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PubMed1980

Technical problems and advances in the cerebellar-stimulating systems used for reduction of spasticity and seizures.

A series of 300 patients were implanted for chronic cerebellar stimulation (CCS) from February 1974 to June 1980. The charge density was in the range of 0.7-1.6 microCi/cm2/phase. There is a very narrow range of stimulation in which CCS is effective. Increasing above the range, clinical benefits cease; at levels over 10 microCi/cm2/phase, damage to the underlying conducting elements occurs which renders the prosthesis ineffective. Periodic monitoring of the implanted equipment is mandatory for a successful clinical program. Scalp recordings and radiography have detected a 53% failure rate in the I-108 RF linked system. The failed receivers were replaced with more reliable I-110 receivers and later with a fully implantable pulse generator. No change has been detected in the electrode button-cortex interface when measuring the access resistance up to 5 years later.

Cerebellum↗

PubMed2003

Application of current guidelines to the management of unstable angina and non-ST-elevation myocardial infarction.

Unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) is a common but heterogeneous disorder with patients exhibiting widely varying risks. Early risk stratification is at the center of the management program and can be achieved using clinical criteria and biomarkers, or a combination. In addition to anti-ischemic therapy and aspirin, the thienopyridine clopidogrel is indicated except in patients who are potential candidates for urgent coronary artery bypass grafting (CABG). Platelet glycoprotein (GP) IIb/IIIa antagonists are indicated in high-risk patients likely to undergo percutaneous coronary intervention (PCI) but are not indicated in the management of lower-risk patients who do not undergo PCI. There is a growing body of evidence to support the substitution of the low-molecular-weight heparin (LMWH) enoxaparin for unfractionated heparin (UFH). Three recent trials have demonstrated the benefit of an early invasive strategy with catheterization followed by revascularization in patients at high and intermediate risk. Lower-risk patients should undergo early noninvasive stress testing. An intensive program of secondary prevention is mandatory and should be begun before hospital discharge.

Angina, Unstable↗

PubMed1997

Motivational distortion of the 16PF by welfare recipients.

The effectiveness of the Sixteen Personality Factor (16PF) motivational distortion correction procedures was investigated with a sample of 212 welfare recipients who completed the 16PF while participating in a mandatory welfare-to-work program. A multiple regression analysis showed that the motivational distortion (MD) score was significantly related to most of the preselected Personality factors. The regression analysis also revealed that primary E (Dominance) was associated with MD, although the manual does not require MD adjustments for this factor. Based on comparisons of mean differences at the various MD correction levels, findings indicated general support for the MD correction procedures described in the manual; however, the magnitude of the correction procedures should be used cautiously as this may overcorrect for MD on some of the 16PF primaries. The relevance of the findings also are discussed in terms of evidence for Cattell's (1968, 1973, 1986) trait-view theory as it applies to response distortions.

Adolescent↗

PubMedDate not supplied

No time for education? Creative teaching tools for educators.

The creative teaching methods discussed in this paper have been successfully integrated into orientation, mandatory education, and continuing education programs. The response to all of the creative teaching methods discussed has been very positive. Nursing staff appreciates the effort educator's take to communicate information effectively and increase learner satisfaction.

Community Health Nursing↗

PubMed1992

[Multicenter paragliding accident study 1990].

During the period from 1.1.90 until 31.12.90, 86 injuries associated with paragliding were analyzed in a prospective study in 12 different Swiss hospitals with reference to causes, patterns, and frequencies. The injuries showed a mean score of over 2 and were classified as severe. Most frequent spine injuries (36%) and lesions of the lower extremity (35%) with a high risk of the ankles were diagnosed. One accident was fatal. 60% of the accidents happened during landing, 26% during launching and 14% during flight. Half of the pilots were affected during their primary training course. Most accidents were caused by inflight error of judgement--especially incorrect estimation of wind conditions--and further the choice of unfavourable landing sites. In contrast to previous injury-reports, only one equipment failure could be noted, but often the equipment was not corresponding with the experience and the weight of the pilot. To reduce the frequency of paragliding-injuries an accurate choice of equipment and an increased attention to environmental factors is mandatory. Furthermore an education-program regarding the attitude and intelligence of the pilot should be included in training courses.

Adolescent↗

PubMed2004

Prevalence of antithyroid microsomal antibody in thyroid patients of endemic goitre area.

The region of greater Mymensingh known for iodine endemicity, recently came under iodine supplementation as a result of mandatory universal iodination of salt program. Autoimmune thyroid diseases (AITD) are among the most common human autoimmune disorders & presence of autoantibodies to the microsomal antigen (AntiMCAb) is a hallmark of disease activity. Both iodine deficiency & iodine supplementation precipitate increase rate of autoimmunity to the thyroid gland. Study was undertaken to determine prevalence of AntiMCAb positive cases among patients with various thyroid diseases. High resolution ultrasound (HRUS), serum thyroid hormone assays & scintiscan were used to classify the thyroid patients into 8 categories. 221 patients were studied during the stipulated period of 3 months. Male patients were 60 & female patients were 161. Age ranged from 11 to 65 years with median age 29.4 years. AntiMCAb test were done with radioimmunoassay (RIA). 126 patients had antimicrosomal antibody (57.01%). All form of hypothyroid (atrophic, goitrous, Hashimoto's) have very high rate of AntiMCAb positive cases. Highest 89.28% were seen in patients showing feature of Hashimoto's thyroiditis or generalized feature of AITD in HRUS with hypothyroidism, followed had 61.29% positive cases, However, antithyroid antibody was found in all form of thyroid disorders. Nodular goiter had 21.73% antiMCAb positive cases. AntiMCAb found positive at the rate of 33.33% in euthyroid patients with HRUS feature of AITD & diffuse euthyroid goiter, 40% in subclinical hypothyroid, 40% in subclinical hyperthyroid. Female rated higher in range of antimicrosomal antibody positivism. 59% of all thyroid patients among female subjects were AntMCAb positive, where as 51.67% male thyroid patients were positive. Highest number of positive cases found in the 30-35 age group. No definite pattern, however, was observed among age distribution. 20 age matched sample from patients unsuspected of thyroid disease shows 10% AntiMCAb positive compared to 73.33% of the same among same age group of thyroid patients. Frank Hashimoto's thyroiditis with positive antiMCAb and hypothyroidism were all detected by HRUS.

Adolescent↗

PubMed2004

Colorectal cancer among Yemeni patients. Characteristics and trends.

OBJECTIVE: This study aimed to describe the characteristics and trends of colorectal cancer registered in Aden Cancer Registry. METHODS: A retrospective analysis of all registered cancers (1735) was performed at Aden Cancer Center, University of Aden, Aden, Yemen from the years 1997-2001, to describe colorectal cancers with regards to age, sex and residency distribution, subsites and histopathology, and incidence rates. RESULTS: The results indicate that digestive system cancers are the most common cancers (17.1%); and colorectal cancer (28%) is the most common of these. Developing countries characteristics of this cancer are clear. These include a relatively high proportion of early-onset tumor (19.3% of cases were <40 years), and left sided subsite distribution (49.4% of cases were in the rectum and rectosigmoid junction). CONCLUSION: Further analytical studies, to address the community-related risk factors, public education, and screening programs for colorectal cancer are mandatory.

Adult↗

PubMed2003

Diagnosis, treatment, and prevention of Clostridium difficile colitis.

OBJECTIVE: To review the risk factors for, diagnosis and treatment of, and strategies for prevention of, Clostridium difficile colitis. The pharmacists' role in optimizing drug therapy is discussed. DATA SOURCES: A Medline search was conducted to identify pertinent clinical studies, consensus guidelines, case reports, and clinical reviews published in the English language through 2002. STUDY SELECTION: Chosen studies evaluated the appropriate clinical management and prevention of Clostridium difficile colitis. Studies selected focused on pharmacists' role in the institutional management of this disease. DATA SYNTHESIS: Major risk factors for developing Clostridium difficile colitis include renal failure, prolonged hospitalization, age greater than 60, and prolonged exposure to antibiotics. Outpatients are colonized with Clostridium difficile at a rate of about 3 percent while hospitalized patients may have a ten-fold higher colonization rate. Clinical presentation of C. difficile colitis includes diarrhea, abdominal cramps, fever, nausea, malaise, anorexia, and dehydration. Treatment consists primarily of oral or parenteral metronidazole for 10 to 14 days. Mandatory infection control and educational programs for both nursing and environmental services staff can greatly reduce the number of institutional infections. Pharmacists can play a key role in these programs as well as optimizing drug therapy. CONCLUSION: C. difficile colitis is a hospital-acquired infection that occurs primarily in elderly debilitated patients following the prolonged use of certain antibiotics. Its incidence can be reduced through aggressive infection control procedures and staff education.

Journal Article↗

PubMed1991

Vaccine choice and program participation rates when two hepatitis B vaccines are offered.

Participation rates of health care workers in voluntary free hepatitis B virus immunization programs are 35% to 40%. University teaching hospital employees at risk for hepatitis B virus and presenting for immunization were surveyed as to vaccine preference. Both plasma-derived and recombinant hepatitis B virus vaccines were available. During a 10-month period, 173 health care workers enrolled in the study. One hundred seventeen received recombinant vaccine, and 56 received plasma-derived vaccine; 66 were immunized postexposure. Concern of a relationship of human immunodeficiency virus to hepatitis B virus plasma-derived vaccine was acknowledged by a small number of health care workers as important in vaccine selection. Recombinant hepatitis B virus vaccine rapidly and substantially supplanted plasma-derived vaccine but did not increase program participation. We suspect that mandatory immunization or proof of immunity will be necessary if hepatitis B virus protection rates in health care workers are to improve.

Hepatitis B↗

PubMed1991

[Smoking habits, knowledge and attitude of pulmonologists concerning problems of smoking in Poland].

An analysis was carried out on 850 self-report questionnaires sent to Polish pulmonologists on their knowledge and attitude toward smoking. In the sampled population 38% of the males and 29% of females smoked. Smoking was dated as first among various noxious factors in human pathology. The knowledge of harmful effect of smoking was restricted to the cardio-respiratory system. Part of the responders, mainly smokers believe that smoking less than 15 cigarettes is harmless. ++Ex-smokers were most active in smoking cessation programs. Knowledge of harmful effect of smoking and cessation programs by physicians is unsatisfactory and teaching programs concerning this problem is mandatory.

Adult↗

PubMed1990

Safety in clinical trials.

Safety deals with the surveillance and detection of possible threats that can arise against a patient. It might not be an obvious one, like an anaphylactic shock, but a bizarre syndrome of late onset preceded by vague signs or symptoms. To be able to conclude about a possible causal relationship between a drug and such a state with as short a delay in time as possible, the collection and analysis of adverse events during the total clinical trial program of a drug is mandatory. To ask investigators for adverse drug reactions instead is to produce an effective filter, which may help in keeping the incidence figures down in the international data sheet but which also may prove to be hazardous for the pharmaceutical industry in the long run.

Animals↗

PubMed1989

Weight change underway and in port in the American Navy.

The introduction of strict weight control guidelines in the American Navy has drawn attention to a theory that obese sailors lose weight more readily at sea than ashore. I tested this hypothesis retrospectively over a 13 month period on a large American naval vessel, using data on 40 obese men who were weighed weekly as part of a mandatory health and physical readiness program. Included in the study period were both a 25 week deployment and a 29 week extended in port period. Ten subjects were enrolled for the entire 13 months, and their mean in port and underway weight changes were compared using a paired t test. Regression analysis was also performed comparing time underway or in port with net weight change for all subjects. The 10 men enrolled for 13 months had a mean weight loss of 6.6 kg during the underway period and a mean weight gain of 4.3 kg during the in port period (P less than 0.005). Number of weeks underway and number of weeks in port were found to correlate with number of kilograms lost and gained, respectively (P less than 0.005). These data suggest that men who have strong incentives to lose weight do so more effectively at sea than after returning from sea.

Humans↗

PubMed1987

Acquired immunodeficiency syndrome in children: report of the Centers for Disease Control National Surveillance, 1982 to 1985.

Since national surveillance for acquired immunodeficiency syndrome (AIDS) began in 1981, the Centers for Disease Control (CDC) has received reports of more than 20,000 cases of AIDS in the United States. As of December 31, 1985, 307 of these cases had been diagnosed in children younger than 13 years of age. The number of cases is increasing rapidly. The number of cases reported in 1985 more than doubled those reported in 1984. The major risk factors in children for acquiring infection with the causative agent, human immunodeficiency virus (HIV), were having a mother known to be infected and/or at increased risk for infection and receiving a transfusion of blood or blood products. Of the 307 children with AIDS, 73% were reported from one of four states: New York, New Jersey, Florida, and California. Most AIDS cases in children occur in black or Hispanic infants and toddlers. The estimated incubation period for AIDS in children has increased each surveillance year, with the longest incubation exceeding 7 years. The prognosis for children with AIDS is poor and infants less than 1 year of age have the shortest survival time following diagnosis. Continued national surveillance for AIDS is mandatory for establishing effective prevention programs to control the spread of the disease. The CDC encourages all health care personnel to report cases of AIDS to their public health departments.

Acquired Immunodeficiency Syndrome↗

PubMed1978

Does continuing education improve nursing practice?

Is a one-time mandated license enough to ensure competent, up-to-date nursing practice in today's hospital? Are present continuing education programs for nurses adequate? Is mandatory relicensure for nurses necessary? The author looks at these questions and provides some thoughtful and thought-provoking answers.

Clinical Competence↗

PubMedDate not supplied

The practice of hospital epidemiology.

The practice and methodology of hospital epidemiology in infection control have begun to mature. At the same time, there is need for an institutionally based clinical epidemiologist to assist in several other mandatory patient care-related programs in the hospital. Hospital epidemiology programs should recognize this need, the parallels in other programs, and the unique opportunity to bring to hospital in-service, teaching, and research, epidemiologic methodology as a natural extension of its present role.

Computers↗

PubMed1997

Scheduled hand washing in an elementary school population.

BACKGROUND AND OBJECTIVES: Hand washing prevents communicable illness. We evaluated the effect of a mandatory, scheduled hand-washing program in elementary school children on absenteeism due to acute communicable illness. METHODS: The study was conducted at Trombley Elementary School in Grosse Pointe Park, Mich. The intervention group, approximately half of the school children (n = 143, including all grades 1-5), washed their hands a minimum of four scheduled times a day. The control group (n = 162) continued hand-washing practices as usual. RESULTS: Of the 37 school days examined, children in the hand-washing group were absent fewer days than the control group due to all acute communicable illness (relative risk = .75). There were less days of absence due to gastrointestinal symptoms (relative risk = .43). The difference in absence due to respiratory symptoms was not statistically significant. CONCLUSIONS: A scheduled hand-washing program will reduce acute communicable (gastrointestinal) illnesses in elementary school-age children.

Absenteeism↗

PubMed1997

[Compulsory, ambulatory psychiatric treatment].

The Treatment of Mentally Sick Persons Law of 1955, was repealed and replaced by the Law of 1991. Under the latter, the Order for Compulsory Ambulatory Treatment (OCAT) was addressed for the first time (Section 11, a-d). According to this law, the district psychiatrist instead of issuing a hospitalization order, may issue an OCAT, under which the required treatment is given within the scope of a clinic which he designates, for up to 6 months and under conditions which he specifies. This is done on the basis of psychiatric examination, or an application in writing from the director of a hospital or clinic, when continued ambulatory treatment is needed after discharge from hospital or instead of compulsory hospitalization. The district psychiatrist may extend the period of treatment for further periods, none of which is to exceed 6 months. Compulsory ambulatory treatment is to enable patients to benefit from the positive aspects of living freely in the community, while receiving prompt treatment under compulsory conditions. The concept offers a partial solution, achieving a balance between civil liberties and clinical needs, between over-confinement and under-treatment which might be dangerous or neglectful. The clinical impression has been that the OCAT has not fulfilled expectations. The purpose of this study was to examine the topic in a systematic way in Jerusalem and the southern districts for the 4 years since inception of the law. In 44.4% of cases OCAT was proven to be effective, while in 33.1% it was found to be ineffective and did not prevent compulsory hospitalization, one of its main goals. It was partially effective in the rest of the cases. It is recommended that suitable means for the enforcement of the law be allocated and that the subject of forceful hospitalization and OCAT be made a mandatory subject in the residency program of psychiatrists.

Ambulatory Care↗

PubMed2005

Canadian rural family medicine training programs: growth and variation in recruitment.

OBJECTIVE: To document the proliferation of rural family medicine residency programs and to note differences in design as they affect rural recruitment. DESIGN: Descriptive study using semistructured telephone interviews. SETTING: All family medicine residency programs in Canada in 2002. PARTICIPANTS: Directors of Canadian family medicine residency programs. MAIN OUTCOME MEASURES: Number of rural training programs and positions; months of rural exposure, degree of remoteness, and specialist support of rural communities within rural training programs. RESULTS: The number of rural training programs rose from one in 1973 to 12 in 2002. Most medical schools now offer dedicated rural training streams. From 1989 to 2002, the number of rural residency positions quadrupled from 36 to 144; large jumps in capacity occurred from 1989 to 1991 and then from 1999 to 2001. Rural positions now represent 20% of all family medicine residency positions. Among rural programs, minimum rural exposure ranged from 4 to 12 months, and the median distance between rural training communities and referral sites ranged from 50 to 440 km (median 187 km). Rotations in communities with no hospital were mandatory in five of 12 rural programs, optional in five, and unavailable in two. The proportion of training communities used by rural programs that had family physicians only (ie, no immediate specialty backup) ranged from 0 to 78% (mean 44%). Most training communities (78%) used by rural programs had fewer than 10 000 residents. Four of 12 rural programs offered various specialty medicine rotations in small communities. CONCLUSION: Rural residency programs have proliferated in Canada. The percentage of residency positions that are rural now equals the proportion of the general population in Canada living in rural areas. National guidelines for rural programs recommend at least 6 months of rural rotations and at least some training in communities without hospitals. Major variations among programs exist, and most program designs differ from designs recommended in national guidelines in at least one aspect.

Canada↗