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PubMedDate not supplied

Diabetologists' judgments of diabetic control: reliability and mathematical simulation.

In study 1, laboratory and supervised blood or urine test data from actual cases were used to develop patient profiles. Seven diabetologists from the same institution rated the diabetic control of 125 profiles on a four-point scale (1 = poor, 2 = fair, 3 = good, 4 = excellent). Six of the 7 diabetologists demonstrated adequate intra- and interrater reliability. Study 2 assessed the reliability of judgments of diabetic control made by diabetologists working in two different settings. There were 9 raters from institution 1 and 8 from institution 2. The impact of the amount and type of information on judgment reliability was evaluated by developing two types of profiles. The test form contained only laboratory and supervised blood or urine test data similar to that utilized in study 1. The history form contained this information as well as other descriptive data typically available to diabetologists. The 17 diabetologists rated 125 anonymous profiles on each of two separate occasions approximately 1 wk apart. On one occasion they rated profiles presented on the test form. On the other occasion they rated profiles presented on the history form. As in study 1, the diabetologist raters demonstrated adequate intra- and interrater reliability. Intrarater reliability was somewhat better when rating test form profiles compared with history form profiles. Reliability was not higher within than between institutions. An analysis of the relative contribution of different diabetes control indices to the diabetologists' judgments indicated that HbA1 influenced raters' judgments at both institutions more than any other single variable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

A pilot study: locus of control and spiritual beliefs in alcoholics anonymous and smart recovery members.

To investigate whether Alcoholics Anonymous' (AA's) "higher power" concept encourages externally dependent behavior, this pilot study tested whether AA and Self Management and Recovery Training (SR) members are equal on measures of external locus of control. The AA sample (N = 48) and SR sample (N = 33) were similar in age, gender, and education levels, and both required a minimum of 8 weeks group involvement. A modified spiritual beliefs questionnaire (SBQ) was first administered to each sample to compare them on spiritual beliefs, and the drinking-related locus of control scale (DRIE) was then conducted to compare each sample on locus of control. Significant differences were found between both samples on five out of seven spiritual measures, with the AA group scoring consistently higher on these factors (p < .01). In addition, the AA sample was significantly more external on the DRIE scale than the SR sample (p = .00003). These findings suggest that AA members are generally more spiritually oriented and exhibit greater external locus of control relative to SR members. Future controlled trials are necessary to confirm whether these results are caused by particular programs or primarily due to a self-selective process.

Adult↗
PubMed1990

Human chromosome 17 NotI linking clones and their use in long-range restriction mapping of the Miller-Dieker chromosome region (MDCR) in 17p13.3.

A NotI linking library constructed from flow-sorted human chromosome 17 material was screened to aid in construction of a long-range restriction map of the Miller-Dieker chromosome region (MDCR) in 17p13.3. A total of 66 clones were mapped to one of eight regions of chromosome 17 using a somatic cell hybrid panel, and 44/66 (67%) of these clones cross-hybridized to rodent DNA on Southern blots. Of these, 24 clones were tested and all mapped to mouse chromosome 11, the homolog of human chromosome 17. Four linking clones mapped to 17p13.3 and were used for pulsed-field gel electrophoresis studies along with six other anonymous probes previously mapped to this region. Clone L132 was found to be deleted in all Miller-Dieker patients tested (n = 15) and therefore lies within the critical region for this disorder. It detects two NotI fragments (180 and 320 kb), one of which (320 kb) was shared by YNZ22 and YNH37, two probes previously shown to be co-deleted in all patients with the Miller-Dieker syndrome (MDS). These results indicate that all MDS patients share a minimum deletion region of greater than 370 kb. Two other NotI clones, L53 and L125, mapped telomeric to the MDS critical region and share a 600-kb MluI fragment with each other and with YNZ22/YNH37. This provides a 930-kb MluI map that encompasses the distal boundary of the MDS critical region but does not include the proximal boundary. A total of over 2 Mbp is represented in the MluI fragments by probes in subband p13.3, a cytogenetic region estimated to be 3-4 Mbp.

Abnormalities, Multiple↗
PubMed1996

Clinical incidents in general practice. Keeping on track with test results.

The incident Monitoring in General Practice Project began as an initiative of the Professional Indemnity Review. Anonymous data from general practitioners about unintended and possibly adverse events were collected in order to develop preventive strategies that might ultimately increase patient safety and therefore reduce litigation. Feedback and sharing of experiences and ideas about these events, possible management strategies or about the project as a whole are invited from readers.

Australia↗
PubMed2003

Drug testing athletes to prevent substance abuse: background and pilot study results of the SATURN (Student Athlete Testing Using Random Notification) study.

PURPOSE: To assess the deterrent effect of mandatory, random drug testing among high school (HS) athletes in a controlled setting. METHODS: Two high schools, one with mandatory drug testing (DT) consent before sports participation, and a control school (C), without DT, were assessed during the 1999-2000 school year. Athletes (A) and nonathletes (NA) in each school completed confidential (A) or anonymous (NA) questionnaires developed for this study, respectively, at the beginning and end of the school year. Positive alcohol or drug tests required parent notification and mandatory counseling without team or school suspension. Thirty percent of the DT athletes were tested. Data were analyzed using the end of the school year measure, adjusted for the initial questionnaire results. Demographics of the athlete sample revealed that mean age was 15.5 years with 81.5% white, 9.6% Hispanic, 4.5% Asian, 2.6% American Indian/Native Alaskan, 1.3% African-American, and 1.3% Native Hawaiian/Pacific Islander. RESULTS: A (n = 276) and NA (n = 507) were assessed at the beginning (baseline) and at the end of the school year (A, n = 159; NA, n = 338). The past 30-day index of illicit drugs (4-fold difference) and athletic enhancing substances (3-fold difference) were lower (p < .05) among DT athletes at follow-up without difference in alcohol use. However, most drug use risk factors, including norms of use, belief in lower risk of drugs, and poorer attitudes toward the school, increased among DT athletes (p < .05). Although a reduction in the illicit drug use index was present among nonathletes at the DT school, at the end of the school year, it did not achieve statistical significance (p < .10). CONCLUSIONS: Random DT may have reduced substance use among athletes. However, worsening of risk factors and small sample size suggests caution to this drug prevention approach. A larger long-term study to confirm these findings is necessary.

Adolescent↗
PubMed2002

A web-based self-monitoring system for people living with HIV/AIDS.

Available evidence indicates that the internet is becoming the main source for delivering information on the prevention, control and treatment of HIV/AIDS. This paper presents a further step in the use of the internet to meet the new challenge of managing HIV as a chronic illness. It describes a work carried out under the SEAHORSE EU project to build and test a Web-based self-monitoring system for HIV/AIDS patient care. The user interface has been carefully designed to provide a high-level of interaction and therefore improve some of the current limitations of Web applications. The system comprises three modules: (1) a patient self-monitoring personal diary, to create a follow-up patient record; (2) a data analysis and visualisation tool; and (3) a section to allow patients to ask for advising and remote doctor support. One of the crucial system design issues has been the system security and users anonymity features required in this clinical domain. A feasibility pilot has been carried out to test the system in three organisations involved in the research project: the Immune Development Trust (London), the Lambeth, Southwark and Lewisham Health Authority (London) and Apoyo Positivo in Madrid. The preliminary results of the system evaluation show the potential validity and usefulness of the tool for helping people living with HIV/AIDS to promote and manage their health and for providing health professionals with new means for tele-monitoring and tele-caring patients.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Multiple signaling pathways mediate anti-Ig and IL-4-induced early response gene expression in human tonsillar B cells.

We have analyzed the relationship between the signaling pathways coupled to surface immunoglobulin and interleukin (IL)-4 receptors in human B cells from the patterns of expression of a panel of phorbol ester-inducible early response genes (ERG) activated by anti-IgM and IL-4 stimulation in vitro. Anti-IgM stimulation led to the induction of all eleven ERG tested. Two of these, the proto-oncogene, c-fos and an anonymous ERG 1R20 were insensitive to protein kinase C (PKC) inhibition with the drug, staurosporine and retained inducibility after down-regulation of PKC activity by purging with phorbol ester. These observations are consistent with previous data showing anti-IgM signaling through both PKC-dependent and PKC-independent pathways. c-fos and 1R20 were also the only ERG inducible in response to IL-4 stimulation and whilst ionomycin induced only c-fos, dibutyryl cyclic adenosine monophosphate stimulation led to induction of both c-fos and 1R20. These observations lend support to a role for the adenylate cyclase pathway being important for coupling of IL-4-generated signals to B cells responses. None of the anti-IgM-responsive ERG was further induced when B cells were co-stimulated with a combination of anti-IgM and IL-4, suggesting that the signaling cascades from these two agents are integrated downstream of third messenger pathways to synergistically promote B cell proliferation.

Alkaloids↗
PubMed1994

Use of pooled residual laboratory sera to assess human immunodeficiency virus prevalence among patients in Italy. The Italian Study Group on Occupational Risk of HIV infection.

An anonymous unlinked seroprevalence study of human immunodeficiency virus (HIV) infection was performed by testing pools of ten sera remaining from specimens submitted consecutively to clinical pathology laboratories at 18 Italian public hospitals during four consecutive days in April 1991. Sera from positive pools were retested individually by three different enzyme immunoassays (EIAs) and considered positive if reactive by all three assays. Only the sera with discordant EIA results were retested by Western blot. Of a total of 22,590 sera, 278 were HIV positive (1.2%). The highest rates were seen in hospitals located in metropolitan areas (1.5%), in infectious disease departments (28%) and in drug addiction treatment units (28%); among men aged 21-30 (4.6%) and 31-40 years (4%); and among women aged 21-30 years (1.6%). The distribution of seropositive patients by gender and age group suggests an increasing role of heterosexual transmissions of the infection. The presence of anti-HIV antibodies in sera from patients of both sexes, in all age groups, and from all clinical settings reinforces the need for health care workers to adhere to universal precautions issued to prevent occupational bloodborne infections.

Adolescent↗
PubMed1994

Risk identification for HIV infection in an inner London antenatal population.

This study was carried out to ascertain whether routine antenatal history taking is an effective means of identifying risk factors for HIV infection. Information about risk obtained at routine booking was compared with answers to selected questions obtained at a research interview. The study was conducted at St. Bartholomew's Hospital Homerton, and ran from February 1991 to March 1992. Of the 3729 women interviewed, 1671 had been hand booked (unstructured questionnaire) and 2058 had been computer booked (structured questionnaire). Hand booking failed to identify 77% of risk factors compared with 7% for computer booking. The findings highlight the underdetection of risk activity and confirm the need for intermittent, anonymous sampling to obtain background information against which a decision to implement universal testing may be made.

Female↗
PubMed2003

[In-hospital cardiac arrest resuscitation: medical and paramedical theory skill assessment in an university hospital].

OBJECTIVES: Theory knowledge and attitude assessment about in-hospital cardiac arrest (CA) basic life support by hospital staff. METHODS: We tested medical and paramedical working staff in a 450 beds university hospital with anonymous questionnaire based on training for basic life support. Questions were about presence of a formation before, clinical signs reached in front of unconscious patient, attitude in front of cardiac-arrest, practical experience with basic life support and ward emergency trolley. RESULTS: Five hundred and seventy one on 996 people answered to handed out questionnaires (57%): 158 from medical staff (Med group) and 413 from nurses "Pmed". Seventy one percent people from "Med" group and 64% from "Pmed" received one time at least training about cardiac-arrest. Front of unconscious patient, no spontaneous breath was reached explicitly by 55% people from Med group and 19% from "Pmed" group and central pulse was reached explicitly by 70% people from "Med" group and 18% from "Pmed" group. Front of CA, 50% people from "Med" group released airway, 75% began ventilation and 86%, External Heart Compression (EHC) and 42% called for rescue. There were respectively 29, 47, 64 and 60% people from "Pmed" group. Eighty-one percent people from "Med" group thought they knew to do ventilation and 82% did it one time at least. Eighty-eight thought they knew to do EHC and 85% did it one time at least. They were respectively 67, 76, 73 and 78% people from Pmed group. Sixty-four per cent of Med group people know that there is emergency trolley in there department versus 89% for "Pmed" group. CONCLUSION: This study showed that theoretical knowledge of hospital staff about cardiac arrest diagnostic and management are insufficient from the point of view of national and international guidelines. Analysis is difficult because of weak response number and knowledge people overestimation.

Allied Health Personnel↗
PubMed2000

Evaluating the outcome of communication skill teaching for entry-level medical students: does knowledge of empathy increase?

BACKGROUND: While the literature shows the clinical value for medical practitioners of skill in communicating with patients in an empathetic manner, objective evaluations of methods to teach empathy are few. PURPOSES: This paper describes a method of teaching entry-level medical students the elements of effective communication with patients, in preparation for their first practical exercises. The paper focuses on how the outcomes of the teaching were evaluated with special attention to empathy. METHODS: Student evaluative ratings were collected after training, and students also completed a pencil-and-paper test of empathy, both before and after the training. While all data were anonymous, student pre- and post-training empathy scores could be compared to assess individual changes in knowledge of empathy after training. RESULTS: Most students (81%) felt better prepared to interview after the training. The pencil-and-paper measure of empathy has good reliability, both internal (alpha 0.83 and 0.91) and inter-rater (kappa 0.96). Overall, students made significant gains in their ability to make empathetic responses, although some (30%) showed no gains. CONCLUSIONS: Further research is required to identify students who fail to acquire skill in expressing empathy after undergoing training, and to validate the pencil-and- paper measure of empathy against real-life performance.

Clinical Competence↗
PubMed2000

A scale of optimism-scepticism in the context of HIV treatments.

The aim of this research was to develop a brief scale of gay men's optimism-scepticism in the context of new HIV treatments. Following comprehensive literature search and communication with other researchers, 34 items about viral load testing, HIV therapies and concern about HIV infection were generated. By way of anonymous, self-complete questionnaires, these items were put to 532 gay men recruited at the Sydney Gay and Lesbian Mardi Gras Fair Day in February 1999. Principal axes factor analysis and item refinement yielded an optimism-scepticism scale based on 12 items (range 12-48, with higher scores indicating greater optimism). The sample mean was 19.8 (SD = 4.7). The scale had high internal consistency reliability (Cronbach's alpha = 0.79). Providing preliminary evidence of validity, men who reported unprotected anal intercourse with a causal partner 'in the past six months' had a significantly higher mean score (21.3) than those who did not report this risk practice (19.5, p < 0.001). Similar validation was provided from separate samples of gay men in Queensland and Sydney. Our scale of optimism-scepticism in the context of new HIV therapies is a brief, reliable instrument which can be incorporated within broader questionnaires and interview schedules. It is a useful tool to monitor attitudes toward HIV therapies and possible associations with risk practices.

Adolescent↗
PubMedDate not supplied

Acetylcodeine as a urinary marker to differentiate the use of street heroin and pharmaceutical heroin.

Acetylcodeine (ACOD) is a synthesis byproduct present in street heroin but not in pharmaceutical diacetylmorphine (DAM) as used in the Swiss program Heroin-Assisted Treatment for Opiate Dependent Drug Users (HAT). ACOD was evaluated and validated as an urine marker to detect the consumption of street heroin by HAT participants. A gas chromatography-mass spectrometry method allowing the quantitation of ACOD concentrations as low as 0.2 ng/mL urine has been developed. In opiate-naïve subjects, intravenous (i.v.) ACOD showed a plasma elimination half-life of 237 +/- 18 min, urine peak concentrations 2 h after administration, and a detection window of 8 h. Only 0.4 +/- 0.1% was excreted unchanged, with codeine (COD) as the main metabolite. ACOD may be formed by transacetylation when i.v. DAM and oral codeine are co-administered. To avoid false-positive results, the calculation of COD/ACOD ratios is recommended. In a study with 105 HAT participants, 14% of the tested urines were ACOD positive. Only a low correlation was found between the anonymously self-declared consumption of street heroin and the ACOD positive rate.

Acetylation↗
PubMed1999

Developing surveillance for HIV transmission and risk behaviours among high-risk groups in a central London health district.

BACKGROUND: Our aim was to describe surveillance data on HIV transmission and risk behaviours in Camden and Islington, an inner London health district (population 360 000). This information is required to assess the effectiveness of HIV-AIDS prevention. METHODS: We focused on two groups in the local population most severely affected by the HIV epidemic: homosexual and bisexual men, and injecting drug users. Data were drawn from routine and survey data, national and local sources, and a special local survey. RESULTS: There were estimated to be 9250 homosexual men, with an estimated prevalence of 7.7 per cent (confidence interval (CI) 5.9-11.0) diagnosed with HIV infection resident within the health district, and 9900 injecting drug users, with an estimated prevalence of 0.8 per cent (CI 0.6-1.1), diagnosed with HIV infection. New HIV infections diagnosed amongst homosexual men having a named test in HIV testing services averaged 281 and was unchanged between 1992 and 1996. However, unlinked anonymous seroprevalence surveys showed a decline in HIV prevalence for both homosexual men attending a genito-urinary medicine clinic and for injecting drug users attending services. Local surveys indicated that, in the preceeding year, one in three homosexual men had had unprotected anal intercourse with a man, and 13 per cent of intravenous drug users had shared equipment. There appeared to be no change in these levels over the years studied. CONCLUSION: Population-based information on HIV is available at local level in England. It can be used for surveillance of HIV transmission and behaviour in high-risk groups, especially homosexual and bisexual men and intravenous drug users. Resources for HIV prevention are provided to all NHS districts, and surveillance is a cost-effective measure of the outcome of HIV prevention.

Adolescent↗
PubMed1994

Risk behaviour and HIV prevalence in international travellers.

OBJECTIVE: To assess risk factors for infection and to determine HIV prevalence in a sample of international travellers. DESIGN: A cross-sectional survey of new patients attending a hospital outpatient clinic, and self-completion of an anonymous questionnaire on sexual behaviour prior to and during travel. Urine samples were tested for the presence of antibodies to HIV. SETTING: The Hospital for Tropical Diseases, London, UK. SUBJECTS: All new patients over a 6-month period. RESULTS: Of 782 people approached, 757 (97%) agreed to participate: 141 (18.6%) had had new sexual partners during their most recent trip abroad. Almost two-thirds of those having sex abroad did not use condoms on every occasion with a new partner, and 5.7% contracted a sexually transmitted disease (STD) during their most recent trip; 26% of men from World Health Organization Pattern I countries who had new sexual partners abroad paid for sex. Sixteen out of 731 (2.2%) participants were HIV-antibody-positive. HIV positivity was associated with being born in east, central or southern Africa, having symptoms of an STD since arriving in the United Kingdom and being treated for an STD since arrival. CONCLUSION: The rates of unsafe sex and payment for sex abroad reported by these international travellers indicate the potential for contracting and transmitting STD, including HIV, in both their foreign and domestic sexual partnerships. With the increasing HIV incidence in Asia (the most common destination for UK travellers after sub-Saharan Africa), the number of cases of HIV contracted abroad may rise in the future.

Adult↗
PubMed2004

Using alcohol screening results and treatment history to assess the severity of at-risk drinking in Veterans Affairs primary care patients.

BACKGROUND: Primary care providers need practical methods for managing patients who screen positive for at-risk drinking. We evaluated whether scores on brief alcohol screening questionnaires and patient reports of prior alcohol treatment reflect the severity of recent problems due to drinking. METHODS: Veterans Affairs general medicine outpatients who screened positive for at-risk drinking were mailed questionnaires that included the Alcohol Use Disorders Identification Test (AUDIT) and a question about prior alcohol treatment or participation in Alcoholics Anonymous ("previously treated"). AUDIT questions 4 through 10 were used to measure past-year problems due to drinking (PYPD). Cross-sectional analyses compared the prevalence of PYPD and mean Past-Year AUDIT Symptom Scores (0-28 points) among at-risk drinkers with varying scores on the CAGE (0-4) and AUDIT-C (0-12) and varying treatment histories. RESULTS: Of 7861 male at-risk drinkers who completed questionnaires, 33.9% reported PYPD. AUDIT-C scores were more strongly associated with Past-Year AUDIT Symptom Scores than the CAGE (p < 0.0005). The prevalence of PYPD increased from 33% to 46% over the range of positive CAGE scores but from 29% to 77% over the range of positive AUDIT-C scores. Among subgroups of at-risk drinkers with the same screening scores, patients who reported prior treatment were more likely than never-treated at-risk drinkers to report PYPD and had higher mean Past-Year AUDIT Symptom Scores (p < 0.0005). We propose a simple method of risk-stratifying patients using AUDIT-C scores and alcohol treatment histories. CONCLUSIONS: AUDIT-C scores combined with one question about prior alcohol treatment can help estimate the severity of PYPD among male Veterans Affairs outpatients.

Adult↗
PubMed1991

Cognitive predictors of not-guilty verdicts in a simulated acquaintance rape trial.

Cognitive predictors, such as relatively accepting attitudes toward forcible date rape, helped identify self-reported sexually coercive college students and were expected to help identify students voting not guilty in a simulated acquaintance rape trial. To test this hypothesis college students self-administered in random order (1) an anonymous sex survey measuring attitudes toward forcible date rape, attitudes toward women, sexual experience, including victimization, sexual permissiveness, and sexual knowledge and (2) a trial survey based on a simulated acquaintance rape trial. Only gender and cognitive variables from the trial (e.g., being male, tending to blame the victim, and uncertainty about one's verdict) identified not guilty verdicts above chance expectancy. Thus, the hypothesis that the cognitive predictors measured here would help identify students voting not guilty in a simulated acquaintance rape trial was not supported.

Adult↗
PubMed2000

A Survey of Final-Year Dental, Medical and Nursing Students: Occupational Injuries and Infection Control.

BACKGROUD: This study investigated nonsterile occupational injuries and infection control practices reported by final-year dental, medical and nursing undergraduates. Data from an anonymous, self-administered questionnaire were analyzed using ANOVA and chi-square tests. Nonsterile occupational injuries in the previous year were reported by 82% of dental, 57% of medical and 27% of nursing respondents, including one hepatitis B virus (HBV) and one human immunodeficiency virus (HIV) exposure. Although students received appropriate management for known HIV and HBV exposure, 48% of dental, 77% of medical and 59% of nursing students reporting injuries also reported no postexposure follow-up. Dental students were more aware of postexposure protocols (p < 0.001) and also reported more frequent use of gloves (p < 0.05), masks (p < 0.001) and protective eyewear (p < 0.001) than other students. Students who reported 2-handed recapping of needles had twice the number of percutaneous injuries (mean = 1.9/year) than those who avoided recapping or recapped with one hand using a device or scoop technique (p < 0.05). All dental, and 99% and 95% of medical and nursing students, respectively, reported HBV immunization; however, 6% of dental students had inadequate response (i.e., titre of antibodies to HBV surface antigen [anti-HBs].10 mIU/mL) and 13% of dental, 24% of medical and 41% of nursing students did not know whether their postimmunization anti-HBs titre was adequate. The majority of students reported occupational injuries that increase risk of exposure to pathogens. Educational interventions are required to improve postexposure follow-up, handling of sharps, use of barriers and HBV postimmunization serology.

Journal Article↗