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PubMed1992

Failure of many ophthalmologists to use lasers safely.

In 1990, after the detection of impairment of colour discrimination in laser operators, the College of Ophthalmologists recommended safety guidelines for the use of lasers. We measured the effectiveness of these guidelines and their impact on ophthalmological practice in the United Kingdom. Previously, in ophthalmologists not following the guidelines, there was a deterioration in colour discrimination after a laser session. No such deterioration was found in 10 ophthalmologists tested who adhered to the guidelines, but their colour discrimination was significantly worse than that of controls. Replies to a questionnaire disclosed that one third of senior ophthalmologists were unaware of the practices recommended.

Color Vision Defects↗

PubMed1999

Biological monitoring of sterilizers and sterilization failures in Norwegian dental offices in 1985 and 1996.

It is essential that dental office sterilizers be regularly challenged with biological indicators (BIs) in order to prove that the test spores are being killed during sterilization. The aims of the study were to biologically monitor Norwegian dental office sterilizers and to identify factors contributing to sterilization failure. In 1985, participants received a packet containing: (i) 4 BI units; (ii) a set of instructions; (iii) a questionnaire concerning operation (including biological monitoring) of the office sterilizer(s), and (iv) a return-address envelope. In 1996, offices were sent (i) a survey which included demographic questions and inquiries concerning instrument sterilization processes; (ii) 2 sets of 3 BI units with instructions for their use on 2 different days; (iii) 1 control BI unit that was not to be processed, and (iv) a return-address envelope. Both private and public offices participated. Response rate to the 1996 study was 60%, which was 9.1% of all dental offices in Norway. Testing results indicated a 6.3% overall sterilization failure rate. Three out of 163 steam autoclaves (SAs) (1.8% of total) and 14 out of 109 dry heat (DH) ovens (12.8% of total) failed. DH ovens were over 7 times more likely to fail BI testing than were SAs (chi2, P < 0.01). Demographic or hygiene procedural factors could not be correlated to sterilization performance (chi2, P > 0.05). The failure rate for SAs (n = 216) in 1985 was almost 5 times greater than in 1996 (8.8% vs 1.8%). Improvement in sterilizer performance during the decade may be related to issuance in 1986 of Norway's 1st infection control guidelines for dentistry and greater awareness of infection control practices and/or to increases over the previous 10 years in the number of postgraduate courses offered in infection control. The current Norwegian guidelines on infection control practices in public health services, including dentistry, recommend regular biological monitoring of sterilizers without specifying how often. There is a lack of information among Norwegian dentists as to how frequently dental office sterilizers should be regularly monitored by BI.

Chi-Square Distribution↗

PubMed2004

A cumulative review of the range and incidence of significant adverse events associated with acupuncture.

OBJECTIVE: To summarise the range and frequency of significant adverse events associated with acupuncture in order to provide evidence on which to base continuing efforts to improve the safety of acupuncture practice. METHODS: Searches were conducted of computerised databases, previous reviews of case reports, population surveys, prospective surveys of acupuncture practice and relevant sections of textbooks for primary and secondary reports to indicate the range of significant adverse events associated with acupuncture. Data from prospective surveys of acupuncture were combined to estimate the incidence of serious adverse events. RESULTS: A total of 715 adverse events was included. There were 90 primary reports of trauma, and 186 secondary reports; the most common were pneumothorax and injury to the central nervous system. Infection accounted for 204 primary reports and 91 secondary reports. Over 60% of these cases were hepatitis B. The next most common infection was of the external ear, as a complication of auricular acupuncture. The 144 miscellaneous events mainly comprised seizures and drowsiness judged severe enough to cause a traffic hazard. There were 12 primary reports of deaths. According to the evidence from 12 prospective studies which surveyed more than a million treatments, the risk of a serious adverse event with acupuncture is estimated to be 0.05 per 10 000 treatments, and 0.55 per 10 000 individual patients. CONCLUSIONS: The risk of serious events occurring in association with acupuncture is very low, below that of many common medical treatments. The range of adverse events reported is wide and some events, specifically trauma and some episodes of infection, are likely to be avoidable.

Acupuncture Therapy↗

PubMed1983

Tactile vision substitution: past and future.

Tactile sensory substitution for blind persons has been studied primarily in a laboratory setting. Although the studies demonstrated the feasibility of the approach, to date no practical systems are in use. In this paper, previous tactile vision substitution studies are described, and the reasons why practical systems have not yet been developed are discussed. The theoretical basis for sensory substitution is examined primarily in regard to the capacity of the somatosensory system to mediate high resolution "visual" information. Future developments that may lead to practical systems for blind persons are considered.

Biomechanical Phenomena↗

PubMed2005

High content screening for G protein-coupled receptors using cell-based protein translocation assays.

G protein-coupled receptors (GPCRs) have been one of the most productive classes of drug targets for several decades, and new technologies for GPCR-based discovery promise to keep this field active for years to come. While molecular screens for GPCR receptor agonist- and antagonist-based drugs will continue to be valuable discovery tools, the most exciting developments in the field involve cell-based assays for GPCR function. Some cell-based discovery strategies, such as the use of beta-arrestin as a surrogate marker for GPCR function, have already been reduced to practice, and have been used as valuable discovery tools for several years. The application of high content cell-based screening to GPCR discovery has opened up additional possibilities, such as direct tracking of GPCRs, G proteins and other signaling pathway components using intracellular translocation assays. These assays provide the capability to probe GPCR function at the cellular level with better resolution than has previously been possible, and offer practical strategies for more definitive selectivity evaluation and counter-screening in the early stages of drug discovery. The potential of cell-based translocation assays for GPCR discovery is described, and proof-of-concept data from a pilot screen with a CXCR4 assay are presented. This chemokine receptor is a highly relevant drug target which plays an important role in the pathogenesis of inflammatory disease and also has been shown to be a co-receptor for entry of HIV into cells as well as to play a role in metastasis of certain cancer cells.

Animals↗

PubMed1990

Assessment of student selection practices and beliefs in dietetic internship programs.

With declining college enrollment, the health professions, including dietetics, are recognizing a need to assess and monitor student selection more closely. In this survey of 102 dietetic internship programs, program directors and a sample of their faculty members were asked to describe their current selection practices and to identify the beliefs they hold about the information obtained from various components of their procedures. Differences in beliefs between program directors and other faculty members were compared by t-test analysis. The five major categories of internship selection procedures are presented with information items faculty members believe are derived from each category, and the results are compared with those of previous surveys of dietetic selection practices. Major findings are that the intern selection process has changed significantly since 1978, with greater emphasis on work experience and extracurricular activities; the number of applicants per position has doubled despite a doubling of dietetic internship programs; and program directors and faculty members agree on the major selection practices but not on the information obtained from a given category. In the discussion, the findings are evaluated against a broad background of health profession education literature; implications are raised for intern selection committees and for the applicant.

Dietetics↗

PubMed1999

A new survey instrument: a sample of a typical TMD practice.

The study evaluated 646 patients treated in a full time TMD practice with a new survey tool based on a patient self-report questionnaire. It would appear that this new approach to practice evaluation has not been previously reported in the literature. The results indicate that the average patient has a significant time delay of 24 to 120 months from onset of symptoms to the beginning therapy and that the majority of patients see three or more practitioners before reaching the TMD therapist. Most significantly, there are strong indications that early intervention and persistent compliance with prescribed therapy produces the highest level of success. Valuable practice statistics regarding patient treatments, patient outcomes and modalities of therapy have proven intensely useful in managing the patients, educating the public, communicating with the referral base, as well as in negotiating participation agreements with managed care institutions.

Adolescent↗

PubMed1987

On rates of improvement with practice.

A survey of practice effects for several sensory-motor tasks shows that no one linear equation relating performance time to practice gives a good description of them all. However, most of the data are well described in terms of equations derived from signal-detection theory, which postulate that, during each trial, activation of a correct response has to be made to an extent that it is discriminable from others. The activation is built up in part during the trial concerned and in part from a carry over from previous trials. In some cases, practice effects are proportional to the time taken by the first trial, but in others they are not. The question is considered of whether effects should be treated in terms of trials or of time. The extra information gained by comparing the regressions for two or more conditions in a task or for groups of subjects, rather than looking at one alone, is noted.

Journal Article↗

PubMed1990

Breast self-examination and the health belief model: variations on a theme.

Variables derived from the Health Belief Model (HBM) were studied in relation to breast self-examination (BSE) performance, which was measured in terms of both frequency and thoroughness. Data were collected from 202 adult women via self-administered questionnaires. Susceptibility and Seriousness were combined to form a "threat of breast cancer" variable, and two approaches were used to compute "net perceived efficacy of BSE." However, barriers and susceptibility in their original form explained more variance in BSE practice than did the combined variables. The negative relationship found between perceived barriers and BSE performance (r = -.44) is consistent with previous findings. Implications for research and practice are presented.

Adult↗

PubMed2004

Challenges in end-of-life care in the ICU: statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003: executive summary.

OBJECTIVE: The purpose of the conference was to provide clinical practice guidance in end-of-life care in the ICU via answers to previously identified questions relating to variability in practice, inadequate predictive models for death, elusive knowledge of patient preferences, poor communication between staff and surrogates, insufficient or absent training of healthcare providers, the use of imprecise and insensitive terminology and incomplete documentation in the medical record. PARTICIPANTS: Presenters and jury were selected by the sponsoring organizations (American Thoracic Society, European Respiratory Society, European Society of Intensive Care Medicine, Society of Critical Care Medicine, Société de Réanimation de Langue Française). Presenters were experts on the question they addressed. Jury members were general intensivists without special expertise in the areas considered. Experts presented in an open session to jurors and other healthcare professionals. EVIDENCE: Experts prepared review papers on their specific topics in advance of the conference for the jury's reference in developing the consensus statement. CONSENSUS PROCESS: Jurors heard experts' presentations over 2 days and asked questions of the experts during the open sessions. Jury deliberation with access to the review papers occurred for 2 days following the conference. A writing committee drafted the consensus statement for review by the entire jury. The 5 sponsoring organizations reviewed the document and suggested revisions to be incorporated into the final statement. CONCLUSIONS: Strong recommendations for research to improve end-of-life care were made. The jury advocates a shared approach to end-of-life decision-making involving the caregiver team and patient surrogates. Respect for patient autonomy and the intention to honor decisions to decline unwanted treatments should be conveyed to the family. The process is one of negotiation, and the outcome will be determined by the personalities and beliefs of the participants. Ultimately, it is the attending physician's responsibility, as leader of the team, to decide on the reasonableness of the planned action. If a conflict cannot be resolved, an ethics consultation may be helpful. The patient must be assured of a pain-free death. The jury subscribes to the moral and legal principles that prohibit administering treatments specifically designed to hasten death. The patient must be given sufficient analgesia to alleviate pain and distress; if such analgesia hastens death, this "double-effect" should not detract from the primary aim to ensure comfort.

Belgium↗

PubMed1977

A dose-response study of atenolol in mild to moderate hypertension in general practice.

A double-blind, crossover, multicentre study of 98 previously untreated patients with mild to moderate essential hypertension was carried out in general practice to assess the effect of 50 mg, 100 mg, and 200 mg atenolol, given once daily, compared with that of placebo over a period of 4 weeks each. At the end of the double-blind phase, all patients took 100 mg atenolol daily for a further 8 weeks. All three doses of atenolol produced statistically significant falls in systolic and diastolic pressure and pulse rate (p less than 0.001). The lowest pressures were achieved with 100 mg daily; a difference of 22/15 mmHg at the end of the double-bling phase, and a difference of 25/16 mmHg at the final observation. Body weight, blood urea, blood uric acid, and serum electrolytes remained within normal limits throughout the study. The incidence of side-effects with 50 mg and 100 mg atenolol was not significantly different from that caused by placebo, but the incidence of tiredness at the 200 mg dose level was greater than that caused by placebo and by the lower doses. The incidence of possible side-effects elicited by a questionnaire was low, the greatest number being volunteered by patients taking placebo. It is concluded that the optimal dose of atenolol for treating patients with mild to moderate hypertension in general practice is 100 mg daily.

Adult↗

PubMed2002

Practice management. Gender offenders.

A postal survey of practice managers in London found that women earned 5,000 Pounds a year less than men, on average. Women who had previously worked as receptionists in the practice were particularly poorly paid. Practice management remains a female-dominated profession. Primary care trusts should seek to standardise rates of pay and promote greater equality.

Data Collection↗

PubMed1998

[Trying vaginal delivery in 1000 patients with previous cesarean section in the Antiguo Hospital Civil de Guadalajara].

Because of the main justification for practicing a cesarean section is due to a previous cesarean and the rasing rates frequency of this operation, we concluded a descriptive and prospective investigation in order to analize the factibility and security of vaginal delivery after one cesarean section. We include 1000 patients with a past history of one previous cesarean section and with the following main characteristics: normal evaluation of the actual pregnancy and a gestational age of at least 36 weeks of pregnancy, no pelvis stenosis and a normal fetal status. The management were expectant and or with the use of oxitocin, prostaglandin PGEJ, uterionhibition and or amnioinfusion according to medical indication, 679 (67.9%) patients had a vaginal delivery; one ruterine rupture (0.001 x 1000) happened (the place of the rupture were not in the scar of the previous cesarean); two uterine dehicence (0.002 x 1000) of the previous uterine scar; one of this require laparotomy and sture of the dehiscence scar and the other one only require observation. We had two intrapartum fetal dead (0.002 x 1000) on due to the uterine rupture and the other one because of a taquisitolia not corrected by betamimetics. The factibility and security of vaginal delivery after one previous cesarean section is a logical and reasonable strategy in order to decrease the actual high rates of cesarean section. Whenever we try a viginal delivery in a patients with one previous cesarean is imperative to keep in mind that if something is not going well during the attempts we must repeat another cesarean.

Adult↗

PubMed1991

Clinical audit of theophylline use in general practice.

The use of therapeutic drug monitoring for theophylline therapy was evaluated in two urban general practices. Of 55 patients studied, 44 (80%) had a sub-therapeutic serum theophylline concentration, 11 (20%) had a therapeutic concentration (10-20 micrograms/ml), and none had an above therapeutic concentration. Patients were reviewed at weekly intervals and had their theophylline dosages adjusted according to serum levels. A therapeutic concentration was achieved in 37 patients (67%). This task proved to be 'laborious but not difficult'. Side-effects were less common than previous reports suggest. The general practice workload involved in adjusting theophylline dosage was approximately four consultations, one dose change and two serum assays per 'average' patient.

Adolescent↗

PubMedDate not supplied

Exploring the nature of informed consent in coronary care practice.

The nature of informed consent is bound within legal and moral duties. An analysis of informed consent includes the elements of understanding, disclosure, competence, voluntariness and authorisation, all of which can be affected by a variety of factors. Nurses can make a unique contribution to informed consent situations either as advocates, interpreters, coordinators, witnesses or culture brokers. In order to fulfill their obligations to the patient and manage potential conflicts, nurses need to have a substantial awareness to the diversity of issues and pitfalls. Communication skills and building a therapeutic alliance with the patient are at the heart of nursing care. Nurses are taking on duties previously associated with medical practice-it is unclear how this affects their roles as information givers.

Communication↗

PubMed2006

Draughtsmen, botanists and nature: constructing eighteenth-century botanical illustrations.

At first glance botanical illustrations of the eighteenth century might be interpreted as being naturalistic portraits of living plants. A more detailed investigation, however, reveals that the pictures were meant to communicate typical features of plant species in the way of a model. To this end, botanists of the period gave botanical draughtsmen specialist training; copying earlier examples and standardised motives from drawing books was a common part of this training. The practice of copying elements of previously published drawings and integrating them into new pictures was also widespread. However, only carefully selected elements were taken over, and even these were improved in terms of their correctness and appropriateness to the new context. This procedure was a strategy that eighteenth-century botanists used so that they would present an illustration that met their own requirements more satisfactorily than existing depictions. From this perspective, botanical illustrations can serve as historical sources on the working practices of eighteenth-century botanists and draughtsmen, which are usually not mentioned in textual sources.

Audiovisual Aids↗

PubMed2002

Current diagnostic criteria and their impact on outcome and management.

The 1997 American Diabetes Association (ADA) Expert Committee on the Diagnosis and Classification of Diabetes Mellitus and the Provisional Report of the WHO Consultation focus on a fasting plasma glucose (FPG) that is 126 mg/dl or greater and confirmed on a subsequent day as the preferred criterion for the diagnosis of diabetes mellitus. This criterion is supported by studies demonstrating that this threshold accurately differentiates between non-diabetic and diabetic populations and is associated with the development of specific diabetic microvascular complications. It corrects for the inequivalence of the FPG and 2- hour post glucose (2hPG) criteria of the previous National Diabetes Data Group (NDDG) and WHO diagnostic schemes and recognises that oral glucose tolerance tests (OGTTs) rarely are performed in clinical practice. Although the new and the previous criteria produce similar estimates of the prevalence of diabetes, there may be a considerable degree of reclassification. Preliminary studies suggest that the new criteria favour the diagnosis of diabetes in younger and more obese individuals, whereas the older criteria increase the likelihood of diagnosis in older, leaner individuals.

Adolescent↗

PubMed2005

When remembering causes forgetting: retrieval-induced forgetting as recovery failure.

Retrieval practice on a subset of previously learned material can cause forgetting of the unpracticed material and make it inaccessible to consciousness. Such inaccessibility may arise because the material is no longer sampled from the set of to-be-recalled items, or, though sampled, its representation is not complete enough to be recovered into consciousness. In 2 experiments, it was examined whether retrieval-induced forgetting reflects a sampling or recovery failure by studying the time course of cued recall in this type of situation. Although retrieval practice reduced recall totals of the unpracticed items, in both experiments, the forgetting was not accompanied by an effect on the items' response latencies. This pattern of results is consistent with the view that inhibited items are successfully sampled but, because of a reduction in their activation level, do not exceed the recovery threshold.

Humans↗