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At least 91 records · Page 5Linked to original sources
PubMed2006

Quality of care in diabetic patients attending routine primary care clinics compared with those attending GP specialist clinics.

AIM: To determine the impact on clinical outcomes of specialist diabetes clinics compared with routine primary care clinics. METHODS: Observational study measuring clinical performance (process/outcome measures) in the primary care sector. A cohort of patients attending specialist diabetes clinics was compared with a control cohort of patients attending routine primary care clinics. RESULTS: Patients seen in specialist diabetes clinics had a significantly higher HbA1c than patients in routine primary care clinics (mean difference 0.58%; P < 0.001) but there was no significant difference in rate of improvement with visits compared with primary care clinics. In contrast, patients seen in the routine primary care clinics had significantly higher cholesterol levels (mean difference 0.24 mmol/l; P < 0.001) compared with patients in specialist diabetes clinics and their improvement was significantly greater over time (mean difference 0.14 mmol/l per visit compared with 0.10 mmol/l; P < 0.006). Patients in routine primary care clinics also had significantly higher diastolic blood pressure (mean difference 1.6 mmHg; P < 0.007) but there was no difference in improvement with time compared with specialist diabetes clinics. Uptake of podiatry and retinal screening was significantly lower in patients attending routine primary care clinics, but this difference disappeared with time, with significant increases in uptake in the primary care clinic group. Weight increased in both groups significantly with time, but more so in the specialist clinic patients (mean increase 0.18 kg per visit more compared with routine clinic primary care patients; P < 0.001). CONCLUSIONS: This study provides evidence that the provision of primary care services for patients with diabetes, whether traditional general practitioner clinics or diabetes clinics run by general practitioners with special interests, is effective in reducing HbA1c, cholesterol and blood pressure. However, the same provision of care was unable to prevent increasing weight or creatinine over time. No evidence was found that patients in specialist clinics do better than patients in routine primary care clinics.

Adult↗
PubMed2002

Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma.

OBJECT: Nonfunctioning pituitary adenomas comprise approximately 30% of all pituitary tumors. The purpose of this retrospective study is to evaluate the efficacy and role of gamma knife radiosurgery (GKS) in the management of residual or recurrent nonfunctioning pituitary adenomas. METHODS: A review was conducted of the data obtained in 42 patients who underwent adjuvant GKS at the University of Pittsburgh between 1987 and 2001. Prior treatments included transsphenoidal resection, craniotomy and resection, or conventional radiotherapy. Endocrinological, ophthalmological, and radiological responses were evaluated. The duration of follow-up review varied from 6 to 102 months (mean 31.2 months). Fifteen patients were observed for more than 40 months. The mean radiation dose to the tumor margin was 16 Gy. Conformal radiosurgery planning was used to restrict the dose to the optic nerve and chiasm. Tumor control after GKS was achieved in 100% of patients with microadenomas and 97% of patients with macroadenomas. Gamma knife radiosurgery was equally effective in controlling adenomas with cavernous sinus invasion and suprasellar extension. No patient developed a new endocrinological deficiency following GKS. One patient's tumor enlarged with an associated decline in visual function. Another patient experienced a deterioration of visual fields despite a decrease in tumor size. CONCLUSIONS: Gamma knife radiosurgery can achieve tumor control in virtually all residual or recurrent nonfunctioning pituitary adenomas. Dose sparing facilitates tumor management even when the adenoma is close to the optic apparatus or invades the cavernous sinus.

Adenoma↗
PubMed2000

An interface of chlamydia testing by community family planning clinics and referral to hospital genitourinary medicine clinics.

OBJECTIVES: To assess compliance with the protocol for the management of women with Chlamydia trachomatis diagnosed in community family planning (FP) clinics; to assess the rate of attendance at genitourinary medicine (GUM) clinics by these women; to assess the rate of adequate treatment and to assess the level of communication between GUM clinics and FP clinics. METHOD: Retrospective review of FP clinic records and case notes to identify all women with positive or equivocal Chlamydia results during a 6 month period, and a retrospective review of records from five local GUM clinics. RESULTS: One hundred and twelve women were identified from FP clinic records with positive or equivocal Chlamydia results. Eighty-nine (79.5%) were referred to a GUM clinic. Twelve out of 14 women not referred had equivocal results. The median delay from the test being taken to the results being seen by a doctor was 9 days, and to the woman being referred was 10 days. Fifty-eight (51.7%, n = l12) women definitely attended a local GUM clinic. The FP clinics provided a letter of referral in 76 (85.4%, n = 89) women and the GUM clinics provided a letter of reply in 21 (48.8%, n = 43) women who attended with a referral letter. Three months after testing, only 54 (48.2%) of the 112 women with positive or equivocal Chlamydia tests were known by the referring FP clinic to have been treated. CONCLUSIONS: The majority of women with positive or equivocal Chlamydia results were referred to a GUM clinic according to the protocol. Attendance at GUM clinics was disappointing, as only 51.7% of the 112 women with positive or equivocal results had documented evidence of having attended. This raises the question not whether community clinics should be testing, but whether they should be initiating treatment and partner notification. Collaborative work between GUM clinics and community clinics around partner notification is needed, as well as funding for training and additional pharmacy costs. Further collaborative work between GUM and FP and reproductive healthcare (RHC) to evaluate the role of community clinics in the diagnosis and management of chlamydial infection and other sexually transmitted infections (STIs) is needed.

Adolescent↗
PubMed2002

The management of clinical laboratories in Europe: a FESCC survey. Forum of the European Societies of Clinical Chemistry and Laboratory Medicine.

The professional duties of the specialists in clinical chemistry differ from country to country in Europe. One of the main goals of the Strategic Plan of the Forum of the European Societies of Clinical Chemistry and Laboratory Medicine (FESCC; IFCC-Europe) is to promote a high scientific and professional standard in the field of clinical chemistry and laboratory medicine in Europe. This can be stimulated by the knowledge of the local conditions in each country and by striving towards a strong and harmonised position in all the European countries. In order to enhance the knowledge of the managerial situation of the specialists in clinical chemistry in Europe, FESCC launched a survey in September 2000. This survey provides information about the position of the specialists in clinical chemistry in the various disciplines in the medical laboratories and in hospitals, and about the advisory tasks and the managerial education during the post-graduate training in clinical chemistry. Of the 35 FESCC member countries 33 have participated in the survey (94%). The results show a rather heterogeneous situation in Europe caused by the local historical developments, the differences in academic background and the relative numbers of private and physicians' office laboratories. Large differences exist between the European countries in the disciplines of laboratory medicine that are headed by a specialist in clinical chemistry. In the different countries the clinical chemistry laboratories are headed by specialists in clinical chemistry in between 20% and 100% of the laboratories. The haematology, immunology, microbiology, therapeutic drug monitoring, molecular biology and haemostasis laboratories and departments of blood banking are headed by specialists in clinical chemistry in between 0% and 100% of the laboratories. The responsibilities for the various managerial tasks of the specialists in clinical chemistry show no uniformity in Europe. In the majority of the countries the general management, the purchase of equipment and reagents and the education of technicians are in >90% the responsibility of the specialists in clinical chemistry. In most countries the majority of the specialists in clinical chemistry are members of the medical staff of the hospitals and have a position equivalent to the position of specialists in other medical disciplines. In some countries, however, it only holds true for the specialists with a medical background. In 79% of the countries the law regulates the profession of the specialists in clinical chemistry and in 60% of the countries the law regulates their position in the medical staff of the hospital. The advisory tasks to physicians, general practitioners and other users of laboratory tests are practised by >90% of the laboratories in 64% of the countries. Information is given directly to the patients by >90% of the laboratories in 30% of the countries. Only in a few countries laboratories give information to the public. The post-graduate training in clinical chemistry includes a managerial training in 58% of the countries, the study of information technology in 61% of the countries and an economy and/or a business administration study in 15% of the countries. In 27% of the countries no managerial education forms part of the post-graduate study in clinical chemistry. Harmonisation of the managerial aspects of the profession is one of the challenges for the European specialists in clinical chemistry. A European syllabus for post-graduate training could be helpful.

Chemistry, Clinical↗
PubMed2005

Patient, provider, and clinic characteristics associated with public STD clinic patient satisfaction.

OBJECTIVES: There is a lack of information describing levels of patient satisfaction among patients seeking sexually transmitted diseases (STD) care in a public clinic setting. We sought to identify patient, provider, and clinic characteristics associated with patient satisfaction within public STD clinics. METHODS: A cross sectional survey with random sampling was conducted among patients attending two public STD clinics. Satisfaction was assessed using questions from validated national surveys. Outcomes for multivariate logistic regression analysis were ratings of overall health care and clinician. RESULTS: 499/605 (82%) patients were enrolled. Patients were mean age 29 years, 51% male, 94% black. Lower rating of clinician technical skills (OR = 15.6 clinic A, OR = 7.9 clinic B) and clinic environment (OR = 3.9 clinic A, OR = 9.6 clinic B) were associated with lower healthcare rating, as was lower rating of television/video in waiting room (OR = 10.2, clinic A) and dysuria (OR = 4.2, clinic B). Higher clinician rating (OR = 0.58, clinic A) and receiving written materials (OR = 0.44, clinic B) were protective of lower healthcare rating. Risks for lower clinician rating at clinic A were greater pain, problems getting care, lower rating of clinician technical skill, and overall health care, while receiving written materials was protective. At clinic B, lower rating of clinician technical skill and clinic environment were risks for lower clinician rating. CONCLUSIONS: Patient satisfaction was associated with modifiable provider and clinic characteristics. Results from our study indicate a need to examine whether health outcomes of STD management vary by patient satisfaction.

Adult↗
PubMed1998

Factors that influence the eligibility of cases for inclusion in clinical trials. The Lung Cancer Chemotherapy Study Group of the Japan Clinical Oncology Group.

BACKGROUND: It is important to minimize the incidence of ineligible cases to improve the quality of clinical trials. To determine factors which may influence the incidence of ineligible cases, the incidence of and reasons for ineligibility in clinical trials were retrospectively analyzed. METHODS: We retrospectively examined the incidence of and reasons for ineligibility for inclusion in eight clinical trials conducted by the Lung Cancer Chemotherapy Study Group of the Japan Clinical Oncology Group and four trials financed by trust funds from a pharmaceutical company. RESULTS: In these 12 clinical studies, the incidence of ineligibility was 4.2% (32/762) (range 0-10.6%). Specific factors that might influence the incidence of ineligible cases were then analyzed. There was a significant difference in the incidence of ineligibility between the methods of registration (P < 0.05). The incidences using a central registration and without using a central registration system were 2.8% (9/322) and 5.2% (23/440) respectively. We also analyzed ineligible cases in clinical studies published in the Journal of Clinical Oncology. In clinical studies published in the Journal of Clinical Oncology recently and 10 years ago, the incidences of ineligible cases were 5.0% (942/18 878) and 4.1% (206/4995) respectively. In clinical studies on lung cancer published in the Journal of Clinical Oncology from 1984 to 1995, the incidence of ineligible cases was 4.7% (900/19,116). There was no significant difference in the incidence of ineligible cases between our 12 studies and the Journal of Clinical Oncology clinical studies by the chi 2 test (P > 0.05). CONCLUSIONS: We conclude that the incidence of ineligible cases in our studies is similar to that in clinical trials published in the Journal of Clinical Oncology. Central registration systems are useful for checking for ineligibility, and to increase the quality of clinical trials.

Clinical Trials as Topic↗
PubMedDate not supplied

Comparison of diabetes care provided by an endocrinology clinic and a primary-care clinic.

OBJECTIVE: To compare the quality of ambulatory diabetes care provided by physicians in an endocrinology clinic with that in a primary-care clinic. METHODS: We conducted a retrospective study of the medical records of patients with diabetes treated for 2 to 4 years in an endocrinology clinic and a primary-care clinic at an academic medical center. Adherence to American Diabetes Association (ADA) clinical practice recommendations and hemoglobin A(1c) (HbA(1c)) levels were assessed in randomly chosen patients-a total of 68 patients from the primary-care clinic and 105 patients from the endocrinology clinic, with total patient-years of follow-up of 241 and 370, respectively. RESULTS: In six of seven areas assessed, the endocrinology clinic was significantly more compliant with ADA recommendations than was the primary-care clinic: queries about hypoglycemia (88% versus 20%); frequency of glycated hemoglobin determinations (3.3 versus 2.1 per patient/yr); yearly lipid panel (44% versus 25%); and yearly ophthalmologic (90% versus 50%), neurologic (56% versus 37%), and foot (88% versus 59%) examinations (all P<0.001). The rate of yearly proteinuria evaluations was similar in the two clinics (66% versus 65%). On assessment of all patients, the mean HbA(1c) level was significantly lower in the endocrinology clinic (8.29%) than in the primary-care clinic (8.73%) (P = 0.01). CONCLUSION: Adherence to ADA clinical practice recommendations was significantly better in the endocrinology clinic than in the primary-care clinic. This finding and the significantly lower levels of HbA(1c) in patients in the endocrinology clinic setting would be expected to translate into improved long-term patient outcome.

Adult↗
PubMed2004

Clinical, haemodynamic, anthropometric, metabolic and insulin profile of men with high-stage and high-grade clinical prostate cancer.

AIMS: Previous studies have shown that non-insulin-dependent diabetes mellitus (NIDDM), hypertension, atherosclerotic disease manifestations, tallness, obesity, dyslipidaemia, hyperuricaemia, hyperinsulinaemia and high alanine aminotransferase (ALAT) levels are risk factors for development of benign prostatic hyperplasia (BPH). This indicates that BPH is a component of the metabolic syndrome. In a subsequent study, we found that there was an association between the BPH growth rate and the development of clinical prostate cancer. These findings generated a hypothesis that clinical prostate cancer also was a component of the metabolic syndrome. In the present study, this hypothesis was tested on 299 patients with recently diagnosed clinical prostate cancer. If this hypothesis is true, patients with clinical prostate cancer of high stage and grade would have a larger prostate gland volume, a faster BPH growth rate and a more pronounced clinical, haemodynamic, anthropometric, metabolic and insulin profile than patients with clinical prostate cancer of low stage and grade have. METHODS: Two hundred and ninety-nine patients in whom clinical prostate cancer was diagnosed were consecutively included. The prevalence of NIDDM, treated hypertension and atherosclerotic manifestations was provided by the respective patient's medical history. Body length, body weight, waist measurement, hip measurement and blood pressure were determined. Body mass index (BMI) and waist/hip ratio (WHR) were calculated. Blood samples were drawn to determine triglycerides, total cholesterol, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, uric acid, ALAT and the fasting plasma insulin level. The prostate gland volume was measured using transrectal ultrasound. The annual BPH growth rate was calculated. The prostate cancer diagnosis was established. RESULTS: Patients with clinical prostate cancer, prostate-specific antigen (PSA) < 50 ng/ml, stage T3, had a bigger prostate gland volume (p < 0.001), a faster BPH growth rate (p < 0.001), were more obese, as measured by body weight (p = 0.062), BMI (p = 0.003), waist measurement (p = 0.011) and hip measurement (p = 0.051) and showed a higher systolic blood pressure (p < 0.070) than patients with T2 clinical prostate cancer. When patients with clinical prostate cancer, PSA > 50 ng/ml, were included at the comparison, T3 tumour patients showed a higher prevalence of treated hypertension (p = 0.026) than patients with T2 tumours. Patients with clinical prostate cancer, PSA < 50 ng/ml, G3, had a greater prostate gland volume (p = 0.004), a faster BPH growth rate (p = 0.005) and were more obese as determined by waist measurement (p = 0.044) and WHR (p = 0.073). Moreover, subjects with a G3 tumour were more dyslipidaemic, as shown by a higher triglyceride level (p = 0.019) and a lower HDL-cholesterol level (p = 0.005), and were more hyperuricaemic (p = 0.023), showed a higher plasma insulin level (p = 0.019) and a higher ALAT level (p = 0.061) than those with a G1 tumour. When patients with clinical prostate cancer, PSA > 50 ng/ml, were included at the comparison, G3 patients had a greater prostate gland volume (p = 0.002) and a faster BPH growth rate (p = 0.003) than patients with G1 tumours. CONCLUSIONS: The results of the present study suggest that the prostate gland volume, the BPH growth rate, hypertension, obesity, dyslipidaemia, hyperuricaemia, hyperinsulinaemia and high ALAT levels are risk factors for the development of clinical prostate cancer. Thus, our results support the hypothesis that clinical prostate cancer is a component of the metabolic syndrome. Patients with clinical prostate cancer may have the same metabolic abnormality of a defective insulin-stimulated glucose uptake and secondary hyperinsulinaemia as patients with the metabolic syndrome. Our data also support the hypothesis that hyperinsulinaemia is a promoter of clinical prostate cancer.

Adenocarcinoma↗
PubMed1998

The effect of clinical targets on productivity and perceptions of clinical competency.

This study investigated the effect of clinical targets on clinical productivity and perceptions of clinical competency of final-year undergraduate dental students. Students were randomly divided into two equal groups. One group was set annual numerical clinical targets while the other had no targets. All final-year students and final-year clinical teachers were asked to complete a questionnaire rating six different aspects of student clinical competency at the end of semester 1 and semester 2. Changes in perception of clinical competency by students and clinical teachers were compared between the target and no-target groups and between students and clinical teachers. The clinical output of both groups was measured. There was no significant difference in performance between the target and no-target group as assessed by clinical teacher or by student self-assessment. However, by the completion of the study the clinical teachers scored the students (irrespective of group) significantly lower for clinical competency than students assessed themselves. There was no significant difference between the productivity of the two groups. The setting of clinical targets had no measurable effect on the perceived clinical competency or productivity of this group of undergraduate dental students.

Clinical Competence↗
PubMed1994

Clinical workstations: identifying clinical requirements and understanding clinical information.

A preliminary exploration of the problem of defining and meeting users' needs, this paper draws the bulk of its content from experiences in the PEN&PAD project in the UK. This program has been researching and developing prototype clinical workstations for direct use in patient care by health care professionals, chiefly doctors. Focusing more on general issues rather than the specific functional requirements embodied in the PEN&PAD prototypes, the paper begins with a brief summary of the goals of PEN&PAD and then outlines the three main axes of the work: user-centred design, medical concept and medical record models, and user interfaces and architectures. The remainder of the paper then concentrates on the first of these topics--working with users to define functional requirements.

Computer Systems↗
PubMed1995

Non-surgical management of early breast cancer in the United Kingdom: the role and practice of radiotherapy. Clinical Audit Sub-committee of the Faculty of Clinical Oncology, Royal College of Radiologists, and the Joint Council for Clinical Oncology.

This paper reports on the delivery of radiotherapy to the primary site and lymphatic pathways in the management of early stage breast cancer. Radiotherapists were clear that their aim of locoregional radiotherapy was to reduce local recurrence. However, variation in policies for delivery were seen: 80% of radiotherapists did not always give radiotherapy routinely following wide local excision as part of breast conserving management; instead they withheld it selectively for a number of reasons. Only 66% routinely used breast boosts. There was a range of indications for giving radiotherapy to the lymphatic pathways; there was also variation in the management of incompletely or marginally excised primary tumours. Most sources of variation in the practice of radiotherapy in the management of women with early stage breast cancer appeared to arise from scientific uncertainty. However, organizational issues influenced many decisions. These scientific uncertainties and organizational issues are best addressed in the context of multidisciplinary breast clinics.

Breast Neoplasms↗
PubMed1990

Clinical survey of syphilis at the Dermatological Clinic of Nippon Medical School Hospital from 1984 to 1988, with special reference to the recent clinical manifestations and evaluation of IgM antibodies to Treponema pallidum.

One hundred eighty-one patients with syphilis were seen from May 1, 1984, to April 30, 1988 at the Dermatological Clinic of Nippon Medical School Hospital. The incidence of syphilis has increased gradually year by year. The number of early infectious syphilis cases was almost twice as high as late latent syphilis ones. As a source of infection, female prostitutes were noteworthy. Among primary syphilis cases, multiple chancres were observed in 29.2%. The frequency of ulcus durum was much higher than initial sclerosis. A relationship with oral sex is suggested. Among secondary syphilis cases, pruritus was observed in 23.9%, prominently on volar lesions. Psoriasiform papular and macular syphilide were the commonest features. Secondary syphilis with persisting chancres were seen in 41.3% and is gradually increasing. JH reactions were observed in 26.3%. The frequency was highest in late primary and in early secondary stages. IgM-TPHA and IgG-TPHA were tested in 94 sera by gel-filtration and 77 by HPLC. IgM-TPHA tests were reactive in virtually all the sera from untreated syphilis cases. The titres in untreated syphilis were higher than in treated cases. IgM-TPHA/IgM-TPHA + IgG-TPHA was higher in early syphilis than in late syphilis. Fifty-eight untreated cases were tested at frequent intervals after treatment for up to 12 months. IgM antibodies disappeared in 53 patients within 12 months. Non-treponemal antibodies measured by the CF test disappeared within 15 patients and TPHA tests remained positive after 12 months in all patients. IgM-TPHA may support a diagnosis of active syphilis.

Adolescent↗
PubMed1999

Clinical update--the teeth and the maxillary sinus: the mutual impact of clinical procedures, disease conditions and their treatment implications. Part 2. Odontogenic sinus disease and elective clinical procedures involving the maxillary antrum: diagnosis and management.

Although odontogenic sinusitis is a rare entity when compared to sinus disease of rhinogenic origin, it is extremely important to identify a dental aetiology when it occurs. The offending tooth or teeth would thus require endodontic treatment or extraction, and the sinus disease carefully assessed and appropriately managed. Aetiology and presentation of oro-antral fistulae are also discussed and guidelines for the management of this complication are recommended. Certain lesions such as cysts and tumours may involve the jaws and hence the maxillary antrum; some of these, such as a radicular cyst are quite common, but the rarer ones are included for completeness. Surgical techniques are continuously evolving to optimise form and function of the jaws, and when applied to the maxilla there may be some impact on nasal and sinus function. The advent, and now proven success, of osseointegrated jaw implants have brought with them innovations and refinements of bone grafting techniques, and more recently distraction osteogenesis for augmentation. Maxillary osteotomies for surgical orthodontics, and to facilitate prosthodontic treatment are briefly mentioned, as most of these inevitably involve the antrum and/or nose. This paper discusses, in summary form, important aspects of clinical dental practice which may involve the maxillary antrum. It is thus a broad overview of certain pathologic conditions and elective surgical procedures which have relevance to both medical and dental practitioners.

Bone Transplantation↗
PubMed1987

Out-of-hospital cardiac arrest in patients without clinically significant coronary artery disease: comparison of clinical, electrophysiological, and survival characteristics with those in similar patients who have clinically significant coronary artery disease.

Fifty nine survivors of out-of-hospital cardiac arrest unassociated with an acute myocardial infarction were referred for intracardiac electrophysiological study. Thirty patients who had no clinically significant coronary artery disease (group 1) were compared with 29 who did (group 2). Ventricular tachycardia or fibrillation was induced in significantly more patients in group 2 than in group 1 (69% vs 40%). Median duration of follow up, which was achieved in all patients, was 31 months in group 1 and 14 months in group 2. In group 1, an effective treatment was identified electrophysiologically in seven patients, and none died; an arrhythmia was induced, but no effective treatment was identified in five patients, and one patient died subsequently; an arrhythmia was not induced in 18 patients, 15 of whom were treated empirically with anti-arrhythmic drugs, and one died. In group 2, effective treatment was identified electrophysiologically in seven patients and three died (two of pump failure) during follow up. In 13 an arrhythmia was induced but no effective drug was identified, and six died or had a recurrence; in another nine patients without inducible arrhythmias, six subsequently died or had a recurrence. A Cox proportional hazards analysis identified previous myocardial infarction as the only predictor of recurrence. Patients without coronary artery disease who suffer an out-of-hospital cardiac arrest have a low inducibility rate at electrophysiological study and an excellent prognosis compared with patients who have coronary artery disease. Electrophysiological testing seemed to be of value in predicting the response to antiarrhythmic drugs, but non-inducibility of arrhythmias in patients with coronary artery disease was of no predictive value.

Adolescent↗
PubMed1997

[Who is ready for clinical discharge? Empirical study on concepts of clinical discharge treatment and clinical readiness].

The purpose of this study was to find criteria characteristic for patients in need of care and social services. The criteria should serve as a guideline for patients and staff to facilitate care planning before discharge. The sample consisted of 49 patients, born before 1925, in need of emergency inpatient treatment, admitted to medical- or orthopaedic wards. Data of the patient's self care needs were collected by interviews, assessment of self care status and need of treatment. The patients could be divided into three groups depending on type of discharge. Group A (n = 27) discharged home, group B (n = 7) discharged to geriatric clinic and group C (n = 15) discharged and in need of further care and social services. Criteria indicating the patients further assistance from the community were in group C (medical- and orthopaedic wards) deficit in daily living activities and locomotion. Group B had an increased need of support from the physiotherapist and the occupational therapist, in locomotion as well as daily living activities The physician's assessment showed that the criteria behind the decision "no further medical treatment appropriate" and "ready for discharge" were not related to medical impairment but to lack of self care, need of care, rehabilitation and social services.

Activities of Daily Living↗
PubMed2000

[Clinical study on risk management for dental implant treatment--Part 1. Clinical retrospective study on the medically compromised patients at clinic for oral implant].

A retrospective study on medically compromised patients was made using 1,000 outpatients who visited the Clinic for Oral Implant, University Hospital, Faculty of Dentistry, Tokyo Medical and Dental University between April 1995 and June 1998. The results were as follows: 1. 35.3% (353 patients: 140 males and 213 females) of the outpatients were medically compromised. 2. The greatest number of medically compromised patients was in the 50-59 age group (118 cases), followed by those in the 40-49 and 60-69 age groups. 3. The highest ratio of medically compromised patients was in the 60-69 age group (48.2%), followed by those in the 70-79 and 50-59 age groups. 4. Among the 353 patients, 96 (27.2%) underwent surgical treatment such as insertion of implant (68 cases), removal of implant, extraction of tooth, and free gingival graft. 5. Among the 68 patients who underwent insertion of implant, in a classification by type of disease, the patients with cardiovascular diseases were the most numerous (33.9%), followed by metabolic and digestive tract diseases. 6. All surgical treatments of implant insertion were performed under local anesthesia, while monitoring cardiac and respiratory function, and SpO2. Among the 68 patients, 9 underwent operation under intravenous sedation and 2 under nitrous oxide inhalation sedation. All 11 patients had hypertension. The results suggested that identification of preoperative risk factors, precise recognition of general condition, and establishment of control system are important to manage medically compromised patients for dental implant treatment.

Adult↗
PubMed2004

Ambulatory versus clinic blood pressure for the assessment of anti hypertensive efficacy in clinical trials: insights from the Val-Syst Study.

BACKGROUND: Several studies have found that measurement of blood pressure (BP) in the clinical setting may lead to overestimation of hypertension and may yield inaccurate assessments of the efficacy of antihypertensive treatment. OBJECTIVE: The aim of this study was to determine whether the use of clinic BP in the Valsartan and Amlodipine for the Treatment of Isolated Systolic Hypertension in the Elderly (Val-Syst) study accurately identified those elderly outpatients with systolic hypertension who had true 24-hour elevations in BP, as well as those who required dose increases in antihypertensive therapy during follow-up. METHODS: In Val-Syst, patients aged between 60 and 80 years with a clinic sitting systolic BP (SBP) of 160 to 220 mm Hg and a diastolic BP <90 mm Hg after a 2-week placebo washout period were randomized to receive valsartan 80 mg or amlodipine 5 mg once daily (level 1). In those with a trough SBP > or =140 mm Hg after 8 weeks of double-blind treatment, doses were titrated upward to valsartan 160 mg or amlodipine 10 mg once daily (level 2). If clinic SBP was > or =140 mm Hg after a further 8 weeks, hydrochlorothiazide 12.5 mg was added for an additional 8 weeks (level 3). Clinical decisions during the active-treatment period were based on clinic BP measurements. Thirteen of the 35 participating centers assessed ambulatory BP as well as clinic BP at baseline and the end of the treatment, making it possible to compare the results of the 2 modes of measurement. The Student test was used to compare drug-induced changes in clinic and ambulatory BP in individual patients. Differences between the decreases in clinic and ambulatory BP at the 3 treatment levels were tested using repeated-measures analysis of covariance (ANCOVA), with baseline as the covariate. RESULTS: One hundred sixty-four elderly patients (age range, 60-80 years; 85 men, 79 women) were included in the study (79 valsartan, 85 amlodipine), and valsartan and amlodipine were reported to have comparable effects on the level and rhythm of 24-hour BP In the present study, 22 of 164 patients had white-coat hypertension at baseline (clinic SBP > or =160 mm Hg and mean 24-hour SBP <130 mm Hg). For both treatments combined, the mean (SD) decreases in clinic SBP were inversely proportional to the treatment level (level 1 = -33.2 (7.9) mm Hg; level 2 = -31.6 (11.8) mm Hg; level 3 = -29.3 (11.6) mm Hg; P = 0.001, overall ANCOVA). In contrast, after adjusting for baseline values, the decreases in mean 24-hour SBP did not differ between treatment levels (level 1 = -10.8 [10.4] mm Hg; level 2 = -13.0 [11.2] mm Hg; level 3 = -16.4 [13.8] mm Hg). The decrease in clinic BP during therapy was similar in patients with white-coat hypertension and sustained hypertension (clinic SBP > or 160 mm Hg and mean 24-hour SBP > or =130 mm Hg), whereas 24-hour and 8- to 9-am SBP decreased significantly only in patients with sustained hypertension (P < 0.001). At the end of the study, mean 24-hour SBP continued to be uncontrolled (> or =130 mm Hg) in 16 of 53 patients (30.2%) at treatment level 1, 27 of 62 (43.5%) at level 2, and 19 of 49 (38.8%) at level 3 (P = NS). CONCLUSION: Based on the findings in this population of elderly patients with systolic hypertension, the management of hypertension may vary depending on whether decisions concerning the selection of patients for clinical trials and treatment adjustments during follow-up are made using clinic or ambulatory BP measurement.

Aged↗
PubMed1998

Clinical research: perceptions, reality, and proposed solutions. National Institutes of Health Director's Panel on Clinical Research.

CONTEXT: The proportion of investigators applying for clinical research grants from the National Institutes of Health (NIH) who are physicians has declined from 40% 30 years ago to 25% today. OBJECTIVE: To recommend NIH policy changes that might encourage physician investigators to undertake careers in clinical research, eg, patient-oriented research, epidemiologic and behavioral studies, outcomes research, and health services research. PARTICIPANTS: The NIH Director's Panel on Clinical Research comprised 14 physicians from academia and industry, chosen by the director. They met in numerous closed sessions and in 5 public meetings from July 1995 to November 1997. CONSENSUS PROCESS: In addition to expert opinion and pertinent literature, data sources included the training characteristics of applicants to NIH who were funded or not. Topics considered included financing of clinical research, recruitment, training, and retention of future clinical investigators, conduct of clinical trials, and peer review of clinical research. Consensus was reached and recommendations were made in response to an interim report, widely circulated to the biomedical community, written by members of the panel, which contained preliminary recommendations. CONCLUSIONS: The panel's final recommendations to NIH included maintaining at least the present proportion of NIH funding for clinical research; continuing mentored opportunities in clinical research for medical students; promoting clinical research training by offering didactic courses and grant opportunities in clinical research to nascent investigators emerging from specialty training programs and providing partial salary support for mentors; restructuring study sections that review patient-oriented research applications to include more physicians; encouraging clinical investigators and basic scientists to work closely together and weld collaborations between academic clinical investigators and colleagues in pharmaceutical and biotechnology companies; and developing a joint policy between academic health centers and NIH for the support of clinical research and clinical research training.

Budgets↗