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At least 937 records · Page 52Linked to original sources
PubMed1999

Aids and cancer in Africa: the evolving epidemic in Zimbabwe.

BACKGROUND: Zimbabwe is severely affected by the AIDS epidemic, and many cancers in African populations are related to infectious agents. OBJECTIVE: To study the current pattern, and short-term changes in incidence, of cancers related to infectious agents (and especially to HIV), with respect to the evolving epidemic of AIDS. METHODS: Analysis of data on the African population of Harare, Zimbabwe, from the Zimbabwe Cancer Registry, for the period 1990-1995. Comparison with data on prevalence of HIV seropositivity, and notifications of AIDS. RESULTS: Comparing results from 1993-1995 with those for 1990-1992 shows a continuing increase in the incidence of Kaposi's sarcoma with a doubling of the rates in both men and women. A dramatic increase in the incidence of squamous cell tumours of the conjunctiva was also observed, as well as a significant increase in the incidence of non-Hodgkin's lymphoma in women. There was no apparent increase in risk for Hodgkin's disease, myeloma, liver cancer, or cancer of the cervix. CONCLUSIONS: The AIDS epidemic has had a dramatic effect on the profile of cancer. The changes in incidence involve several cancers previously linked to AIDS in North America and Europe.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Evolving concepts about the role of antineutrophil cytoplasm autoantibodies in systemic vasculitides.

This review discusses the main issues of antineutrophil cytoplasm autoantibodies (ANCA) that have emerged from the literature. From January 1997 to August 1998, 216 papers were published on ANCA. Two major themes seem to be evolving from these articles. The first theme concerns the specificity and sensitivity of ANCA testing in clinical practice in relation to diagnosing systemic vasculitic syndromes. We focus on immunofluorescence patterns, ANCA antigens, testing methodology, and the (predictive) value of ANCA in clinical practice. Second, there is the unsolved question of how ANCA are etiologically involved in the development of the vasculitic lesion. Ongoing research questions the role of ANCA in stimulating granulocytes, monocytes, and the endothelium.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed1999

The evolving role of direct amplification tests in diagnosing osteoarticular infections caused by mycobacteria and fungi.

Polymerase chain reaction-based direct amplification tests have been developed for many species of mycobacteria and fungi. Their applications in clinical medicine are evolving rapidly but are still not fully defined. Uncritical use of direct amplification tests for individual patients without a clear understanding of their limitations and how to integrate their results with other clinical and laboratory data may lead to incorrect patient management. Although presently available tests seem to be clinically useful when properly applied, further technical development and clinical studies are needed before these powerful diagnostic tools achieve their full value.

Aspergillosis↗
PubMed1999

Evolving role descriptions of the acute care nurse practitioner.

Currently, more than 1,200 advanced practice nurses have sought certification as acute care nurse practitioners (ACNPs). Surveys of practicing ACNPs have shown that the role is expanding in terms of practice settings and role components. This article reports on the results of ongoing survey with ACNPs that portray the role of the ACNP as an evolving career opportunity for advanced practice nurses.

Acute Disease↗
PubMed1984

Treatment of the fetus in utero: evolving concepts.

The rapidly evolving ability to detect the presence of major anomalies in the developing fetus and the emerging prospect of intrauterine treatment of some of these disorders are coupled to create an exciting new frontier in care of the high-risk pregnancy. Preliminary reports suggest that in some highly selected instances perinatal death and morbidity may be prevented by intrauterine surgical procedures. The technical ability to treat the disorder as described is at hand and is unlikely to be the limiting factor in the advance of this area of fetal treatment. However, the very fact that treatment is possible cannot be considered as proof of efficacy. The physician faced with the knowledge that a potentially treatable condition is present in a given fetus may feel the necessity of instituting treatment, but the validity of such an approach is far from established. It is our opinion that efforts should be made to set at the earliest point proper controlled scientific studies from which the benefit, if any, of this surgical approach to fetal disease may be established. Such clinical studies should be conducted in concert with studies in appropriate animal models. It should be noted that fetal surgical treatment is not without potentially lethal fetal and maternal complications. Before such risks, however small, are taken, it seems reasonable to determine the long-term benefits of the surgical procedure. To this end, participation in the International Fetal Surgery Registry is encouraged.

Arnold-Chiari Malformation↗
PubMed2001

Evolving antimicrobial chemotherapy for Staphylococcus aureus infections: Our backs to the wall.

Staphylococcus aureus is responsible for many nosocomial and community-acquired infections. Its evolving resistance to traditional antimicrobial chemotherapy and emerging prevalence outside of the healthcare environment are serious concerns. This review of the changing epidemiology of methicillin-resistant S. aureus, the emergence of vancomycin (glycopeptide)-resistant isolates, and the mechanisms of resistance to beta-lactams and glycopeptides provides an update for clinicians regarding effective strategies for treatment.

Anti-Bacterial Agents↗
PubMed1990

School consultation: evolving issues.

Schools are currently facing (1) increasing demands for special services, (2) parents' expectations for academic achievement, (3) budget constraints, (4) an older faculty, and (5) a broadening mandate to nurture young children and prevent self-destructive behavior in adolescence. Whether as consultants or caring for individual children, child psychiatrists should consider these evolving issues in their work with parents and schools.

Achievement↗
PubMed1998

Current results and evolving indications for liver transplantation in children.

Liver transplantation continues to be successful and effective treatment for acute and chronic liver failure, and many important lessons have been learned. The development of innovative operative techniques has much reduced the waiting list mortality rate and has extended transplantation to younger and sicker children and to those with functionally normal livers who may benefit from auxiliary liver transplantation. The incidence and range of postoperative complications have improved with increased medical and surgical expertise. As information on long-term outcome for liver transplantation is gained, it is clear that many children will benefit from early elective liver transplantation before the development of significant growth or psychosocial retardation. Early transplantation is also indicated in children with cirrhosis and intrapulmonary shunting or cystic fibrosis with moderate lung disease. During the same period, evolving medical therapy has altered the natural history, patient selection, and timing of transplantation in children with tyrosinaemia type I, primary bile acid disorders, neonatal haemochromatosis, and potentially, cystic fibrosis. It is now clear that children with significant multisystem disease, such as mitochondrial disorders or severe systemic oxalosis, are no longer suitable candidates for liver transplantation. The successful development of liver transplantation has brought good quality life to many children and their families. There are still many lessons to learn and there are future challenges such as the ever-increasing problems of donor scarcity and the search for potent but less toxic immunosuppressive agents.

Child↗
PubMed1998

Hemodynamic effect of amrinone depends on pretreatment vascular resistance in patients with evolving congestive heart failure: correlation between vascular resistance and neurohormonal activity.

We investigated the hemodynamic effects of amrinone and assessed its effects on neurohormonal factors in 15 patients with evolving congestive heart failure with various origins. We serially determined the pulmonary and systemic vascular-resistance indices after amrinone infusion and examined the relation between changes in hemodynamic parameters and changes in concentrations of norepinephrine, atrial natriuretic peptide, angiotensin II, and endothelin-1 in the pulmonary capillary wedge region (PCWR) and in the peripheral veins. Amrinone significantly reduced pulmonary vascular-resistance index (PVRI; Wood x m2) in patients with high PVRI (> or =15) before the infusion, significantly reduced systemic vascular-resistance index (SVRI; Wood x m2) in patients with high SVRI (> or =50) before the infusion, and had little effect on vascular resistances in patients with low PVRI (<15) and low SVRI (<50). The reduction in PVRI was correlated with the reduction in the endothelin-1 level (r = 0.75) in the PCWR, and the reduction in SVRI with norepinephrine level (r = 0.70) in the peripheral veins. The angiotensin II level did not change throughout the study. These findings suggest that amrinone had selective hemodynamic effects on pulmonary and systemic circulations with neurohormonal effects, according to PVRI and SVRI before infusion.

Aged↗
PubMed1999

Evolving experience with direct puncture therapeutic embolization for adjunctive and palliative management of head and neck hypervascular neoplasms.

OBJECTIVES: The use of percutaneous, direct puncture therapeutic embolization (DPTE) of hypervascular head and neck neoplasms is a relatively new modality that may be used to supplement or supplant conventional endovascular transarterial embolization. Although the preliminary clinical experience reported by a single group has been favorable, extensive case series experience is lacking. This prompted us to review our recent clinical experience with these techniques to determine safety, efficacy, and emerging role in the overall neurointerventional therapeutic armamentarium. STUDY DESIGN: A retrospective analysis of the previous 34 consecutive cases of hypervascular tumors undergoing DPTE referred to our service for therapeutic devascularization was performed. METHODS: Complete case record review was undertaken. Twenty-six of 34 cases involved DPTE of head and neck neoplasms. Conventional diagnostic angiography was performed for therapeutic planning and to assist in precise localization. When performed, standard microcatheter transarterial embolization techniques were used either before or after attempted DPTE. Cyanoacrylate embolic mixtures (n-butyl cyanoacrylate [NBCA], lipiodol, powdered tungsten) were used in 21 of 24 cases, and absolute ethanol in 3 of 24. Direct puncture angiography of the targeted tumor neovasculature was always performed before DPTE. RESULTS: Twenty-four of 26 cases had technically successful DPTE. Combined transarterial embolization with DPTE was used in 16 of 24 cases, although for the last 12 cases, 9 were treated predominantly or exclusively by DPTE. There were no major or minor clinical complications, and there was one asymptomatic technical complication. Total or near-total devascularization was achieved in all cases. All preoperative cases had excellent hemostasis within the resected tumor bed. CONCLUSIONS: Our results lend further support to the safety and efficacy of DPTE in the management of hypervascular neoplasms of the head and neck. With our increasing experience, this technique is evolving into a primary therapeutic modality for optimal tumor devascularization.

Adult↗
PubMed1998

Nursing competence--an evolving regulatory issue in Kentucky.

Competency validation for nursing licensure is an evolving regulatory issue in Kentucky. Societal and professional forces are driving the shift from mandatory continuing education requirements for relicensure to a competency-based evaluation paradigm. The Kentucky Board of Nursing has issued a working position paper, Accountability and Responsibility of Licensees to Assure Nursing Competence (October 1997), as the basis for a dialogue about shaping Kentucky nursing regulation in the twenty-first century. While the position paper explores new models for both initial and continuing licensure requirements, this article focuses on continued competence issue.

Clinical Competence↗
PubMed1997

Evolving fixation methods in endoscopically assisted forehead rejuvenation: controversies and rationale.

The goals of surgical rejuvenation of the forehead include component brow manipulation, attenuation of transverse forehead rhytids, and reduction of glabellar frown lines. The endoscopic approach has proved successful in achieving these goals in selective patients while minimizing incisions and improving scalp sensation. Efficacy of endoscopic brow manipulation is dependent on (1) complete release of the brow at the supraorbital rim, (2) brow depressor muscle resection/release, and (3) tension-free fixation of the brow position until wound healing has occurred. Fixation of the brow using an endoscopic technique, unlike the open technique, is dependent on skin retraction and tension-free scalp fixation during the process of wound healing to maintain the desired brow position. Techniques for endoscopic fixation are arbitrarily divided into endogenous and exogenous. Endogenous methods include extensive galea-frontalis-occipitalis release, lateral spanning suspension sutures, external bolster fixation, anterior port skin excision, galea-frontalis advancement, cortical tunnels, and tissue adhesives. Exogenous techniques include internal screw or plate fixation, Mitek anchor fixation, external screw fixation, and absorbable K-wires. This article provides a goal-oriented review of these evolving techniques and a rationale for the use of fixation methods in endoscopically assisted forehead rejuvenation.

Bone Plates↗
PubMed1998

Evolving thoughts on correcting posttraumatic enophthalmos.

Posttraumatic enophthalmos, though a difficult problem, is correctable by traditional craniofacial techniques. Based on considerable experience with these wide exposure operations, our surgical strategy has evolved and has been distilled into one of limited exposure via lateral upper blepharoplasty, transconjunctival without canthotomy and intraoral incisions. The advantages of this approach are reduced morbidity and hospital stay, shorter operating time, and avoidance of blood transfusions. However, this technique should be reserved until valuable insight is gained using the more conventional coronal approach.

Adult↗
PubMed2001

The importance of serial neurologic examination and repeat cranial tomography in acute evolving epidural hematoma.

Computed tomography (CT) has revolutionized the diagnosis and management of head-injured patients, and its increasing availability has led to its liberal use. CT scanning provides excellent anatomic detail of the brain as fixed static images, but the dynamic nature of human physiology means that many injury patterns will evolve in time. We describe an 8-year-old child who had fallen 8 feet from a tree. He had a brief loss of consciousness but a normal neurologic evaluation on arrival to the emergency department (ED). He underwent expedited cranial CT scanning, which revealed no acute brain injury. Two and one half hours later, the patient had a mild depression in consciousness, prompting a second CT scan in the ED, which revealed an acute epidural hematoma. He had acute surgical evacuation of the hematoma and made a full neurologic recovery. This case illustrates that a single early CT examination may at times provide a false sense of security and underscores the importance of serial neurologic examinations.

Accidental Falls↗
PubMed2004

Evolving guidelines for intravitreous injections.

Intravitreous (i.v.t.) injection is increasingly being incorporated into the management of ocular diseases. While only fomivirsen sodium (Vitravene) is currently approved by the Food and Drug Administration as an i.v.t. injection, the number of approved i.v.t. injections indications is anticipated to grow on the basis of promising results from ongoing clinical studies. Despite the potential benefits that may be derived from intraocular injections of different agents, no guidelines have been published previously for i.v.t. injection. The purpose of this document is to identify specific strategies for the delivery of i.v.t. injection that may reduce risks and improve outcomes. Consensus was sought among a panel of investigators, surgeons experienced with this technique, and industry representatives. Objective evidence was sought for all guidelines, but consensus was accepted where evidence remains incomplete. In the absence of either evidence or consensus, the current manuscript identifies outstanding issues in need of further investigation. It is anticipated that more complete guidelines will evolve over time, potentially altering some of the guidelines included here, based on new applications of i.v.t. injection, additional clinical experience, and results of clinical trials.

Humans↗
PubMed1989

Extramedullary blast crisis and hemolytic anemia in a patient with t(3p+;4q-) and rapidly evolving myelogenous leukemia.

We have reported the case of a patient with a rapidly evolving myelogenous leukemia associated with hemolytic anemia, extramedullary evolution, and an isolated translocation of the long arm of chromosome 4 to the short arm of chromosome 3. The hemolytic process was primarily extravascular and was not associated with pyruvate kinase or glucose-6-phosphate dehydrogenase deficiency. Although blasts were absent from the peripheral smear and represented less than 10% of the bone marrow myeloid precursors, multiple organs including the heart, liver, lungs, and spleen were infiltrated with blasts at autopsy.

Anemia, Hemolytic↗
PubMed1991

Theoretic diversity: evolving paradigmatic issues in research and practice.

Although research and practice differ in that one is the building of knowledge and the other the application of that knowledge, it is suggested herein that there are interesting parallels to explore between the evolving debate on research methods and the emerging theoretic debates on practice. On the basis of the Canadian experience and the trend toward adoption of a single-theory approach, the authors argue for theoretic diversity in nursing practice settings.

Humans↗
PubMed2001

Empowerment as a process of evolving consciousness: a model of empowered caring.

This qualitative exploratory study used nominal group technique in a series of focus groups with public health nurses to identify their conceptualization of empowerment, the strategies they identified as empowering, and the outcomes of empowering strategies they observed in their practice. A model emerged from these data that conceptualized empowerment as a process of evolving consciousness in which increasing awareness, knowledge, and skills interacted with the clients' active participation to move toward actualizing potential. Clients, who nurses identified as having been empowered through their practice, were interviewed, and their narratives were examined for congruence with the model. The model that emerged from this study is solidly grounded in nursing practice, consistent with global approaches to public health and contemporary nursing theories, and supported by the perceptions of clients receiving nursing care.

Consciousness↗