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PubMedDate not supplied

The principles of pressure sore prevention.

In the first Practice Profile to be published in Nursing Standard, Debbie Quinn demonstrates how studying a Continuing Education reader helped to develop an area of clinical practice--the prevention of pressure sores. Continuing Education Readers are made up of between four and six CPD (previously CE) articles and Debbie based her Profile on one of these. We will be publishing further Practice Profiles related to CPD articles.

Clinical Nursing Research↗
PubMed1998

The effect of spherical and other aberrations upon the modulation transfer of the defocussed human eye.

Relative modulation transfer is defined as contrast sensitivity under blur normalised to contrast sensitivity at optimum focus. Measured relative modulation transfer exceeds relative modulation transfer as calculated for aberration free optics at higher spatial frequencies (> 2 cpd). The contribution of spherical aberration to this discrepancy was studied. In the case of positive blur, spherical aberration increases relative modulation transfer for spatial frequencies of approximately 4 cpd and over. However, spherical aberration does not explain the entire difference between measured and calculated relative modulation transfer. Chromatic aberration does not provide a noticeable additional explanation. With negative blur, spherical aberration increases the relative modulation transfer much more. The effect of other monochromatic aberrations on relative modulation transfer is discussed.

Contrast Sensitivity↗
PubMed1999

Obstetric outcome of teenage pregnancy in northwestern Ethiopia.

OBJECTIVE: To investigate and compare the difference in pregnancy outcome in teenage pregnancies and pregnancy in an older age group. DESIGN: A cross sectional observational study. SETTING: Department of Obstetrics and Gynaecology, Gondar College of Medical Sciences (GCMS) Hospital. SUBJECTS: All teenage pregnant women and older pregnant women who delivered in the hospital over one year period were evaluated. MAIN OUTCOME MEASURES: Antenatal care (ANC) attendance, pregnancy induced hypertension, cephalo-pelvic-disproportion (CPD), low birthweight (LBW), prolonged labour, preterm delivery, assisted delivery, stillbirth and low Apgar score. RESULTS: Mean age of teenagers and older age group was 17.6 +/- 1 and 28.6 +/- 5.7 years, respectively. Statistically significant difference (p < 0.05) was observed in the following variables when teenagers were compared to the older age group: ANC attendance 60.9% versus 74.8%; weight less than 50 kg. 40% versus 18.9%; height less than 150 cms 21.2% versus 7.3%; CPD 11.8% versus 2.1%; prolonged labour 9.2% versus 5.6%; delayed second stage 18.3% versus 4.4%; preterm delivery 21.8% versus 11.3%; assisted delivery 21.8% versus 9.3% and LBW 27% versus 10%. No significant difference was observed in the mean Apgar score and stillbirth rate in the two groups. CONCLUSION: Teenage pregnancy is associated with adverse outcome; and teenagers perform poorly in labour and delivery. We recommend the initiation of a programme which should create a means of easily reaching the adolescent to promote family life education, contraception, counselling and education related to early marriage.

Adolescent↗
PubMed1999

Peritoneal mesothelial cells produce complement factors and express CD59 that inhibits C5b-9-mediated cell lysis.

The CD59 membrane protein confers protection from C5b-9-mediated cell lysis. Because evidence exists for complement (C) activation and generation of C5b-9 in the peritoneal cavity during chronic peritoneal dialysis (CPD), we investigated, on mesothelial cell (MC) lines, the expression of CD59 and the production of C components. Four MC lines were obtained from children on CPD, and two from non uremic children. CD59 expression on MCs was investigated with anti-CD59 monoclonal antibody (mAb) and polyclonal goat immunoglobulin G (IgG). MC lines were positive for staining with anti-CD59 mAb. Western blotting analysis of MC membrane demonstrated a band with the same molecular weight as CD59. Incubation of MC with anti-CD59 mAb abrogated the protective effect of CD59 (100% cytotoxicity). C3, C4, and C6 were detected in the supernatants of MC; in non uremic MC supernatants, C5, C7, C8, and C9 were also detectable, and C4 concentration was tenfold higher. CD59 expression confers to MCs protection from C5b-9-mediated lysis. MCs produce C factors. These findings suggest that production of complement components and expression of CD59 on MCs could play a role both in peritoneal cavity infection (decreased complement production) and in peritoneal membrane damage (decreased CD59 expression and reduced remesothelialization owing to MC lysis).

CD59 Antigens↗
PubMed2000

Association between external pelvimetry and vertex delivery complications in African women.

OBJECTIVE: To assess association between external pelvimetry and delivery complications in vertex presentation. METHODS: Prospective cohort study of 2,413 pregnant women antenatally measured for height and external pelvimetry in four hospitals of the former Republic of Zaire. OUTCOME MEASURES: Complications during delivery of single fetus weighing 2,000 g or more in vertex presentation. Cut-off values at risk for delivery complications were height and pelvic distances closest to the study population 10th percentile. RESULTS: In univariate analysis, maternal height showed significant relative risk for predicting primary cesarean section for failure to progress: 2.0 (95% CI=1.0-4.1; p=0.050) and vacuum or forceps delivery: 15.7 (95%, CI=6.6-37.5; p<0.001). Selected external pelvic distances showed significant relative risks for predicting the following complications: primary cesarean section for failure to progress, elective repeat cesarean section, vacuum or forceps delivery and spontaneous intrapartum stillbirth. Among pelvic predictors, transverse diagonal (TD) of Michaelis sacral rhomboid area was associated with all of these complications. Intertrochanteric (IT) diameter was associated with three of them. The relative risks ranged from 2.3 (95% CI=1.1-6.3; p=0.030) to 9.6 (95% CI=4.1-22.5; p<0.001) for these strongest predictors. CONCLUSIONS: External pelvic distances help to predict vertex delivery complications in African women. The predicted complications are compatible with the cephalopelvic disproportion concept (CPD). After validation of current results in a separate cohort, measurements of IT and/or TD are recommended to improve antenatal screening of women at risk for CPD in limited resources settings.

Adolescent↗
PubMed1975

Effect of agitation on platelet aggregation and microaggregate formation in banked blood.

Blood stored at 4 C in ACD or CPD solution develops microaggregates composed primarily of fibrin and platelets. This debris has been implicated in the pathogenesis of posttraumatic pulmonary insufficiency in man. Recent work indicates that gentle agitation of the blood during storage appears to decrease debris formation. These studies were undertaken to establish more clearly the effect of agitation on debris formation. Blood was drawn in CPD from healthy young males, non-aspirin ingesting donors and stored at 4 C. One-half of the bags were gently and continuously agitated for 21 days and the other half remained stationary. At the end of the storage period, platelet counts and screen filtration pressures were measured. Agitated blood showed significantly less debris formation and significantly higher platelet counts. Gentle agitation was shown to be an effective method for preventing debris formation in banked blood.

Adult↗
PubMedDate not supplied

[Continuing medical education in Croatia and the European Union].

The Continuing Medical Education (CME), with attention to other forms of Continuing Professional Development (CPD) in Croatia and the today endeavors in the European Union, are presented. In European Union the formal CME is in its starting. The "European Accreditation Council for Continuing Medical Education" (EACCME) of the UEMS is established, which has formulated the principles of continuing education, the credit hours and their realizing, that would enable the mutual recognition of education in all European countries. In Croatia the starting of CME was at beginning of the 20th century, when the professional societies of Croatian Medical Association were founded. CPD was almost exclusively connected to activities of "Andrija Stampar" School of Public Health, to the School of Medicine in Zagreb and partly in Rijeka, which established a great number of postgraduate studies. The CME i.e. the courses of education were tightly connected to activities of the Croatian Medical Association, of its professional societies and its Academy of Medical Sciences, but also to activities of School of Medicine in Zagreb and Rijeka, and recently in Split and Osijek. Since 1995 the third partner, the Croatian Medical Chamber joined too. The number of CME meetings during 1998 is presented. The approximate calculation for needed annual courses of CME for all medical specialties in Croatia is presented. The formation of the National Authority for CME is suggested, in which all the interested institutions should be represented.

Croatia↗
PubMed2001

Normalization models applied to orientation masking in the human infant.

Human infants can discriminate the orientation of lines within the first week after birth (Atkinson et al., 1988; Slater et al., 1988) but have immature orientation-selective pattern masking until after 6 months of age (Morrone and Burr, 1986). Here the development of orientation processing is further examined using a visual-evoked potential paradigm and normalization models of pattern masking. Contrast response functions were measured for 1 cycle per degree (cpd) gratings, counterphase-reversed in contrast at either 3.3 or 5.5 Hz. A second 1 cpd, 20% contrast, 8.3 Hz grating of either the same or orthogonal orientation was added as a mask. Evoked responses associated with the test grating, the mask, and intermodulation between the two were individually extracted using spectral analysis of the scalp-recorded EEG. Adults exhibited orientation selectivity in the masking of their test component responses and in nonlinear intermodulation between the test and mask stimuli. Infants <5 months old, however, demonstrated nonselective masking or a reversed selectivity in their responses to the test component, with adult-like orientation selectivity in their intermodulation responses. Within the context of a normalization model of pattern masking, the results are consistent with the existence of oriented filters early in life the responses of which are normalized immaturely until approximately 5 months of age.

Adult↗
PubMed2001

[Continuing should be a part of the clinical reality. Courage is required to see both the strong and the weak sides of the professional situation].

Continuing professional development (CPD) is a joint responsibility of the individual physician and the employer. CPD should focus on identification and documentation of the learning needs of the individual, based on professional demands. Reflection, feedback and evaluation of the results are central elements of the process. Efficient learning demands active participation; modern information technology is now becoming more widely available.

Curriculum↗
PubMedDate not supplied

[Humoral response to the injection of acellular Pertussis vaccine].

The humoral response of mice and rabbits to the injection of whole-cell pertussis vaccine (PV) and acellular pertussis vaccine (APV), developed at the Mechnikov Research Institute for Vaccines and Sera (Russian Acad. Med. Sci.) in Moscow, was studied. In the sera of immunized animals antibodies to the antigenic complex were determined in the direct hemagglutination (DHA) test, specific antibodies to filamentous hemagglutinin (FHA) and pertussis toxin (PT)--in the enzyme immunoassay (EIA) and antibodies neutralizing PT in a cytopathogenic dose (CPD)--in neutralization test on Chinese hamster ovary (CHO) cells. In mice and rabbits immunized with APV the antibody titers determined in the DHA test were higher than those in the animals immunized with PV. Specific antibodies titers to FHA and PT in the sera of rabbits immunized with APV were also higher than those in the sera of rabbits immunized with PV. High dilutions of sera taken from the animals immunized with APC neutralized 4-16 doses of PT in the neutralization test on CHO cells. The most important result of this study was the detection of a more pronounced immune response in the animals immunized with APV in comparison with that induced by PV according to the results obtained in EIA and in the test of PT CPD neutralization on CHO cells.

Adhesins, Bacterial↗
PubMed2002

Prospective comparative study of two cerebral protection devices in carotid angioplasty and stenting.

BACKGROUND: The aim of the study was to compare two of the available cerebral protection devices (CPD) PercuSurge, balloon type (group A) and Angioguard, filter type (group B) used in carotid stenting and angioplasty (CAS). METHODS: From September 1999 to February 2001, 26 consecutive patients undergoing CAS were alternatively assigned to group A and B. Postoperative disabling stroke and neurological mortality, nondisabling stroke, TIA and non-neurological mortality were examined. CPD features included time required, ease of handling, device rupture or malfunctioning, radiopaque markers evidence, abnormal major mobility of the opened system. RESULTS: RNCR was 0 and TIAs were not observed in either group. Four patients (3 in group A and 1 in group B) showed drowsiness in the immediate postoperative period. Perioperative carotid occlusion and surgical conversion were observed in 1 case of group A. Average time calculated from the beginning of set-up to complete removal was 46 min in group A versus 31 min in group B. Abnormal major mobility of the opened system was very often observed during endovascular maneuvers with both devices. CONCLUSIONS: CAS may protect against postoperative procedure-related neurological events. Common and specific disadvantages were observed in both systems showing they were not close enough to the ideal device.

Aged↗
PubMed2002

[Experience with the clinical use of beta-tri-calcium phosphate (Cerasorb) as a bone replacement graft material in human periodontal osseous defects].

Various bone replacement graft materials have been used in attempting to restore periodontal bone structure lost as a result of periodontal inflammation. The pure beta-tricalcium phosphate has been successfully used in oral surgery for replacing lost bone but the periodontal data available are very limited. The major objective of the present clinical trial is to evaluate the regenerative-reparative potential of beta-tricalcium phosphate (CERASORB) in the treatment of two-three-wall vertical periodontal bony defect. 21 patients with advanced intrabony defects were selected for this study. Parameters used for assessment: Bleeding on probing, Clinical Probing Depths (CPD), Clinical Attachment Loss (CAL), Clinical Gingival Recession (CGR) and Radiological evaluation on standardized periapical radiographs. Following local anesthesia, intracervicular incisions is placed and a full thickness mucoperiosteal flap is raised vestibularly and lingually. The granulation tissue was completely removed from the defects and the roots were thoroughly scaled and planed using hand and ultrasonic instruments. Osseous recontouring was not performed. Following defect debridement, the CERASORB bone-grafting material was carefully applied and gently condensed in the bone crater then the flaps were repositioned in a coronal position and closed with vertical or horizontal mattress sutures. Six months after surgery CPD, CAL and CGR parameters were also measured and compared to baseline data. Bone defects treated with beta-TCP bone grafting materials showed a great variation in healing tendency. The best radiological results (bone fill) were obtained in three wall defects. Even using the most thorough suturing technique substantial part of the bone grafting material was lost during the first post-surgical week. If no sequestration occurred substantial bone fill and clinical attachment gain occurred especially in the three wall defects one year after grafting. The use of biological barrier membranes are recommended.

Adult↗
PubMed2002

Obstructed labor at a district hospital.

A retrospective analysis of all deliveries that occurred at Jimma hospital, south western Ethiopia from September 1990 to May 1999 was conducted to determine the incidence, maternal and perinatal outcome, sociodemographic and clinical characteristics of mothers with obstructed labor. Seven percent (945/13,425) of the deliveries were complicated with obstructed labor with an overall increasing trend noted during the study period. Sixty seven percent of the cases were primigravida and grand multiparous mothers. Fourteen percent of obstructed labor occurred among teenage pregnant mothers. Forty four percent of the cases had no antenatal care while 35.1% had antenatal care. Cephalopelvic disproportion (CPD) was responsible for 80.6% of the cases, malpresentations accounting for the remainder, shoulder presentation being the commonest (11.5%). Fifty eight percent of the CPD cases were among the primigravida but para two to four mothers were not immune accounting for 25.7% of the cases, the rest being grand multipara, (15%). Fifty seven percent of the ruptured uterus cases were para two to four mothers while primigravids accounted for 7.2%. Maternal mortality was 9.1% while 62.1% of the perinates died with only 12.5% of the neonates having normal first minute apgar scores. Obstructed labor was the commonest cause of maternal and perinatal mortality at the hospital during the study period responsible for 45.5% and 37.4% of the deaths respectively. Any attempt to reduce maternal mortality at the hospital must comprehensively address the issue of obstructed labor, identify risk groups of mothers for this peripartum complication and design preventive strategies.

Adolescent↗
PubMed2002

Comparison of quality-of-life assessment in Russia and the United States in chronic peritoneal dialysis patients.

Numerous reports of quality-of-life data in chronic peritoneal dialysis (CPD) patients in the United States and Western Europe use the short form questionnaire (SF-36). Few centers in Europe have reported data examining the incidence of depression in CPD patients. Depression has been shown to correlate with morbidity and mortality in dialysis patients. A high incidence of clinical depression is seen in end-stage renal disease patients in the United States. We thought it could be important to compare depression measurements between the United States and European countries. Quality-of-life data of the peritoneal dialysis patients from the New Haven continuous ambulatory peritoneal dialysis (CAPD) unit and from the New Technology Center at Hospital #31 in St. Petersburg were compared. The Beck Depression Inventory (BDI) and the SF-36, which includes the mental component score (MCS) and the physical component score (PCS), were administered to the patients. The study participants included 147 Russian and 96 U.S. patients. The BDI, PCS, and MCS scores were similar in both groups. The BDI scores in the Russian patients indicated that a high incidence of clinical depression likely exists in that patient population. The utility of the BDI in assessing quality-of-life issues in Europe and Russia requires further evaluation.

Activities of Daily Living↗
PubMed2002

Racial differences and peritonitis in an urban peritoneal dialysis center.

Racial differences have been reported among various groups with end-stage renal disease maintained on dialysis. In particular, patient survival on dialysis has been reported to be better in African-American patients than in Caucasian patients. Peritonitis rates and dropout from chronic peritoneal dialysis (CPD) have been reported to be higher in African-American patients. We decided to review our experience with peritonitis rates in African-American and Caucasian patients. From 1994 to 2000, 403 patients were maintained on CPD in the New Haven continuous ambulatory peritoneal dialysis (CAPD) unit. Peritonitis rates were 1 episode in 14 patient-months in Caucasian patients and 1 episode in 13.6 patient-months in African-American patients. Mean ages at the start of dialysis were 52.4 +/- 16.2 years in the Caucasian patients and 62.6 +/- 14.9 years in the African-American patients. African-American patients were older. African-American and Caucasian patients had similar peritonitis rates. Time of first episode of peritonitis was not different in the two groups.

Adult↗
PubMed2002

Continuous ambulatory peritoneal dialysis: Indian scenario.

Chronic peritoneal dialysis (CPD) has been initiated as a treatment modality for chronic renal failure patients in the Indian subcontinent since 1990. Over a period of 9 years both continuous ambulatory peritoneal dialysis (CAPD) and continuous cyclic peritoneal dialysis (CCPD) have emerged as accepted forms of renal replacement therapy in our country. Although there were government restrictions on import of dialysis fluid until 1993, the availability of locally manufactured fluid in collapsible bags had facilitated the expansion of the programme to the far corners of the country and in neighbouring countries. Initially majority (78%) of the patients who were started on this programme were diabetics with other comorbid conditions who were drop-outs from haemodialysis and unfit for transplantation. Both CAPD and CCPD have been used for all age groups and for men and women. Majority of the patients do 3 x 2 l exchanges a day on CAPD; 8-10 l using a cycler at night those who are onCCPD. Peritonitis rate was 1 episode every 18 patient months. With the introduction of new connection and disposable sets the incidence of peritonitis is dropping down. The major cause of drop-out is cardiovascular death followed by peritonitis. Malnutrition is a major problem in both CAPD and haemodialysis patients. The programme has been expanded and there are over one thousand patients on this treatment in the country. The introduction of CPD had a major impact on the treatment of renal failure in India.

Blood Urea Nitrogen↗
PubMed1992

Continuous peritoneal dialysis in children.

During the period from June 1985 to December 1991, 48 children were treated with continuous peritoneal dialysis (CPD) in our centre because of acute renal failure. The median age was 1.8 years (range 0.01-17.1). The most common diagnoses were: hemolytic uremic syndrome (n = 22), anuria after cardiac surgery (n = 7), and septicemia with multiorgan failure (n = 7). Kidney function recovered in 35 (73%); 13 (27%) died of their original disease. One further patient with HUS recovered from dialysis but died of cerebral complications shortly afterwards. One patient remained anuric and requires renal replacement therapy. Hyperkalemia, when present initially, and uremia could be controlled adequately in all cases. However, ultrafiltration posed problems when cardiac output was low. Peritonitis occurred in 11 patients; in 8 children the Tenckhoff catheter had to be revised because of leakage (5), flow problems (2), or bowel perforation (1). CPD proved to be an excellent method to treat acute renal failure in children of all age groups. The rate of complications was acceptable.

Acute Kidney Injury↗
PubMed1992

Complement activation during storage of blood under normal blood bank conditions. Effects of proteinase inhibitors and leukocyte depletion.

During storage of CPD-A1 preserved whole blood factors of the complement cascade become activated, as evidenced by a rapid increase in the concentrations of C3a-desArg and C4a-desArg. After 10 to 14 days of whole blood storage, the elevations of C3a and C4a levels were highly significant. This increase was paralleled by an increase in the concentration of the lysosomal proteinase elastase from polymorphonuclear (PMN) granulocytes. By contrast, the concentration of the C3 activator complex C4b2b remained unchanged even after 3 weeks of storage. The supplementation of the anticoagulant CPD-A1 with the polyvalent-proteinase-inhibitor aprotinin and the specific elastase-inhibitor eglin C failed to inhibit complement activation, whereas leukocyte depletion could partially abolish the increase of the concentration of C4a, but had no effect on C3a concentrations. These observations support the notion that cleavage of C4 during storage of whole blood is partially leukocyte dependent, whereas the activation of C3 is possibly caused by the activation of the alternate pathway of the complement system by contact of plasma with plastic surfaces.

Aprotinin↗