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PubMed1998

Modern oral contraceptive use and benign liver tumors: the German Benign Liver Tumor Case-Control Study.

OBJECTIVE: To analyze the association between oral contraceptive use and the risk of benign liver tumors. METHODS: Two parallel case-control studies on hepatocellular adenoma and focal nodular hyperplasia. Collaborative study of 15 German liver centers. Cases defined by histology and compared with population controls. RESULTS: Fifty-one hepatocellular adenoma and 143 focal nodular hyperplasia cases (women) were recruited between 1990 and 1997, and compared to 240 population controls with a recent abdominal imaging test. The frequency age-matched odds ratio was 1.25 (95% confidence interval (CI), 0.37-4.22) and 1.96 (95% CI, 0.85-4.57) for hepatocellular adenoma and focal nodular hyperplasia, respectively. For hepatocellular adenoma, there was neither a significantly increased risk with longer duration of oral contraceptive use, nor an association with time since first or last use. For focal nodular hyperplasia, however, a slightly increased odds ratio was found with longer duration of use and more recent last use. CONCLUSION: There is little evidence for an increased risk for hepatocellular adenoma in women using modern oral contraceptives. If there is a risk not detected by the limited study size, hepatocellular adenoma is an extremely rare, and focal nodular hyperplasia a rare, adverse effect potentially associated with long-term oral contraceptive use and likely to be without public health importance.

Adenoma, Liver Cell↗
PubMed1993

Use of a modern relational database for photographic department information management.

Recording the details of photographic work in a modern computer database brings many opportunities. Among these is the ability to use the computer cost-effectively to produce accurate routine paperwork like invoices, reports, and records, and to provide management with control information in the form of reports, charts and graphs hitherto too time-consuming to produce by hand. The development and operation of an up-to-date computer business system for a photographic department handling approximately 6500 clinical and non-clinical photographic sessions a year is described.

Database Management Systems↗
PubMed2006

Veterinary medical education for modern food systems: past, present, and brainstorming a future.

Concepts presented here were derived from breakout sessions constituted by the 90 attendees of the Veterinary Medical Education for Modern Food Systems symposium, held in Kansas City, Missouri, USA, in October 2005. The attendees were food-animal educators, veterinary faculty, college deans and administrators, and veterinarians employed in government, industry, and private practice. Discussions at these breakout sessions focused on four primary areas: (1) determining the data needed to document the current demand for food-supply veterinarians (FSVs); (2) defining the information/skills/abilities needed within veterinary school curricula to address the current demands on FSVs; (3) outlining pre-DVM educational requirements needed to support FSVs; and (4) considering the role of post-DVM programs in meeting the demand for FSVs.

Animal Welfare↗
PubMed2001

A comparison of free-stall barns used by modernized Wisconsin dairies.

A primary objective of the Wisconsin Dairy Modernization Survey was to compare features of free-stall barns available to dairy producers. This study used data from a large random sample of expanding dairy farms to determine whether the theoretical benefits of particular free-stall configurations bear out under on-farm conditions. Comparisons were made among herds using free-stall barns as their primary housing for new versus remodeled facilities, barn design, bedding used, feed-delivery design, manure removal strategies, animal restraint, maternity areas, overcrowding, and cooling methods. Producers who made the transition from tie-stall housing to free-stall housing were satisfied with this decision. New free-stall barns provided a more desirable environment for the herds than remodeled free-stall barns, although initial investments were higher. When new free-stall barns were compared, herds with four-row barns had higher production, lower somatic cell count, and higher stocking rates than herds with six-row barns. Respondents were more satisfied with four- and six-row barns than with two- and three-row barns. Respondents felt sand provided some advantages for cow comfort, while satisfaction with bedding cost and manure handling was higher with mattresses. Dairy Herd Improvement data showed no difference in milk production or somatic cell count for producers who chose sand or mattress-based free stalls. Respondents were more satisfied with the use of drive-through feeding than other feed-delivery designs. Most producers chose to use tractor scrapers to remove manure; however, producers who used automated systems were more satisfied with manure management. Few differences were observed when comparing self-locking head gates to palpation rails. Overcrowding did not have any adverse affect on production or user satisfaction with feed intake or cow comfort. Using supplemental cooling appeared to facilitate higher production.

Animal Feed↗
PubMed2001

Modeling milk production and labor efficiency in modernized Wisconsin dairy herds.

The 1999 Wisconsin Dairy Modernization Project was conducted to examine variation in milk production and labor efficiency among herds that had recently expanded. Data were obtained from a sample of Wisconsin herds that expanded between 1994 and 1998. Using rolling herd average milk production in 1998 as the dependent variable in the milk production model, milking frequency, bovine somatotropin use, sprinkler use, average linear somatic cell score, average age at first calving, average days dry, and rolling herd average milk production in 1994 predicted 69% of the variation in milk production. Milking three times daily, using bovine somatotropin, using sprinklers to cool cows, and decreasing linear somatic cell score, age at first calving, and days dry were associated with increased milk production. Each of these variables supports previous research from designed experiments with on-farm results. Variation in milk production is determined primarily by differences in management ability and management practices employed by the dairy producer. Using cows per full-time equivalent as the dependent variable in the labor efficiency model, acres per cow, number of people involved in the milking operation, milking system type, herd size, and interactions between milking system types and herd size predicted approximately 43% of the variation in labor efficiency. As expected, labor efficiency increased with larger herd sizes, fewer acres per cow, and fewer people involved in the milking process. Parallel milking parlors were associated with the highest cows per full-time equivalent followed by herringbone parlors, flat barns, and stall barns.

Animal Husbandry↗
PubMed2005

Harvey Cushing and Oskar Hirsch: early forefathers of modern transsphenoidal surgery.

The transnasal transsphenoidal approach is the preferred route for removal of most lesions of the sella turcica. The concept of transnasal surgery traversing the sphenoid sinus to reach the sella has existed for nearly a century. A comprehensive historical overview of the evolution of transsphenoidal surgery has been reported previously. In the present vignette, the authors focus on transsphenoidal surgery in the early 1900s, particularly on the methods advocated by Harvey Cushing and Oskar Hirsch, two prominent pituitary surgeons who pioneered the transsphenoidal technique. Cushing championed the sublabial approach, whereas Hirsch was the master of the endonasal route. Coincidentally, both surgeons independently performed the submucous septal resection for the first time on June 4, 1910. Although Cushing's and Hirsch's approaches were predicated on the work of their predecessors, their transsphenoidal procedures became the two most popular techniques and, for future generations of pituitary surgeons, laid the foundation for modem transsphenoidal surgery. In this comparative analysis, the authors compare the operative nuances of the approaches of Cushing and Hirsch and describe the contributions of these pioneers to modern transsphenoidal surgery.

Austria↗
PubMed2003

[Researches into the modernization of tongue diagnosis: in retrospect and prospect].

With the further development of clinical modernization of traditional Chinese medicine (TCM), new request to tongue diagnosis for objectivity and quantification is raised. Many researchers have devoted themselves to this field and have achieved some accomplishments since 1950's. Especially in recent years, the revolution of information technique derived from computer industry brings the research new chances. The research history of the past five decades can be divided into three stages: (1) looking for micro-markers by newly-developed medical technique; (2) quantifying traditional markers by new technique; (3) further development based on information technique and corporation of multiple subjects. This article reviewed the three stages and described its prospect.

Humans↗
PubMed1999

Head and neck replacement prostheses in revision hip arthroplasty: experience with a single modern design.

This study reviewed 52 revision hip arthroplasties in which calcar cortical deficiencies were addressed by implantation of a cemented, modern-design head and neck replacement femoral prosthesis. Mean clinical follow-up was 38 months. Radiographic follow-up beyond 22 months was available for 34 patients (mean: 35.8 months). Mean Mayo clinical hip score (maximum: 80) improved from 28.2 preoperatively to 55.2 at last follow-up. No femoral component was revised for aseptic loosening. However, radiographic analysis demonstrated one prosthesis was probably loose and two were possibly loose. A 92.7% Kaplan-Meier 5-year implant survival rate free from radiographic loosening was projected. This type of prosthesis has yielded good clinical results and excellent early survival.

Adult↗
PubMed2006

The evolution of ureteroscopy: a modern single-institution series.

OBJECTIVES: To evaluate a modern ureteroscopy series, including the use of new technological advances, operative procedures, and potential complications, at a single institution and to compare our current experience with our prior published series and the current literature. MATERIAL AND METHODS: We retrospectively reviewed 1000 consecutive ureteroscopies performed in 961 patients from December 1999 to February 2003 at our institution. RESULTS: Semirigid and flexible ureteroscopes were used in 60.3% and 37.0% of the cases, respectively. In 2.6% of cases, a combination of both rigid and flexible ureteroscopes was required. The most common indications for ureteroscopy were as follows: stone, 57.9%; diagnostic, 20.6%; and urothelial carcinoma, 12.6%. Of the stones treated, 31.8% were proximal or middle and 59.1% distal. The overall, proximal, and distal stone-free rates were 91.7%, 87.3%, and 94.2%, respectively. Average operative time was 81 minutes (range, 5-280 minutes). Average follow-up was 2.36 months (range, 1-24 months). The overall complication rate was 1.9% (18/961), including a 0.2% (2/961) incidence of ureteral strictures. CONCLUSION: Current practice trends have shifted to an increased use of flexible ureteroscopes and more frequent ureteroscopic treatment of proximal calculi. Our single treatment stone-free rates are competitive with quoted shock wave lithotripsy success. In addition, there has been a decrease in ureteroscopic-associated complications in our series, with no ureteral avulsions. The improvements in treatment success and decrease in complications may be secondary to advances in ureteroscopic technology.

Adolescent↗
PubMed2006

Association of PTSD and depression with medical and specialist care utilization in modern peacekeeping veterans in Canada with health-related disabilities.

OBJECTIVE: We examined the relative associations between posttraumatic stress disorder (PTSD) and depression severity with medical and specialist care use in modern peacekeeping veterans with health-related disabilities. METHOD: The participants consisted of 1016 male veterans who served in the Canadian Forces from 1990 to 1999, selected from a larger random sample of 1968 veterans who voluntarily completed an anonymous general health survey conducted by Veterans Affairs Canada in 1999. Survey instruments included the PTSD Checklist-Military Version (PCL-M), Center for Epidemiological Studies-Depression Scale, and questionnaires of health problems and service use, sociodemographic characteristics, and military history. RESULTS: Among peacekeeping veterans with health disabilities, "probable" PTSD (PCL-M score > or = 50) was associated with significantly more medical service use (primary and specialty care combined), with a mean of 16.4 times (SD = 17.4) compared with 6.0 times (SD = 6.6), p < .001, for veterans without PTSD. We found that in multivariate analyses, general medical care intensity (i.e., number of visits) was related to increased health problems, greater probable PTSD diagnosis, and greater depression symptom severity. We also found that depression severity accounted for health care use intensity and that PTSD only added a small amount of incremental variance above that. CONCLUSIONS: The observed association between PTSD (diagnosis and severity) and medical care utilization stresses the importance of PTSD screening in primary care settings, especially in patients with a history of military service. This association is also useful for clinicians and hospital administrators in understanding potential medical and psychiatric needs for military veterans.

Canada↗
PubMed2003

Adverse health effects from ambient air pollution in relation to residential wood combustion in modern society.

This is a review of the adverse health effects of ambient air pollution in relation to residential wood combustion in modern society. From a literature search of PubMed, nine relevant studies were identified. All of them focused on the effects of short-term exposure such as asthma, respiratory symptoms, daily mortality, and lung function. Substantial quantitative information was only found for acute asthma in relation to particulate matter with an aerodynamic diameter of <10 microm. In comparison with the present general estimations for ambient particulate matter and adverse health effects, the relative risks were even stronger in the studies in which residential wood combustion was considered a major source of particulate matter. Thus there seems to be no reason to assume that the effects of particulate matter in areas polluted by wood smoke are weaker than elsewhere.

Air Pollution, Indoor↗
PubMed2006

Is modern medicine at risk of losing the plot?

Contemporary medicine has much to its credit, but has created an insatiable demand for new technologies and more health services, fed by commercial promotion, professional advocacy and sociopolitical pressure. Total health expenditure at the national level is now almost 10% of gross domestic product and is expected to top 16% by 2020. After recent inquiries into the failings of its public health system, the Queensland Government has committed itself to a 25% increase in expenditure on health over the next 5 years. But will it lead to better population health, and is it sustainable? The return-on-investment curve for modern health care may be flattening out, in an environment of growing numbers of older patients with chronic illnesses, maldistribution of services and hospital overcrowding. A change in thinking is required if current medical practice is to avoid imploding when confronted with the next major economic downturn. Health policy, service funding and clinical training must focus on critical appraisal of the effectiveness of health care technologies and the structure and financing of health care systems. Practising clinicians will be obliged to provide leadership in determining value for money in the choice of health care for specific patient populations and how that care is delivered.

Australia↗
PubMed2005

Technologic advances in surgery for brain tumors: tools of the trade in the modern neurosurgical operating room.

Surgery is an essential part of the oncologic treatment of patients with brain tumors. Surgery is necessary for histologic diagnosis, and the cytoreduction of tumor mass has been shown to improve patient survival time and quality of life. Ultimately, the goal of any oncologic neurosurgery is to achieve maximal safe resection. Over the years, many technologic adjuncts have been developed to assist the surgeon in achieving this goal. In this article, we review the technologic advances of modern neurosurgery that are helping to reach this goal.

Brain Mapping↗
PubMed2005

Impact of the Medicare modernization act on low-income persons.

BACKGROUND: Low-income Medicare beneficiaries without prescription benefits have high out-of-pocket medication expenses that can discourage adherence to treatment regimens. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 created a temporary drug discount card program and a prescription benefit with low-income provisions to assist with medication expenditures for eligible seniors. OBJECTIVE: To determine the impact of the new drug discount card and prescription benefit on medication expenditures by low-income Medicare recipients who require pharmaceutical company assistance for obtaining medications. DESIGN: Retrospective, nonrandomized evaluation. SETTING: Family practice physicians' office in northern Virginia. PATIENTS: 137 Medicare recipients without prescription coverage who received assistance from pharmaceutical companies for medications. MEASUREMENTS: Patients were stratified into 3 categories according to income, household size, and the federal poverty line (FPL), as defined by the new Medicare act. Participants' long-term oral and inhaled medications, dosages, and instructions for use were obtained. The MMA criteria for low-income provisions were applied for the drug discount program and for the prescription benefit. Medication costs under the new Medicare benefits were compared with those incurred without assistance and with the use of pharmaceutical company programs for the cohort and FPL categories. RESULTS: In all income categories, medication costs were lower after enrollment in all programs than those of patients without assistance. Compared with pharmaceutical company assistance, Medicare drug discount cards resulted in less savings for all income groups. For the prescription benefit, persons with incomes less than 135% of FPL had the greatest benefit because of low-income subsidies. Persons ineligible for low-income subsidies receiving the standard benefit had a smaller reduction in out-of-pocket costs and variable monthly expenditures; they realized a superior savings with pharmaceutical company assistance programs. LIMITATIONS: The generalizability of these findings is limited because the authors used a discount pharmacy to determine drug costs for persons receiving no assistance, could not determine asset criteria for the MMA drug benefit low-income subsidy, and used a selected Medicare population. CONCLUSIONS: In a low-income Medicare population without prescription coverage, pharmaceutical company programs offered considerable savings and were superior to the Medicare drug discount cards. For the Medicare prescription plan, the greatest savings was among those eligible for low-income subsidies. Month-to-month medication costs may vary substantially for persons ineligible for such subsidies, and pharmaceutical company assistance may be a better alternative.

Aged↗
PubMed1977

The book of job and the modern view of depression.

The Biblical Book of Job is a wisdom book. Wisdom, in this context, refers to the intellectual discipline taught by the sages of ancient Isreael to provide professionals with a realistic approach to the problems of life. Chapter 30 of the Book of Job is a key-index of ideas that, if followed through the book, discloses a modern scientifically accurate description of a depression that, at times, was life-threatening. There are practical clinical clues to distinguish between normal mourning and depression, as well as aids to the differential diagnosis of somatic symptoms that may arise from depression. A timeless model of the scope and limitations of the professional relation between patient and comforter is also presented. Part of the wisdom of the Book of Job is to use depression as an example of a life-threatening illness to provide an unexcelled standard of clinical observation and medical intervention.

Bible↗
PubMed1979

The doctor's white coat. The image of the physician in modern America.

The social perception of the physician has changed during the past century. This is reflected in the changing use of a symbol of the profession, the white coat. This dress originated in operating rooms, scientific laboratories, and modern hospitals, each of which contributed to the social understanding of what it means to be a healer. Adding the cultural significance of "whiteness" reveals a broad spectrum of meaning surrounding the healing encounter whose most important aspects are the authority and supernatural powers of scientific physicians and the protection of patients. A major force aiding in the adoption of this symbol was the shift in sick care from home to hospital, where it served to legitimate otherwise socially taboo behavior. Recent changes in how scientific medicine is publicly viewed have eroded these established meanings. The resulting tensions affect individual patient-physician encounters and interactions between the profession and society as a whole.

Clothing↗
PubMedDate not supplied

A post-modern nursing model.

For some time, nursing has been based on the structure of the nursing process and nursing models. However, in an age where the old order of science and medicine can no longer answer all of society's questions, can a nursing model, with its roots firmly based in the modernist structure of the nursing process, be post-modern?

Decision Support Techniques↗
PubMedDate not supplied

The Royal College of Physicians--ancient and modern.

The history of the College's first 430 years was covered in three volumes ending in 1947. It required an entire fourth volume to cover the next 36 years up to 1984. During this time the almost incredible changes and advances in medicine were accompanied by a metamorphosis in the scale, scope, behaviour and attitude of a very traditional College--now housed in one of Denys Lasdun's finest modern buildings. Led by a series of remarkable presidents, the College has met its challenges with considerable panache. It strongly supported the National Health Service at its inception, published ground-breaking reports on smoking and other 'lifestyle' threats to health, and made constant efforts to improve medical standards and defend academic medicine. Its story, as told by Asa Briggs, is enough to provide nostalgia for the elderly and much food for thought for the not-so-old.

Education, Medical, Continuing↗