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The injecting of illicit drugs frequently involves the sharing of injection equipment and a risk of HIV transmission. Injecting drug use at any time since 1980 should be considered a high-risk activity and users should be advised to have HIV testing. Recognition of this important lifestyle clue is more likely to occur if the doctor has evolved a practical approach to the possibility of illicit drug use.
A bill for Advanced Practice Nurse (APN) Prescriptive Authority was introduced into the Michigan state legislature in 1996, and again in 1997. The legislation would add registered professional nurses with specialty certification to the list of health practitioners granted independent prescribing rights. Currently, licensed dentists, medical doctors, osteopathic doctors, podiatrists, certified optometrists and veterinarians comprise the list of prescribers.
OBJECTIVE: To determine (a) the amplitude and duration of reduction of the symptom score and improvement of the HRQL score (including sexual function), (b) the adverse effects and (c) the incidence of acute urinary retention and prostatic surgery during the 3 years of alfuzosin treatment. MATERIAL AND METHODS: 3,228 patients suffering from BPH were included by 812 centers in a 3-year open prospective study and were treated with alfuzosin (immediate release) at the recommended dosage. A symptom score (modified Boyarsky) and a specific HRQL score, comprising 20 items including 3 questions on sexuality (Urolifetm BPH Qol20) were self-administered on inclusion and after 3, 6, 12, 18, 24, 30 and 36 months. RESULTS: 2,579 patients (79.9%) completed the 3 years of the study. The symptom score was significantly decreased by 54% at 3 months and this reduction was maintained until 36 months (-48.4%); the HRQL score was significantly improved by 45.4% at 12 months and this improvement was maintained until 36 months (+43.4%). Alfuzosin was well tolerated: the qualitative and quantitative distribution of adverse effects was identical to that previously observed in placebo-controlled trials (vertigo-dizziness: 2.1%). Adverse effects were responsible for 4.2% of drop-outs from the trial. 120 patients (3.7%) were operated for BPH and 9 patients (0.3%) developed acute urinary retention. CONCLUSION: This prospective study confirms the long-term safety of use of alfuzosin under routine general practice conditions and emphasizes the need to measure HRQL in the context of the patient's opinion.
The purpose of the present study is to determine the efficacy of induction ovulation with recombinant FSH in patients treated with in vitro fertilization and embryo transfer (IVF-ET) and basic assisted reproductive techniques (ART). One hundred seven cycles were analyzed. The patients were divided in two groups: Group 1, treated with IVF (n = 12) and group 2, treated with basic ART (n = 95). Only recombinant FSH was utilized for ovulation induction; human corionic gonadotropin (hCG), 10,000 IU, were administered when one or more dominant follicles with diameter > or = 18 mm were presents; oocyte retrieval was performed 34 hour, while intrauterine insemination was practiced at 36 hours after the hCG injection. The pregnancy rate per IVF cycle was 25.0%, and 16.4% for basic ART. It is concluded that ovulation induction with recombinant FSH is a good and efficient alternative for both variations of ART.
The tunnel or 'internal' restoration to restore an approximal caries lesion was first described in 1984. The technique allows the operator to conserve the important external anatomical features of the tooth, thereby saving considerable clinical time while leaving relatively little of the material externalized. The development of a new generation of glass-ionomer materials with higher flexural and compressive strengths appears to satisfy the main objective of carious dentine replacement facilitated by a 'keyhole' internal preparation. The long-term clinical evaluation of these materials is difficult since new formulations are being continually developed. The literature was reviewed. Clinical cases restoring approximal caries lesions in permanent molars and premolars were observed in a private practice. Over the course of eight years 60 tunnel restorations were placed in 48 regularly attending patients. The materials used in both total and partial tunnel restorations were Ketac Silver, Hi-Dense and Fuji IX. At eight years a failure rate of 15% was seen in the 50 restorations observed at last dental examination. The findings suggest that modern tunnel techniques may offer a restorative technique worthy of consideration in treating primary approximal caries lesions.
Bioassay technicians sometimes have limited statistical training and require more help when preparing bioassay data for filing with regulatory agencies. Three things should be considered when approaching problems in statistics: (i) Assess the situation: data should be checked for accuracy and bias; (ii) Is the situation resolving on its own? Are the skills in place to answer this question? (iii) If no to 2, find expert help. Some sources of variability in bioassays are listed. Some sources of expert help are listed. An example is given of how a statistics problem was solved by a technician unfamiliar with statistics. Some practical tips for design, analysis and regulatory issues are presented.
The nursing classification systems have contributed to delimit our professional domain, by identifying concepts that are part of our professional language, and by promoting the knowledge concerning those concepts meanings. In this work, the authors report the process of transcultural adaptation of 145 terms (or concepts) identified in the CIPESC project and already included in the axis Focus of nursing practice of the Nursing Phenomena Classification/ICNP--Beta version. The process of transcultural adaptation was done through the comparison of the translation of those 145 terms into the Portuguese of Brazil with the translation of the same terms into the Portuguese of Portugal, taking the original text in English as the basis of comparison.
A commitment to quality must run throughout the organisation, from top management to grassroots staff. Evaluation of service quality needs to be a systematic, continuous part of working practice. Improved quality management can enhance client-centred healthcare.
The contribution into activities connected with the development of the quality of nursing care is closely combined with the process of systematic recording of accumulated data, of undertaken activities and achieved results. This in turn constitutes the essence of the 31st Aim of WHO which speaks not only about the need to continue the rational contribution towards the increase in the nursing care quality but also the application of adequate computer technologies to improve this quality. The aim of this work is to demonstrate the scope and character of the activities that have been over years undertaken by the nursing community towards the development of the classification systems which are comparable with those used in medicine. The focus has been specifically put on the taxonomy of diagnosis used by the North American Nursing Diagnosis Association (NANDA) and the European International Classification of Nursing Practice (ICNP). The analysis of the reference sources constitutes the methodological foundation applied in this work. It has allowed to show the pioneering contribution of the American Nursing Association (ANA) into the process of recording and coding of the data that are essential in care delivery as well as their value for the development of ICNP. The latter one is a systematic and multi-axial structure which uses unified terminology and numeric codes for the three categories of variables: the recognized conditions, the undertaken activities and the achieved results.
This contribution describes practice and tools which allow occupational physicians the realization of theirs tasks not only respecting law and ethical codes, but also in view of a continuous improvement of their activities and customers (companies) and consumers (workers) care.
This article is the first in a series of four providing up-to-date information about the tobacco problem and how physicians can effectively intervene. Three of the four articles are accredited for free continuing medical education (CME) credit for physicians. The CME credit is being provided free of charge by Nemours via the Web site www.pedseducation.org. Physicians may obtain credit by logging on to this site, registering, and completing the post-test and evaluation materials. This article reviews the best evidence-based approaches for tobacco intervention in the busy office. It discusses the implementation of the following components of a tobacco-control program to effectively and efficiently address the tobacco problem: 1) physician counseling to promote smoking cessation, 2) strategies to promote abstinence from smoking, 3) strategies to minimize environmental tobacco smoke exposure, 4) strategies to encourage tobacco use cessation, and 5) office-based interventions. By reading the article and completing the post-test, it is anticipated that the following learning objectives will be met: 1) physicians will become familiar with best practice interventions for tobacco counseling and limiting secondhand smoke exposure, and 2) physicians will become familiar with office based strategies to promote a strong anti-smoking message.
Maintaining the healthcare organization's charitable mission to the community is best served by having formal policies in place. Must-haves include: A written charity care policy tailored to the organization. Financial assistance policies. Processes for identifying and communicating with patients who may need financial assistance. Formal discounting and collection policies and practices that take into account every patient's ability to pay.
The role of the nurse executive is dynamic, requiring a high degree of leadership skill and managerial competence linked with clinical nursing knowledge and research. Preparation for the role requires an integrated curriculum in nursing administration and life span leadership development. Recognition of the professional level of differentiated practice as nursing administration is essential if professional nursing is to remain vital in the 21st century. Transformed schools should be named schools of nursing administration, and the new product should be the nurse executive who has the ability to function in a wide variety of settings on earth and in space.
One hundred and seventy-six men who had engaged in sexual activity with other men in the past six months were interviewed, in the western area of Sydney, about their sexual activities and knowledge as related to the acquired immunodeficiency syndrome (AIDS). Comparisons were made between men who had frequented "beats" (public toilets, parks or isolated roads where men meet for homosexual encounters) in the past six months, and those who did not use beats. One-quarter of those men who frequented beats reported beats as their only venue for meeting men for sexual contact, while other men reported them as one of many venues that they used to meet men. Although all interviewed men were engaging in sexual activities with men, 12 men described themselves as heterosexual, and 12% of those men who used beats, and 7% of the beat non-users, were married or in de-facto relationships. In comparing those who used beats with the beat non-users, 64% of beat users had engaged in sexual practices with between six and 50 different partners in the past six months compared with 8% of beat non-users. Beat users also were more likely to engage in unprotected anal intercourse with causal partners. Nineteen men claimed to be HIV-seropositive for the human immunodeficiency virus, with 11 of these men still engaging in high-risk sexual activities. The implications for AIDS education are discussed.
In a 5-year retrospective study (1982-1978) in a well defined population of 332 patients (representing greater than or equal to 2140 anticoagulation years) from a heart specialist's practice, the question was studied whether optimum anticoagulation (Quick test between 18-29%, INR 4.0-2.75, Geigy thromboplastin, capillary blood method) with minimum complications could be achieved. In the qualitative study it was found that 75% of Quick determinations were in the optimum range for phenprocoumon, 71.6% for clorindion, 62% for acenocoumarol and 72% for all anticoagulants. 77% of phenprocoumon patients were optimally anticoagulated for more than 3 years. With phenprocoumon there was no difference in intensity of anticoagulation between the oldest and youngest patient groups, as all mean Quick values ranged over 20% (means Q% 1982-1978 = 25, INR = 3.0). It was also shown that after 6 months' anticoagulant therapy it is clearly recognizable whether optimum anticoagulation is feasible or not: at that moment the criteria for halting or continuing anticoagulant therapy can and should be reviewed.
We examined the relation of physicians' clinical specialty, personal health habits, and health-related beliefs to their practices in counseling about smoking, weight, exercise, and alcohol. We surveyed a random sample of members of a county medical society in selected specialties. Physicians with better personal health habits and more positive attitudes toward counseling counsel a broader range of patients and counsel more aggressively. Surgeons counsel less than nonsurgeons, even after controlling for differences in health-related attitudes and personal habits.
Therapeutic efficacy and practicability of an interval treatment were investigated in a multi-center study in a total of 1573 patients with psoriasis or eczema, respectively. Fluocortolone monohydrate as Syracort and Syracerin as steroid-free "partner drug" were applied at 4-/3-day intervals. The findings and established results substantiate equivalent therapeutic success in comparison with consistent treatment. Starting from the premise that the risk of steroidinduced skin lesions can be reduced, if not avoided, by interval application of topical corticosteroids one may consider steroid application at intervals as superior to consistent therapy.
A survey of the infant feeding practices of 270 families who belonged to a prepaid medical insurance program revealed extensive use of commercially prepared infant formulas during the first months of life, introduction of beikost before 3 months of age and introduction of cow milk into the diet at 3 to 5 months. Ethnic, as well as socioeconomic differences, were observed in the use of milks and formulas, timing of introduction of beikost, and method of feeding solid foods. Average calorie intakes approached or were greater than the recommended dietary allowances. With the exceptions of vitamin D and iron, most infants received much greater than the recommended intake of all nutrients examined. Average sodium intakes were well above advisable intakes. Many infants received supplements of vitamins A, B1, B2, B6, and C in addition to adequate dietary intakes. Results of this survey indicate that many mothers look to pediatricians for advice on how to feed their infants and several findings indicate that nutrition education efforts directed toward pediatricians and parents must be more vigorous than they have been in the past.