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PubMed1999

Visiting elective students at the University of Toronto from the Korea University Medical College.

OBJECTIVES: The main goal of the international elective programme was to provide the Korean students with a cross-cultural educational environment. DESIGN: This programme was carried out on a voluntary basis during the summer vacation, rotating students through various clinical divisions in the teaching hospital. SETTING: The University of Toronto. SUBJECTS: Medical students from the Korea University Medical College. RESULTS: The students found the student-teacher relationship to be much more open and liberal. Due to a different curricular structure, the Canadians have better clinical skills and problem-solving abilities in real clinical settings. The cultural differences perceived by the students during the elective programme led them to believe that educational reform in Korea imperatively requires curricular change, but more importantly, a change in our traditional psychological and behavioural traits which derive from Confucianism. CONCLUSIONS: Extreme politeness, passiveness and blind respect for teachers, which are encouraged by Confucianism, are not effective in higher education. All the elective students, as well as the Canadian preceptors, believe that this programme is an invaluable asset.

Cross-Cultural Comparison↗
PubMed2001

Development of body temperature rhythm: 6 years follow up of three cases.

The present study was conducted to evaluate longitudinally the relationship between phase of temperature rhythm and sleep habits. Sleep-logs were recorded from three children for 3 weeks during school term and 1 week before the experiment, and oral temperature was recorded for 2 consecutive days during summer vacations for 6 years. Although previous studies have reported that phase of temperature rhythm was established by 5 years old, phase delay of temperature was found in all subjects even after 5 years old. These results suggest that the establishment of temperature phase is after 5 years old.

Adolescent↗
PubMed1999

Urinary incontinence after radical prostatectomy: a randomized controlled trial comparing pelvic muscle exercises with or without electrical stimulation.

OBJECTIVES: To assess the effectiveness of intensive conservative treatment on and the impact of urinary incontinence after radical retropubic prostatectomy. PATIENTS AND METHODS: Sixty-three men with urinary incontinence >/= 8 weeks after radical prostatectomy were randomized to one of three groups; group 1, standard treatment (control); group 2, intensive pelvic muscle exercises (PME); or group 3, PME plus electrical stimulation (PME+ES). Group 1 received verbal and written instructions about postoperative PME from their urologist and from the nurses at the pre-admission clinic. Groups 2 and 3 were treated by a physiotherapist for 30 min twice a week for 12 weeks and carried out home exercises three times a day on the days when they were not treated. Outcome was assessed using the 24-h pad test, two validated quality-of-life questionnaires and a urine symptom inventory, all obtained at baseline, 12, 16 and 24 weeks after enrolment. The final pad test was carried out approximately 8 months after surgery. RESULTS: Fifty-eight patients completed the study, 21 in group 1, 18 in group 2 and 19 in group 3; five discontinued, three with bladder neck contractures requiring dilatation, one with rectal pain when doing the exercises and one unable to complete therapy while on vacation. The mean (median) time elapsed from surgery to entry into the study was 19 (8) weeks. At 12 weeks from baseline, the mean overall urine loss had decreased from 463 g to 115 g but there were no differences among groups, nor were there significant differences in urine loss at 16 and 24 weeks (F=0. 16, P=0.69). There was a significant impact on quality of life during the early recovery. Despite preoperative instructions, many patients revealed little or no knowledge about catheter care, bladder spasms, rectal pain, incontinence and erectile dysfunction. Little of the preoperative education was retained because of the overwhelming nature of the diagnosis. CONCLUSIONS: From the initial assessment to the final pad-test at approximately 8 months after surgery, incontinence improved greatly in all three groups. This rapid improvement may have masked any treatment benefit. Further research should address incontinence in men whose urine loss has stabilized and who underwent surgery >8 months previously. Moreover, a telephone-based follow-up soon after discharge may alleviate many of the concerns expressed.

Aged↗
PubMed2000

The future of diagnostic virology, part 2: staffing the service.

The first part of this review discussed the facilities that are needed to provide a competent diagnostic virology service at the turn of the century. Just as important is to consider who will run it. Hitherto, there have been specialist virologists in most countries. Their roles have evolved with time, developing and running a variety of diagnostic tests, often to answer local needs and their own curiosity, and frequently linked to their research projects. Recently, the advent of an increasingly long list of commercial tests has raised the real possibility of introducing standardized centrally validated testing methods, and using them to bring laboratories up to a similarly uniform level. Unfortunately, they have also had the effect of seeming to make specialist virologists unnecessary, except in a few central reference laboratories. As a consequence, and because of increasing pressure on health service resources, vacated senior virology posts have remained unfilled and this now threatens the career structure of those who want to become, and continue as, virologists. This review explores these issues and offers a possible solution.

Diagnostic Services↗
PubMed2002

A study of issues in administering library services to nursing studies students at Glasgow Caledonian University.

Glasgow Caledonian University has had a Scottish Office pre-registration nursing and midwifery contract since 1996. Nursing studies students seemed dissatisfied with the library service and there were frequent complaints. A major study was undertaken during 2000 consisting of: an initial lis-link enquiry, separate analysis of returns from nursing studies students of the Library's annual general satisfaction survey (conducted every February), separate analysis of returns from nursing studies students of the Library's opening hours planning survey, and four focus groups held in October 2000. These studies showed the concerns of nursing studies students to be similar to other students but more strongly felt. The four main issues were textbook availability, journal availability, opening hours and staff helpfulness. Working conditions, placement requirements, study requirements and domestic circumstances were all found to be important factors. IT skill levels tended to be low but there is a growing appreciation of the need for training in this area. Concluded that: Library's services to nursing studies students have become enmeshed with the problems of delivery and assessment of education for nurses. Greatly extended opening hours are essential including evening opening during vacations. The problem of access to textbooks is so severe that conventional solutions are not going to work. Programmes of core text digitization and the promotion of e-books are needed. Reciprocal access programmes with local hospital libraries is essential.

Consumer Behavior↗
PubMedDate not supplied

Sensitization to para-phenylenediamine from a streetside temporary tattoo.

"Temporary" henna tattoos (skin painting or pseudotattooing) are in vogue among American and European youngsters, particularly when vacationing. A 17-year-old girl presented with a severe contact dermatitis of her scalp and face after having dyed her hair with a permanent oxidative hair dye. She denied previous use of oxidative hair dye. Eight months earlier she had a "temporary" henna tattoo applied on her shoulder by a transient artist in downtown Montreal and developed an acute, erythematous, edematous eruption that resolved with residual, prolonged hyperpigmentation. As henna tattooing is a lengthy and tedious procedure, para-phenylenediamine (PPD) may be added to the mixture to accelerate the process, to darken, and to give more precision to the design. This short-lived fad can have longer-term sequelae then expected, ranging from postinflammatory hyperpigmentation of the tattoo site to permanent sensitization to PPD and related compounds.

Adolescent↗
PubMed1997

Sumatriptan relieves migrainelike headaches associated with carbon monoxide exposure.

We report a 58-year-old woman with long-standing migraine who developed a pattern of weekend headaches which occurred only while staying at her Connecticut vacation home. The headaches promptly responded to sumatriptan. Investigation revealed a high carbon monoxide level in her home due to a defective furnace. Replacing the furnace eliminated the headaches. This case highlights the importance of searching for secondary causes of headache even in patients responsive to sumatriptan. It also suggests that carbon monoxide may trigger headaches mediated by trigeminovascular inflammation.

Carbon Monoxide Poisoning↗
PubMedDate not supplied

Ultrafiltrable adenosine triphosphate and 2,3-diphosphoglycerate concentrations in cold-stored human erythrocytes.

Free ATP and DPG concentrations in ACD-preserved human erythrocytes (rbc) were estimated by measuring these organic phosphates in ultrafiltrates of cell lysates prepared at 0 to 2 C. The free ATP concentration in hypotonic hemolysates decreased from 0.59 to 0.08 mumol/ml rbc during four weeks of cold storage. In French Pressure Cell lysates, free ATP increased from 0.23 to 0.47 mumol/ml rbc in the first week and then declined to 0.12 mumol/rbc during the following three weeks. In two weeks, the free DPG level decreased from 0.64 to 0.41 mumol/ml rbc in hypotonic lysates and from 1.08 to 0.15 mumol/ml rbc in French Pressure Cell lysates. It is proposed that, as total DPG concentration decreases during cold storage, free ATP concentration also decreases due to increased ATP binding to hemoglobin sites vacated by DPG. It is suggested that it is the change in the free rather than the total ATP which may be more relevant to the metabolism of the cold-stored erythrocyte.

Adenosine Triphosphate↗
PubMed1994

Effects of new brochures on blood donor recruitment and retention.

BACKGROUND: Currently, donors may arrive at blood collection sites without prior knowledge of eligibility and deferral criteria. STUDY DESIGN AND METHODS: The effects of distributing newly developed recruitment brochures 2 weeks in advance of blood drives and the provision of brochures on temporary deferral at the taking of health history were examined in four southeastern regional blood collection centers. Twenty-four similar pairs of worksites, with employee-only recruitment, were randomly assigned to a control (C) or experimental (E) group. Information about sponsor recruitment strategies, worksite factors, and first-time, repeat, and temporarily deferred donors was obtained at three collection drives per site over a 1-year period. Drive 1 was used as a baseline. Two weeks before Drives 2 and 3, the recruitment brochures were distributed to all Group E employees, with temporary deferral brochures provided as needed when the health history was taken. RESULTS: No significant differences between groups or drives were found in the total percentage of employees recruited or returning as a result of recruitment or deferral brochure distribution (Wilcoxon's signed rank test and t test). Substantiating previous observations by donor recruiters, the study results showed decreased donations during vacation periods and busier times at the workplace. Loudspeaker announcements led to decreased donations; increased donations followed special appeals in relation to a specific patient, an accident, or a natural disaster. CONCLUSION: The brochures may have encouraged previous donors to return, but their use did not significantly increase the recruitment of new donors or the return of temporarily deferred donors.

Blood Donors↗
PubMed1987

[5 cases of Mediterranean boutonneuse fever in Switzerland].

The Boutonneuse Fever also called Marseilles or Eruptive Mediterranean Fever is an common disease in mediterranean area, in Africa and Indien. Rickettsia conorii is the microorganism involved and Rhipicephalus sanguineus is the most common vector. In Switzerland, this dog's tick don't exist in the nature, but it may be introduced by a dog contaminated elsewhere outside of the country and remain alive in our houses. It the reason why this disease is very uncommon in Switzerland. However, it may be observed in people coming back from vacation or in patients in contact with imported Rhipicephalus. In this paper, five cases of Boutonneuse Fever diagnosed between 1980 and 1985 are reported. The epidemiological relationships between four of these cases are of special interest. The clinical picture of the disease is presented with the different serological tests useful in confirming the diagnosis. Prevention and treatment are discussed.

Adult↗
PubMed2004

Penicillin: its discovery and early development.

In August 1928, Alexander Fleming returned from a vacation to his usually messy, disordered laboratory. In one of the Petri dishes that had not been touched by the Lysol, he noticed an unusual phenomenon: separate colonies of staphylococci and, near the dish's edge, a colony of mold approximately 20 mm in diameter. The finding proved to be a watershed in the history of medicine. This discovery lay dormant for some time before other researchers took up the challenge to investigate its clinical possibilities. Two investigators at Oxford, Sir Howard Walter Florey and Ernst Boris Chain, brought penicillin's potential for medical use to fruition and, along with Fleming, shared the 1945 Nobel Prize for Medicine. The discovery and development of penicillin represent one of the most important developments in the annals of medical history. This article presents a brief overview of the events that occurred in the progress from discovery to implementation as a therapeutic agent.

Animals↗
PubMed2002

A brave New World: Virtual Grand Rounds in Dermatology.

Two dermatologist friends, widely separated by geography, had the dream to build a virtual grand rounds that could connect colleagues around the world for diagnostic and therapeutic suggestions as well a intellectual stimulation. They recrulted 2 students and constructed the site over a summer vacation. Virtual Grand Rounds in Dermatology is a prototype for what can be launched by nonacademic practitioners with few resources. We envision Virtual Grand Rounds in Dermatology as a service to dermatologists who practice at a remove from university hospitals and tertiary referral centers, as well as to others who wish to collaborate with colleagues distributed over a wide geographical net. For us, this has been a voyage into a brave new world with many exciting vistas. It can be accessed online: http://www.vgrd.org.

Dermatology↗
PubMed2000

Ecosystems supporting clusters of sporadic TSEs demonstrate excesses of the radical-generating divalent cation manganese and deficiencies of antioxidant co factors Cu, Se, Fe, Zn. Does a foreign cation substitution at prion protein's Cu domain initiate TSE?

Analyses of food chains supporting isolated clusters of sporadic TSEs (CWD in N Colorado, scrapie in Iceland, CJD in Slovakia) demonstrate a consistent 2 1/2+ fold greater concentration of the pro-oxidant divalent cation, manganese (Mn), in relation to normal levels recorded in adjoining TSE-free localities. Deficiencies of the antioxidant co factors Cu/Se/Zn/Fe and Mg, P and Na were also consistently recorded in TSE foodchains. Similarities between the clinical/pathological profile of TSEs and Mn delayed psycho-neurotoxicity in miners are cited, and a novel theory generated which suggests that sporadic TSE results from early life dependence of TSE susceptible genotypes on ecosystems characterised by this specific pattern of mineral imbalance. Low Cu/Fe induces an excessive absorption of Mn in ruminants and an increased oxidation of Mn2+ into its pro oxidant species, Mn3+, which accumulates in mitochondria of CNS astrocytes in Mn SOD deficient genotypes. Deficiencies of scavenger co factors Cu/Zn/Se/Fe in the CNS permits Mn3+ initiated chain reactions of auto-oxidant mediated neuronal degeneration to proliferate, which, in turn, up-regulates the expression of the Cu-metalloprotein, prion protein (PrP). Once the rate of PrP turnover and its demand for Cu exceeds the already depleted supply of Cu within the CNS, PrP can no longer bind sufficient Cu to maintain its conformation. Mn3+ substitutes at the vacated Cu domain on PrP, thus priming up a latent capacity for lethal auto-oxidative activity to be carried along with PrP like a 'trojan horse'; where Mn 3+ serves as the integral 'infectious' transmissible component of the misfolded PrP-cation complex. The Mn overactivation of concanavalin A binding to glycoprotein and Mn-initiated autoxidation results in a diverse pathological profile involving receptor capping, aggregation/modification of CNS membrane/cytoskeletal proteins. TSE ensues. The BSE/nv CJD strain entails a 'synthetic' induction of the same CNS mineral disturbance, where 'in utero' exposure to Cu-chelating insecticides/Mn supplements accelerates the onset of a more virulent 'strain' of adolescent TSE.

Amino Acid Sequence↗
PubMed2001

Does an ultra violet photooxidation of the manganese-loaded/copper-depleted prion protein in the retina initiate the pathogenesis of TSE?

Ecosystems supporting clusters of sporadic transmissible spongiform encephalopathy (TSE) are characterized by common properties of high-manganese/low-copper, zinc, selenium mineral status, and high-altitude/snow-covered/pre-cambrian mountain terrain where above-average intensities of ultra violet/ozone oxidants are prevalent. Cell culture trials have confirmed the hypothesis that manganese (Mn) substitutes at Prion Protein's (PrP's) vacated copper (Cu) domain, whereupon PrP loses its Cu-mediated antioxidant function, transforming into a protease-resistant misfolded isoform that aggregates into fibril 'tombstone' structures - the key hallmark distinguishing TSE central nervous system (CNS) pathology. The cellular localisation of PrP suggests PrP serves a 'front line' contributory role in neutralizing radicals generated by incoming environmental oxidants, whilst an intensive expression of PrP messenger ribonucleic acid (mRNA) in the retina, melanocytes, epidermis, etc., suggests PrP performs a key antioxidant role as a 'photooxidative shock absorber'; binding of porphyrin IX, Congo red and other photosensitisers to PrPc suggests PrPc serves as an integral associate of the porphyrin/melanin chromophore electron transfer chain; thereby serving as a quencher of singlet O2/superoxide generated by photoenergised chromophores/xeno photosensitisers. It is proposed that sporadic TSE pathogenesis is initiated in the retina of environmentally/genetically predisposed individuals via a two-stage chronic toxic process - Mn substitution at PrP's Cu domain forming a stable Mn2+-PrP complex, followed by an ultra violet in situ photo-oxidization of the Mn2+ component; whereby the latent 'Jekyll and Hyde' capacity of the Mn2+-PrP conjugate is activated into the fully fledged, 'infectious' lethal auto-oxidizing, Mn3+-PrP 'prion' agent. Thus, PrPc's Cu-mediated antioxidant function is replaced by a Mn3+-mediated autooxidant dysfunction. Could the UK's increased loading of a cocktail of environmental oxidants that penetrated the CNS of the UK bovine (ultra violet microwaves/ozone/systemic cu-chelating insecticides) account for a more virulent Mn4+ mediated acceleration of the TSE degenerative process in Mn-contaminated/genetically predisposed individuals, manifesting as the widespread emergence of new-variant bovine spongiform encephalopathy (BSE)/variant Creutzfeldt-Jacob disease (VCJD)/FSE in younger mammals?

Animals↗
PubMed2001

[Fulminant course of falciparum malaria].

HISTORY AND ADMISSION FINDINGS: A 57-year-old white man had been travelling in Kenya for vacation until 14 days before admission. Due to apprehension about side effects, the patient had refused any malaria prophylaxis. Ten days before admission he developed low grade temperatures and suffered from pain in the limbs, from nausea and vomiting. A new episode of tachyarrhythmia was diagnosed two days before admission and was treated by his general practitioner. Finally he was admitted to our hospital because of high temperatures, chills and progressive clinical deterioration. Autopsy revealed prominent congestion of liver, spleen and cerebral vessels as well as subdural and subarachnoidal hemorrhage. INVESTIGATIONS: In both thin and thick peripheral blood smears Plasmodium parasites were demonstrated in approximately 30% of the eryhthrocytes and the diagnosis of Plasmodium falciparum was immediately confirmed by an immunological test. TREATMENT AND COURSE: Due to the fulminant clinical and neurological deterioration with progressive hypoxaemia, the patient required ventilator therapy already one hour after admission. Therapy with chinine and doxycycline was initiated and exchange transfusion was considered. However, due to hyperkalaemia and cardiac arrest, the patient died 4 hours after admission due to parasitic hemolysis. CONCLUSIONS: Severe Plasmodium falciparum infection in non-immunized patients is a medical emergency and requires immediate diagnosis and treatment. Malaria should always be considered in the differential diagnosis in persons who have travelled to endemic areas and presenting not only with temperatures, but also with non-specific clinical signs, like cardiac arrhythmias. Although never entirely effective, chemoprophylaxis is highly recommended.

Anti-Bacterial Agents↗
PubMed2001

[Fever and exanthema after trip to the Mediterranean area--Mediterranean spotted fever (Boutonneuse fever)].

HISTORY AND CLINICAL FINDINGS: In connection with a period of residence in the Mediterranean basin (Portugal, Spain, Sicily) one woman and two men (age: 28, 31 and 40 years) got sick with fever in August and in the midst of October. In addition, they complained about headache in two cases and myalgias, arthralgia and vomiting in one case, respectively. Two of the vacationers (cases 2 and 3) had been accompanied by their dogs. One of them (case 2) was bitten of a tick. The woman (case 3) removed few days after vacation-beginning ticks from her dogs. Patients 1 and 2 appeared severely ill and presented with high fever and generalized maculopapular rash which included also the soles and palms. Patients 2 and 3 had a primarily-lesion ("eschar"). In patient 3 the eschar was pustular and associated with regional lymphadenitis. INVESTIGATIONS: All three patients showed an increased erythrocyte sedimentation rate and elevated liver enzymes. Cases 1 and 2 presented with a significantly elevated activity of lactate dehydrogenase, leukocyturia and microhematuria. Indirect immunofluorescent assay for specific antibodies directed against Rickettsia conorii revealed titers between 1:40 and 1:640 (normal: negative). DIAGNOSIS, TREATMENT AND COURSE: Diagnosis was based on the triad fever, rash and eschar as well as on epidemiological data which include a recent period of residence in the Mediterranean basin during the summer and contact with a dog. In case 1 diagnosis was difficult because of the absence of an eschar. This patient had been treated with penicillin for two days without success. Only the parenteral administration of ciprofloxacin caused complete defervescence and clinical improvement within two days. A complete defervescence within two days was reached with doxycycline also in case 2. In comparison to these cases, the course in the third patient was mild, and the patient defervesced spontaneously. CONCLUSION: Mediterranean spotted fever should be considered in the case of unclear fever and rash following a period of residence in the Mediterranean basin during summer time. An eschar may confirm this diagnosis, and early start of therapy may shorten the course of the disease and prevent complications.

Adult↗
PubMed2002

[Chronic diarrhea after a journey to Sri Lanka].

A 51-year-old woman was referred for evaluation of chronic diarrhea. She had spent a 14 day vacation in Sri Lanka three years ago. The clinical examination of the patient was unremarkable. Values for protein, iron, zinc, copper and folic acid were decreased and the Shilling- and D-xylose tests revealed pathological results. Gliadin and Endomysium antibodies were not detectable. Histologic examination of the duodenum displayed chronic duodenitis with increased epithelial regeneration and villous atrophy. In the MRI a segment of the mid small bowel with increased thickness of the intestinal wall was described. Abdominal CT-scans demonstrated multiple, enlarged mesenteric lymph nodes. Laparoscopy with biopsies of the ileum and mesenteric lymph nodes excluded a malignant lymphoma, mycobacteriosis or Whipple's disease. Oral therapy with tetracyclines (250 mg q. i. d.) and substitution of folic acid and iron led to rapid improvement of the clinical symptoms which persisted after cessation of the antibiotic therapy. In view of the clinical course tropical sprue has to be assumed despite the short duration of the journey to a tropical region.

Administration, Oral↗
PubMed2003

[Evaluation of an established course of hospital management through structured telephone survey of former participants].

AIM OF THE STUDY: Participation in courses for health and hospital management is increasingly becoming a conditio sine qua non for candidates for executive positions in the health professions. The aim of this study was thus to evaluate the two-semester university course for health and hospital management offered by the University of Innsbruck since 1994. METHODS: A structured telephone survey was conducted to poll the participants (n = 184) of previous courses concerning time invested, cost-benefit ratio, quality of the course as well as implementation of course content. RESULTS: The university courses (n = 7) for health and hospital management of the University of Innsbruck evaluated in this study were rated in the upper half of the of the five-part scale (scores 2 to 3) for overall quality, cost-benefit ratio and implementation of course content. Only approx. 25 % of the course participants reported that the course had a positive influence on their career. The relatively high course fee was borne in part by the local hospital operator, a fact that had a certain influence on the selection of course participants. Participation in the course was largely made possible by exemptions from job duties (approx. 75 %) and to a lesser extent by vacation time (approx. 20 %) or time off for overtime (approx. 5 %). Of total absences from the course (3.18 +/- 3.41 d) 75 % was for job-related reasons, 6 % for illness and 19 % for other reasons. Overall, participants were absent more often, the larger the number of personnel in their department or clinic. CONCLUSION: All in all, the courses were considered important and recommendable, particularly with regard to communication, organization, time management and cost awareness. Streamlining (i. e. more content in less time), stronger practical orientation and a switch from mainly local to more international speakers would be important steps toward improving course quality. Thanks to its demonstrated quality, it can be said that the university course for health and hospital management held by the University of Innsbruck and evaluated in this study is certainly a worthwhile course offered in a still emerging market, namely one that will come under increasing pressure from the candidates for executive positions in the health professions to provide what is best for their careers and the health services industry in general.

Cost-Benefit Analysis↗