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PubMed1996

Selection of key community descriptors for community-orientated primary care.

BACKGROUND: Community-oriented primary care (COPC) requires the development of practical tools if it is to be carried out. A previous study demonstrated a practical approach to carrying out one portion of a community assessment for COPC using a few representative health indicators. OBJECTIVE: To determine the validity of this process elsewhere, we tested whether these findings were generalizable to other settings and to the same setting a decade later. METHOD: In a cross-sectional study design, data on 18 health indicators were collected for census tracts in two target areas and for the entire state of Ohio, USA, for 1990. A factor analysis was performed to identify factors underlying the health indicators in the three areas examined. RESULTS: Two underlying factors, termed age and poverty, were present in all locations and over time. Each factor was defined by core indicators and a cluster of associated indicators. CONCLUSIONS: These results suggest that one part of a COPC community assessment can be done by selecting very few indicators. The distribution of indicators of age and income explains the variability of most of the health related indicators studied. These factors are stable over time and location. A community assessment should include indicators which, at a minimum, provide information on these two factors.

Adolescent↗
PubMed2006

Improving patient outcomes with ambulatory blood pressure monitoring in elderly with hypertension.

PURPOSE: The purpose of this article is to review the current knowledge regarding ambulatory blood pressure monitoring (ABPM) use in clinical practice and to provide example cases for its use in a hypertension (HTN) specialty clinic. DATA SOURCES: Published research trials, medical literature, and cases from the Center for Senior Hypertension. CONCLUSIONS: The knowledge of ABPM benefits to using ABPM are substantial and improves the care and management of many conditions, including white coat HTN, white coat normotension, resistant, borderline, episodic, paroxysmal HTN, and finally orthostatic hypotension. Third-party payers only cover ABPM for "white coat" HTN. IMPLICATIONS FOR PRACTICE: This article reviews previous studies and explains the benefit to changing our current practice to match the knowledge we have gained through research through case studies.

Age Factors↗
PubMed1992

Survey of the contamination of eyedrops of hospital inpatients and recommendations for the changing of current practice in eyedrop dispensing.

Topical ophthalmic medications used on the ward and from the outpatient area have been taken and cultured for potential bacterial contamination in the laboratory. We examined 143 bottles used by patients who had had routine cataract surgery and trabeculectomy. We also examined for bacterial contamination 216 bottles of eyedrops used in the outpatient area of the hospital. No contamination was found in the postoperative eyedrops, but five bottles were contaminated from the outpatient area (2.3%). The bacterial growth from outpatient drops was of the same order of magnitude as in previous studies. The practice in the UK for postoperative eyedrops to be discarded and fresh, separate bottles to take home is discussed. We recommend that this practice be changed so that the postoperative drops used for 72 hours or less are taken home.

Cataract Extraction↗
PubMedDate not supplied

A new technique to map vulva microcirculation using laser Doppler perfusion imager.

The location of the vulva has had limited technologic progress in the assessment of the skin microcirculation and its application to clinical practice. Our group previously demonstrated increased perfusion in vulvar cancer compared to adjacent uninvolved skin with the laser Doppler flowmetry (LDF). The LDF is severely limited by its low spatial resolution ( approximately 1 mm(2)) and pressure involved in positioning of the probe, which may affect value of the underlying tissue perfusion. Topographic perfusion mapping of the whole vulvar skin using LDF is also time consuming and is not clinically practical. We describe for the first time the application of the novel laser Doppler perfusion imager (LDPI) to map vulvar skin blood flow and give example in two cases with well-defined vulvar pathology-psoriasis and lichen sclerosus with invasive neoplasia-and discuss the potential of LDPI to study vulvar skin blood flow.

Adult↗
PubMed2001

Women's HIV transmission risk perceptions and behaviors in the era of potent antiretroviral therapies.

The availability of potent antiretroviral medications has raised new concerns regarding continued HIV transmission risk behavior among seropositive persons. Relatively little is known about how women with HIV perceive secondary transmission risk in the context of HIV treatment advances. This study describes sexual risk perceptions and behaviors of 80 women enrolled in HIV outpatient care in 1999. Participants completed structured interviews assessing sexual risk perceptions, attitudes regarding severity of HIV disease, sources of HIV prevention information, and sexual practices during the previous 6 months. Medical histories including 6-month cumulative incidence of sexually transmitted diseases (STDs) were obtained from a clinic database. Thirty-five percent of the sample had engaged in unprotected intercourse or had been diagnosed with an STD in the past 6 months. Only 5% of women believed that medication-related reductions in viral load signify safer sex is unimportant, but 15% indicated they practice safer sex less often since the advent of new HIV treatments and 40% believed AIDS is now a less serious threat. These data suggest women's perceptions of diminished disease severity may be more influential than beliefs regarding diminished infectivity. Study results have implications for framing prevention messages for women and suggest that close integration of secondary prevention and clinical HIV services may be beneficial.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Improving the practical space and time efficiency of the shortest-paths approach to sum-of-pairs multiple sequence alignment.

The MSA program, written and distributed in 1989, is one of the few existing programs that attempts to find optimal alignments of multiple protein or DNA sequences. The MSA program implements a branch-and-bound technique together with a variant of Dijkstra's shortest paths algorithm to prune the basic dynamic programming graph. We have made substantial improvements in the time and space usage of MSA. The improvements make feasible a variety of problem instances that were not feasible previously. On some runs we achieve an order of magnitude reduction in space usage and a significant multiplicative factor speedup in running time. To explain how these improvements work, we give a much more detailed description of MSA than has been previously available. In practice, MSA rarely produces a provably optimal alignment and we explain why.

Algorithms↗
PubMed2001

Pressure-temperature phase transition diagram for wheat starch.

Wheat starch suspensions in water (5% dry matter) were subjected to various pressures (0.1-600 MPa) and temperatures (-20 to 96 degrees C) for 15 min. The gelatinization rate was measured after treatment by using microscopic measurements of the loss of birefringence of the granules. This method was previously calibrated by differential scanning calorimetry. Curves of isogelatinization were found to be quite similar to a pressure-temperature (P-T) diagram of unfolding proteins. Results were first analyzed by considering the thermodynamic aspects related to the dT/dP curve shifts. On the basis of equations already shown for proteins, the P-T gelatinization diagram of wheat starch would show different kinds of thermal contributions, suggesting endothermic, athermic, or exothermic melting reactions. Second, as a practical consequence, these previous P-T areas corresponded to specific gelatinization conditions as confirmed by hydration evaluation measured by starch swelling index. Depending on the pressure-temperature conditions, gelatinization would involve hydration. Lowering the pressure and temperature resulted in a complete gelatinization with less hydration in comparison with a thermal treatment at atmospheric pressure. A hydration model based on an energetic approach was proposed.

Birefringence↗
PubMed2004

Self-esteem and "at risk" women:determinants and relevance to sexual and HIV-related risk behaviors.

In this study, we describe the relationship between self-esteem and HIV-related risk behaviors, and explore what factors predict self-esteem levels of "at risk" women. Interviews were conducted with 250 (predominantly African American) women living in the Atlanta, Georgia metropolitan area between August 1997 and August 2000. A community identification process was used to identify potential study participants, with further expansion of the sample via targeted and theoretical sampling and ethnographic mapping procedures. Self-esteem was related to the number of times having oral sex, the number of times having sex with paying partners, the frequency of sexual risk-taking (all during the 90 days prior to interview), the number of different HIV risk behaviors practiced during the previous year, and condom use attitudes and self-efficacy. Greater involvement HIV risk behaviors was associated with lower self-esteem. Multivariate analyses revealed five significant predictors of women's self-esteem levels: race, religiosity, childhood experiences with emotional neglect, the number of money-related problems experienced, and the number of drug-related problems experienced. The findings indicate that self-esteem is highly relevant to "at risk" women's HIV risk behavior practices, and this has important implications for HIV intervention programs.

Adolescent↗
PubMed2003

[Long-term usefulness of an information programme on practices in surgical antimicrobial prophylaxis].

INTRODUCTION: In France, numerous concordant studies show that there are some discrepancies between guidelines on surgical antibiotic prophylaxis and the current practice. In a previous study, conducted in April-June 2001, we found that the rate of appropriateness of surgical antimicrobial prophylaxis was approximately 40%. An information programme was implemented and the purpose of this paper was to present the short- and long-term usefulness of this campaign. METHODS: A total of 13 pairs of surgeons/anaesthetists participated in data collection during the three periods of the study. Prescriptions were observed in order to answer to five questions. Five variables describing practices concerning antibiotic prophylaxis in surgery were compared to national recommendations (updated in 1999): did the surgical procedure require antibiotic prophylaxis and was this carried out? Was the antibiotic used appropriate? Was the timing of the first injection optimal? Was the total duration of the treatment correct? Was the dose correct? RESULTS: The overall compliance with recommendations was significantly improved during the third period (P = 0.0002). This improvement was particularly marked for antimicrobial prophylaxis duration. CONCLUSION: It seems that sequential surveillance of antimicrobial prophylaxis, including numerous surgical teams, could considerably improve the practices, if it was associated to informations that allowed physicians to appropriate the procedures.

Antibiotic Prophylaxis↗
PubMedDate not supplied

[The opinions of Belgian physicians about their practice].

QUESTIONS: Considering the numerous changes in the health system, do medical doctors (MDs) feel difficulties in practising their profession? Are there complaints regarding the fact that the "medical chart" is in danger? Is Herzberg's theory about factors of satisfaction confirmed? METHOD: Qualitative analysis of MDs' spontaneous comments, stated at the end of a postal survey (MDs of the French speaking universities of Belgium, settled since 5 to 10 years or 15 to 20 years): 5 546 were contacted in 1999 and 2040 answered; 862 provided comments about their career and/or about their feelings regarding their profession (the latter theme had not been specifically addressed by the main survey). Most comments were issued by practitioners providing care: 296 general practitioners and 396 specialists; the remaining physicians perform other types of activities in the health system (prevention, teaching, research, management, ...): they number 170. RESULTS: A large diversity of careers; a few typical patterns are noticeable. Several satisfactions, which are largely outnumbered by the amount of complaints: onerousness, lack of collaboration, patients' requirements, bureaucracy, political interference, insufficient fees, lack of family- and private life and, mainly for specialists, shortcomings of training and problems with the hospital administration. Complaints about the medical chart are absent. Herzberg's theory holds true partially: among positive comments, "hygiene factors" are as frequent as aspects related to the content of work. INTERPRETATION: 1) The evolution of relations with the patients is probably not only due to the changes within the health sector; other factors are also to be scented, e.g the difficulty of a) bearing uncomfortable working conditions within an hedonistic culture and b) meeting the various challenges proposed by diverse paradigms regarding the norms of good practice. 2) The previous importance of the medical chart enters in conflict with worries more down to earth. 3) All the positive comments do not reflect a large satisfaction: some are rather relative, regarding an improvement compared with a worse situation in the past or with difficulties endured by colleagues.

Belgium↗
PubMed2001

Position of the American Dietetic Association: dietetics professionals can implement practices to conserve natural resources and protect the environment. (Previously titled "natural resource conservation and waste management").

It is the position of the American Dietetic Association to encourage environmentally responsible practices that conserve natural resources, minimize the quantity of waste that is generated, and have the least adverse affect on the health of all living organisms and the environment. All components of the food system, from farmer to consumer, are affected by the availability and cost of energy and the availability and quality of water. Outdoor and indoor air quality significantly impacts the health of all living organisms. Decisions that dietetics professionals make as practitioners and consumers can affect the quantity and type of solid waste generated. The demand for natural resources should be evaluated when selecting the most cost-effective, environmentally sensitive approach to the management of solid waste. Special precautions are needed when using and disposing of hazardous and medical waste to protect the safety of our clients and employees. This position paper provides information and resources for dietetics professionals for addressing the complexity of the environmental issue presented. Conservation strategies are identified that dietetics professionals can use in their worksites and at home. These conservation practices may reduce cost and decrease the environmental impact we have on our communities and the world.

Air Pollution↗
PubMed1976

Kidney preservation by continuous hypothermic albumin perfusion without membrane oxygenation.

Continuous hypothermic albumin perfusion in the new Gambro device utilising surface oxygenation of the perfusate was studied in 20 consecutive human kidneys at the Transplantation Clinic in Gothenburg. The results were compared with previous results of kidney storage using simple hypothermia and continuous perfusion with membrane oxygenation. The mean preservation time was increased from eight and 24 hours in the previous material to 30 hours in the studied group. Immediate onset of function occurred more frequently after surface oxygenation and all kidneys perfused for the longest period of 30 to 48 hours, had immediate onset of function. No increased LDH release was observed after prolonged perfusion. Delayed onset of function could in most cases be attributed to prolonged warm ischaemia time in which cases also increased LDH release was observed. Continuous albumin perfusion using surface oxygenation was found to be equally efficient in clinical practice as the previously used system with membrane oxygenation.

Albumins↗
PubMed1993

Evaluation of different MCQ-scoring-system in a medical school.

The MCQ scores of final medical students in surgery for the years 1990 and 1991 were analysed. The score for a correct answer was plus 1 mark in both years. The penalty for incorrect answer for the year 1990 was minus-1 mark as had been practiced during the previous 15 years. The penalty for the year 1991 was minus 1/4 for an incorrect answer. This low penalty of minus 1/4 resulted in an inflated MCQ score as compared with the essay questions and both clinical and oral examination results. The low score recorded during the year 1990 is a genuine reflection of inadequate performance rather than bad evaluation since the MCQ bank is the same and the panel of examiners has not changed. It is concluded that minus 1 mark penalty has many advantages and therefore should be the practice.

Attitude↗
PubMed2000

Why are investigations not recommended by practice guidelines ordered at the periodic health examination?

Evidence-based guidelines recommend few routine investigations for healthy adults at the periodic health examination (PHE). However, small studies indicate that laboratory tests are commonly ordered at the PHE. This study examined PHE laboratory testing that is not recommended by recognized guidelines ('discretionary'). Using administrative data from the universal health care system in Ontario, Canada, we studied 792,844 adults having a PHE in 1996 and the 3,727 physicians who administered them. We measured the number of discretionary laboratory tests per PHE along with the patient and physician factors potentially influencing laboratory testing. A multilevel, multivariate model was used to examine the association between the number of discretionary laboratory tests at the PHE with patient and physician characteristics. A mean of 7.1 discretionary tests (SD 7.1) was ordered per PHE. Renal, haematological, glucose and lipid tests each were conducted in more than a third of PHEs. Testing varied extensively between physicians and was more common in healthy patients. With the exception of age, patient factors had little effect on discretionary testing. However, each physician factor we examined was independently associated with the number of discretionary tests. Physician specialty, practice volume and previous testing patterns had the strongest influence on discretionary testing. Discretionary investigations are common at the PHE. Testing varies extensively between physicians and seems to be driven more by physician than by patient factors. Interventions to modify discretionary test utilization at the PHE should consider these physician factors.

Adult↗
PubMedDate not supplied

Environmental and direct measures of exposure.

The need for epidemiologic reproductive studies of workers exposed to antineoplastic agents has been underscored by a proliferation of literature expressing concern about the potential for biologic hazard, animal and patient studies demonstrating reproductive effects of these drugs, and by the two recent case-control studies reporting findings of reproductive hazard, specifically spontaneous abortion and congenital malformations. The numbers of workers with past exposure must be approaching 100,000, based on the number of exposed workers per hospital in a study at one point in time by Stellman et al. Many of those handling these drugs in the past probably experienced substantial exposure because protection was unavailable and handling practices were careless since the hazard was not recognized until 1979. Because of the recent and continuing publicity given in the professional literature to antineoplastic drugs as potential hazards to the health and reproductive function of pharmacists and nurses, it is hoped that exposure to these agents will decrease in sizable portions of the occupational groups who have current and past exposure to these drugs, although many workers have reported to the author that they used protection for a short time after hearing a report of possible effects, then returned to their previous unprotected handling practices. Since substantial numbers of persons were heavily exposed in the past, questions about the long-term effects of such exposures remain an issue and need to be studied. Effects on menstrual function, for example, could have ongoing reproductive implications. Answers about reproductive hazard and utility of various protective measures are needed to guide policy decisions about how to best protect workers. Conflict has arisen between nurses and administrators regarding institutional policies that prohibit pregnant nurses from handling antineoplastic drugs or caring for patients on drug protocols. If pregnant nurses are to be permitted to handle these drugs, then it is essential to provide evidence that the use of protective clothing and equipment gives adequate protection. The development of biologic markers of cumulative exposure is thus a desirable, although hard to realize, ideal.(ABSTRACT TRUNCATED AT 400 WORDS)

Abnormalities, Drug-Induced↗
PubMed2002

Factors affecting the match rate of rural training tracks in family practice.

BACKGROUND AND OBJECTIVES: Rural training track (RTT) family practice residencies are designed to prepare family physicians for rural practice. Residents in these programs spend 1 year in an urban location, followed by 2 years in a rural setting. Anecdotally, one hears that some programs have problems filling their available positions for residents. No published studies have systematically evaluated this fill rate. This study determined the match rate of rural track family practice residencies and examined factors associated with higher rates. METHODS: Questionnaires were mailed to program directors of all 28 rural track residencies identified in 1998 by the Residency Review Committee for Family Practice. Five programs proved ineligible, and 22 of the 23 eligible programs responded (96%). Directors provided information on fill rates and program characteristics from 1996 through 1998. Programs' reported fill rates were compared to rates previously reported for family practice residencies as a whole. Descriptive statistics were used to compare rural track programs that did and did not fill through and after the National Resident Matching Program (NRMP) (the "Match "). We also report data recently updated to reassess the situation for the 2001 Match. RESULTS: Rural track residency programs offered 52 first-year positions in 1998. All positions were offered through the NRMP. From 1996 through 1998, programs had a mean Match rate of 61%, compared with a rate of 86% reported previously for all family practice residencies. RTT programs in more-desirable communities (as determined by location near a listing in Fortune Magazine's "Best Places to Live") and those in the western and northeastern United States filled more positions than programs in less-desirable locations and in the southern and central United States. There were no other differences in the characteristics of programs or their faculty between programs that filled their positions and those that did not. These same trends held true for the 2001 Match. CONCLUSIONS: In recent years, rural track residencies were less likely to match their first-year positions than other family practice residencies. Geographic and community characteristics seemed to influence the Match rate, whereas characteristics of programs and their faculty did not.

Education, Medical, Continuing↗
PubMed1989

Sexual practices and condom usage in a cohort of homosexual men in relation to human immunodeficiency virus status.

Between January 1, and October 31, 1987, 420 homosexual men who participated in a cohort study of infection with the human immunodeficiency virus (HIV) completed a questionnaire that examined their sexual practices during the previous six months. Of the subjects, 205 (48.8%) men were HIV-seropositive and 215 (51.2%) men were HIV-seronegative. Although there was an appreciable level of condom usage in both groups, 13.5% of the HIV-seronegative men had engaged in unprotected receptive anal intercourse and 6.3% of the HIV-seropositive men had engaged in unprotected insertive anal intercourse. Condom breakage was reported on approximately 6% of occasions by a minority of subjects. Among subjects who were in a relationship with a regular male sexual partner, the most commonly reported sexual practices were deep kissing, mutual masturbation and receptive oral intercourse without ejaculation. No HIV-seronegative man engaged in unprotected receptive and/or insertive anal intercourse, receptive oral intercourse with ejaculation or receptive and/or insertive "fisting" with a regular partner who was HIV-seropositive. No HIV-seropositive man engaged in unprotected insertive anal intercourse to ejaculation with an HIV-seronegative partner, although they did so with partners who were HIV-seropositive or of unknown status. On multivariate analyses the subject's antibody status was found to be associated with receptive anal intercourse with a condom (P = 0.007) and mutual masturbation (P = 0.001), with HIV-seronegative men being more likely to practise either; no significant independent effect was associated with the partner's antibody status. These findings provide important information on the types and levels of sexual practices in a group of homosexual men after the recognition of the acquired immunodeficiency syndrome in this country.

Adult↗
PubMed1989

Bilateral anterior transposition of the inferior obliques.

Sixty-one children with bilateral overaction of the inferior oblique muscle with concurrent or previous infantile esotropia received bilateral inferior oblique recessions with anteriorization to a point 2 to 4 mm anterior to the lateral end of the inferior rectus insertion. Subsequent reoperation for recurrent overaction of the inferior obliques was needed in only one case. Also, substantial reduction in dissociated vertical deviation (DVD), when present, and almost complete absence of subsequent need for surgery for DVD among the 61 children of this series were new findings. Only one of the 61 required subsequent surgery for manifest DVD. In another series of 60 infantile esotropes of similar ages drawn from the same practice who had previously had no inferior oblique surgery, nine needed surgery for DVD. This difference (one of 61 vs nine of 60) was significant.

Child↗