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At least 523 records · Page 29Linked to original sources
PubMed1992

The impact of HLA frequency differences in races on the access to optimally HLA-matched cadaver renal transplants. The Medical Advisory Committee.

We examined the donor/recipient HLA match of 448 consecutive cadaver renal transplants to determine if donor race had an impact on the quality of HLA match that was achieved. Eighty (17.9%) kidneys from black donors and 368 (82.1%) from nonblack donors (87.8% caucasians) were distributed to the blood type compatible and crossmatch negative recipients on the basis of a local variance of the United Network for Organ Sharing (UNOS) point system. There were 278 (62%) nonblack and 170 (38%) black recipients, numbers close to those of nonblacks and blacks on the waiting list (59% and 41%, respectively). Kidneys from nonblack donors represented 86% (240/278) of transplants for nonblack and 75% (128/170) of transplants for black recipients. The best matches, i.e., zero-A,B,DR, zero-A,B, zero-B,DR, and 1-A,B,DR mismatches, for nonblack recipients were solely derived from the nonblack donors, and the few well-matched kidneys from black donors were distributed to black recipients. Black recipients with zero mismatches were few (3, 2%) compared with nonblacks (21, 8%). Kidneys received by black recipients were more likely to be poorly matched (5-6 mismatches) if coming from nonblack donors (57/128, 44%) than black donors (11/42, 26%), P = 0.035. It was also observed from HLA frequency comparisons that well-matched kidneys from nonblack donors were rarely distributed to black patients with HLA phenotypes unique to or more common in blacks who represented a sizeable portion of blacks on the waiting list. We conclude that better donor/recipient HLA matches are achieved when both donors and recipients are of the same race. Thus a larger number of black donors are needed to improve the quality of HLA matching for potential black kidney transplant recipients.

Black People↗
PubMed1991

Clinical spectrum of the syndrome of growth hormone insensitivity. Advisory Committee on Growth Hormone Insensitivity.

A survey of 46 patients with suspected growth hormone (GH) insensitivity is presented. Clinical details and plasma samples from these patients were analysed centrally. A diagnostic score based on basal levels of GH and insulin-like growth factor I (IGF-I), IGF-I response to GH (0.1 U/kg daily for 4 days) and height SDS was determined for all patients to identify those with GH insensitivity. A total of 29 such patients was identified (14 males and 15 females; age range, 3.2-22.6 years). Their mean height SDS was -6.0 (range, -8.9 to -2.6), mean weight SDS was -2.9 (range, -5.2 to 1.2). Pubertal development was delayed in three out of three boys and two out of six girls of pubertal age. Their basal GH level was 32.4 mU/l (range, 0.8-158.2 mU/l) and mean basal IGF-I level was 33.6 ng/ml (range, 20-97 ng/ml). None of the 29 patients showed a significant serum IGF-I response to injections of GH.

Adolescent↗
PubMed1995

Modelling the market uptake of new drugs following listing for subsidy in Australia. A report from the Drug Utilisation Subcommittee of the Australian Pharmaceutical Benefits Advisory Committee.

The market uptake of five drugs following subsidy listing in Australia during the period 1990 to 1992 has been modelled using the sigmoid Emax model for drug-receptor binding. Utilisation trends for simvastatin, omeprazole, budesonide, fluoxetine and moclobemide in defined daily dose (DDD) per 1000 population per day were smoothed by expressing as rolling annual averages. The results indicate good fits of the model to the data except for omeprazole, with good estimates of uptake rate and eventual maximum utilisation. Substantial differences between the drugs occurred in uptake rate which may be related to public education campaigns on asthma and coronary heart disease occurring during the release period. The very slow uptake of omeprazole relative to other drugs is likely to be due to restrictions on subsidised use. Modelling the market uptake rate and eventual utilisation of new drugs is useful as an aid to regulatory, quality use of medicines and financial decisions and allows comparisons between drugs to investigate factors important in market uptake.

Australia↗
PubMed1992

British Diabetic Association's discussion paper on the role of 'diabetic' foods. Nutrition Subcommittee of the British Diabetic Association's Professional Advisory Committee.

1. Most diabetic foods provide slightly, but not substantially, less energy than comparable non-diabetic products. 2. Many diabetic foods have a higher fat content than their non-diabetic equivalents. This is contrary to the requirements of the 1984 Food Labelling Regulations. 3. Many diabetic products have a relatively high content of protein. 4. In percentage terms, the greatest difference between diabetic and non-diabetic foods remains that of carbohydrate content, particularly carbohydrate other than fructose or sorbitol. On a per portion basis (for instance, per teaspoon of jam) the difference is relatively small and likely to be of minimal practical significance. 5. Diabetic foods cost between 1.5 and 4 times as much as their non-diabetic equivalents. 6. Some ordinary reduced-sugar/low calorie products are preferable to diabetic products in terms of fat and energy content and cost. 7. The promotion and widespread availability of diabetic foods tend to delude patients into believing that these products are advantageous, or even necessary. Their existence also undermines current dietary teaching by implying that people with diabetes cannot eat normal foods. 8. Diabetic foods offer no significant physiological or psychological benefits to diabetic patients and can even be counterproductive to good diabetic control. There is no longer a need for special diabetic foods in the modern dietary management of diabetes.

Diet, Diabetic↗
PubMed1993

Population screening for diabetes mellitus. Professional Advisory Committee of the British Diabetic Association.

The role and value of screening for diabetes mellitus is still unclear. If asymptomatic subjects are to be screened, then a fasting plasma glucose > 6.6 mmol l-1 or a venous plasma glucose 2 h after a 75 g oral glucose load > 8.0 mmol l-1 or the presence of any glucose in a urine sample passed 2 h after a main meal should be regarded as a positive result. A fasting plasma glucose in the range 5.5-6.6 mmol l-1 is an equivocal result which should lead to retesting in 6-12 months if there is any risk factor for diabetes (obesity, family history of diabetes, Asian/African racial origin). Other screening tests or combinations of tests are not recommended. Screening should be restricted to subjects between 40 and 75 years and should be undertaken only every 5 years (3 years if a risk factor for diabetes is present), ideally in parallel with other health screening test; subjects with a positive result should have further investigations as necessary to reach a diagnosis in line with WHO criteria.

Adult↗
PubMed1993

Dietary recommendations for children and adolescents with diabetes: an implementation paper. British Diabetic Association's Professional Advisory Committee.

General Recommendations: 1. Children with diabetes mellitus have the same basic nutritional requirements as other children. 2. Dietary recommendations should be based on good eating habits for the whole family. Radical changes in diet involving unusual foods or eating patterns for the child with diabetes alone are not appropriate. 3. Energy requirements of children vary widely and the energy content of the diet should be based on what the child usually eats. The diet should be reviewed regularly to meet the changing needs of growth and physical exercise without obesity. 4. The insulin regimen should, as far as is possible, be chosen to fit the child's daily lifestyle and preferred eating habits. Insulin type, dose, and frequency should be reviewed with the diet as the child develops. 5. Regular distribution of meals and snacks throughout the day remains the most important way to avoid extremes of hyperglycaemia and hypoglycaemia. This distribution should be based on an exchange system, using handy measures and taking into account food and meal type, the particular insulin regimen and the child's exercise patterns and usual eating habits. Currently this exchange system is based on carbohydrate foods but in the future the energy and fat contents will need further consideration. 6. Most special 'diabetic foods' are unnecessary. Low calorie sweeteners, as used in low calorie fruit squashes and fizzy drinks, are useful. 7. Children with diabetes from specific ethnic minority groups, or on vegan diets or living in deprived circumstances require special dietary attention for their diabetes. Those with coexisting chronic disorders such as cystic fibrosis or coeliac disease, should receive dietary advice from professionals with specialist knowledge. 8. Translating the principles of diabetic dietary management into a varied diet, arranged readily by the parents and eaten by the child, is demanding. It can best be met by a skilled dietitian working in close co-operation with child, parents, diabetes specialist nurse and doctor. Infancy 9. The diet should not differ from that of infants without diabetes. Breast feeding should be encouraged or a standard infant formula-feed used. Solids may be introduced from 3-6 months, but breast milk or a modified infant formula is encouraged as part of the increasingly mixed diet to at least the end of the first year. 10. Diabetes is rare in infancy so expert advice should be sought from dietitians experienced in paediatric diabetes. Under fives: 11.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1992

The Bulletin of the North American Society of Phlebology. Insurance Advisory Committee Report.

The treatment of varicose veins as taught within the specialty of phlebology consists of the best combinations of sclerotherapy and surgery after a thorough evaluation by physical examination and Doppler ultrasound, as well as other techniques. Although patients can experience some relief of symptoms by external compression hosiery, only treatment that closes up leaky valves will stop the progression of disease. Sclerotherapy is a safe, well-accepted, non-investigational, highly effective method to treat abnormally enlarged veins. Surgical procedures may be necessary to supplement sclerotherapy in certain anatomic sites. Varicose veins cause patients to experience pain, lose time from work, and can ultimately lead to permanent disability. Our healthcare system must provide the most high quality cost effective care for these patients. By keeping costs down as compared with full-scale surgical procedures, the approach of sclerotherapy or sclerotherapy with outpatient surgery, performed by properly trained physicians, provides a means to accomplish this. Medical necessity criteria allow exclusion of payments for patients seeking treatment purely for cosmetic needs.

Cardiology↗
PubMed1988

Recommendations of the Immunization Practices Advisory Committee, Centers for Disease Control. Prevention and control of influenza.

These recommendations update information on the vaccine and antiviral agent available for controlling influenza during the 1988-89 influenza season (superseding MMWR 1987;36:373-380,385-387). Changes include statements about 1) updating of the influenza strains in the trivalent vaccine for 1988-89, 2) increased emphasis on the need for vaccination of health-care workers, 3) prevention of influenza in persons with human immunodeficiency virus (HIV) infection, and 4) dosage considerations for amantadine.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Immunization of adolescents: recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Medical Association.

This report concerning the immunization of adolescents (ie, persons 11-21 years of age, as defined by the American Medical Association [AMA] and the American Academy of Pediatrics [AAP]) is a supplement to previous publications (ie, MMWR 1994;43[No. RR-1] 1-38; the AAP 1994 Red Book: Report of the Committee on Infectious Diseases; Summary of Policy Recommendations for Periodic Health Examination, August 1996 from the American Academy of Family Physicians [AAFP]; and AMA Guidelines for Adolescent Preventive Services [GAPS]: Recommendations and Rationale). This report presents a new strategy to improve the delivery of vaccination services to adolescents and to integrate recommendations for vaccination with other preventive services provided to adolescents. This new strategy emphasizes vaccination of adolescents 11-12 years of age by establishing a routine visit to their health-care providers. Specifically, the purposes of this visit are to a) vaccinate adolescents who have not been previously vaccinated with varicella virus vaccine, hepatitis B vaccine, or the second dose of the measles, mumps, and rubella (MMR) vaccine; b) provide a booster dose of tetanus and diphtheria toxoids; c) administer other vaccines that may be recommended for certain adolescents; and d) provide other recommended preventive services. The recommendations for vaccination of adolescents are based on new or current information for each vaccine. The most recent recommendations from ACIP, AAP, AAFP, and AMA concerning specific vaccines and delivery of preventive services should be consulted for details.

Adolescent↗