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Effectively displaying broad scope sub-licensee radioactive material inventory allocations and possession quantities.

As part of its annual broad scope license radiation protection program review, the University of Texas Health Science Center at Houston radiation safety program discovered that although inventory control and monitoring mechanisms were being effectively implemented at the sublicensee level, a method did not exist to demonstrate compliance with collective broad scope license possession limits at the institutional level. To address this shortcoming, the radiation safety program data warehouse system was modified, and an automatic summary report showing collective sub-licensee maximum possession authorizations was created. But this report did not effectively present the summary information in a manner that key stakeholders could readily comprehend, as the data was not referenced to collective institutional possession limits. So a graphic version of the summary report was created wherein, for each isotope possessed, the collective institutional limit was displayed, along with the totals of all the individual sub-licensee maximum possession limits and current amounts on hand. This simple graphic served to effectively communicate the current status of the institution's radiation source inventory to the radiation safety committee, executive management, and state regulatory officials. The effort has served to simplify the sometimes-complicated source inventory control process and has facilitated subsequent program reviews. In the future, the method is expected to assist the radiation protection program in anticipating when broad license amendments may be needed to accommodate operational changes.

Licensure↗

[The Edward method of subfascial resection in communicating vein insufficiency in the calf].

The purpose of this study was to identify the operative method that gives the best immediate and remote results. The study includes: a retrospective study, a prospective study and remote results. In the retrospective and prospective studies the immediate complication and the results of surgical treatment were evaluated. The total number of immediate complications amounts to 30% and the least of them has Edwards section (3.8%). The best immediate results have been achieved by Edwards method, too (the curing rate of insufficient perforating veins and varix is 93.3%, and of insufficient perforating veins and ulcer is 90.9%). The best remote results have been established at the subfascial section, combined with stripping of insufficient superficial veins and extirpation of varix (the curing rate at 71.4%). This operative procedure can be considered as a selective method in surgical treatment of blood reflux through insufficient perforating veins, and particularly in those regions of the calf characterised by strong indurative and sclerotic changes, as well as by cured and fresh ulcers.

Humans↗

Evidence-based cognitive rehabilitation: recommendations for clinical practice.

OBJECTIVE: To establish evidence-based recommendations for the clinical practice of cognitive rehabilitation, derived from a methodical review of the scientific literature concerning the effectiveness of cognitive rehabilitation for persons with traumatic brain injury (TBI) or stroke. DATA SOURCES: A MEDLINE literature search using combinations of these key words as search terms: attention, awareness, cognition, communication, executive, language, memory, perception, problem solving, reasoning, rehabilitation, remediation, and training. Reference lists from identified articles also were reviewed; a total bibliography of 655 published articles was compiled. STUDY SELECTION: Studies were initially reviewed according to the following exclusion criteria: nonintervention studies; theoretical, descriptive, or review papers; papers without adequate specification of interventions; subjects other than persons with TBI or stroke; pediatric subjects; pharmacologic interventions; and non-English language papers. After screening, 232 articles were eligible for inclusion. After detailed review, 61 of these were excluded as single case reports without data, subjects other than TBI and stroke, and nontreatment studies. This screening yielded 171 articles to be evaluated. DATA EXTRACTION: Articles were assigned to 1 of 7 categories according to their primary area of intervention: attention, visual perception and constructional abilities, language and communication, memory, problem solving and executive functioning, multi-modal interventions, and comprehensive-holistic cognitive rehabilitation. All articles were independently reviewed by at least 2 committee members and abstracted according to specified criteria. The 171 studies that passed initial review were classified according to the strength of their methods. Class I studies were defined as prospective, randomized controlled trials. Class II studies were defined as prospective cohort studies, retrospective case-control studies, or clinical series with well-designed controls. Class III studies were defined as clinical series without concurrent controls, or studies with appropriate single-subject methodology. DATA SYNTHESIS: Of the 171 studies evaluated, 29 were rated as Class I, 35 as Class II, and 107 as Class III. The overall evidence within each predefined area of intervention was then synthesized and recommendations were derived based on consideration of the relative strengths of the evidence. The resulting practice parameters were organized into 3 types of recommendations: Practice Standards, Practice Guidelines, and Practice Options. CONCLUSIONS: Overall, support exists for the effectiveness of several forms of cognitive rehabilitation for persons with stroke and TBI. Specific recommendations can be made for remediation of language and perception after left and right hemisphere stroke, respectively, and for the remediation of attention, memory, functional communication, and executive functioning after TBI. These recommendations may help to establish parameters of effective treatment, which should be of assistance to practicing clinicians.

Brain Injuries↗

Differences in education, knowledge, self-management activities, and health outcomes for patients with heart failure cared for under the chronic disease model: the improving chronic illness care evaluation.

BACKGROUND: The objective of this study was to determine whether participation in a quality improvement (QI) collaborative for heart failure (HF) was associated with better interpersonal aspects of care and health outcomes. METHODS AND RESULTS: We conducted a cross-sectional telephone survey of patients in 6 organizations who participated in a QI collaborative for HF (participants, n = 387) and 6 comparable control organizations (controls, n = 414) and measured provider-patient communication, education received, knowledge of HF, self-management behaviors, satisfaction, and quality of life. The participant group patients were more likely to report their doctor and nurse discussed treatment options and reviewed self-management (P < .01 for both). A total of 88% of participants were told to weigh themselves daily and record their weight compared with 34% of controls (P < .01). Participants were more likely to know how often to check their weight (P < .01), recognize symptoms of worsening HF (P < or = .01 for all), have a scale (P = .002), and monitor their weight daily (P < .001). Participants had similar quality of life but fewer emergency department visits and hospitalizations. CONCLUSION: Participation in a QI collaborative for HF was associated with better communication, education, and knowledge, and lower health care use. Collaboratives may be a useful method for disseminating quality improvement strategies.

Adolescent↗

Determination of standard zinc values in the intact tissues of mice by ICP spectrometry.

The most commonly encountered difficulties for the quantitative measurement of zinc in biological samples are the limited sample amount, total and effective digestion of connective and fatty residues, and low zinc concentrations. These problems often lead to the determination of lower zinc values than actually present, so that the sample preparation, digestion, and analytical procedure deserve careful attention. In this short communication, a new method for microwave tissue disintegration is described. The authors have obtained consistent and reproducible results with tissue samples of 0.5 g or less.

Animals↗

Is cancer communicable?

Recent developments in cancer epidemiology have led to the possibility of an exceedingly complex communicable factor(s) in cancer etiology. The transmission of such an agent(s) may require a susceptible genotype and/or other promotional events. Likely candidates which support this supposition include: Epstein-Barr virus (nasopharyngeal carcinoma, Burkitt's lymphoma, salivary gland tumor among Eskimos, X-linked lymphoproliferative syndrome of Purtilo); human T-cell leukemia virus (adult T-cell leukemia); acquired immune deficiency syndrome (AIDS), complicated by Kaposi's sarcoma (etiologic agent remains elusive, though epidemiology suggests possible infectious transmission); abnormal immune phenomena in households of Hodgkin's disease patients; and clustering of various types of cancer in spouses, the general population, and families. We have selectively reviewed the literature and evolved an etiologic hypothesis which integrates a communicable agent(s) in concert with genetic and/or environmental carcinogenic interaction which could conceivably explain a significant fraction of the total cancer burden.

Epidemiologic Methods↗

Scaled down method for the reproducible recovery to high purity of human serum albumin from low volume blood samples.

A basic need for a protein-based dosimeter is a purified protein. In this communication we present an isolation protocol and an HPLC-based assay which allows one to determine the purity of the isolated albumin. A total of 168 human blood samples were collected from workers of a benzene processing plant and from nearby countryside at Kohtla-Järve, Estonia. Albumin was isolated from plasma by sequential precipitation and the purity was determined by HPLC. The amount of albumin present in plasma varied between the individuals, being 147 +/- 26 mg/5 ml (n = 168), which is about 59% of plasma albumin. However, the isolated albumin was highly pure (100.9 +/- 8.2%, n = 5). All albumin samples analyzed demonstrate two peaks in HPLC analysis. The two peaks detected were collected and subjected to MS analysis, which demonstrates a difference of 120 mass units between the two albumin products isolated. We have developed an assay, which is easy to carry out and is not too labor intense. The HPLC analysis can be applied to confirm the purity of the isolated albumin as well as to confirm the quantity of the albumin in samples.

Benzene↗

Test-retest reliability of isokinetic muscle strength of the lower extremities in patients with stroke.

OBJECTIVE: To i the test-retest reliability of isokinetic strength measurements of 3 muscle groups of the lower extremities in stroke patients. DESIGN: Isokineth tests of bilateral hip flexors, knee extensors, and ankle plantarflexors at 2 angular velocities, performed during 2 sessions scheduled 1 week apart for each subject. SETTING: Outpatilitation clinic of a local hospital in Taiwan. PARTICIPANTS: Nts with mild spastic hemiparesis secondary to stroke and with poststroke onset time of at least 6 months. All subjects could communicate and voluntarily move the affected lower extremity. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The maximal peak torque, total work, and average power of the 3 muscle groups on the affected side examined during each test were quantified by using the normalization and the deficit methods. The normalization method divides the measured strength value by the patient's body weight, whereas the deficit method divides the difference between the strengths of the unaffected and affected extremities by the strength of the unaffected extremity. RESULTS: The normalized strength measures for muscles on the affected side showed good to excellent test-retest reliability (intraclass correlation coefficient [ICC] range,.62-.94; P<.05), whereas the deficit strength measures did not always show good reliability (ICC range,.13-.91). The knee extensors and ankle plantarflexors, but not the hip flexors, on the affected side showed better test-retest reliability of isokinetic strength generated at faster velocity (ICC range,.73-.94) than that generated at slower velocity (ICC range,.62-.88). The normalized peak torque (ICC range,.76-.94) and total work (ICC range,.83-.91) were more reliable than the normalized average power (ICC range,.62-.90) for all 3 muscle groups on the affected side. CONCLUSIONS: Quantitative assessment of muscle strength of the affected lower extremity in patients with mild spastic hemiparesis secondary to stroke is feasible using isokinetic testing. However, the test-retest reliability of isokinetic strength measures is affected by the quantifying method, testing velocity, and strength measures.

Adult↗

Percutaneous nephrolithotomy for caliceal diverticular calculi: a novel single stage approach.

PURPOSE: Current percutaneous treatment of symptomatic caliceal diverticular calculi involves renal access, stone removal, dilation of the diverticular communication, fulguration of the cavity and placement of a nephrostomy tube. We reviewed the outcomes of patients undergoing a novel single stage percutaneous nephrolithotomy technique for radiopaque caliceal diverticular stones that eliminates ureteral catheterization and entry into the renal collecting system. MATERIALS AND METHODS: A total of 21 patients (8 male and 13 female including 1 bilateral) with a mean age of 42.4 years underwent percutaneous nephrolithotomy for caliceal diverticular stones from February 2001 to May 2003. Of the diverticula 12 were upper pole, 4 were interpolar and 6 were lower pole. Infracostal access was established by the urologist directly onto the radiopaque stones without the aid of a ureteral catheter. After balloon tract dilation a 30Fr Amplatz sheath was placed and following stone removal the diverticulum was fulgurated. The infundibulum was neither cannulated nor dilated. A 20Fr red rubber catheter or an 8.5Fr Cope loop was placed into the diverticulum. Stone-free status was assessed by noncontrast computerized tomography on postoperative day 1 (POD1). The drainage tube was removed if there was no urine drainage and the kidney was stone-free. Excretory urography was performed at 3 months to evaluate diverticular resolution. RESULTS: Of 21 patients 20 were discharged home tubeless on POD1 and 18 of 21 (85.7%) renal units were stone- free on POD1 noncontrast computerized tomography. Mean operative time was 58.5 minutes and mean stone burden was 138.9 mm. Mean stone diameter was 11.6 mm and mean diverticular diameter was 15.3 mm. Of 22 renal units 16 had followup excretory urography. All diverticula decreased in size and 14 (87.5%) had complete resolution. CONCLUSIONS: In patients with symptomatic radiopaque caliceal diverticular stones, a single stage procedure without the need for ureteral catheterization combined with direct infracostal diverticular puncture allows for a rapid procedure with little morbidity.

Adolescent↗

Pharmacotherapy interventions undertaken by pharmacists in the Fleetwood phase III study: the role of process control.

BACKGROUND: The Fleetwood Model incorporates prospective review, direct communication with the prescriber, and formalized pharmacotherapy planning in patients at highest risk for medication-related problems. OBJECTIVES: To describe the intervention activities performed by consultant pharmacists and dispensing pharmacists in the context of the Fleetwood Phase III Study. METHODS: We report on a total of 4272 residents living in 12 nursing homes included in the intervention arm of the demonstration project. The intervention period was January through December 2004. Using pharmacotherapy planning software with a Web-based interface, daily interchange of information from the commercial pharmacy software, as well as laptop-based software for use in the nursing homes, pharmacists documented the reason for the intervention, the level of service, and the extent to which the recommendations were accepted. RESULTS: There were 2118 Fleetwood interventions performed on 4272 residents (intervention rate: 9.48/100 resident months), with 81% of interventions performed by consultant pharmacists. The top 5 reasons for Fleetwood interventions by dispensing pharmacists were: missing information/clarification needed (19.8%), drug-age precautions (14.4%), excessive duration alert (9.5%), suboptimal regimen (8.7%), and laboratory test needed (7.3%). The top 5 reasons for involvement of the consultant pharmacists were: laboratory test needed (13.1%), missing information/clarification needed (13%), unnecessary drug (10.3%), product selection opportunity (10.3%), and excessive duration alert (9.1%). CONCLUSIONS: Extending the federally mandated medication review process in nursing homes to incorporate elements of the Fleetwood Model is possible. The recommendation acceptance rates for pharmacist interventions are high.

Community Pharmacy Services↗

Quality systems for the clinical laboratory. Canadian Society of Laboratory Technologists Working Group.

This paper has outlined some of the factors which have given rise to the interest in TQM which is evidenced by changing accreditation requirements and widespread implementation in health care facilities. Implementation of TQM in the clinical laboratory is dependent upon: 1. A clear focus on the most important aspects of the service we provide, where if quality fails patient care would be most seriously effected (high volume procedures, high risk and/or problem prone). 2. A focus on the customers of our services: ensuring that process improvements address their requirements. 3. A new leadership philosophy: tapping into the expertise of each member of the team to achieve service improvements. 4. Recognition of the importance of interdisciplinary and/or multidisciplinary collaboration: closing the gaps in our existing QA programs and ensuring that quality is defined in terms of the broad experience of patients receiving health care. 5. Taking advantage of staff development in the use of team tools to provide teams the opportunities to be successful in collaborative projects. 6. Demonstrating perseverance and commitment to quality improvement. Giving the process time to demonstrate success. The methods and tools used to accomplish the transformation from quality assurance to TQM are various. The important point for laboratory professionals is to ensure that our plans are consistent with the total quality picture for patient care. To do this will require collaboration, coordination and communication between the various care givers with whom we interact. It will also require recognition that no one health care process stands alone: quality patient care requires an intersection of processes that ensures our ultimate customer, the patient, of service that will meet expectations and will produce a successful outcome.

Canada↗

[Systematic reviews on infectious diseases. The Cochrane Collaboration].

BACKGROUND: Theoretically, doctors update their knowledge from the scientific literature, and bibliographic databases have made it possible to overcome many of the limitations with this information, but not all of them. When faced with a therapeutic issue, the practice of evidence based medicine requires the efficient access to information derived from controlled clinical trials (CCT). Reviews of the scientific literature are of increasing importance. The Cochrane Collaboration is dedicated to preparing, maintaining and disseminating updated, systematic reviews of CCTs of health care interventions, which are published in the Cochrane Library. OBJECTIVE: To describe the Cochrane Collaboration and to locate, with the greatest exhaustiveness possible, CCTs published in the journals "Enfermedades Infecciosas y Microbiología Clínica", describe their characteristics and include them in a global database of clinical trials maintained by the Cochrane Collaboration. METHODS: The CCTs were identified by systematic manual searches of all issues of the journal. A descriptive analysis of the CCTs located was made. RESULTS: A total of 24 CCTs were published in 15 years (1.6 per year), 10 were original articles and 14 were communications at congresses. All were done in Spain and the majority were done in hospitals. The most frequently researched question was antibiotic prophylaxis and all evaluated pharmaceutical interventions. The majority of the CCTs published had important information missing (phase of study, randomization, blinding, etc.). CONCLUSIONS: The identification of CCTs is a prerequisite for the development of systematic reviews. There were few clinical trials published in the 15 years of publication of this journal, and the most common characteristic is, clearly, the absence of basic data. The most common is a lack of on the phase of the clinical trial, the follow-up period, and funding sources. The idea of what experimental clinical investigation in infectious diseases is in our country needs to include the identification of CCTs published in other Spanish and international journals.

Bibliometrics↗

[Malaria imported to Norway 1989-98].

BACKGROUND: Increasing numbers of imported cases of malaria have been reported from several European countries. MATERIAL AND METHODS: By analysing data from the Norwegian Surveillance System for Communicable Diseases (MSIS) from 1989 to 1998, the incidence of imported malaria and the most important risk groups for acquiring the disease in endemic areas are assessed. RESULTS: In the ten-year period a total of 744 cases of malaria imported into Norway were reported. An increase in incidence has been observed during the period. Since 1992 Plasmodium falciparum has been the most common reported parasite. 58% of the cases were among people of non-Norwegian origin, and 41% among people of Norwegian origin. Immigrants from Pakistan, India and Sri Lanka constitute 26% of all imported cases. During the five year period from 1994 to 1998, 60% of patients of non-Norwegian origin, and 19% of patients of Norwegian origin took no chemoprophylaxis prior to their illness. From 1994 to 1998, 23% of the patients developed malaria despite taking recommended chemoprophylaxis. The majority of these patients used chloroquine and proguanil and developed falciparum malaria after visiting sub-Saharan Africa. INTERPRETATION: Increased emphasis should be put on avoiding exposure to mosquitoes while in endemic areas. Mefloquine should be recommended as prophylaxis to the majority of travellers visiting regions with chloroquine-resistant malaria.

Adolescent↗

Evolution of living donor liver transplantation in Egypt.

OBJECTIVE: To date, cadaveric organ donation is illegal in Egypt. Therefore, Egypt recently introduced living donor liver transplantation (LDLT), aiming to save those who are suffering from end stage liver disease. Herein, we study the evolution of LDLT in Egypt. METHODS: In Egypt, between August 2001 and February 2004, we approached all centers performing LDLT through personal communication and sent a questionnaire to each center asking for limited information regarding their LDLT experience. RESULTS: We identified and approached 7 LDLT centers, which collectively performed a total of 130 LDLT procedures, however, 3 major centers performed most of the cases (91%). Overseas surgical teams, mainly from Japan, France, Korea, and Germany, either performed or supervised almost all procedures. Out of those 7 LDLT centers, 5 centers agreed to provide complete data on their patients including a total of 73 LDLT procedures. Out of those 73 recipients, 50 (68.5%) survived after a median follow-up period of 305 days (range 15-826 days). They reported single donor mortality. Hepatitis C virus cirrhosis, whether alone or mixed with schistosomiasis, was the main indication for LDLT. CONCLUSION: Egypt recently introduced LDLT with reasonable outcomes; yet, it carries considerable risks to healthy donors, it lacks cadaveric back up, and is not feasible for all patients. We hope that the initial success in LDLT will not deter the efforts to legalize cadaveric organ donation in Egypt.

Cultural Characteristics↗

How do surgical residents and non-physician practitioners play together in the sandbox?

INTRODUCTION: The reduction of resident work hours due to the 80-hour workweek has created pressure on academic health-care systems to find "replacement residents." At the authors' institution, a group of nurse practitioners (NPs) and physician assistants (PAs), collectively referred to as non-physician practitioners (NPPs), were hired as these reinforcements, such that the number of NPPs (56) was almost twice the number of clinical categorical surgery residents (37). An experienced leader with national credibility was hired to run the NPP program. On each service, the call system was changed to a night float system, whereby residents were pulled from traditional resident teams to serve as nighttime residents during the week. A total of 1-3 NPPs were hired for each team, but whether NPPs worked for the team as a whole, or were assigned to individual attendings, was left to the discretion of the division chiefs. One year after the start of this program, the authors wanted to study the effects it has had on both surgery resident education and NPP job satisfaction. METHODS: An electronic, anonymous survey was conducted during a monthly surgery resident meeting, and out of 72 categorical and preliminary surgery residents, 50% submitted answers to 12 questions. A similar electronic survey was administered to all 56 NPPs, with 45% responding. RESULTS: Overall, 63% of residents believed that lines of communication between surgery team members were clear, and 58% of residents and 71% of NPPs believed that attendings, residents, and NPPs worked together effectively. A total of 91% of residents believed that the addition of NPPs to the teams was positive overall, and 80% of NPPs were satisfied with their positions. Overall, 60% of residents and 50% of NPPs felt that educational goals were being met. DISCUSSION: Implementation of the 80-hour workweek and introduction of NPs and PAs onto the inpatient surgical services has altered resident education at the authors' institution. Although overall most residents view the addition of NPPs to the clinical services as positive, there are concerns about the program. Although hired to fill the void left by decreasing labor hours of residents, NPPs do not necessarily have the same goals as surgery residents and there is confusion about how NPPs fit into the hierarchy of the traditional surgical team.

Academic Medical Centers↗

[Change in life expectancy in connection with three large groups of causes of death in Medellín, Colombia, between 1989-1991 and 1994-1996].

OBJECTIVES: To examine changes in life expectancy in Medellin, Colombia, between 1989-1991 y 1994-1996, in connection with four large groups of causes of death commonly employed in studies on the burden of disease: group 1, communicable diseases, perinatal and maternal health problems, and nutritional deficits; group 2, non-communicable diseases; group 3, wounds; group 4, ill-defined causes. The latter were excluded from the analysis because of their ambiguity. METHODS: The calculations were made according to the method described by J. H. Pollard in 1986, with the aid of Microsoft Excel, by using the recommended formulas. The computations were double checked with EPIDAT (version 3.0, unofficial). RESULTS: Between 1989-1991 y 1994-1996, a total gain of 1.93 years in life expectancy was seen in Medellin, with a rise from 62.13 to 64.06 years. The gain was greater in men than in women (2.42 vs. 1.09 years, respectively). The increase noted among females was greatest in the extreme age groups (girls 1 to 4 and women over 54 years of age); in men, it was highest in the middle years (between the ages of 25 and 44). In both sexes, the greatest percentage loss in life expectancy was seen in persons 15 to 19 years of age (23% in men and 4% in women, roughly). In the group comprising communicable diseases, perinatal and maternal health problems, and nutritional deficits, a loss in life expectancy was seen in men (0.04 years), whereas in the group of non-communicable diseases there was a gain in life expectancy in both sexes (0.60 years among men and 0.55 years among women). The greater gain in life expectancy among men was linked to a reduction in mortality from wounds (1.98 years). CONCLUSIONS: If one compares the results obtained in Medellin at the end of the study period with life expectancy at birth in Colombia in 1995, which was 70 years, it is obvious that life expectancy in Medellin is still lagging behind, even though it has risen progressively over the years. This is in keeping with the epidemiological transition the city has experienced, which has been linked with a rise in mortality from degenerative and cardiovascular diseases, chronic respiratory ailments, and diabetes, as well as from diseases resulting from human activity. Nevertheless, this epidemiological transition has been slow in Medellin when compared to Colombia as a whole due to high rates of death from infectious and parasitic diseases, which are more characteristic of the transition in its earlier stages. Despite the fact that mortality from wounds has decreased in Medellin, particularly among young males, it may be worthwhile to reassess the effectiveness of interventions undertaken in recent years to promote peaceful coexistence and tolerance in the community.

Adolescent↗

Erectile dysfunctions in patient-physician communication: optimized strategies for addressing sexual issues and the benefit of using a patient questionnaire.

INTRODUCTION: Erectile dysfunctions are prevalent but underdiagnosed and undertreated health problems. Communication barriers between patients and physicians are one of the main reasons for this and responsible for a low report rate of sexual dysfunction. AIM: The main aim of the study was to investigate which phrasing and communication strategies gained the highest acceptance from physicians and their patients and were considered the most effective. MAIN OUTCOME MEASURES: A documentation form on which each consultation was rated by the participating physicians. METHODS: A large group of physicians was asked to hand out a short patient questionnaire to all male patients over 30 years. The physician was instructed to discuss the questionnaire with the patient and to ask him about sexual problems. A total of 1,191 physicians took part in the study that documented a total of 10,622 consultations with an average duration of 15 minutes. RESULTS: The main results were: (i) the patient questionnaire found a high level of acceptance and 54% of discussions of sexual health were prompted by it; (ii) the patients' reaction to physicians addressing sexual health was positive in more than two-thirds of the sample and characterized by openness, willingness to communicate, and relief that their sexual problems had been addressed; (iii) from the physicians' perspective, the most favored communication strategies were a clear signaling of a willingness to talk, and addressing treatment possibilities or signaling that help was available; and (iv) the resulting discussion led to further diagnostic measures in 25% of patients and to further therapeutic measures in 60% of patients. CONCLUSIONS: There are good grounds for concluding that: (i) addressing a patient's sexual health as part of a physician's everyday routine is feasible in terms of duration and content; and (ii) a short patient questionnaire is an excellent aid for patients and physicians for initiating communication on the topic.

Adult↗

[Inter-organ neural communications in the innervation of bronchi and pulmonary circulation vessels].

By means of V.P. Vorobiov's preparation in complex of the thoracic cavity organs of persons at various age and sex in fetuses, sources of innervation of bronchi and vessels of the pulmonary circulation have been stated. They make the composition of the cardiac nerves getting off the superior, middle cervical, cervico-thoracic (stellate) and from 3 to 5 thoracic nodes of the sympathetic trunk, superior and inferior cardiac branches of the nervus vagus. Connection between the nerves of the bronchi and vessels of the pulmonary circulation with the cardiac and esophageal nerves and formation of interorganic nervous plexuses are demonstrated. Not always the diaphragmal nerve participates in the innervation of the bronchi and pulmonary vessels. In total preparations and flat sections, elective revealing of the nervous elements with Shiff reagent in M. G. Shubich and A. B. Khodos modification and Gomori thiocholine method, makes it possible to follow connections of the pulmonary veins nerves with the left atrium, intrapulmonary connection of the perivascular and peribronchial plexuses, as well as participation of nervous elements of the pulmonary trunk in innervation of the right ventricle walls. There are multiple vegetative communications participating in innervation of the bronchi and vessels of the pulmonary circulation. The relations of the pulmonary nerves with the nerves of other thoracic organs are very complex; this explains the nature of the repercussive reactions of the lungs after surgical interventions performed in the other organs of the thoracic cavity.

Animals↗