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PubMed2006

Test characteristics of placental location screening by transabdominal ultrasound at 18-20 weeks.

OBJECTIVES: To determine the test characteristics of a second-trimester transabdominal fetal anomaly scan in screening for placenta previa. PATIENTS AND METHODS: This was a case-control study carried out at a tertiary obstetric hospital involving 54 women (0.5% of the total number booked for antenatal care and delivery at the center) with clinically significant placenta previa at the time of delivery, and 168 randomly selected controls who attended for antenatal care and delivery in 2000-2003. Sensitivity, specificity and false positive rate of the placenta-os measurement in the second-trimester transabdominal fetal anomaly scan for identification of clinically significant placenta previa were assessed. RESULTS: Women with placenta previa at delivery had significantly different second-trimester placenta-os measurements from those of controls (P < 0.0001). For women with placenta previa, the mean (standard deviation) placenta-os measurement was -0.96 cm (1.95) vs. 4.15 cm (1.77) for controls (P < 0.0001). Using the anomaly scan as a screening test for placenta previa with a placenta-os measurement cut-off point of < or = 2 cm, all cases of placenta previa should be identified, but 11.1% (95% CI, 7.1-14.8) of women without placenta previa would have false positive results. At cut-off points of 3 cm and 1.5 cm the false positive rates were 25.7% (95% CI, 18.8-30.2%) and 6.6% (95% CI, 3.8-9.6%), respectively, but at 1.5 cm 3.8% of cases would be missed. CONCLUSIONS: The second-trimester transabdominal fetal anomaly scan is a useful screening test for placenta previa. However, because of false positives among the much larger population of women without placenta previa, we estimate that with a cut-off point of < or =2 cm, 23 women would have to be followed up to confirm one true placenta previa.

Adolescent↗
PubMed1984

Increased frequency of diabetes mellitus in patients with bullous pemphigoid: a case-control study.

A case-control study was designed to assess the occurrence rate of primary diabetes mellitus (DM) in patients with bullous pemphigoid (BP) by retrospectively reviewing the records of our thirty histopathologically and immunopathologically proved cases of BP from the past 10 years. One hundred twenty patients were selected as controls, which included two names immediately before and two names immediately after each case of BP in our histopathology record book. The occurrence rate of primary DM prior to the administration of systemic corticosteroids was significantly higher in patients with BP than in the controls (20% and 2.5%, respectively; p = 0.004). Among patients over 50 years of age, this occurrence rate was again higher in patients with BP than in the controls (23% and 3.6% respectively; p = 0.02). This study suggests a higher than chance association of BP and primary DM.

Adolescent↗
PubMed1999

Twelve-step and mutual-help programs for addictive disorders.

Psychiatrists may wonder why both addiction treatment and the 12-step programs recommend abstinence. In his 50-year follow-up of two groups of alcoholics, Vaillant compared those who established secure abstinence with those who continued to drink. Secure abstinence was associated with: Living longer Better mental health Better marriages Being more responsible parents Being successful employees In considering the various routes to secure recovery, Vaillant recommended that clinicians: Offer the patient a nonchemical substitute for alcohol Remind the patient ritually that even one drink can lead to pain and relapse Repair the social and medical damage that the patient has experienced Restore the patient's self-esteem The preponderance of the research data now available indicates that the 12-step programs of AA, NA, Cocaine Anonymous, and Al-Anon are most helpful for alcohol-dependent and other drug-addicted patients as they seek to achieve secure, long-term abstinence. A growing number of clinicians is recommending that physicians become more knowledgeable and skilled in referring and supporting patients in working 12-step programs of recovery. Specific recommendations include: 1. Be familiar with 12-step activities and tools. These include meetings, home groups, sponsors, the Twelve Steps and Twelve Traditions, books, pamphlets, and slogans. To be able to discuss the meanings and applications of these tools for recovery is useful. Physicians can select those that are most suitable for the individual, recognizing that meeting attendance might not be the most important activity. 2. Support referral by facilitating a meeting between the patient and a temporary contact from the 12-step program. This means becoming familiar with local 12-step programs. Phoning the local AA or NA central office or hot line makes connecting patients to someone who will take them to a meeting that same day possible. AA and NA have committees whose members are interested in working with physicians to help get patients to meetings and to get information to physicians. These are the Cooperation with the Professional Community, Treatment Facilities, and Hospitals and Institutions committees. 3. Work with the resistance of patients. Many addicted patients are resistant to the idea of attending 12-step or mutual-help programs. Reminders of their painful personal database associated with the use of alcohol or other drugs can help break through denial. Involvement of family members and friends in the network therapy developed by Galanter can be effective in reducing resistance. Being patient and persistent in developing the therapeutic alliance helps to maintain contact during the first difficult year of recovery. Physicians should be prepared to work with patients as long as necessary to stabilize their sobriety. Zweben has suggested ways psychotherapy can help deepen work with the steps. 4. Help dual diagnosis patients understand AA's and NA's singleness of purpose. These programs work only with addiction; they do not try in any way to deal with other mental disorders. All patients have to say is, "I want to stop drinking or using drugs," and they will be welcomed and accepted at meetings (see Tradition 3). If they talk only about their psychiatric symptoms or medications, someone may suggest that they go elsewhere for help. Occasionally, well-intentioned AA or NA members tell patients to stop taking their medications. The authors always direct patients to the pamphlet The AA Member: Medications and Other Drugs. This pamphlet tells AA members not to play doctor and to take the medications their doctors prescribe. Copies of the pamphlet are widely available at many AA meetings, or they can be ordered by physicians from Alcoholics Anonymous World Services, General Service Office, Box 459, Grand Central Station, New York, NY 10163 (212-870-3400). 5. Get comfortable with the spiritual dimensions of healing. Zweber and Brown offer good suggestions for getting com

Alcohol-Related Disorders↗
PubMed1994

The chest pain emergency department and the outpatient chest pain evaluation center: revolution or evolution?

STUDY OBJECTIVE: To define the chest pain emergency department and the outpatient chest pain evaluation center, and to critically analyze the costs and benefits of modifying or replacing the current system of hospital-based evaluation of chest pain patients with these new systems. DATA SOURCES: Peer-reviewed articles, published letters, book chapters, national health statistics, and personal communications were used. Sources were limited to those describing experiences in the United States. STUDY SELECTION: Relevant sources from the United States were reviewed. DATA SYNTHESIS: The widespread adoption of the chest pain ED as currently configured would result in increased health care expenditures of between $389 million and $3.9 billion. It is estimated that this expenditure might save a maximum of 1,029 additional lives per year, at a cost of between $378,000 and $3.78 million per life saved. CONCLUSION: Current hospital-based systems for evaluating patients presenting with symptoms suggestive of acute ischemic heart disease need improvement. Modification of the system of initial patient evaluation should occur as an evolutionary change to the current ED system. Adoption of a formal system of chest pain EDs represents an inefficient use of resources. Design and implementation of patient education programs about ischemic heart disease should be a public sector responsibility. More research is needed before the proper role of the outpatient chest pain evaluation center can be evaluated.

Adult↗
PubMed2000

Polyploidy: occurrence in nature, mechanisms, and significance for the megakaryocyte-platelet system.

OBJECTIVE: Polyploidy, the state of having greater than the diploid content of DNA, has been recognized in a variety cells. Among these cell types, the megakaryocytes are classified as obligate polyploid cells, developing a polyploid DNA content regularly during the normal life cycle of the organism, while other cells may become polyploid only in response to certain stimuli. The objective of this review is to briefly describe the different cell cycle alterations that may lead to high ploidy, while focusing on the megakaryocyte and the importance of high ploidy to platelet level and function. MATERIALS AND METHODS: Relevant articles appearing in scientific journals and books published in the United States and in Europe during the years 1910-1999 were used as resources for this review. We selected fundamental studies related to cell cycle regulation as well as studies relevant to the regulation of the endomitotic cell cycle in megakaryocytes. Also surveyed were publications describing the relevance of high ploidy to high platelet count and to platelet reactivity, in normal situations and in a disease state. RESULTS: Different cells may achieve polyploidy through different alterations in the cell cycle machinery. CONCLUSIONS: While upregulation of cyclin D3 further augments ploidy in polyploidizing megakaryocytes in vivo, future investigation should aim to explore how normal megakaryocytes may initiate the processes of skipping late anaphase and cytokinesis associated with high ploidy. In humans, under normal conditions, megakaryocyte ploidy correlates with platelet volume, and large platelets are highly reactive. This may not apply, however, to the disease state.

Animals↗
PubMed1998

Central nervous system metastases.

OBJECTIVES: To provide an overview and up-to-date information on the presentation and treatment of central nervous system (CNS) metastases, including brain metastases, spinal cord compression, and leptomeningeal metastases. DATA SOURCES: Published articles, research reports, and book chapters pertaining to CNS metastases. CONCLUSIONS: Most patients with CNS metastases have a limited life expectancy. Therapies are palliative, except in select patients who have improved chances for long-term control or occasional cures. In general, early detection and treatment of CNS metastases prevents devastating neurological disabilities. IMPLICATIONS FOR NURSING PRACTICE: Nurses across all health care settings can play an important role in early recognition of signs and symptoms of CNS metastases, and assist patients and families in preventing devastating neurological disabilities. Nurses are also frontline care providers for patients requiring various treatments and rehabilitation for metastatic CNS disease.

Brain Neoplasms↗
PubMed2002

Are planning, working memory, and inhibition associated with individual differences in preschool ADHD symptoms?

The association between executive function (EF; planning, working memory, and inhibition) and individual differences in symptoms of attention deficit hyperactivity disorder (ADHD) was explored in a sample of preschool children. One hundred sixty children (between the ages of 3 years, 0 months and 5 years, 6 months), selected so as to oversample high ADHD scorers, performed 3 tasks previously shown to measure planning (Tower of London), working memory (Noisy Book) and inhibition ("Puppet Says..."). EF measures were reliable (kappa > .77) and were correlated with IQ (rs > .38) and age (rs > .59). Once IQ and age were controlled, planning and working memory (r = .41) were correlated. Planning and working memory were not correlated with inhibition (rs < .20). There was no association between ADHD and working memory or planning (rs < .12). There was a significant negative association between ADHD and conduct problems and inhibition (r = -.30 and r = -.25, respectively). Only the link with ADHD persisted after the effects of other factors were controlled for in a multiple regression. Specific deficits in inhibitory control rather than general EF deficits are associated with ADHD in the preschool period. This association is linear in nature, supporting the idea that ADHD is better seen as a continuum rather than a discrete category. This association provides evidence for Barkley's (1997) view that ADHD is underpinned by inhibitory deficits in the preschool period.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

[Clinical and pathological staging of prostate cancer].

In Japan, UICC TNM staging system is widely accepted and used for clinical and pathological classification of prostate cancer. "General rule for clinical and pathological studies on prostate cancer" was also edited by Japanese urological association and the Japanese society of pathology. In this book, clinical staging system modified from Jewett staging system is demonstrated. Though both staging systems are widely used in clinical practice to select treatment and speculate prognosis after treatment, there still exists many limitations and unreasonable problems that must be solved in the future. In this paper, these staging systems with their specific problems and new grouping trials will be introduced.

Humans↗
PubMed1966

Topics in library technology: copying techniques.

Photocopying applications in the library include the combining of previously separate material, the separation of a single item into two or more of its parts, and the selection of parts of existent material by the use of overlays. The production of catalog cards, the creation of sheet material (new book lists, reference bibliographies) from card-form materials, an Index Medicus-derived alerting service, and overdue notices copied from charge cards are among the applications exemplifying these general types. Larger-scale operations employing microfilm are noted. The distinction between copying and printing, in the light of equipment advances, is discussed.

Copying Processes↗
PubMed1995

Decline of U.S. medical student career choice of psychiatry and what to do about it.

OBJECTIVE: In 1994, only 3.2% of U.S. medical school graduates chose psychiatry, the lowest proportion since 1929. Success in recruiting such graduates is necessary to maintain adequate numbers of psychiatrists. The authors' goal was to gain an understanding of the determinants of specialty selection to ensure adequate recruitment. METHOD: They reviewed all recruitment-related English-language publications since 1959: 173 papers, 17 reports, and 10 books. RESULTS: They found that recruitment has been cyclical, with success from 1940 to 1969 and from 1985 to 1988, decline from 1970 to 1984 and from 1989 to 1994, and a possible small upswing in 1995. The 1940-1969 success began with 1) public recognition of a dramatic shortage of psychiatrists to serve in the military and treat casualties and 2) the fervor of the community mental health movement, which promised to prevent mental illness; massive resources were provided for psychiatry during this period. The declines were associated with 1) the failure of the community mental health movement to fulfill its promise, 2) psychiatry's becoming more biologically oriented and medically conventional, and 3) the effects of managed care and increased competition for patients. The psychiatry departments that have high recruitment rates are in public-supported schools, particularly in the South, or give considerable priority and resources for medical student psychiatric education. CONCLUSIONS: A study of the psychiatric workforce is needed to ascertain whether there is a surplus or a shortage of psychiatrists. Regardless, to ensure adequate recruitment, medical institutions and departments of psychiatry must commit resources for student education in psychiatry.

Attitude↗
PubMedDate not supplied

Carvedilol: a nonselective beta blocking agent with antioxidant properties.

Despite advances in therapy, congestive heart failure is a major public health problem with a high mortality and morbidity. The benefits of beta blockers in slowing disease progression and decreasing mortality have recently been shown in large clinical trials. Oxidative stress contributes to disease progression in both post-myocardial reperfusion injury and dilated cardiomyopathy. Several medications are known to have antioxidant effects, including some angiotensin-converting enzyme inhibitors. Carvedilol is a non-selective beta blocker with antioxidant properties approved for use in congestive heart failure.

Adrenergic beta-Antagonists↗
PubMed2006

Triphasic versus monophasic oral contraceptives for contraception.

BACKGROUND: Side effects of oral contraceptive pills (OCs) discourage adherence to and continuation of OC regimens. Strategies to decrease adverse effects led to the introduction of the triphasic OC in the 1980s. Whether triphasic OCs have higher accidental pregnancy rates than monophasic pills is unknown. Nor is it known if triphasic pills give better cycle control and fewer side effects than the monophasic pills. OBJECTIVES: To compare triphasic OCs with monophasic OCs in terms of efficacy, cycle control, and discontinuation due to side effects. SEARCH STRATEGY: We searched the computerized databases of MEDLINE, EMBASE, POPLINE, LILACS and CENTRAL. Additionally, we searched the reference lists of relevant articles and book chapters. We also contacted researchers and pharmaceutical companies in Europe and the U.S. to identify other trials not found in our search. SELECTION CRITERIA: We included randomized controlled trials (RCTs) comparing any triphasic OC with any monophasic pill used to prevent pregnancy. Interventions had to include at least three treatment cycles. DATA COLLECTION AND ANALYSIS: We assessed the studies found in the literature searches for possible inclusion and for their methodological quality. We contacted the authors of all included studies and of possibly randomized trials for supplemental information about the methods and outcomes studied. We entered the data into RevMan 4.2 and calculated odds ratios for the outcome measures of efficacy, breakthrough bleeding, spotting, withdrawal bleeding and discontinuation. MAIN RESULTS: Of 21 trials included, 18 examined contraceptive effectiveness: the triphasic and monophasic preparations did not differ significantly. Several trials reported favorable bleeding patterns, i.e. less spotting, breakthrough bleeding or amenorrhea, in triphasic versus monophasic OC users. However, meta-analysis was generally not possible due to differences in measuring and reporting the cycle disturbance data as well as differences in progestogen type and hormone dosages. No significant differences were found in the numbers of women who discontinued due to medical reasons, cycle disturbances, intermenstrual bleeding or adverse events. AUTHORS' CONCLUSIONS: The available evidence is insufficient to determine whether triphasic OCs differ from monophasic OCs in effectiveness, bleeding patterns or discontinuation rates. Therefore, we recommend monophasic pills as a first choice for women starting OC use. Large, high-quality RCTs that compare triphasic and monophasic OCs with identical progestogens are needed to determine whether triphasic pills differ from monophasic OCs. Future studies should follow the WHO recommendations on recording menstrual bleeding patterns and the CONSORT reporting guidelines.

Contraception↗
PubMed2002

Is there a role for the use of pressure immobilization bandages in the treatment of jellyfish envenomation in Australia?

BACKGROUND: The aim of this paper was to review the literature relating to the use of pressure immobilization bandages in the first aid management of jellyfish sting in Australia and to attempt to make a recommendation about their use based on the current literature. METHODS: A descriptive review of all published cases of jellyfish envenomation in Australia was performed, with specific focus on the discussion of pressure immobilization bandages in the management of such cases. A Medline search was performed using the key words listed for this article. Selected articles were reviewed and further publications were identified from the published reference lists given in the selected articles. RESULTS: The published articles were grouped into three groups: in vitro evidence, case reports and editorial comment (either in journals or book). Fifteen references were identified that discussed the use of pressure immobilization bandages in the management of jellyfish envenomation. Other articles were identified that had significant management issues discussion. CONCLUSION: Most of the 'jellyfish' literature is in relation to envenomation by Chironex fleckeri. This jellyfish is usually found in tropical Australia and has resulted in the deaths of 67 people in Australia. The last death was near Cairns in 2000. Unfortunately, there are few good data on marine envenomations, with most of the literature being Chironex envenomation case reports. There are minimal data on the effect of pressure immobilization bandages on other jellyfish envenomations. There is no good evidence to support the use of pressure immobilization bandages in the management of jellyfish sting in Australia [corrected].

Animals↗
PubMed1989

Teenage pregnancy in western Sydney.

The obstetric performance of 121 young teenagers (less than 17 years of age) confining as public patients at Blacktown District Hospital was retrospectively compared with a randomly-selected control group of older gravidas. These adolescents were less likely to be married, to be certain of their last menstrual period, to book into the hospital early or to attend the antenatal clinic regularly than their older counterparts. However, there was no difference in the rates of anaemia, spontaneous or operative delivery, gestational age at confinement, birth-weight, perinatal mortality or neonatal morbidity rates. When the teenagers were compared with primigravidas from the control group, labour length was significantly shorter and the rates of preeclampsia were similar. These results are more optimistic than previous overseas reports regarding the obstetric performance of young adolescents.

Adolescent↗
PubMed1992

[Gender variables in nursing theories. A text analysis of 5 theories].

During individual care planning in the education of nurses, the students learns to plan, carry out and assess care on the basis of nursing theory. Neutral terms such as patient, client, individual and person commonly occur in planning. The level of personalization can not, however, be considered satisfactory if no attention is paid to gender related variables and if differences in the reaction of men and women to problems and illnesses are not underlined. The aim of the study was to investigate if and how gender related aspects appear in nursing theories. The book "Nursing theories--the base for professional nursing practice" was used as the primary source for the choice of theorists. From the initial selection (n = 12) the five most quoted theorists according to Nursing citation index 1988-1989 (Orem, Rogers, Roy, Nightingale och Peplau), were studied. The result shows that little attention is paid to the gender perspective of patients. Consequently needs of differentiation between women and men are imperfectly observed in individual care planning.

Female↗
PubMedDate not supplied

[Vasoactive substances and the modulation of the hepatic microvascular system].

PURPOSE: To review some aspects of the hepatic phylogeny and ontogeny, the hepatic microvascular system, and the modulation of the tonus on this vascular system by different vasoactive substances. METHOD: Text books and articles from MEDLINE-indexed journals were consulted. RESULTS: Fifty-two articles, that were published between 1949 and 1997, were selected. They provided us with information concerning hepatic phylogeny and ontogeny, the hepatic microvascular system, and the modulation of the tonus in this vascular system. CONCLUSION: The architecture of the hepatic microvascular system, a unique and complex vascular system, is well suited to the functions of the organ. Different factors, including endothelial vasoactive substances, participate in the modulation of the vascular resistance through the liver adequating the liver perfusion to the homeostatic needs. The liver is eminently a maintainer of internal stability.

Angiotensins↗
PubMed2004

[Breastfeeding and maternal medications].

OBJECTIVE: To contribute with information about the adequate administration of drugs during breastfeeding. SOURCES OF DATA: MEDLINE articles from 1993 to 2004, and Lilacs articles from 1995 to 2004 were selected in Portuguese, Spanish and English, by including the following keywords: breastfeeding, lactation, drugs and medicines. Other updated references found in articles and books were also included in this review, in order to provide additional information. SUMMARY OF THE FINDINGS: Most of the drugs are compatible with breastfeeding. Few were considered inadequate, such as antineoplastic drugs, radiopharmaceuticals and drugs of abuse. Some drugs require concern, as they may cause adverse effects in breastfed babies or reduce the mother's breast milk volume. However, further knowledge on some medicines during lactation is required. CONCLUSION: The fundamental principle in the prescription of medicines for lactating mothers is mostly based on the concept of risk and benefit. The option must be, as much as possible, for a drug that has already been studied, which is little released in the maternal milk or that does not mean an apparent risk for the infant's health. Medicines that reduce the mother's production of milk should be avoided during the lactation period. The use of galactogogos is reserved for particular situations. Therefore, only safety drugs should be administered during breastfeeding, which should rarely be discouraged or discontinued in such cases.

Breast Feeding↗
PubMed2005

[Historical flashes on prostatic symptoms and urinary retention].

OBJECTIVES: To perform a chronological search about symptoms of bladder outlet obstruction of prostatic origin and some of its treatments. METHODS/RESULTS: Over the years we have been collecting data about the topic from books and journals; we present them in such a way that they can be consulted chronologically. From more than 100 references we have selected the 60 most relevant to our judgment. CONCLUSIONS: Many ideas about the syndrome and the way to solve it have arisen, which vary from one time to another. For most urologists, the main operative complication has always been bleeding, leading to the development of a great number of techniques to avoid it. Infection, the other great complication, prompted that initially surgical maneuvers were performed very fastly and with the small incisions. In addition, big drainages were necessary.

Equipment Design↗