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PubMed2003

Intrathecal neurolytic blocks for the relief of cancer pain.

Intrathecal neurolytic blocks for the treatment of chronic pain were first described by Dogliotti in 1931. Since then, many authors have described the intrathecal injection of various neurolytic substances for the treatment of oncologic pain. In recent years, alcohol and phenol have been the substances most commonly used for this purpose. There are no controlled studies, so the literature consists of observations, reports and book chapters reflecting the opinions of experienced clinicians. This chapter describes the indications, contraindications, potential complications, and expected benefits of intrathecal injection of alcohol and phenol in the treatment of cancer pain. Four cases of cancer patients whose intractable pain was treated by the authors using intrathecal neurolysis are presented. Pertinent literature is reviewed. In this account, the emphasis is on proper selection of patients and techniques.

Aged↗
PubMed1997

Hormonal, immunological, and hematological responses to intensified training in elite swimmers.

The purpose of this study was to compare the responses of selected hormonal, immunological, and hematological variables in athletes showing symptoms of overreaching with these variables in well-trained athletes during intensified training. Training volume was progressively increased over 4 wk in 24 elite swimmers (8 male, 16 female); symptoms of overreaching were identified in eight swimmers based on decrements in swim performance, persistent high ratings of fatigue, and comments in log books indicating poor adaptation to the increased training. Urinary excretion of norepinephrine was significantly lower (P < 0.05, post hoc analysis) in overreached (OR) compared with well-trained (WT) swimmers throughout the 4 wk. There were no significant differences between OR and WT swimmers for other variables including: concentrations of plasma norepinephrine, cortisol, and testosterone, and the testosterone/cortisol ratio; peripheral blood leukocyte and differential counts, neutrophil/lymphocyte ratio, and CD4/CD8 cell ratio; serum ferritin and blood hemoglobin concentrations, erythrocyte number, hematocrit, and mean red cell volume (MCV). MCV increased significantly over the 4 wk in both groups, suggesting increased red blood cell turnover. These data show that, of the 16 hormonal, immunological, and hematological variables measured, urinary norepinephrine excretion appears to be the only one to distinguish OR from WT swimmers during short-term intensified training. Low urinary norepinephrine excretion was observed 2 to 4 wk before the appearance of symptoms of overreaching, suggesting the possibility that neuroendocrine changes may precede, and possibly contribute to, development of the overreaching/overtraining syndromes.

Adolescent↗
PubMed1986

A comprehensive bibliography database using a microcomputer.

A system was implemented using a commercial database management program and a microcomputer for computerising references from journals and other sources. In addition to the citation, the user can enter the address of the institution where the study was carried out, a description of the article and of the work, key words, and an abstract. References are added, edited, searched for, displayed on screen, typed on paper, or sent to a text file, using selection criteria entered by the user. When a search is performed the printout will include the abstract of each paper, similar to that obtained from larger bibliographic services. The computer also writes requests for reprints. This program now holds over 30 000 references and has been in use for over three years. Such a system is beneficial for personal study, for writing books, articles, and theses, and for use by institutions, departments, and small libraries.

Bibliographies as Topic↗
PubMedDate not supplied

Lessor known ayurvedic physicians from an Urdu book Rumoozul Atibba: part II.

Rumoozul Atibba, a rare Urdu book compiled by Hakim Fairozuddin is in two Volumes. It is published by Darul Kutub Rafiqul Atibba, printed in "Rifah-e-Aam press in 1913 at Lahore which contains short biographies of Ayurvedic and Unani physicians. It has been compiled to disclose the tested formulae hidden in the minds of eminent scholars of Ayurveda and Unani with their life sketches. The selection of this work has been aimed to enlight the Ayurvedic History prevailed in different languages. Twenty biographies of Ayurvedic Physicians were in first volume of 'Rumuzul Atibba', which were published prior to this article (Bulletin of Indian Institute of History of Medicine. Vol XXVI (1996). This article contains only three biographies of Ayurvedic physicians.

Biographies as Topic↗
PubMed2005

Eyes wide shut?--A conceptual and empirical critique of methadone maintenance treatment.

BACKGROUND: Methadone maintenance treatment (MMT) has been the 'gold standard' pharmacotherapy treatment for illicit opioid dependence for over 30 years. It has been widely evaluated, and is generally claimed to be 'effective'. METHODS: The objective of this paper is to review the rationale of MMT as an intervention for a biomedical disorder with primary social objectives as well as the methodological quality and evidence of MMT outcome research. Data sources included opioid dependence treatment practice, review and outcome research literature (1965-2001) in the form of peer-reviewed articles, books, monographs and reports that are preeminently cited and reviewed international studies on MMT. RESULTS/DATA SYNTHESIS: Rigorous and appropriate evaluation (i.e., RCTs, intent-to-treat, patient-centered) methods in MMT evaluations are rare. Evidence of MMT's effectiveness on primary treatment objectives is mixed and appears to be largely partial and short-term. Positive outcomes may be the result of selection effects of compliant patients and loss in proportion when more rigorous standards of analysis are applied. CONCLUSIONS: The quality of existing MMT research, and evidence for its general effectiveness are limited. Key concepts of self-medication and psychiatric comorbidity are largely ignored in MMT treatment and research frameworks, although they may serve to explain MMT's limited treatment success. Emerging new opioid pharmacotherapies require the fundamental review of the existing MMT paradigm as well as the application of rigorous and appropriate evaluation methods for future treatment.

Comorbidity↗
PubMedDate not supplied

Neurobehavioral testing of chemicals: impact on recommended standards.

Historically, the American Conference of Governmental Industrial Hygienists (ACGIH) has served as a major source of information on recommended safe exposure limits (Threshold Limit Values or TLV's) for chemicals most frequently encountered in U. S. industry and of known toxicologic significance. A review of the ACGIH Documentation book, which details the basis for their judgements, has indicated that 167 of the 588 chemicals for which they assigned recommended standards have, as one of their bases, direct nervous system effects. In order to increase the impact of future behavioral toxicology research on recommended standards, the neurotoxicologist can utilize certain strategies: (a) Focus on established mixtures in the environment of interest or select exposures of particular chemical classes, considering population size and severity of effect; (b) Ensure that the results of the study are referable to the expected route of exposure in the environment of interest; and (c) Select tests with face validity for non-psychologists, using reference substances. Finally, the neurotoxicologist is urged to consider effects related to safety as well as health in developing his/her research.

Air Pollutants, Occupational↗
PubMed1996

The H1-receptor antagonist chlorpheniramine decreases the ending phase of the mismatch negativity of the human auditory event-related potentials.

Auditory event-related potentials (ERPs) were recorded in 20 healthy male humans, who received either a single 4 mg dose of d-chlorpheniramine or a placebo, according to a double-blind design. Subjects were instructed to read a book and to ignore random sequences of 90% standard (1000 Hz) and 10% deviant (1100 Hz) tones, presented with stimulus-onset asynchrony (SOA) of 480 ms. Deviant tones elicited the mismatch negativity (MMN) response, which was smaller at its ending phase in the chlorpheniramine group. The auditory exogenous components (N1 and P2) were similar in both groups. Results demonstrate that the antihistamine chlorpheniramine selectively affects the automatic stimulus-change detector associated with MMN, and suggest an involvement of the histamine H1-receptor in the genesis of the MMN.

Acoustic Stimulation↗
PubMed1995

Outpatient management of the depressed patient.

Major depression is a serious, potentially life-threatening illness that can cause significant pain and suffering. It afflicts up to 50% of patients who are seen in the primary care setting. However, it is a remarkably treatable disorder, once it is recognized. The mainstay of treatment is education about the illness, brief supportive counseling, and antidepressant medication. This monograph is a synopsis of a book, Outpatient Management of the Depressed Patient, recently published on this subject. We focus on how to diagnose and treat major depression in the primary care setting, in which the vast majority of patients with this condition are seen. We review the condition itself, how to establish the diagnosis, what education and brief supportive counseling are needed and how to provide them, how to select an antidepressant, and how to use the drug to induce and maintain remission.

Adult↗
PubMed1998

Domenico Battini and his description of congenital megacolon: a detailed case report one century before Hirschsprung.

More than one century after the epochal paper of Harald Hirschsprung, and in spite of fast and remarkable advances in the pathophysiology of congenital megacolon, our understanding of how bowels may become functionally obstructed, and especially its variability, remains largely incomplete. While much more needs to be known about normal gastrointestinal physiology, an interaction between genetic and environmental factors seems to be of paramount importance in the pathogenesis of Hirschsprung's disease. While reviewing the relevant literature, we came across a virtually unknown contribution by an Italian physician, Domenico Battini, who happened to follow-up for about 10 years a case of severe constipation. This contribution, published posthumously as a book in 1800, not only describes very carefully the clinical evolution of that patient, but also provides a detailed post-mortem examination of the abdominal viscera, with particular reference to the alterations occurred in the intestines. We conclude that Battini, nearly one century before Hirschsprung, had succeeded in reporting a typical case of congenital megacolon, and had perceived a number of features (familiarity, selective involvement of "neural layers" in the gut mucosa) that were to become characteristic of Hirschsprung's disease a few decades after Hirschsprung himself had published his article.

Hirschsprung Disease↗
PubMed1990

[Use of computers for patient data and billing].

The security and speed with which data can be handled in a medical software context depends on the kind of filing and sorting codes used. Thus software producers can be classified by how good the follow-up program is, as well by the quality of the filing and sorting codes applied. Using a sorting code that is composed of patients' initials, partially enlarged by their data of birth, is not sufficient to fulfill the demand for user comfort and input-security. An alternative often used, a patient number, demands a highly cooperative patient, who keeps his special number in mind and presents it when visiting the doctor's office. When used as a unique filing code, if that number is missing at the patient check-in counter in the office, an additional search must be made in a book listing patients. Besides wasting a lot of time, this kind of filing system is too insecure and unreliable. The best searching and filing code in medical software should be composed of parts of a patient's name, family name and date of birth. Large and small numbers should be accepted by the input window. The amount of matching codes should be minimized and selecting the patient in question should be done by clicking the mouse. A definite advantage in using a computer in the office is to manage routine data. Addresses, telephone numbers, insurance companies, drugs, therapy, mailing addresses, etc. must be made exclusively the computer's tasks. In this way, the speed of handling and data security can be improved. The benefits from an office computer will grow.(ABSTRACT TRUNCATED AT 250 WORDS)

Confidentiality↗
PubMedDate not supplied

Racial disparities in preterm births. The role of urogenital infections.

OBJECTIVES: To evaluate the impact of urogenital infections on the racial gap between black and white women in preterm birth rates. METHODS: A computer-assisted search of the medical literature was conducted through MEDLINE aided by a manual bibliographic search of published articles and relevant books. Estimates of the relative risk for preterm birth were extracted from published studies for the following infections: N. gonorrhea, syphilis, trichomoniasis, Chlamydia trachomatis, Group B streptococcal vaginal colonization, asymptomatic bacteriuria, genital mycoplasmas, and bacterial vaginosis. Estimates of the prevalence among black and white women by race for each of these infections were extracted from published studies. The attributable risk for preterm birth for selected infections was then calculated for the black and white populations and the impact on the racial gap in preterm births was estimated. RESULTS: Only bacterial vaginosis and bacteriuria appear to be established risk factors for preterm births. Significantly higher rates of bacterial vaginosis among black women may account for nearly 30% of the racial gap in preterm births. Higher rates of bacteriuria among black women may account for roughly 5% of the gap. CONCLUSION: Although these findings are limited by the reliability of published estimates of prevalence and relative risk for these infections, treatment of infections during pregnancy, particularly bacterial vaginosis, offers hope for reducing the racial gap in preterm births.

Bacteriuria↗
PubMed1996

Reaching smokers with lower educational attainment.

Between 1977 and 1994, smoking rates declined among men and women, but the decline was steeper for men. While smoking rates fell among people at all levels of education, the smallest drop was among those with high school graduation or less, particularly women. For those who had stopped smoking, health concerns had been the overriding factor. Smokers with lower education reported encountering fewer smoking restrictions in their daily activities than did those with higher education. All smokers cited the mass media as their major source of information about smoking, but those with lower education reported the mass media less often than did smokers with higher levels of attainment, and were less likely to obtain information from books, pamphlets or magazines. In addition, smaller percentages of smokers with lower education recalled printed warnings about heart disease on cigarette packages. Variations in the decline of smoking suggest that health promotion and smoking cessation programs should consider sex and educational differences when targeting the smoking population. Differences in rates of smoking among people aged 20 and over were examined by educational attainment using selected health surveys conducted between 1977 and 1994. A Health Canada-sponsored supplement to Statistics Canada's National Population Health Survey was used for data on other aspects of smoking such as cutting back or attempting to quit, sources of health information, and awareness of smoking restrictions and cigarette package warnings.

Adult↗
PubMed2004

Clinical prioritisation for curative radiotherapy: a local waiting list initiative.

AIMS: Waiting time for radiotherapy is a major problem in radiation oncology practice. The aim of this paper is to present the experience of the Peter MacCallum Cancer Centre in trialling a number of strategies to reduce patient waiting times. MATERIALS AND METHODS: All patients starting megavoltage radiotherapy with curative intent in three separate 1-week blocks had their waiting times recorded. The cohorts were each 8 weeks apart and were before (September), during (November) and after (January) the introduction of a priority points system. RESULTS: Median waiting time was 35 days in September, 42 days in November and 31 days in January. The number of extremely long waits (>90 days) decreased to 1 by January. Significantly more patients were pre-booked for treatment in January (27/51) compared with September (17/65; P = 0.003) and November (12/65; P < 0.001). Pre-booked patients had shorter waiting times compared with patients who was not pre-booked (P < 0.0001). Difficulties at one particular treating location contributed to the longer median waiting times in November. Although there had no significant difference in waiting time in non-breast unit patients between the three cohorts, there was a decrease in waiting times in breast unit patients, especially between November and January (P = 0.0008). There was no significant increase in delay to starting treatment in other treating units, resulting in more equitable access across all units. CONCLUSIONS: A combination of encouraging pre-booking and the introduction of a priority points system has led to a decrease in waiting times, especially among breast unit patients.

Appointments and Schedules↗
PubMed2006

How we do it: analysing GP referral priorities: the unforeseen effect of 'Choose and Book'.

The introduction of Choose and Book may have a significant effect on the proportion of urgent referrals seen by ENT surgeons. Much of the responsibility for prioritisation will be transferred to the GP. Patients who are considered urgent by the ENT surgeon will be added to those considered urgent by the GP. Our results show that there was little agreement between GPs and ENT surgeon on what constitutes an urgent referral. The combined effect of joint prioritisation and the removal of the 'soon' category resulted in a 270% increase in 'urgent' referrals in our sample. This potentially unforeseen consequence of the Choose and Book system should be taken into consideration by ENT departments to allow for an expansion of the 'urgent' category.

Appointments and Schedules↗
PubMed2002

Guide for the practical application of the ICRP Human Respiratory Tract Model. A report of ICRP supporting guidance 3: approved by ICRP committee 2 in October 2000.

The ICRP Publication 66 Human Respiratory Tract Model for Radiological Protection (HRTM) has been applied to calculate dose coefficients (doses per unit intake) and bioassay functions in ICRP Publications 68, 71, 72 and 78. For these purposes, ICRP assigned numerical values to a range of model parameters, such as the size of the inhaled particles and the breathing rate of the subjects. These are known as 'default' or 'reference' values, and were chosen to be typical, representative values. In any particular situation the actual values of many parameters can be considerably different from the reference values. Usually, doses from intakes of radionuclides are low compared with the relevant limit or constraint, and the resulting difference is unimportant. There are, however, circumstances where more reliable assessments of intake and dose are desirable. This Guidance Document therefore gives advice on applying specific information within the framework of the HRTM for assessing occupational and environmental exposures and for interpreting bioassay data. Chapters on each aspect of the model (morphometry, physiology, deposition, clearance, gases and vapours, dosimetry) provide: A summary of how the HRTM treats that topic;Information on the reference values of relevant parameters;Guidance on choosing between default values;Information on how doses and bioassay quantities (lung retention, urine, and faecal excretion) vary with the values of selected parameters, giving guidance on the importance of obtaining specific information;Simple examples of the use of specific information relating to the topic.Annexes give additional information for those directly involved in applying the HRTM to specific situations, including guidance on obtaining parameter values. A brief overview is given of the deposition, characterisation, and sampling of aerosols, with references to further information, as there are relevant text books already available. Issues specific to radioactive aerosols, such as low particle number concentrations for high specific activity materials are, however, addressed. Guidance on obtaining information about absorption of inhaled radionuclides into blood is given in greater detail, because this is a topic on which ICRP has traditionally given guidance, and because a compilation of such information is not readily available elsewhere. Several detailed examples are also provided. One involves assessment of an individual's intake and committed dose from comprehensive bioassay monitoring data. The others deal with the derivation of HRTM absorption parameter values from experimental data, and their application, with additional information on e.g. size distribution, to calculate dose coefficients and interpret bioassay data.

Adolescent↗
PubMed2001

Computer modelling of a cataract waiting list.

AIM: To compare three different strategies for determining admission dates for patients awaiting cataract extraction after scoring for visual impairment. METHODS: 357 patients attending for assessment for cataract surgery were scored for visual impairment. These scores were used as a basis for ranking patients into three impairment strata. A computer simulation was used to compare 3 years' operation of different admission strategies-a first come first served booking system, a triage booking system, and a waiting list system in which admissions were strictly ordered according to priority stratum. Differences in priority weighted delays before treatment were analysed. RESULTS: Both the triage system and the priority based waiting list system gave considerable reduction in priority weighted delay compared with a first come first served admission policy. The percentage reduction achieved (30%-60%) is strongly influenced by the number of weeks fully booked when the booking systems are introduced. The priority weighted delay of the triage system, where booking decisions were made at the time of the outpatient assessment, was consistently and substantially outperformed by the priority based waiting list system where the decision to allocate an admission date was delayed as long as possible. CONCLUSIONS: There is considerable scope for reducing delays to high priority patients if simple rules are used to determine admission dates. Using these rules, booking patients at the time of the outpatient assessment gives substantially less benefit in terms of reducing delays to high priority patients than if the decision about the admission date is deferred.

Cataract Extraction↗
PubMedDate not supplied

Sources of sexual information and its relevance to sexual behaviour in Nigeria.

A study was carried out to identify the various sources of sexual information by adolescents in Nigeria and their influence on the sexual behaviours of the subjects, using: a) coitus prior to marriage b) expectation with first coitus c) freeness to discuss with spouse or anybody as parameters. The study was carried between 1997 and 1998 using subjects randomly selected from three Nigerian communities, viz: Enugu, Benin and Nnewi. Coitus before marriage was significantly higher in those who got their first ever information from peers than those who got it from other sources (P < 0.01). Fulfillment of expectation with first coitus was also significantly higher among those who were taught by parents, peers and teachers than those who sought their information on their own from books, magazines and films (p < 0.05). However, in considering their ability to discuss with anybody, this was found to be significantly higher in those who sought information on their own than those who got their first information by personal contact with parents, peers and teachers (p < 0.05). The latter was found to be more inhibited from discussing sexuality with their spouse or anybody than those who got their information from books/magazines and films. Sex education of adolescents should, therefore, be provided in a cultural, community-based setting of which the guardian programme should be only one component. It may be counter-productive in Nigeria if the adolescents continue to learn about sexuality on their own from books, magazines and films.

Adolescent↗
PubMed2006

[Quality and quality development in medical practices--epidemiological results of the accompanying evaluation of the new KBV quality management system].

The motivation for quality management has now reached medical and psychotherapeutic practices. This is partly due to exogenous factors, including regulatory requirements such as Sect. 135a SGB V (German Book of Social Code) demanding the implementation and further development of internal quality management from both out-patient and in-patient healthcare providers. The National Association of SHI-Accredited Physicians in Germany (KBV), along with several regional associations, responded to these internal demands and external requirements by developing the quality management system "Quality and Development in Practices (QEP)". Assisted by an independent institute, 61 selected practices participated in the pilot study. The pilot phase included five interview rounds held between April and November 2004 with 60 practices taking part. The results describe practitioners' expectations for the current state of and the demand for internal quality management. Only one in five practices expects improvements from the implementation of quality management in the area of healthcare processes and management. The improvement of organizational processes, patients' safety and patient outcomes are considered more important. In a self-assessment procedure which included 73 targets with 236 verifications from the quality target catalogue a distinct potential for quality improvement has been revealed. The greatest need for improvement has been identified in cases where quality management defines specific requirements for the practices. These include: treatment pathways, patient information, risk management, case discussions and instruction, quality improvement, regulations and quality measurement. Even practices with advanced quality development activities were able to detect some potential for improvement with the application of the QEP catalogue. In order to attain 15 selected quality targets with 45 verifications, the practices were provided with tools like sample documents and suggestions for internal regulations to be used for quality improvement and requiring relatively small efforts. The effectiveness of implementing a quality management system cannot be adequately demonstrated by an accompanying evaluation. However, established instruments (such as the quality target catalogue and verifications), complemented with suitable outcome indicators, allow the effects of the implementation of internal quality management to be measured in a comparative, or, ideally in a randomized study.

Epidemiology↗