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PubMedDate not supplied

Disease duration, hypertension and medication requirements are associated with organ damage in childhood-onset systemic lupus erythematosus.

OBJECTIVE: To investigate the frequency of organ damage in childhood-onset systemic lupus erythematosus (SLE) and to identify disease variables and patient characteristics related to organ damage. METHODS: A cohort of 71 patients was examined in a cross-sectional study after a mean disease duration of 10.8+/-8.2 years (mean age 26.4+/-9.8 years). The occurrence of organ damage was measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Factors analysed as possible explanatory variables of organ damage were the following: demographic variables, clinical variables at diagnosis and during disease course, as well as medication use. Growth and self-reported health status were also measured. RESULTS: The most frequent areas of organ damage were in the neuropsychiatric (28%), renal (13%) and musculoskeletal (13%) organ systems. Forty-three patients (61%) had evidence of damage. The mean SDI score was 1.3 for the whole study population. Hypertension, longer disease duration and use of cyclophosphamide were factors significantly related to an increasing SDI score in multiple linear regression analyses. Furthermore, patients with damage (SDI > or =1) compared to those without damage (SDI = 0) had a significantly higher cumulative corticosteroid dose (24.7 g versus 10.6 g) and more frequently required high-dose prednisolone at diagnosis (68% versus 43%). CONCLUSION: Evidence of organ damage was found in 61% of all patients. Long disease duration, known hypertension and use of cylophosphamide were significantly associated with an increasing SDI score. Furthermore high-dose prednisolone at diagnosis and cumulative prednisolone dose were significantly related to the presence of organ damage.

Adolescent↗
PubMed2000

Aerosolized diuretics for preterm infants with (or developing) chronic lung disease.

BACKGROUND: Lung disease in preterm infants is often complicated with lung edema. OBJECTIVES: The aim of this review is to assess the risks and benefits of aerosolized diuretic administration in preterm infants with or developing chronic lung disease (CLD). Primary objectives are to assess effects on short term outcome (changes in need for oxygen or ventilatory support) and effects on long-term outcome. Secondary objectives are to assess changes in pulmonary mechanics and potential complications of therapy. SEARCH STRATEGY: We used the standard search method of the Cochrane Neonatal Review Group. We used the following keywords: ¿ or ¿ and , limited to and limited to or . We searched Medline (1966-1998), Embase (1974-1998) and the Cochrane Controlled Trials Register (CCTR) from the Cochrane Library (1998, Issue 4). In addition, we hand searched several abstract books of national and international American and European Societies. SELECTION CRITERIA: We included in this analysis trials in which preterm infants with or developing chronic lung disease and at least five days of age were all randomly allocated to receive an aerosolized loop diuretic. Eligible studies needed to assess at least one of the outcome variables defined a priori for this systematic review. Primary outcome variables included important clinical outcomes, and secondary outcome variables included pulmonary mechanics and potential complications of therapy. DATA COLLECTION AND ANALYSIS: We used the standard method for the Cochrane Collaboration which is described in the Cochrane Collaboration Handbook. Two investigators extracted, assessed and coded separately all data for each study, using a form that was designed specifically for this review. Any disagreement was resolved by discussion. We combined parallel and cross-over trials and, whenever possible, transformed baseline and final outcome data measured on a continuous scale into change scores using Follmann's formula. MAIN RESULTS: We identified eight studies which met selection criteria. Most studies focused on pathophysiological parameters and did not assess effects on important clinical outcomes defined in this review or the potential complications of diuretic therapy. No study assessed the amount of diuretic effectively delivered to the patient. Furosemide was the only diuretic used in the eight studies included in this review. Among preterm infants < 3 weeks of age developing CLD, not enough information is available to assess the effect of aerosolized furosemide on outcome or lung function. Among infants > 3 weeks with CLD, a single aerosolized dose of 1 mg/kg of furosemide may transiently improve pulmonary mechanics. Not enough information is available to assess the effect of chronic administration of aerosolized furosemide on oxygenation and pulmonary mechanics. REVIEWER'S CONCLUSIONS: In preterm infants > 3 weeks with CLD administration of a single dose of aerosolized furosemide improves pulmonary mechanics. In view of the lack of data from randomized trials concerning effects on important clinical outcomes, routine or sustained use of aerosolized loop diuretics in infants with (or developing) CLD cannot be recommended based on current evidence. More double-blinded randomized trials are needed (1) to analyze factors likely to affect the response to aerosolized furosemide, e.g. , washout period and delivery of furosemide to distal airways, and (2) to assess the effects of chronic administration of aerosolized furosemide on mortality, O2 dependency, ventilator dependency, length of hospital stay and long-term outcome.

Aerosols↗
PubMed2004

Unilateral Angle II in functional lateralities.

The aim of this study was to explore unilateral Angle II-type malocclusion prevalences in functionally true right-sided (TRS) and non-right-sided (NRS) children having one or more left-sided functions (eye, hand, foot). A half cusp sagittal relationship of the upper and lower M1 and Dm2 was determined on dental casts of 1423 young American black and white children in a cross-sectional sample with the mean age of 8.5 years (range 6-12 years). Hand, foot and eye preferences were recorded at the age of 4 years during the Collaborative Perinatal Study. The prevalences of symmetric bilateral Angle I and II and asymmetric unilateral Angle II right and Angle II left cases were compared between TRS and NRS children using Chi-square analysis. In general, unilateral Angle II right occurred in 9 per cent of the population and Angle II left in 6.5 per cent. In moderate non-right sideness (two-thirds of left dominant functions), these proportions were 17 and 3 per cent, respectively, and in true right sidedness 8 and 6 per cent, respectively. TRS subjects were more symmetric (bilateral Angle I or II in 85 per cent of cases) than NRS children (80 per cent), and the differences were statistically significant (P < 0.02). These results highlight the anatomical relationships of structures supporting the occlusion and the symmetry/asymmetry of the neurocranium, cranial base, masticatory apparatus, and probably also the sidedness and the growth-stimulating effect of lateralized jaw function. Based on the results and considering earlier observations on brain asymmetry in functional lateralities, it can be hypothesized that a normal symmetric sagittal occlusal relationship is based on unilateral sagittal compensatory growth to maintain optimal bite, challenging early preventive orthodontic treatment in suspect unilateral Angle II cases.

Black People↗
PubMed1998

Neurovascular free muscle transfer combined with cross-face nerve grafting for the treatment of facial paralysis in children.

Microneurovascular free muscle transfer is fast becoming a standardized procedure in the treatment of established or long-standing facial paralysis. However, there is no general agreement as to whether muscle transfer should be employed for children who still are growing. A patient's natural growth may influence or disturb reproduction of a smile, or a child may not be able to collaborate with postoperative rehabilitation sufficiently well to obtain a satisfactory result. One may hesitate to employ the procedure for children aged under 10 out of fear of its technical difficulties. To investigate the influence of age, the results experienced by 23 patients under the age of 15 who underwent free muscle transfer combined with cross-face nerve grafting were compared with those of adult patients. The treatment employed was a two-stage operation consisting of cross-face nerve grafting and subsequent free muscle transfer.

Adolescent↗
PubMed2004

Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.

We searched the literature on the epidemiology, diagnosis, prognosis, treatment and costs of mild traumatic brain injury. Of 428 studies related to prognosis after mild traumatic brain injury, 120 (28%) were accepted after critical review. These comprise our best-evidence synthesis on prognosis after mild traumatic brain injury. There was consistent and methodologically sound evidence that children's prognosis after mild traumatic brain injury is good, with quick resolution of symptoms and little evidence of residual cognitive, behavioural or academic deficits. For adults, cognitive deficits and symptoms are common in the acute stage, and the majority of studies report recovery for most within 3-12 months. Where symptoms persist, compensation/litigation is a factor, but there is little consistent evidence for other predictors. The literature on this area is of varying quality and causal inferences are often mistakenly drawn from cross-sectional studies.

Adult↗
PubMed2004

Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections.

BACKGROUND: The evaluation of young febrile infants is controversial, in part because it is unclear whether clinical evidence of a viral infection significantly reduces the risk of serious bacterial infections (SBIs). Specifically, it remains unclear whether the risk of SBI is altered in a meaningful way in the presence of respiratory syncytial virus (RSV) infections. OBJECTIVE: The objective of this study was to determine the risk of SBI in young febrile infants who are infected with RSV compared with those without RSV infections. METHODS: We conducted a 3-year multicenter, prospective, cross-sectional study. All febrile (> or =38 degrees C) infants who were < or =60 days of age and presented to any of 8 pediatric emergency departments from October through March 1998-2001 were eligible. General clinical appearance was evaluated using the Yale Observational Scale. We determined RSV status by antigen testing of nasopharyngeal secretions. We defined bronchiolitis as either wheezing alone or chest retractions in association with an upper respiratory infection. We evaluated infants with blood, urine, cerebrospinal fluid, and stool cultures. Urinary tract infection (UTI) was defined by single pathogen growth of > or =5 x 10(4) cfu/mL, or > or =10(4) cfu/mL in association with a positive urinalysis in a catheterized specimen, or > or = 10(3) cfu/mL in a suprapubic aspirate. Bacteremia, bacterial meningitis, and bacterial enteritis were defined by growth of a known bacterial pathogen. SBI was defined as any of the above-mentioned 4 bacterial infections. RESULTS: We enrolled 1248 patients, including 269 (22%) with RSV infections. The overall SBI status could be determined in 1169 (94%) of the 1248 patients, and the rate of SBIs was 11.4% (133 of 1169; 95% confidence interval [CI]: 9.6%-13.3%). The rate of SBIs in the RSV-positive infants was 7.0% (17 of 244; 95% CI: 4.1%-10.9%) compared with 12.5% (116 of 925; 95% CI: 10.5%-14.8%) in the RSV-negative infants (risk difference: 5.5%; 95% CI: 1.7%-9.4%). The rate of UTI in the RSV-positive infants was 5.4% (14 of 261; 95% CI: 3.0%-8.8%) compared with 10.1% (98 of 966; 95% CI: 8.3%-12.2%) in the RSV-negative infants (risk difference: 4.7%; 95% CI: 1.4%-8.1%). The RSV-positive infants had a lower rate of bacteremia than the RSV-negative infants (1.1% vs 2.3%; risk difference: 1.2%; 95% CI: -0.4% to 2.7%). No RSV-positive infant had bacterial meningitis (0 of 251; 95% CI: 0%-1.2%); however, the differences between the 2 groups with regard to bacteremia and bacterial meningitis did not achieve statistical significance. CONCLUSIONS: Febrile infants who are < or =60 days of age and have RSV infections are at significantly lower risk of SBI than febrile infants without RSV infection. Nevertheless, the rate of SBIs, particularly as a result of UTI, remains appreciable in febrile RSV-positive infants.

Bacteremia↗
PubMed1988

Immunogenicity of a 92kDa component of porcine zona pellucida isolated using a monoclonal antibody (3A4-2G1) exclusively cross-reactive with porcine and human zonae pellucidae.

Three monoclonal antibodies (Mabs) to solubilized porcine zona pellucida (s-PZP) were produced. They reacted exclusively to porcine and human zonae pellucidae (ZPe) and two of them blocked sperm penetration of ZP in humans by collaborating with goat anti-mouse gamma-globulin serum as a second antibody. The antigen corresponding to one of these Mabs (Mab 3A4-2G1) was fractionated from s-PZP by immunoaffinity chromatography bound Mab 3A4-2G1. The antigen corresponding to Mab 3A4-2G1 was further fractionated by SDS-PAGE and the protein band corresponding to 92kDa was found to react to Mab 3A4-2G1, as demonstrated by Western blotting. The 92kDa fraction of s-PZP was isolated and injected into mice with complete and incomplete Freund's adjuvants to obtain an antiserum. It was shown that the antiserum to the 92kDa molecule reacted in a tissue-specific manner to human ZP and exhibited a strong inhibitory effect on sperm penetration of ZP of human oocytes.

Animals↗
PubMed2004

Central venous catheter-related bloodstream infections in cancer patients.

OBJECTIVE: To determine the frequency of central venous catheter-related bloodstream infections (CR-BSI) in cancer patients and the antimicrobial susceptibility pattern of the isolates. DESIGN: A cross-sectional study. PLACE AND DURATION OF STUDY: The study was conducted between April 2002 and March 2003 at the Armed Forces Institute of Pathology, Rawalpindi in collaboration with Oncology Units of Armed Forces Bone Marrow Transplant Centre and Combined Military Hospital, Rawalpindi. SUBJECTS AND METHODS: Cancer patients requiring short or long-term central venous catheterization at the time of admission or thereafter were included. Catheter tips on removal were cultured quantitatively; specimens of blood and pus were cultured qualitatively. Isolates were identified and antimicrobial susceptibility testing was performed by standard techniques. RESULTS: Eighty-nine patients were included in the study. The frequency of CR-BSI was 17%. Out of the 19 organisms isolated, 10 (53%) were Gram-positive cocci, 8 (42%) were Gram-negative rods and 1 (5%) was a fungus. Coagulase negative staphylococci (27%) were the predominant pathogens. Among the staphylococci, 46% of the isolates were methicillin-resistant. All Gram-positive isolates were susceptible to glycopeptides. Gram-negative rods were resistant to most of the commonly used antimicrobial groups. CONCLUSION: Central venous catheter is an important source of bloodstream infections in cancer patients. Most of the infections are caused by Gram-positive cocci. Rigorous infection control measures and continuous surveillance are required to curb the frequency of these infections.

Adolescent↗
PubMed1985

Chemical probes and possible targets for the induction of aneuploidy.

There is an increasing interest in developing assay systems that are effective in detecting aneuploidy-producing agents. Because the current methodology for detecting aneuploidy is extremely varied, presently no comparisons of the validity and sensitivity of various assays can be made. This is due to a lack of sufficient data on the testing of the same compounds in multiple systems. Thus, there is an imminent need to select a few model compounds to be tested in all the available assays. This chapter discusses the rationale for the selection of model compounds. Approximately 30 compounds were identified as candidate compounds for various reasons. It is not our intention to discourage studies of compounds not discussed in this chapter. It is merely our effort to facilitate the final selection of a few model compounds to be used for comparative studies in diverse assays or for collaborative studies to determine interlaboratory variation of selected assays.

Aneuploidy↗
PubMed2006

A survey of delirium guidelines in Europe.

OBJECTIVE: The aim of this study was to investigate the existence and content of delirium guidelines of the national psychiatric associations in Europe. METHOD: A survey was sent by email to national coordinators of the European Association for Consultation-Liaison Psychiatry and Psychosomatics. RESULTS: Responses were obtained for 12 of the 14 countries that were approached. Of these 12 countries, only two national psychiatric associations reported having national delirium guidelines. The Dutch Psychiatric Association was the only national psychiatric association that had developed a comprehensive multidisciplinary guideline on the diagnosis and treatment of delirium. The German Association of Scientific Medical Societies has a comprehensive guideline on the treatment of alcohol withdrawal delirium, in which the German Society for Psychiatry, Psychotherapy, and Mental Disorders participated. In addition, the delirium guideline of the British Geriatrics Society and the guideline for alcohol withdrawal delirium of the German Neurological Society were mentioned by respondents. CONCLUSIONS: Although the development of evidence-based treatment guidelines is considered an important way to improve clinical practice, the national psychiatric associations of only two countries have such a guideline for the diagnosis and treatment of delirium. The advantages of supranational collaboration in the development of guidelines are stressed.

Alcohol Withdrawal Delirium↗
PubMed2001

Search for quark-lepton compositeness and a heavy W' Boson using the enu channel in p p macro collisions at square root of [s] = 1.8 TeV.

We present searches for quark-lepton compositeness and a heavy W' boson at high electron-neutrino transverse mass. We use approximately 110 pb(-1) of data collected in p p macro collisions at square root of [s] = 1.8 TeV by the CDF Collaboration during 1992-1995. The data are consistent with standard model expectations. Limits are set on the quark-lepton compositeness scale Lambda, the ratio of partial cross sections sigma(W'-->enu)/sigma(W-->enu), and the mass of a W' boson with standard model couplings. We exclude Lambda<2.81 TeV and a W' boson with mass below 754 GeV/c(2) at the 95% confidence level. Combining with our previously published limit obtained using the muon channel, we exclude a W' boson with mass below 786 GeV/c(2) at the 95% confidence level.

Journal Article↗
PubMedDate not supplied

IV steroids for MS relapse: clinical governance implications.

The face of the NHS is set to change enormously during the next decade providing more choice, more personalized care and real empowerment of people to improve their health (Department of Health, 2005b). Fundamental to this approach will be the management of patients' health needs in the community setting. Using a robust clinical governance framework, the MS team at the National Hospital for Neurology and Neurosurgery worked with the voluntary and commercial sector to design a trial to gather evidence for a new approach to the management of acute MS relapse using intravenous steroids within a home environment. The study was completed in advance of recent governmental initiatives/reforms. This paper focuses on the clinical governance implications of cross-boundary working. It is hoped that by sharing the processes put in place, others contemplating the delivery of acute care outside of hospitals or design of collaborative research trials will find the frameworks useful.

Anti-Inflammatory Agents↗
PubMed1991

Factors in recent reductions in liver cirrhosis deaths.

Since the mid-1970s, there have been substantial declines in liver cirrhosis deaths in many Western countries following a long period of increases. There is variability in the pattern of changes observed: in a sample of 29 countries between 1974 and 1982-83, seven countries showed a significant linear decline, three revealed a curvilinear pattern, increases were observed in six and the rest (13) showed no notable changes. Although reductions in per capita consumption of alcohol may be a contributing factor, these reductions do not seem to account for all of the decreases in cirrhosis deaths that have been observed. Among other factors that might contribute, changes or increases in treatment for alcohol abuse and AA membership have been most strongly linked to these declines; changes in patterns of consumption, dietary habits, prevention efforts and reduced exposure to predisposing factors may also be involved. In view of the importance of these declines for the understanding and prevention of alcohol problems, further research on this issue, perhaps involving international collaborative studies, is needed.

Alcoholism↗
PubMedDate not supplied

Outcomes-based pharmacist reimbursement: reimbursing pharmacists for cognitive services part 1.

OBJECTIVES: (1) Describe the structure of an outcomes-based method of pharmacist reimbursement for cognitive services, (2) outline the structure of an intervention program, (3) explain a mechanism to increase the provision of pharmacists. cognitive services, and (4) summarize findings from the first year of operations of this outcomes-based pharmacist reimbursement program (OBPR). METHODS: A cross-sectional descriptive study was completed using the claims submitted by pharmacists to summarize findings from the first year of operations of this OBPR. The program involves collaboration between pharmacy benefit managers (PBMs) and community pharmacists to improve medication use. Pharmacists were reimbursed for (1) converting therapeutic regimens to generic drugs or preferred formulary medications when a prescriber contact is required; (2) conducting patient education and follow-up after initiation of new medications, changes in drug therapy, or following an over-the-counter (OTC) consultation; and (3) resolving drug-therapy problems. An efficient, no-cost billing system was created. Pharmacies participating in this program are located in cities throughout Iowa, ranging in population from a few hundred to more than 100,000. The main outcome measures were descriptive statistics of prescriptions, intervention claims, and pharmacist participation in the program. Frequency distributions and descriptive statistics were used to summarize the first year of claims. Comparisons of averages were completed with t tests. Chi-square tests were used to compare frequency distributions. RESULTS: Data analysis for the first year of operation, July 1, 2000, through June 30, 2001, showed that 11,326 enrollees obtained 124,768 prescriptions. The majority of individuals (n=8335, 74%) received some intervention service. The majority (90%) of intervention services were patient education and follow-up on new prescriptions or changes in prescriptions. More than 200 individuals had drug-related problems. There was variability in the level of service per pharmacy as the median number of intervention services was 30, while the mean was 113?188, among those providing any interventions. CONCLUSION: This unique system of outcomes-based pharmacist reimbursement permits community pharmacists to document and bill for cognitive services. It has demonstrated that PBMs and community pharmacists can work together to improve drug therapy, and it may reduce health care costs.

Journal Article↗
PubMed2001

Bacteremia due to Mycobacterium tuberculosis or M. bovis, Bacille Calmette-Guérin (BCG) among HIV- positive children and adults in Zambia.

BACKGROUND: Among adults with advanced HIV infection in developing countries, bacteremia due to Mycobacterium tuberculosis (MTB) is common and bacteremia due to M. bovis (bacille Calmette-Guérin; BCG) is rare. Comparable data are not available for children with HIV. OBJECTIVE: To compare the prevalence of bacteremia due to M. tuberculosis or M. bovis BCG in hospitalized children and adults with HIV infection in a developing country with a high prevalence of tuberculosis and HIV and > 95% BCG immunization coverage. DESIGN: Descriptive cross-sectional study. METHODS: Prospectively hospitalized patients in Lusaka, Zambia who were suspected to have HIV infection underwent phlebotomy for HIV ELISA, HIV viral load, and lysis-centrifugation blood culture for mycobacteria. Histories were obtained and patients were examined for BCG scars. Mycobacterial isolates were identified using DNA probes for MTB complex (MTBC), multiplex PCR and IS6110 typing. RESULTS: The median age of 387 HIV-positive children was 15 months; 98% were BCG immunized. The median age of 344 HIV-positive adults was 32 years; 44% were BCG immunized. Blood cultures were positive for mycobacteria in six children (2%) and 38 adults(11%) (P < 0.001). The six pediatric isolates included five MTBC (40% clustered) and one BCG. The 38 adult isolates included 36 MTBC (16% clustered) and two M. avium complex. CONCLUSION: Bacteremia due to MTB is less common among children than adults with advanced HIV infection in Zambia. Bacteremia due to M. bovis BCG is rare even among children with recent BCG immunization and symptomatic HIV infection.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Relationship between fill volume, intraperitoneal pressure, body size, and subjective discomfort perception in CAPD patients. Mexican Nephrology Collaborative Study Group.

OBJECTIVE: To determine changes in intraperitoneal pressure (IPP) when dialysate fill volume is increased from 2.0 L to 2.5 L to 3.0 L per exchange, and to evaluate the relationship with subjective discomfort perception. DESIGN: Cross-sectional survey. SETTING: Seven Mexican hospital-based dialysis centers. PATIENTS: Eighty-one adult patients on continuous ambulatory peritoneal dialysis (CAPD) without restriction criteria for age, gender, or time on dialysis, were studied. Patients seropositive for HIV or hepatitis B, and those with cancer or receiving immunosuppressive drugs were excluded. Participants were studied as outpatients. MAIN MEASURES: Blindly and in random order, 2.0-, 2.5-, and 3.0-L volumes of dialysate were infused consecutively. Body surface area (BSA) was calculated from patient height and weight. IPP was assessed with the patient lying supine, measuring the height of the dialysate column inside the peritoneal dialysis bag tubing. Blood pressure and subjective discomfort perception (using a visual analog scale of 0-100 mm) were also evaluated and registered after each of the three exchanges. RESULTS: The IPP rose with each increase of dialysate volume and was higher in males than in females for each fill volume level. For males IPP was 18.9 +/- 6.9, 20.8 +/- 7.1, and 22.9 +/- 7.5 cm H2O; and for females it was 16.5 +/- 5.7, 18.4 +/- 5.5, and 19.7 +/- 6.2 cm H2O for 2.0-, 2.5-, and 3.0-L fill volumes respectively (p < 0.01 among fill volumes and between genders). Intraperitoneal pressure showed significant negative correlation with the fill volume corrected for patient body size as reflected by the dialysate volume/ BSA ratio (r= -0.393, p < 0.01; r= 0.319, p < 0.01; and r= -0.274, p < 0.02 for 2.0-, 2.5-, and 3.0-L fill volumes respectively). Discomfort score rose as fill volume rose, with a median of 0, 2.5, and 13.0 for 2.0-, 2.5-, and 3.0-L fill volumes respectively (p< 0.001). It is interesting, however, that with 2.5-L and 3.0-L dialysate infusion volumes, 64% and 44% of the patients, respectively, had no discomfort at all. CONCLUSION: Dialysate volume increase is associated with higher IPP, which is modulated by the gender and body size of the patients. Although the mean discomfort score was higher with larger dialysate volumes, there was no significant correlation between discomfort and IPP or the dialysate volume/BSA ratio. Many patients had no discomfort with 2.5-L or even with 3.0-L dialysate infusions; theoretically, they can be treated with larger volumes.

Adult↗
PubMed2001

Health care seeking behavior of pulmonary tuberculosis patients visiting TB Center Rawalpindi.

OBJECTIVE: To determine the health care seeking behavior of TB patients in seeking care and health care providers for delivering care. DESIGN: Cross sectional descriptive survey. The interviewers administered a standardized open-ended questionnaire after training and pre-testing. SETTING: Federal Government TB Center, Rawalpindi. (specialized TB clinic). SUBJECT: One hundred and sixty newly registered TB patients at TB Center, Rawalpindi between 20 November to 21 December 1998. RESULTS: Prior to their consulting TB Center, 96% patients had already reported to a health care provider, i.e., to first, second or third health care providers. OF 154 patients, 48 were diagnosed as TB and only 29 (19%) of them received antituberculosis treatment. Most of the patients 118 (77%) consulted the health care provider within three weeks time. CONCLUSION: Delay is more on part of health care providers than on patients. Proper implementation of guidelines of TB program with public-private sector collaboration and continuing education of health care providers is necessary.

Adolescent↗
PubMed2006

Use of quality-of-life assessment for nasopharyngeal cancer.

AIMS: To determine the interest in and use of quality-of-life (QOL) questionnaires among international experts in nasopharyngeal cancer (NPC). MATERIALS AND METHODS: An anonymous cross-sectional 12-question survey was conducted among participants in an international symposium on NPC held in Toronto, Canada, in June 2005. A descriptive analysis is presented. RESULTS: Among 161 participants, 60 returned surveys (response rate 37%); 38/63 physicians (60%) responded. The respondents were evenly divided between men and women, with a median age of 42 years. QOL was familiar to 53 (88%); 38 (63%) used QOL instruments for head and neck cancer (HNC) patients and 30 (50%) used QOL instruments for NPC patients. The most commonly used instruments were the European Organization for Research and Treatment of Cancer questionnaire and the Functional Assessment of Cancer Therapy. English was the most frequently used questionnaire language (46; 77%); 16 (27%) used multiple languages. Questionnaires were used for research only (33; 55%), clinically (10; 17%) or for both (3; 5%). Published QOL data were read by 48 (80%) respondents, with 28 (47%) using these data to inform patients or as an aid to the choice of treatment. All who answered the survey endorsed the collection of QOL data in NPC trials at least 'sometimes' (39 [65%] 'always'). Participants raised concerns about the ability of current HNC QOL questionnaires to measure issues unique to NPC patients. CONCLUSIONS: International investigators are interested in using QOL instruments. Collaboration to improve current instruments to meet the needs of NPC patients is warranted.

Adult↗