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Pain in human immunodeficiency virus disease.

OBJECTIVES: To review the prevalence and etiology of pain in persons with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), and issues and considerations for pain management in this patient population. DATA SOURCES: Research studies, review articles, and books related to pain in persons with HIV/AIDS. CONCLUSIONS: Pain is a common problem for individuals with HIV/AIDS that is often poorly managed and net well documented. Many of these patients have multiple, coexisting illnesses that are painful. Adequate assessment of the underlying cause will help in the treatment or eradication of pain. IMPLICATIONS FOR NURSING PRACTICE: The management of pain in persons with HIV/AIDS is an important responsibility for oncology nurses because increasing numbers of persons with HIV/AIDS are being treated for neoplastic complications, cytopenias, or being referred to hospice care.

HIV Infections↗

The admission of Asian patients to intensive therapy units and its implications for kidney donation: a preliminary report from Coventry, UK.

OBJECTIVE: To determine the relative admission rates of Asian and non-Asian patients to intensive therapy units (ITUs) in Coventry and to explore the implications of these rates for the transplantation of organs to Asian people. DESIGN: Examination of 1991 census data and a retrospective review of ITU admissions books. Data were collected on ethnic background, presenting diagnosis, and clinical outcome for each admission. SETTING: The three ITUs in Coventry. PATIENTS: All admissions to the ITUs from 1990-93 inclusive. RESULTS: Asian patients were admitted to ITUs disproportionately to their numbers in the Coventry population. Members of the Asian community were less than half as likely to be admitted to an ITU (p < 0.001) and more likely to die while there (p = 0.007) than members of the non-Asian population in Coventry. The proportions of patients referred to the transplant unit and the rates of subsequent donation do not seem to differ significantly for Asian and non-Asian patients (p = 0.26 in both cases). CONCLUSIONS: There are clear implications for the availability of cadaveric kidney transplantation to Asian patients, given that few kidneys from non-Asian donors are histocompatible with Asian recipients. Indeed, in Asians, promotion of living related donation may be more effective in countering the organ shortfall than efforts to increase consent to cadaveric transplantation. However, it may be valuable to investigate any patterns of morbidity or social or cultural factors that might explain the initial low admissions rates to ITUs for Asian patients.

Asia↗

A connectionist approach to making the predictability of English orthography explicit to at-risk beginning readers: evidence for alternative, effective strategies.

A case is made (and illustrated with empirical data with children) for connectionist models that are not only computationally explicit but also instructionally explicit. First-graders (N = 128) at the bottom of their classes in reading (average 11.5 percentile on nationally normed tests) participated in a 3-layer intervention. In the first layer, kept constant for all treatment groups, the alphabet principle was taught, making functional spelling units and alternations explicit. In the second layer, which varied systematically across treatment groups, children received different kinds of tutor modeling in learning a set of words of varying spelling-sound predictability, using different connections between printed and spoken words, singly or in combination. In the third layer, also kept constant, children read and discussed illustrated books. Over the 4-month, 24-lesson intervention, all 7 treatment groups in the second layer improved more in word-specific learning than a contact control group that received phonological and orthographic awareness training without explicit instruction on orthographic-phonological connections. Of these 7, only 3 kinds of explicit modeling (whole word, letter-phoneme, and combined whole word and letter-phoneme) resulted in greater transfer to untrained words than the contact control or the other 4 kinds of explicit modeling. Results are discussed in reference to the controversy over whether dual route or connectionist models best account for the acquisition of reading.

Child↗

[Man and his fellow-creatures under ethical aspects].

It is for reasons of age I will have to terminate my work at the Literary Review in the form developed since 1995. The report is being reduced to a concentration of ethically relevant reviews as exemplified in the fourth-quarter issue of ALTEX. This is to ascertain that essential developments in this field will not be overlooked. Insofar, the Literary Review will be continued under the heading "New literature concerning topics of animal ethics". The more central topics of animal ethics are being "used up" the more new questions are being formulated. Thus it was that during the last few years the plant-world, long neglected, was rediscovered and received attention through the publication of important works. Another recent discovery concerns itself with "cognitive ethology" which developed out of the critique of behaviourism and which is dealt with in a separate chapter in this issue. But there is also a "classic" of ethics who has been reviewed and interpreted anew repeatedly. In her book "Albert Schweitzer, a prophet of medical ethics", Heike Baranzke describes Schweitzer's ethics as not sentimental or nostalgic but rather as a radically modern stance, committed to the enlightenment. Manuel Schneider, also, conveys a comprehensive view of Albert Schweitzer's ethics in "Life in the middle of life - the relevance of the ethics of Albert Schweitzer", a book edited by Altner, Frambach, Gottwald and himself in 2005. For this, in particular, he derives a possibility of a physiocentric ethics. By contrast, Beate Weinzierl approaches Schweitzer on a complete personal and human level in "Yearning for nature - access to inner and outer nature with Albert Schweitzer". Wolfgang Senz is undertaking a critical appreciation of Albert Schweitzer's concept of "life" and this, foremost, in the light of Schweitzer's rejection of the Cartesian "I am". In the end, Jean Claude Wolf cannot manage without citing Schweitzer either, referring to him in his not accepting the (western) world's excessive meat consumption as a "cruel necessity". Klaus Peter Joern also enters into Schweitzer's fundamental argumentation in his "A good bye to the disparagement of our fellow creatures". Quotation: "It just cannot go on that Christianity lets the validity of the commandment of love end at the behaviour towards humans, simply because that is the tradition. We rather have to, in this instance, deny the authority of the Bible it's due respect, as this has deemed Schweitzer already inevitable." The killing of animals, irrespective of the motives, remains a critical issue in the understanding (or the lack thereof) with regard to the dignity of all creation. Manuela Linnemann, Charles Patterson, Evelyn Ofensberger and the German Veterinary Association for the Protection of Animals have dealt with this issue extensively. As always, more space is taken up by publications dealing with legal questions and developments. In particular, the conference report of the Protestant Academy at Bad Boll should be mentioned "Animal protection on good constitution". Contributions to this report, edited by the academy, include Hans Georg Kluge's "The governmental aim 'animal protection' and it's implementation in jurisdiction" and Johannes Caspar's "effects of the governmental goal 'animal protection' in the protected area of unconditional fundamental rights". Regarding animal experiments, the last two position papers commissioned by the Foundation for animal-free research (FFVFF), dealing with perspectives of 3R research, have been published within the period of time covered by this report. Alternatives in basic research (with once again rising numbers of experimental animals) and in biomedical education are the themes dealt with by Franz P. Gruber and his co-authors Thomas Hartung and David Dewhurst.

Altruism↗

Use of a parent questionnaire in emergent and early literacy assessment of preschool children.

PURPOSE: The purpose of this project was to evaluate the use of a parent questionnaire in the assessment of emergent and early literacy skills of preschool children with language impairments (LI) and their typically developing (TD) peers to determine the relationship between parent report and more formal measures of early literacy, as well as to compare home literacy practices of these two groups of children. METHOD: Preschool children with LI (n = 17) were referred by area school district speech-language pathologists, and age-matched peers (n = 20) were recruited from local preschools. Examiner-administered measures of early literacy included assessment of rhyme, knowledge of environmental print, knowledge of print conventions, and letter-name and letter-sound knowledge, as well as analyses of narrative abilities. The parent questionnaire included 31 closed questions with responses chosen on a 5-point scale that addressed a number of domains of knowledge: phonological awareness, response to print in the environment, alphabet knowledge, interactions around books, writing, orientation to literacy, and parent practices, in addition to a number of open-ended questions. RESULTS: Results revealed a strong relationship between examiner-administered measures of early literacy and parent report for the children with LI only. Parents of children with LI rated their children more poorly across domains of literacy knowledge than did parents of the comparison group. Finally, a comparison of home literacy practices found differences between the groups in time spent watching television, age parents began reading to the child, and number of books owned by the child. CLINICAL IMPLICATIONS: Findings support the use of parent report as a tool in the assessment of emergent and early literacy knowledge and skills for children with LI.

Case-Control Studies↗

The evolution of the Environmental Quality concept: from the US EPA Red Book to the European Water Framework Directive.

BACKGROUND: Water Quality Criteria were firstly defined in the 1970s by the EPA in the USA and the EIFAC in Europe, recognizing the need for protecting water quality in order to allow the use of water resources by man. In the 1990s, the European Commission emphasized the importance of safeguarding structure and function of biologic communities. These approaches were chemically-based. The European Water Framework Directive (WFD) substantially changes the concept of Water Quality, by assuming that a water body needs to be protected as an environmental good and not as a resource to be exploited. In this frame, the biological-ecological quality assumes a prevailing role. MAIN FEATURES: The Water Quality concept introduced by the WFD is a challenge for environmental sciences. Reference conditions should be defined for different typologies of water bodies and for different European ecoregions. Suitable indicators should be developed in order to quantify ecological status and to define what a 'good' ecological status is. Procedures should be developed for correlating the deviation from a good ecological to the effects of multiple stressors on function and structure of the ecosystem. The protection of biodiversity becomes a key objective. In this frame, the traditional procedures for ecotoxicological risk assessment, mainly based on laboratory testing, should be overcome by more site-specific approaches, taking into account the characteristics and the homeostatic capabilities of natural communities. In the paper an overview of the present knowledge and of the new trends in ecotoxicology to get these objectives will be given. A procedure is suggested based on the concept of Species Sensitivity Distribution (SSD). RECOMMENDATIONS AND PERSPECTIVES: The need for more site-specific and ecologically-oriented approaches in ecotoxicology is strongly recommended. The development of new tools for implementing the concept of 'Stress Ecology' has been recently proposed by van Straalen (2003). In the same time, more 'cological realism' is needed in practically applicable procedures for regulatory purposes.

Animals↗

An investigation of three commercial methods for rapid identification of non-enteric gram-negative rods. Application on Pseudomonas paucimobilis and some other Pseudomonas species.

Three commercial systems for the identification of non-enteric gram-negative rods were compared with conventional bacteriological methods as reference. The three systems were the API 20 NE, BIO-TEST ID-Trident, and ROSCO Diagnostic Tablets. The systems were tested on a set of 47 strains from the genus Pseudomonas, with the emphasis upon the yellow-pigmented species. The overall identification accuracy was 97% with the API, 19% with the BIOTEST and 68% with the ROSCO system. The API system was thus reliable, and it presented no major practical problems. The BIOTEST system was very handy. The main reason for the low accuracy was an error in the code book. The ONPG reaction was depicted as negative in the species P. paucimobilis. A positive ONPG test is a keymark in this species and 76% of the 20 strains of P. paucimobilis included in this investigation were also found positive with the BIOTEST system. The ROSCO tablets are convenient if the result of single reactions is desired. The time consumption per strain was 5.4, 4.4, and 6.2 min for the API, BIOTEST, and ROSCO systems respectively.

Predictive Value of Tests↗

Humor in the pediatric emergency department: a 20-year retrospective.

Humorous events often take place in pediatric emergency departments without being recorded. A written account of amusing situations occurring in an emergency department has been compiled over 20 years by personnel at a large urban children's hospital. Data from this reference were analyzed for humorous content and presented in the following categories: most interesting chief complaints, suspicious sounding chief complaints, favorite telephone inquiries, and illustrative cases. This study demonstrates that an emergency department may be a fertile source of medical humor. Recognition of these statements and events helps to relieve the stress of medical training and emergency department work.

Books↗

New crossmatch technique eliminates interference by humanized and chimeric monoclonal antibodies.

Humanized and chimeric antilymphocyte antibodies (Ab) are used to prevent and treat rejection and for treatment of human disease. Rituximab (RIT, anti-CD20), daclizumab (DAC; anti-CD25), alemtuzumab (ALE; anti-CD52), or infliximab (IFX) may interfere with Ab detection methods such as complement-dependent cytotoxicity (CDC) and flow cytometric crossmatch (FCXM). These agents are recognized as anti-human Ab or fix complement and are not differentiated from anti-allo-Ab. A new enzyme-linked immunosorbent assay crossmatch (XM) utilizing class I and II HLA antigens from donor cells called Transplant Monitoring System (TMS; GTI, Waukesha, Wisc) potentially precludes interference by eliminating non-major histocompatability complex antigens. To test this, normal sera (nonsensitized volunteers) were supplemented with 0.1 or 10 microg/mL of RIT, DAC, IFX or ALE, and were tested using three methods: the TMS T-cell CDCXM with antihuman globulin (AHG); and B-cell CDCXM without AHG; and FCXM with mean channel shifts of 45 and 150 indicating positive T-cell and B-cell crossmatch, respectively. No reactivity occurred with normal sera using any crossmatch technique. At 0.1 and 10 microg/mL, RIT interfered with CDC B-cell, but not T-cell crossmatch. RIT at 10, but not 0.1 microg/mL interfered with B-cell FCXM. No interference occurred with RIT in T-cell FCXM or TMS. ALE interfered with B-cell and T-cell CDC and FCXM but neither class I nor II TMS. DAC did not interfere with CDC or FCXM at 0.1 microg/mL, but gave false positive B-cell FCXM and CDCXM with some samples. No interference by DAC occurred using TMS. TMS may be useful to differentiate de novo donor-specific Ab after treatment with humanized or chimeric Ab.

Alemtuzumab↗

Storage and retrieval of SNOP-coded pathologic diagnoses using offsite computing and optical character recognizing systems.

A computerized cross-reference system for retrieving autopsy and surgical pathology cases on the basis of case number or diagnosis has been implemented. The system achieves economy and flexibility by using offsite computer service bureaus for job production, eliminating the need for expensive onsite equipment. Coded diagnoses may be typed using the OCR (Optical Character Recognition) font simultaneously with or separately from the clinical documentation. The flexibility of new OCR equipment permits production of machine-readable code sheets with an ordinary pencil and completely eliminates the need for typing. The system produces year-to-date books that list all diagnoses, on an accumulating basis, in alphabetic order by SNOP* topology, morphology, etiology and function, and will be compatible with SNOMed. Because all data are stored on magnetic tape, they may be manipulated and retrieved as desired through user programming. The initial setup cost was dollar 1,000 for programming and testing, and production runs and all report printing cost about dollar 1,000 per year (autopsies and surgical pathology cases), which is about 1.1 cents per diagnosis.

Computer Systems↗

A survey of chrome-cobalt RPD design in Ireland.

PURPOSE: The aims of this study were to investigate the quality of written instructions given to dental laboratories for fabrication of chrome-cobalt removable partial dentures (RPD) in Ireland, and to examine the extent and nature of technical/laboratory support available for the fabrication of this prosthesis type. MATERIALS AND METHODS: All dental laboratories listed in the commercial telephone book were contacted and invited to participate in the study. Written instructions received by dental technicians for fabrication of chrome-cobalt RPDs were examined for evidence of four design variables: denture base configuration, retention, support, and connector design. The use of diagrams was also examined. RESULTS: Of 112 dental laboratories listed, 100 agreed to take part. Sixteen laboratories had the facilities to fabricate chrome-cobalt frameworks on their premises; 122 sets of written instructions were received. All four design variables were described in 10% (n = 12) of instructions, 7% (n = 9) contained reference to three variables, 13% (n = 16) contained reference to two variables, and 17% (n = 20) contained reference to one variable. No design features were prescribed in 53% (n = 65), and 5% (n = 6) requested the technician to design the prosthesis. Only 7% (n = 8) of instructions included a diagram. CONCLUSION: A high proportion of written instructions to dental laboratories regarding fabrication of chrome-cobalt RPDs contained no reference to the mentioned design variables.

Chromium Alloys↗

Timing-dependent modulation of insulin mitogenic versus metabolic signalling.

This chapter will not deal sensu stricto with the mechanisms and biological significance of pulsatile hormone secretion, the general theme of this book. Rather, we will attempt to demonstrate that timing events at the receiving end of the hormonal signal, i.e. the kinetics and duration of receptor activation in target cells and subsequent downstream signalling, can play an equally important role as that of the timing aspects of secretion, in determining the qualitative and quantitative aspects of hormonal responses. We will focus on the mechanisms that determine signalling specificity by the receptor tyrosine kinases, especially the insulin receptor and the type I insulin-like growth factor receptors (IGF-I receptor). We will be succinct and refer the reader to our recent reviews and publications on this topic and references therein.

Animals↗

Practical application of the European Field Guide in screening for diabetic retinopathy by using ophthalmoscopy and 35 mm retinal slides.

The Welsh Community Diabetic Retinopathy Study was designed to assess the effectiveness of the Field Guide Book for screening for diabetic retinopathy in Europe. A community-based sample (prevalence 2%) of diabetic patients was recruited from four general practices. Standardised training and equipment were provided. All patients were invited to attend practice-based screening sessions on two occasions over 3 years (phases 1 and 2). After mydriasis, clinical ophthalmoscopy was performed by a study optometrist and general practitioners (GPs). 2 x 45 field 35 mm retinal slides were obtained according to EURODIAB protocol. Anonymised slides were assessed by GPs, diabetologists and the optometrist. All the findings were graded externally (reference standard). In phase 2 community optometrists also performed ophthalmoscopy and assessed photographs. For detecting sight threatening diabetic retinopathy using ophthalmoscopy, GPs achieved a sensitivity of 65.7%, specificity 93.8% and positive predictive value (PPV) 65.7%. Community optometrists achieved a sensitivity of 82.2% with a PPV of 50.7%; the study optometrist 79.2 and 55.9%, respectively. The use of 35 mm slides improved sensitivity for the detection of sight threatening retinopathy to 87.3, 91.1 and 97.2% for GPs, community optometrists and the study optometrist, respectively. PPV fell to 51.2% for GPs, 40.6% for community optometrists, but increased to 58.8% for the study optometrist. Diabetologists achieved a sensitivity of 88.7% and a PPV of 65.6%. It is concluded that the European field guide is an effective tool for screening for retinopathy in clinical practice.

Confidence Intervals↗

[The death of emperor Valentine I in the descriptions of Ammianus Marcellinus and other authors].

The history of neurology, especially before 1800, has been treated almost completely as "literary history". Most interest centred around the works of famous physicians and their writings. Especially in the classical era, non-medical testimonies have received little attention. This makes it a particularly pleasant surprise for a medical histroical in search of such material to come across a description of a "neurological illness" in a history book from ancient times. 'Rerum gestarum libri' by Ammianus Marcellinus, the last Roman historiographer of note, gives a fairly descriptive account of the fatal illness of Emperor Valentine I (30, 6, 1-6). Valentine was suddenly taken ill with apoplectiform symptoms during a campaign in Pannonia in 375 AD. He died few hours later, despite the attempts of a physician quickly brought to the scene. The account of Ammianus Marcellinus combines literary features with a clear interpretation of medical symptoms according to contemporary doctrines. This description was later to become a model for non medical references and commentaries dealing with this "famous case", written by Christian authors including Orosius, St. Jerome, Socrates and the pagan historian Zosimos.A retrospective diagnosis of Valentine's last disease is difficult. It is impossible to prove that he really died from a stroke. Death by infectious disease might also be supposed. Finally, similar symptoms can be found in the case of the Emperor Claudius, who was poisoned by his last spouse in Agrippina in 54 AD. Our study is an attempt to analyse this very important case report from a medical, historical and cultural perspective, thus contributing to the historiography of "neurology in the ancient world".

Cause of Death↗

Motion analysis of cervical vertebrae during whiplash loading.

STUDY DESIGN: The motion of each cervical vertebra during simulated rear-end car collisions was analyzed. OBJECTIVES: To clarify the mechanism of zygapophysial joint injury during whiplash loading. SUMMARY OF BACKGROUND DATA: The zygapophysial joint is the suspected origin of neck pain after rear-end car collision. However, no studies have been conducted on the mechanisms of zygapophysial joint injuries. METHODS: Ten healthy male volunteers participated in this study. Subjects sat on a sled that glided backward on inclined rails and crashed into a damper at 4 km/kr. The motion of the cervical spine was recorded using cineradiography. Each vertebra's rotational angle and the instantaneous axes of rotation of the C5-C6 motion segments were quantified. These measurements implemented the template method. RESULTS: There were three distinct patterns of cervical spine motion after impact. In the flexion-extension group, C6 rotated backward before the upper vertebrae in the early phase; thus, the cervical spine showed a flexion position (initial flexion). After C6 reached its maximum rotational angle, C5 was induced to extend. As upper motion segments went into flexion, and the lower segments into extension, the cervical spine took an S-shaped position. In this position, the C5-C6 motion segments showed an open-book motion with an upward-shifted instantaneous axis of rotation. CONCLUSIONS: The cervical spine is forced to move from the lower vertebrae during rear-end collisions. This motion completely differs from normal extension motion and is probably related to the injury mechanism.

Accidents, Traffic↗

Cerebral monitoring in the operating room and the intensive care unit: an introductory for the clinician and a guide for the novice wanting to open a window to the brain. Part I: The electroencephalogram.

While there is an increasing body of knowledge in regard to central nervous system function and/or the mode of action of centrally active agents on neuronal function, little is done to develop new techniques on how to measure such changes. Also, monitoring of the cardiovascular system in the past has made extensive progress especially when it comes to evaluate the failing heart. In contrast monitoring of the central nervous system is only done in rare cases where operative procedures likely impede nervous function integrity. Since in the past decade the aging population undergoing operation has rise considerably, the risk of cerebral malperfusion or minute signs of degradation of the aging central nervous system (CNS) to anesthetics and agents being used in the operation room (OR) or the intensive care unit (ICU), needs continuous monitoring of an organ which presents the highest vulnerability and is likely to deteriorate faster than the cardiovascular system. In spite the rapid improvement in technology regarding the electroencephalogram (EEG) and evoked potential monitoring, physicians still are reluctant to use a technology on a routine base, which will give them insight information into brain function and activity. Such "windows to the brain" now not just are reserved to specialists working in the area of neurology and/or psychiatry. More so, cerebral monitoring is getting an integrated part in the overall therapy in patients undergoing operation or who need ventilatory support in the ICU as it effects the well-being and the outcome. The present book therefore, is intended for the practitioners who work with the patient, guide the clinician in his decision making and outlining those situations where cerebral monitoring presents an integrated part in the diagnosis and therapy of patient care. Without going too much into the technical details, representative cases underline the potential use of cerebral monitoring in the underlying clinical situation where either the patient presents borderline perfusion of the CNS, undergoes vascular surgery, or where monitoring of cerebral function in the intensive care in a head trauma patients is an integrated part in therapy. The book therefore is meant for all those clinicians who have to deal with the CNS in a day-to-day situation. This may be the anesthesiologist, the surgeon, the intensive care therapist, the nurse anesthetist as well as all other medical personal involved in intensive care therapy. The aim of the book therefore is to outline the possibilities, the limitations, and the options for therapy when the windows to the brain are opened, how to interpret the data in the light of other physiological parameters and aid the user in the technical details of how to avoid artifacts in recording which may have an impact on final decision making. Therefore, emphasis is placed on the electrode placement, artifact and electrical noise reduction, as well as data interpretation so that cerebral function diagnosis can be made on reliable grounds. The following serves as an introduction to and as a reference guide for Cerebral Monitoring in the OR and the ICU: Gives complete coverage of EEG power spectra analysis. Describes in detail the EEG machines available to be used in the OR and ICU setting. Describes in detail the major features of EEG power spectra and evoked potential measurements, including amplifiers, filter setting and microprocessor algorithm for data reduction. Gives suggestions for assessing and improving signal quality, including noise and artifact rejection, which usually are encountered in the operation room and the intensive care unit, both of which can be considered as electrically contaminated. Gives examples of EEG power spectra and evoked potential monitoring related to different types of anesthesia, in coma, after head trauma, and for the detection of ischemic events. In addition, gives complete coverage of those machines being available for the OR and the ICU, including a list of parameters regarding latency and amplitude in evoked potential As an introductory, recommendations are given for the novice to start cerebral monitoring and guide the beginner in setting up cerebral monitoring in the clinical environment.

Artifacts↗

On-site physicians at a major sporting event in Nigeria.

INTRODUCTION: Although the need for on-site physicians at mass gatherings has been investigated in developed countries, it has not been studied in a developing country, where resources are limited, paramedical services are unavailable, and transportation and other facilities are inadequate. HYPOTHESIS: The presence of on-site physicians would result in the effective management and prehospital care of casualties at mass gatherings or major sporting events in a developing country. METHODS: A retrospective review of the planning procedures and medical records of the 19th Nigerian University games was conducted. Data from demographic profiles of visitors presenting to the on-site, secondary, and tertiary medical centers and the treatments used were extracted from log-books and processed and interpreted. RESULTS: The Games hosted 6000 accredited athletes and officials, and an estimated 80,000 spectators. Medical coverage was provided by 54 doctors and other healthcare staff at on-site, secondary, and tertiary medical centers. No trained paramedics were available. A total of 494 visits were made to the medical centers (medical usage rate of 2.1/1000, patient presentation rate of 0.08). Forty-six percent of the visitors were evaluated by a physician on-site. Ninety percent of the visits were managed on-site, while 5% and 3% were referred to secondary and tertiary medical centers, respectively. CONCLUSION: The presence of on-site physicians at a major sporting event resulted in the majority of injuries and complaints being effectively treated on-scene. This reduced the number of hospital referrals and saved time and money for treatment.

Anniversaries and Special Events↗

Can a disease-specific education program augment self-management skills and improve Health-Related Quality of Life in people with hip or knee osteoarthritis?

BACKGROUND: Patient education and self-management programs are offered in many countries to people with chronic conditions such as osteoarthritis (OA). The most well-known is the disease-specific Stanford Arthritis Self-Management Program (ASMP). While Australian and international clinical guidelines promote the concept of self-management for OA, there is currently little evidence to support the use of the ASMP. Several meta-analyses have reported that arthritis self-management programs had minimal or no effect on reducing pain and disability. However, previous studies have had methodological shortcomings including the use of outcome measures which do not accurately reflect program goals. Additionally, limited cost-effectiveness analyses have been undertaken and the cost-utility of the program has not been explored. METHODS/DESIGN: This study is a randomised controlled trial to determine the efficacy (in terms of Health-Related Quality of Life and self-management skills) and cost-utility of a 6-week group-based Stanford ASMP for people with hip or knee OA. Six hundred participants referred to an orthopaedic surgeon or rheumatologist for hip or knee OA will be recruited from outpatient clinics at 2 public hospitals and community-based private practices within 2 private hospital settings in Victoria, Australia. Participants must be 18 years or over, fluent in English and able to attend ASMP sessions. Exclusion criteria include cognitive dysfunction, previous participation in self-management programs and placement on a waiting list for joint replacement surgery or scheduled joint replacement.Eligible, consenting participants will be randomised to an intervention group (who receive the ASMP and an arthritis self-management book) or a control group (who receive the book only). Follow-up will be at 6 weeks, 3 months and 12 months using standardised self-report measures. The primary outcome is Health-Related Quality of Life at 12 months, measured using the Assessment of Quality of Life instrument. Secondary outcome measures include the Health Education Impact Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index (pain subscale and total scores), Kessler Psychological Distress Scale and the Hip and Knee Multi-Attribute Priority Tool. Cost-utility analyses will be undertaken using administrative records and self-report data. A subgroup of 100 participants will undergo qualitative interviews to explore the broader potential impacts of the ASMP. DISCUSSION: Using an innovative design combining both quantitative and qualitative components, this project will provide high quality data to facilitate evidence-based recommendations regarding the ASMP.

Adult↗