastfeeding included medical conditions with known treatments that did not preclude breastfeeding. The majority of pediatricians (72%) were unfamiliar with the contents of the Baby-Friendly Hospital Initiative. The majority of pediatricians had not attended a presentation on breastfeeding management in the previous 3 years; most said they wanted more education on breastfeeding management. CONCLUSION: Pediatricians have significant educational needs in the area of breastfeeding management.

Adult↗
PubMed2006

Leaching characteristics of copper flotation waste before and after vitrification.

Copper flotation waste from copper production using a pyrometallurgical process contains toxic metals such as Cu, Zn, Co and Pb. Because of the presence of trace amounts of these highly toxic metals, copper flotation waste contributes to environmental pollution. In this study, the leaching characteristics of copper flotation waste from the Black Sea Copper Works in Samsun, Turkey have been investigated before and after vitrification. Samples obtained from the factory were subjected to toxicity tests such as the extraction procedure toxicity test (EP Tox), the toxicity characteristic leaching procedure (TCLP) and the "method A" extraction procedure of the American Society of Testing and Materials. The leaching tests showed that the content of some elements in the waste before vitrification exceed the regulatory limits and cannot be disposed of in the present form. Therefore, a stabilization or inertization treatment is necessary prior to disposal. Vitrification was found to stabilize heavy metals in the copper flotation waste successfully and leaching of these metals was largely reduced. Therefore, vitrification can be an acceptable method for disposal of copper flotation waste.

Copper↗
PubMed1977

Palliation of malignant esophago-respiratory fistulae by permanent indwelling prosthetic tube.

Malignant esophago-respiratory fistula is an incurable condition calsing severe distress to those patients suffering from it. Sixty two successive patients with esophago-respiratory fistulae, secondary to squamous cell carcinomas of the esophagus, were intubated for palliation. The first 14 were intubated by a traction technique using the Celestin tube, and the remaining 48 were intubated by the Procter-Livingstone tube inserted by a pulsion method. Celestin intubation had a mortality of 64.3% but 75% of those intubated by the Procter-Livingstone tube were discharged from hospital, swallowing satisfactorily and relieved of their respiratory distress. In our experience the insertion of the Proctor-Livingstone tube by a pulsion technique, can be performed in a few minutes, with little morbidity and allows the patient to be discharged from hospital within 3-4 days of the procedure. It is a successful and acceptable method of treating malignant esophago-respiratory fistulae.

Adult↗
PubMed2006

The other side of clinical trial monitoring; assuring data quality and procedural adherence.

BACKGROUND: Data monitoring can mean different things. It can mean statistical methodologies for clinical trial monitoring, interim data analysis, monitoring for quality control or assurance or safety reporting to regulatory agencies. PURPOSE: The various facets of data monitoring will be discussed and reviewed from primarily an industry perspective. METHODS: By careful attention to the design and conduct of a clinical trial, the expense of monitoring can be markedly reduced. Careful attention should be given to the qualifications of investigators in the selection of clinical sites and central facilities. Site personnel must be adequately trained. The sponsor should utilize appropriately qualified individuals to supervise the overall conduct of the trial. The monitor should visit the investigator at the site of the investigation frequently enough to ensure acceptable quality. The monitor is responsible for inspecting the case report forms at regular intervals. Quality control should be applied to each stage of data handling to ensure that all data are reliable and have been processed correctly. The auditor will assess whether the site is being monitored in accordance with the monitoring plan. The determination of the extent and nature of monitoring should be based on considerations such as the objective, design and complexity of the trial. Statistical sampling may be an acceptable method for selecting the data to be verified. The monitor should ensure that adverse events are reported. Study data will be monitored on an ongoing basis to ensure patient safety. The sponsor may utilize a Data Monitoring Committee to protect the validity of a trial. CONCLUSIONS: Discussions between industry, academia and regulatory groups regarding the optimal extent and methods for monitoring of clinical trials are encouraged.

Adverse Drug Reaction Reporting Systems↗
PubMed1999

Alternative and controversial treatments for attention-deficit/hyperactivity disorder.

ADHD is a syndrome that can be treated effectively, safely, and economically with stimulant medications. There is no equal alternative to these agents in short-term treatment of ADHD symptoms. However, many families seek alternatives to stimulants and other drug treatments for a variety of reasons. Alternative approaches reflect the complexity and heterogeneity of the disorder by being equally manifold, complex, and often obscure in their modus operandi. Scientific evidence suggests that individualized dietary management may be effective in some children. Trace element supplementation also may be beneficial when specific deficiencies are present. At this point, nootropics, herbs, and homeopathy are being seriously researched regarding their role in neurologic functioning, but evidence to support their role in the specific treatment of ADHD is inconsistent or lacking. Self-regulatory techniques such as hypnotherapy and biofeedback do not alter the core symptoms of ADHD but may be helpful in controlling secondary symptoms. These methods are unique in ADHD treatment because children can become active agents of their own coping strategies. There is no scientific evidence to support the validity of vision therapy, oculovestibular treatment, or sound training (Tomatis method) as treatment modalities for ADHD. However, auditory stimulation with individualized music may help to improve situational performance in cognitive tasks. Regardless of the treatment approach, the diagnosis of ADHD and other comorbidities first must be established through a standard medical evaluation. The standard treatment options always should be presented and discussed carefully. If alternative approaches are sought, the merits of available options should be reiterated. If the primary care provider is not comfortable or knowledgeable about an acceptable method, referral to capable and responsible practitioners in the community who are experienced in these areas should be considered. The primary care provider, the alternative "specialist," and the family all should be willing to engage in "collaborative research," applying the same standards for treatment evaluation that one would apply in mainstream methods. Communication among all parties involved in a treatment strategy is the key to demystifying alternative approaches, creating strong therapeutic relationships, and optimizing management.

Attention Deficit Disorder with Hyperactivity↗
PubMed1996

Transinguinal laparoscopy for nonpalpable testis.

BACKGROUND: About 20% of all undescended testes are nonpalpable. Although surgical exploration was previously the method of choice for management, laparoscopy from the inferior edge of the umbilicus has been established as a useful method of examining a testis that is nonpalpable. However, conventional subumbilical laparoscopy is unnecessary when the testis or its remnant is located below the internal inguinal ring. We evaluated the efficacy of transinguinal laparoscopy after inguinal exploration performed for nonpalpable testis. METHODS: Twelve children with 14 nonpalpable testes (2 children had bilateral nonpalpable testes) were considered for a novel method of laparoscopy. We performed laparoscopy through the internal inguinal ring after opening the inguinal canal. RESULTS: Inguinal exploration revealed the testis or its remnant in 5 patients, and thus prevented unnecessary laparoscopy in these individuals. Transinguinal laparoscopy identified the anatomy in 7 patients. Four of the latter were found to have blind-ending vas deferens and spermatic vessels, while in 3 patients, the testes were located in the peritoneal cavity. CONCLUSION: Transinguinal laparoscopy may become the accepted method for managing nonpalpable testes, as inguinal exploration can eliminate the need for laparoscopy in some cases, and the visualization achieved with transinguinal laparoscopy is just as good as that with conventional laparoscopy.

Child↗
PubMed2002

Fetal reduction in multifetal pregnancy--ethical dilemmas.

As a result of the increased use of drugs that enhance fertility, and the advent of in vitro fertilization and embryo transfer over the last 2 decades, the incidence of multifetal pregnancies has increased exponentially. In parallel with this increase methods of care for women carrying multiple fetuses have become more complex and well developed. Importantly, it has become obvious that in the case of such pregnancies the rates of mortality and morbidity of both fetuses and mothers, particularly in cases where four or more fetuses are involved, are extremely high. Improvements in the techniques of assisted fertilization should result in fewer iatrogenic multifetal pregnancies and a commensurate decrease in related risks. Fetal reduction seems to be an acceptable method of improving maternal and fetal outcome in high order multiple pregnancies despite the many unresolved medical and ethical dilemmas.

Ethics, Medical↗
PubMed2004

[Ultrasonography methods in the diagnosis of renal osteodystrophy].

Bone disease, i.e. renal osteodystrophy, is commonly seen in patients with chronic renal failure. It encompasses all the disorders of mineral and bone metabolism associated with chronic renal insufficiency, i.e. secondary hyperparathyroidism, retention and accumulation of beta 2 microglobulin and aluminum. The most frequent cause of renal osteodystrophy is secondary hyperthyroidism, with a consequence of high turnover bone disease. Secondary hyperparathyroidism, i.e. increased parathyroid hormone (PTH) secretion and parathyroid gland hyperplasia, develops early in the course of chronic renal insufficiency. Hypocalcemia, phosphate retention and deficiency of calcitriol stimulate PTH synthesis and secretion and parathyroid cell proliferation, i.e. hyperplasia. Parathyroid cell proliferation is initially polyclonal (diffuse hyperplasia), and later it is monoclonal or multiclonal (nodular hyperplasia). Calcitriol receptors as well as calcium-sensing receptors are significantly reduced in parathyroid glands in nodular hyperplasia. Patients with such parathyroid gland hyperplasia are often resistant to vitamin D therapy. A specific form of bone disease is beta 2 amyloidosis. Destructive arthropathy, cystic changes and carpal tunnel syndrome are clinical manifestations of dialysis-related amyloidosis, which is one of the major complications in patients on longterm hemodialysis. Aluminum intoxication leads to the low turnover bone disease and consequential osteomalacia or aplastic bone lesions, the cause of which has not yet been fully clarified. Ultrasound can be a useful, economical and noninvasive method in the evaluation of renal osteodystrophy. Ultrasound waves are very important for noninvasive imaging of soft tissue, especially parathyroid glands, pathologic changes of the joints, and for detection of metastatic calcifications. They are also useful in the evaluation of skeletal status in dialysis patients. Ultrasound waves of a frequency above the limit of human hearing are used in the morphological diagnosis of parathyroid gland. Today, because of its simplicity and non-invasiveness, it is a generally accepted method for the detection of enlarged parathyroid gland in patients with secondary hyperparathyroidism, for the monitoring of pathologic changes, and for making decisions on the method of treatment based on the size and number of parathyroid glands. Ultrasound can distinguish nodal from diffuse parathyroid hyperplasia. Under ultrasound guidance it is possible to perform fine needle aspiration biopsy, to confirm ultrasound findings, and percutaneous inactivation of parathyroid gland (PEI) with alcohol. Ultrasound is useful in the diagnosis of pathologic changes of the musculoskeletal system in patients with beta 2 amyloidosis, to assess the process of its spread, especially in the shoulder joint where the changes are most pronounced (rotator cuff thickness, amyloid deposits as hyperechogenic pads, and detection of fluid in the joint), but it can also be used to examine other joints as well as soft tissue in which metastatic calcifications may occur. Standard ultrasound equipment (pulse-echo) and linear probe of 5-13 MHz are used, also serving for ultrasound examination of the neck, joints and soft tissue. Quantitative bone ultrasonometry is based on different physical characteristics of the ultrasound including: transmission, Speed Of Sound (SOS) in meters/sec and Broad Band Attenuation (BUA) in dB/MHz, and different concepts of the apparatus. These parameters depend on the strength and architecture of the bones and describe better the changes in bone structure in dialysis patients by calculation of the Stiffness Index (QUI), better than the standard bone densitometry by dual-energy x-ray absorptiometry, which only measures bone density. Combined ultrasound measurement of the bone in several locations may be successful in monitoring dialysis patients.

Bone and Bones↗
PubMed1993

Age-related macular degeneration: the current understanding of the status of clinicopathology, diagnosis and management.

BACKGROUND: This paper represents an up-to-date review of the current thoughts regarding the etiopathogenesis and management of the various varieties of age-related macular degeneration (ARMD). METHODS: Included is a look at the epidemiology as well as the clinicopathologic basis for the development of the degenerative process. CONCLUSIONS: The clinicopathologic basis for development of ARMD is divided into drusen, lipofuscin development, solar radiation effects, photochemical damage and mediation by antioxidants, choroidal neovascularization, scarification, and retinal pigment epithelial detachment. The clinical presentation of both non-exudative and exudative ARMD is discussed with synopses of the mimickers of both outlined in the text. RESULTS: Current accepted methods of therapy are discussed including; laser intervention, surgical removal of membranes, and investigational modes of treatment including antioxidants. Specific management protocol is discussed based on the current knowledge base.

Aged↗
PubMed1991

Disinfectant testing in the USA.

The federally mandated registration of disinfectants with the United States Environmental Protection Agency (EPA) requires the submission of efficacy test data obtained with the accepted methods of the Association of Official Analytical Chemists (AOAC). These include qualitative suspension tests for bacteria and fungi and carrier tests with use-dilutions for bactericidal, mycobactericidal and sporicidal activity. There is no AOAC method for virucides, and the present methods set forth by the American Society for Testing and Materials (ASTM) and the EPA are under scrutiny by the scientific community. The AOAC use-dilution test was challenged by the users, and two collaborative studies by the EPA and the AOAC did not resolve all questions. A new, quantitative supension test was proposed. The AOAC mycobactericial carrier test was found to be deficient for testing glutaraldehydes; an updated version and a new quantitative suspension test have been accepted by the EPA for registration. As a result, different glutaraldehyde preparations carry different label claims which are confusing to the consumer. National and international standardization of testing is desirable.

Chemistry Techniques, Analytical↗
PubMed2002

Methods for obtaining menstrual-cycle data in menstrual-synchrony studies: commentary on Schank (2001).

J. C. Schank (2001) claimed to identify 2 categories of error-measurement error and recall biases-in the methodology used in studies of menstrual synchrony. This commentary focuses on the 2nd of these, recall biases, and other errors that he argued may result from "allowing participants to fill out menstrual-cycle-onset calendars" (p. 3). J. C. Schank's detailed discussion of various types of recall biases is inappropriate and misleading given that the majority of menstrual-synchrony studies have used prospective menstrual calendars. The use of menstrual calendars is a well-accepted method in a number of research areas and demands little of participants. J. C. Schank questioned the validity of menstrual calendar data on the basis of assumptions about recall bias for which he had no evidence.

Female↗
PubMed1975

Management of acute epiglottitis by nasotracheal intubation.

In 40 cases of acute epiglottitis in children, intubation was the chosen method for the management of airway obstruction. Six patients were treated without the establishment of an artificial airway, and no tracheostomies were done. No patients who were admitted to the hospital died of airway obstruction, although one sustained irreversible brain damage before admission, and two died of overwhelming infectionmthe average duration of intubation was 2.days and the average hospital stay was 5.days. Two children developed subglottic granulation tissue that was removed successfully and did not recur. Nasotracheal intubation is an acceptable method of management of epiglottitis.

Acute Disease↗
PubMed2003

Muscle co-activation around the knee in drop jumping using the co-contraction index.

The purpose of this study was to examine the co-activation of the rectus femoris (RF) and biceps femoris (BF) during drop jumping exercises using the co-contraction index (CI). Ten trained male long jumpers performed drop jumps from 20 cm (DJ20), 40 cm (DJ40) and 60 cm (DJ60) on a force platform. Surface electromyographic (EMG) activity of the RF and BF, vertical ground reaction force data and knee joint angular displacement and angular velocities were recorded and normalized as percentage of maximum isometric values. The CI was calculated for the pre-contact, braking and propulsive phases of the jump using four methods: (1) by dividing the double integrated antagonistic activity by the sum of the RF and BF EMG; (2) by finding the amount of overlap between the linear envelopes of the agonist and antagonist muscles and dividing by the number of data points; (3) by calculating the co-contraction at any instant point of time; and (4) by dividing the BF integrated activity by the total registered muscle activity around the knee. The CI ranged from 13.03+/-9.33 to 70.80+/-25.81%, depending on the estimation method used. A two-way analysis of variance (ANOVA) indicated that the CI was not affected by drop jumping height (p>0.05) while it was significantly higher (p<0.05) in the pre-contact phase compared to the braking and propulsion phases. The CI can be useful when examining muscle co-activation using EMG measurements in drop jumps. However, the conclusions on muscle co-activation depend on the equation used to estimate CI and therefore a commonly accepted method is necessary.

Adult↗
PubMed1978

Laparoscopic tubal occlusion with silicone rubber bands.

Application of the silastic ring to the Fallopian tubes through the laparoscope seems to be a simple, safe and acceptable method of tubal sterilization. The technique and results in 337 patients are described. In the majority of cases, the procedure was effected in the outpatient department under local anaesthesia. Transsection of the tube (with or without bleeding), tearing of the mesosalpinx, and avulsion of the tube at the uterotubal junction were the most common complications; with experience and adherence to the proper technique of ring application, the above can be minimized. The pregnancy rate following this procedure seems to be acceptable, but long-term follow-up is necessary for definitive conclusions.

Adolescent↗
PubMed1990

Medical practice guidelines: current activities and future directions.

OBJECTIVE: To examine the state of the art in the field of medical practice guidelines, to identify limitations, and to suggest future directions. DESIGN: Informal descriptive survey using a questionnaire administered by telephone, supplemented by comments, by opinions, and by examples solicited from the participating organizations. PARTICIPANTS: Eight prominent organizations representing prototypic approaches to guideline development; these organizations included three medical societies, two health care organizations, two insurers, and one private health benefits management company. RESULTS: Improving the quality of medical care was a stated goal of all eight surveyed organizations. However, their objectives have not been stated in operational terms, reflecting the lesser emphasis placed on methods and means for both implementing guidelines and evaluating their impact on health practices and outcomes. In contrast, several systematic methods for developing guidelines exist. They differ in the stress placed on formal literature reviews, reliance on local as opposed to national experts, and formal methods of group judgment, but no evidence exists on which approaches produce sounder and more usable guidelines. CONCLUSIONS: Guidelines are being vigorously promoted as a means to improve the effectiveness of the health care system. Current initiatives show both strengths and weaknesses. In particular, the attention now paid to the development of guidelines needs to be matched by attention to implementation strategies and to the scientific evaluation of their effectiveness in real clinical settings. Also, more agreement is needed on acceptable methods for developing guidelines, assessing their content, and evaluating their impact on professional behavior, patient outcomes, and health care costs. Fortunately, several initiatives to bring greater order and quality to this field are under way.

Goals↗
PubMed1994

[Rescue radical prostatectomy following radiation in prostatic carcinoma].

Accepted methods for the treatment of localized prostatic cancer are radiotherapy and radical surgery. Results of different authors and analysis of survival curves suggest a higher cure rate with surgery, although there are no prospective randomized studies that demonstrate it. Patients treated with radical prostatectomy who relapse locally are usually treated with radiotherapy or hormone therapy. On the other hand, patients with failed radiation therapy raise a difficult therapeutic solution. A wait and see policy or early hormone therapy are generally accepted as treatment options as well as additional radiotherapy or salvage surgery in selected patients. General experience with salvage surgery is short. Only 228 cases, including two presented in this study, have been published, lacking data on long term survival. Herein we present two patients treated with salvage surgery for radiation failure and discuss the different treatment options in such cases.

Adenocarcinoma↗
PubMed2006

Rapid determination of the main organic acid composition of raw Japanese apricot fruit juices using near-infrared spectroscopy.

The potential of near-infrared (NIR) spectroscopy to rapidly determine citric and malic acid contents of raw Japanese apricot (Japanese "ume", also known as the Japanese plum) fruit juice was investigated. In total, 314 raw juice samples with different organic acid compositions were collected over a long growth period, and spectra (1100-1850 nm) of these samples were acquired using an NIR spectrophotometer with a 1-mm path length. Calibrations were performed using a partial least-squares regression method based on a calibration sample set (211 samples), while validations were performed based on a validation sample set (103 samples). The results revealed good agreement between NIR spectroscopy and capillary electrophoresis, including the correlation coefficient (r2), standard error of prediction (SEP), and bias; no statistically (p = 0.05) significant differences were found for these parameters. Moreover, standard deviation ratios of reference data in the validation sample set to the SEP were higher than 3, indicating that NIR spectroscopy may represent an acceptable method for quantitative evaluation of citric and malic acids in raw Japanese apricot fruit juice.

Beverages↗
PubMed1976

Development of concentric zones in the Proteus swarm colony.

Two main mechanisms of concentric ring formation in cultures of Proteus species are described. One of these is the classically accepted method, wherein rings are produced as the advance of the swarm stops and recommences. In the other, the ring is produced as a fold inside the colony. These are considered to be extremes of a spectrum of growth types, the common feature being that rings are formed by piling-up of growth, and this process is not always directly correlated with morphological change in the individual bacteria, or with cessation of advance of the swarm. The validity of the presently accepted theories of ring formation and swarming in general are thus called into question.

Models, Biological↗