Health&clinical Management

1: PLoS ONE. 2008 Jul 9;3(7):e2646. Related Articles, Links

Use of evidence-based practices in pregnancy and childbirth: South East Asia Optimising Reproductive and Child Health in Developing Countries project. SEA-ORCHID Study Group, Laopaiboon M, Lumbiganon P, McDonald SJ, Henderson-Smart DJ, Green S, Crowther CA.Collaborators (62) Laopaiboon M, McDonald SJ, Lumbiganon P, Festin MR, Ho JJ, Hakimi M, Henderson-Smart DJ, Green S, Crowther CA, McDonald SJ, Thomas M, Narash N, Ewens M, Hakimi M, Supiyah , Amanah L, Lukitasari D, Astuti D, Amanah L, Amanah L, Lukitasari D, Astuti D, Ho JJ, Cham SS, Cham SS, Aw ET, Cham SS, Lumbiganon P, Khianman B, Pharprapa A, Nachaipet J, Narash N, Poombankor R, Saenrien B, Srisutthikamol N, Panikom S, Khunudom C, Thipawat S, Choonhapran S, Nuanbuddee S, Jarudphan P, Hempira A, Narash N, Poombankor R, Tharnprisan P, Sarapon P, Ponpun O, Narash N, Poombankor R, Festin MR, Ubaldo-Anzures C, Canete LN, Magsipoc , Festin JL, Torralba E, Canete LN, Magsipoc , Festin JL, Henderson-Smart D, Green S, Crowther CA, McDonald SJ. BACKGROUND: The burden of mortality and morbidity related to pregnancy and childbirth remains concentrated in developing countries. SEA-ORCHID (South East Asia Optimising Reproductive and Child Health In Developing countries) is evaluating whether a multifaceted intervention to strengthen capacity for research synthesis, evidence-based care and knowledge implementation improves adoption of best clinical practice recommendations leading to better health for mothers and babies. In this study we assessed current practices in perinatal health care in four South East Asian countries and determined whether they were aligned with best practice recommendations. METHODOLOGY/PRINCIPAL FINDINGS: We completed an audit of 9550 medical records of women and their 9665 infants at nine hospitals; two in each of Indonesia, Malaysia and The Philippines, and three in Thailand between JanuaryDecember 2005. We compared actual clinical practices with best practice recommendations selected from the Cochrane Library and the World Health Organization Reproductive Health Library. Evidence-based components of the active management of the third stage of labour and appropriately treating eclampsia with magnesium sulphate were universally practiced in all hospitals. Appropriate antibiotic prophylaxis for caesarean section, a beneficial form of care, was practiced in less than 5% of cases in most hospitals. Use of the unnecessary practices of enema in labour ranged from 1% to 61% and rates of episiotomy for vaginal birth ranged from 31% to 95%. Other appropriate practices were commonly performed to varying degrees between countries and also between hospitals within the same country. CONCLUSIONS/SIGNIFICANCE:

Whilst some perinatal health care practices audited were consistent with best available evidence, several were not. We conclude that recording of clinical practices should be an essential step to improve quality of care. Based on these findings, the SEA-ORCHID project team has been developing and implementing interventions aimed at increasing compliance with evidence-based clinical practice recommendations to improve perinatal practice in South East Asia. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18612381 [PubMed - in process] PMCID: PMC2440816

2: Emerg Infect Dis. 2008 Jul;14(7):e2. Related Articles, Links

Online Report: Management of Accidental Laboratory Exposure to Burkholderia pseudomallei and B. mallei. Peacock SJ, Schweizer HP, Dance DA, Smith TL, Gee JE, Wuthiekanun V, Deshazer D, Steinmetz I, Tan P, Currie BJ. Mahidol University, Bangkok, Thailand; Colorado State University, Fort Collins, Colorado, USA; Health Protection Agency (South West), Plymouth, UK; Centers for Disease Control and Prevention, Atlanta, Georgia, USA; US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA; Universität Greifswald, Greifswald, Germany; Genome Institute of Singapore, Singapore; and Menzies School of Health Research and Royal Darwin Hospital, Darwin, Northern Territory, Australia. The gram-negative bacillus Burkholderia pseudomallei is a saprophyte and the cause of melioidosis. Natural infection is most commonly reported in northeast Thailand and northern Australia but also occurs in other parts of Asia, South America, and the Caribbean. Melioidosis develops after bacterial inoculation or inhalation, often in relation to occupational exposure in areas where the disease is endemic. Clinical infection has a peak incidence between the fourth and fifth decades; with diabetes mellitus, excess alcohol consumption, chronic renal failure, and chronic lung disease acting as independent risk factors. Most affected adults ( approximately 80%) in northeast Thailand, northern Australia, and Malaysia have >/=1 underlying diseases. Symptoms of melioidosis may be exhibited many years after exposure, commonly in association with an alteration

in immune status. Manifestations of disease are extremely broad ranging and form a spectrum from rapidly life-threatening sepsis to chronic low-grade infection. A common clinical picture is that of sepsis associated with bacterial dissemination to distant sites, frequently causing concomitant pneumonia and liver and splenic abscesses. Infection may also occur in bone, joints, skin, soft tissue, or the prostate. The clinical symptoms of melioidosis mimic those of many other diseases; thus, differentiating between melioidosis and other acute and chronic bacterial infections, including tuberculosis, is often impossible. Confirmation of the diagnosis relies on good practices for specimen collection, laboratory culture, and isolation of B. pseudomallei. The overall mortality rate of infected persons is 50% in northeast Thailand (35% in children) and 19% in Australia. PMID: 18598617 [PubMed - as supplied by publisher] 3: J Vector Borne Dis. 2008 Jun;45(2):105-11. Related Articles, Links

Can visceral leishmaniasis be eliminated from Asia? Joshi A, Narain JP, Prasittisuk C, Bhatia R, Hashim G, Jorge A, Banjara M, Kroeger A. Institute of Medicine, Tribhuvan University, Kathmandu, Nepal. [email protected] Data on the burden of visceral leishmaniasis (VL) in Indian sub-continent are vital for elimination programme planners for estimating resource requirements, effective implementation and monitoring of elimination programme. In Indian sub-continent, about 200 million population is at risk of VL. Nearly 25,00040,000 cases and 200-300 deaths are reported every year, but these are grossly underestimates. Recent well-designed multicentric studies identified VL burden of 21 cases/10,000 among sampled population in Indian sub-continent (Bangladesh, India and Nepal). This estimates 4,20,000 cases per 200 million risk population clearly indicating that the disease is highly under-reported. Chemical and environmental vector control studies show that the indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) are effective and significantly reduce sandfly densities. The findings documented from different sources revealed that some gaps and weakness in existing policies for introducing VL vector control interventions. Our studies emphasize the need of integrated vector management with both IRS and LLIN vector control interventions. Active case detection with rK39 strip test as diagnostic tool is the key element for detection of VL cases. The use of oral drug miltefosine for the treatment after assessing feasibility at community level is important. Kala-azar elimination in Indian subcontinent is possible if elimination programmes ensure access to health care and prevention of kala-azar for people at risk with particular attention to the poorest and marginalized groups. The evidence-based policy should be designed that

motivates to implement the programmes, which will be cost-effective. Maintaining the acceptable level of incidence requires public awareness, vector control, appropriate diagnosis and treatment. The five pillars of VL elimination strategies identified are: early diagnosis and complete treatment; integrated vector management and vector surveillance; effective disease surveillance through passive and active case detection; social mobilization and building partnerships; and clinical and operational research which need to be re-enforced to effective implementation. PMID: 18592839 [PubMed - in process] 4: Int J Health Care Qual Assur. 2008;21(2):159-74. Related Articles, Links

Testing not-so-obvious models of healthcare quality. Badri MA, Attia ST, Ustadi AM. College of Business Administration, United Arab Emirates University, Al Ain, United Arab Emirates. [email protected] PURPOSE: The purpose of this paper is to show that, although there has been some research to identify the dimensions on which healthcare quality and inpatient satisfaction should be measured, the confirmation of constructs and indicators that constitute an overall care quality and satisfaction remains unclear. The objective is to present several models of service quality and satisfaction in healthcare for discharged patients; and to test those models in a sample of discharged patients in public hospitals in the United Arab Emirates. DESIGN/METHODOLOGY/APPROACH: A detailed in-patient survey (using interviews) was used. Data were collected with questionnaires from adult discharges (n = 244) in public hospitals in the UAE. Several structures are proposed and tested. Confirmatory Factor Analysis (CFA) and LISREL SIMPLIS using maximum likelihood estimation were used to estimate and test the parameters of the hypothesized models derived deductively from the previous literature. FINDINGS: Several models (with one, two, three and four constructs) with different structures were tested using CFA. The final recommended model is based on three constructs--quality of care, process and administration, and information. The goodness-of-fit statistics supported the basic solution of the healthcare quality-satisfaction model. ORIGINALITY/VALUE: The model has been found to capture attributes that characterize healthcare quality in a developing country such as the UAE and could represent other modern healthcare systems. It can be used as a basis for evaluation in healthcare practices from discharges (in-patients) point of view. The study highlights the importance of patients' satisfaction with care as predictors of quality of care. The results also confirm the construct validity of the previously discussed healthcare quality scales.

Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18578201 [PubMed - indexed for MEDLINE] 5: Vasc Health Risk Manag. 2008;4(2):415-20. Related Articles, Links

Japanese study to organize proper lifestyle modifications for metabolic syndrome (J-STOP-MetS): design and method. Munakata M, Honma H, Akasi M, Araki T, Kawamura T, Kubota M, Yokokawa T, Maruhashi A, Toyonaga T; J-STOP-MetS Study Group. Preventive Medical Center, Tohoku Rosai Hospital, Sendai, Japan. [email protected] Prevalence of the metabolic syndrome is now a very serious health problem in Japan and a public preventive strategy is essential to reduce morbidity. A systematic interventional strategy for the metabolic syndrome remains to be established. In order to address this issue, a multi-center study; Japanese Study to Organize Proper lifestyle modification for the metabolic syndrome (J-STOPMetS), has been established by nine preventive medical centers among Rosai hospital groups. This study comprises a cross-sectional study (J-STOP-MetS 1) and a prospective randomized control study (J-STOP-MetS 2). J-STOP-MetS 1 examines the causes of the metabolic syndrome by means of a questionnaire in a large cohort of patients with the metabolic syndrome and control subjects matched for age and sex. J-STOP-MetS 2 examines the hypothesis that guidance on lifestyle modifications will help at risk patients to reduce abdominal fat and cardiovascular risk factors. The metabolic syndrome patients are randomly assigned either to a single visit to a guidance group or multiple visits every two months. The individualized guidance is provided by the coordination of physician, trained nurse, dietician and exercise trainer. Several parameters are measured before and six months after the first guidance session, including, body weight, waist circumference, blood pressure, several blood markers and arterial stiffness. The J-STOP-MetS is the first large-scale clinical study of the metabolic syndrome in Japan and should provide important evidence for the practical management of the metabolic syndrome. Publication Types: • •

Multicenter Study Randomized Controlled Trial

•

Research Support, Non-U.S. Gov't

PMID: 18561516 [PubMed - indexed for MEDLINE] 6: Clin Gastroenterol Hepatol. 2008 Jun 14. [Epub ahead of print] Related Articles, Links

Clinical and Pathologic Outcomes of Colorectal Cancer in a MultiEthnic Population. Koo JH, Kin S, Wong C, Jalaludin B, Kneebone A, Connor SJ, Leong RW. Gastroenterology and Liver Services, Evidence Management and Surveillance, Sydney South West Area Health Service, Sydney, Australia; Faculty of Medicine, The University of New South Wales, Sydney, Australia. BACKGROUND & AIMS: The influence of birthplace on the clinical and pathologic outcomes of colorectal cancer (CRC) in Australia is unknown. Addressing inequalities in health care provision in immigrant groups may improve the overall quality of CRC care. METHODS: The South Western Sydney Colorectal Tumour Group registry prospectively collects data on new patients with CRC from a population of 800,000. Survival data were cross-linked with the New South Wales population death registry. RESULTS: From 1997 to 2004 there were 1496 patients (55% males) who were recruited and grouped according to country of birth: Australia, 64%; Southern Europe, 19%; Asia, 12%; and the Middle East, 5%. Significant heterogeneity in CRC characteristics was found, especially in Asians. Compared with Australians, Asians were diagnosed at a younger age (median age, 64 vs 70 y; P < .001, 25.6% were younger than 50 years vs 9.5%; P < .001), had fewer poorly differentiated cancers (8.9% vs 17.7%; P = .004), and fewer metastatic cancers (12.1% vs 21.0%; P = .001). Being Asianborn was associated with improved overall survival independent of age, emergency surgery, grade, and stage (hazard ratio, 0.66; 95% confidence interval, 0.47-0.93; P = 0.02). CRC screening was especially low among Asian- and Middle Eastern-born patients. Complications and treatment were not affected by birthplace, indicating no differences in the provision or acceptance of care based on birthplace. CONCLUSIONS: Despite an equitable distribution of resources, we found significant heterogeneity in presentations and outcomes according to birthplace, with improved survival in Asian-born patients. The lower rates of screen-detected CRC in Asian- and Middle Eastern-born patients and their younger ages at diagnosis indicate that targeted screening strategies may need to be implemented. PMID: 18558515 [PubMed - as supplied by publisher]

7: Isr Med Assoc J. 2008 Apr;10(4):277-81. Related Articles, Links

Anti-tumor necrosis factor therapy: 6 year experience of a single center in northern Israel and possible impact of health policy on results. Braun-Moscovici Y, Markovits D, Rozin A, Toledano K, Nahir AM, BalbirGurman A. B Shine Department of Rheumatology, Rambam Medical Health Care Campus, Technion, Haifa, Israel. [email protected] BACKGROUND: Infliximab and etanercept have been included in the Israeli national list of health services since 2002 for rheumatoid arthritis and juvenile idiopathic arthritis, and since 2005 for psoriatic arthritis and ankylosing spondylitis. The regulator (Ministry of Health and health funds) mandates using fixed doses of infliximab as the first drug of choice and prohibits increased dosage. For other indications (e.g., vasculitis), anti-tumor necrosis factor therapy is given on a "compassionate" basis in severe refractory disease. OBJECTIVES: To describe our experience with anti-TNF therapy in a single tertiary referral center in northern Israel and to analyze the impact of the national health policy on the results. METHODS: We reviewed the medical records of patients who received anti-TNF therapy in our institution, and analyzed demographic data, diagnosis, clinical and laboratory features, previous and current therapies, and anti-TNF treatment duration and side effects. RESULTS: Between 2001 and 2006, 200 patients received anti-TNF therapy for rheumatoid arthritis (n = 108), juvenile idiopathic arthritis (n = 11), psoriatic arthritis (n = 37), ankylosing spondylitis (n = 29), adult Still's disease (n = 4), overlap disease (RA and scleroderma or polymyositis, n = 6), temporal arteritis (n = 1), polyarteritis nodosa (n = 1), dermatomyositis (n = 1), amyloidosis secondary to RA (n = 1) and Wegener's granulomatosis (n = 1). Forty percent of RA patients discontinued the first anti-TNF agent due to side effects or insufficient response. Higher sedimentation rate and lower or negative rheumatoid factor predicted better response to therapy among RA patients. AS and PS patients had a better safety and efficacy profile. Severe infections occurred in 2% of patients. All eight patients who presented lung involvement as part of their primary rheumatic disease remained stable or improved. A significant improvement was achieved in all six patients with overlap disease. CONCLUSION: Our daily practice data are generally in agreement with worldwide experience. The 'deviations' might be explained by the local health policy at that time. The impact of health policy and economic and administrative constraints should be taken into account when analyzing cohort daily practice data. Publication Types:

•

Clinical Trial

PMID: 18548981 [PubMed - indexed for MEDLINE] 8: J Thorac Cardiovasc Surg. 2008 Jun;135(6):1306-12. Epub 2008 May 2. Related Articles, Links Comment in: •

J Thorac Cardiovasc Surg. 2008 Jun;135(6):1202-9.

Effect of procedural volume on outcome of coronary artery bypass graft surgery in Japan: implication toward public reporting and minimal volume standards. Miyata H, Motomura N, Ueda Y, Matsuda H, Takamoto S. Departments of Healthcare Quality Assessment and Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. [email protected] BACKGROUND: Since the Japanese government updated the medical practice laws, each hospital has to submit procedural volume from April 2007 and may sometime in the future have to submit some outcome indicators. It is very important to examine whether procedural volume is accurate and appropriate. METHODS: We analyzed 4581 procedures from 36 centers between 2003 and 2005 by clinical database. The effect of hospital volume on each outcome was tested by a hierarchical mixed-effects logistic regression model, covering clinical risk factors, procedural year, clinical processes, and hospital volume/surgeon volume as a fixed effect and random intercepts for sites. RESULTS: Logistic regression model revealed a significant association between hospital bypass graft volume and 30-day mortality (P < .05) and operative mortality (P < .01). Surgeon procedural volume, however, did not have a significant effect on those outcomes. The effect of hospital procedural volume was associated with better outcomes in most patient subgroups: age younger than 65 years (P < .05), age 65 years and older (P < .01), low risk (P = .58), and high risk (P < .01). CONCLUSION: In Japan, high-volume compared with low-volume providers had better outcomes. As for public reporting in Japan, hospital-based evaluation might be more credible than surgeon-based evaluation. Although minimal volume standards might be effective to improve quality to some extent, volume has limitations as a marker of quality because of its wide range of variance. Publication Types:

•

Comparative Study

PMID: 18544377 [PubMed - indexed for MEDLINE] 9: Acad Med. 2008 Jun;83(6):541-9. Related Articles, Links

Involvement abroad of U.S. academic health centers and major teaching hospitals: the developing landscape. Merritt MG Jr, Railey CJ, Levin SA, Crone RK. The chartis Group, New York, New York, USA. PURPOSE: To compile information about major offshore clinical, education, and research programs and operations of U.S. academic health centers (AHCs) and major teaching hospitals, and to describe how these offshore activities relate to each institution's underlying mission and to the organizational mechanisms that link the activities to the organization's core mission while protecting the organization from potential risks. METHOD: The authors collected information regarding the major offshore activities of 16 AHCs and major teaching hospitals from a variety of sources during the months of March to May 2007. The data sources included telephone interviews with leaders of each organization's offshore activities, review of information on each organization's Web site, and a review of the literature on this topic. A framework was then developed to distinguish the type and scale of offshore activities among these 16 organizations. RESULTS: The extent and nature of offshore activities varies widely across the studied institutions, ranging from a limited number of education and training programs to major commitments to deliver patient care, education, and research services offshore. Offshore activities seem to follow a four-stage development path, which the authors describe. There seem to be four reasons that US AHCs and major teaching hospitals are engaging in these offshore activities. CONCLUSIONS: Development of offshore activities requires a major commitment and is only appropriate for those AHCs whose mission is to serve a global market and who are able to dedicate significant faculty, management, and staff resources. While some have achieved tangible benefits, the creation of truly global AHCs will require many years of development with uncertain results. PMID: 18520457 [PubMed - indexed for MEDLINE] 10: Food Nutr Bull. 2008 Mar;29(1):43-8. Related Articles, Links

Determination of the leading central obesity index among

cardiovascular risk factors in Iranian women. Shahraki T, Shahraki M, Roudbari M, Gargari BP. Research Center for Children and Adolescents' Health, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Islamic Republic of Iran. BACKGROUND: It is unknown whether the waist circumference (WC) or the waist-to-hip ratio (WHR) is a better predictor of cardiovascular risk factors at different ages. OBJECTIVE: To compare WC and WHR as predictors of cardiovascular risk factors and to determine the prevalence of some cardiovascular risk factors in overweight and obese adult women at different ages. METHODS: In this clinical cross-sectional study, 714 overweight and obese women aged 20 to 70 years who were referred to two nutrition clinics in Sistan and Baluchestan province, Islamic Republic of Iran, were studied. The subjects were classified into three groups, 20 to < 35, 35 to < 50, and > or = 50 years of age. Anthropometric indices were measured according to the standard protocol. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and TC/HDL-C ratios were enzymatically determined. RESULTS: Older subjects (> or = 50 years old) had significantly higher values of body mass index (BMI), WC, TC, TG, and LDL-C than those in the two younger age classes. The prevalence rates of obesity, high WC, high WHR, high TC, high TG, high LDL-C, and high TC/ HDL-C ratios were higher in the older subjects. After adjustment for age and BMI, multiple linear regression showed that WC was significantly related to TC and TG in the 20- to < 35-year-old group and to TG in the 35- to < 50-year-old group. In the older participants, WHR was significantly related to TG. CONCLUSIONS: The prevalence of cardiovascular risk factors increases with age. In clinical practice, WC is a better index for predicting some cardiovascular risk factors in younger and middle-aged women; however, for older women, WHR is better. PMID: 18510204 [PubMed - indexed for MEDLINE] 11: Asia Pac J Clin Nutr. 2008;17 Suppl 1:361-4. Related Articles, Links

Sharing Singapore's experience in dietetic practice and school nutrition programmes. Lim YP. Department of Nutrition and Dietetics, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. [email protected] Dietetic practice in Singapore is mainly applied at the clinical settings, such as hospitals. The main scope of practice is in providing medical nutrition therapy to

patients in a multidisciplinary team approach at both inpatient and outpatient clinics. This is delivered in the form of nutrition counseling and nutrition support. Dietitians are also involved in other areas such as conducting nutrition workshops and talks and provide consultation to the hospital's food service department. They set dietary guidelines for inpatient meal services and equip the food service personnel with the knowledge to plan and prepare healthier menus and therapeutic diets. In the schools, all the students are taught the basic principles of nutrition in the school curriculum. Healthy eating messages are reinforced through various interesting activities in schools. Nutrition guidelines on creating healthy and nutritious menus in the school tuckshops are available for schools to implement the Model School Tuckshop Programme. This programme is aimed at cultivating healthy eating habits among school children. For overweight students, they are referred to the students health centre for medical screening, assessment and for regular nutrition counseling at the Nutrition Clinic. Publication Types: •

Review

PMID: 18296379 [PubMed - indexed for MEDLINE] 12: Asia Pac J Clin Nutr. 2008;17 Suppl 1:352-6. Related Articles, Links

Advancing institutional dietetics and school nutrition program in Korea. Kwak TK, Chang HJ. Yonsei University, Department of Food and Nutrition, Shinchon-Dong, Seodaemun-Gu, Seoul 120-749, Korea. [email protected] More than 21,000 practicing dietitians are working in the various fields of institutional foodservice settings in Korea. For the effective placement and practice of dietitians in their special areas, proper enactment and implementation of required legislations shall be imperative. Following legislations are few of those: regulations for dietitians enacted in 1963 in accordance with decree of the Ministry of Health and Social Affair; the School Meals Act in 1981; placement regulation for dietitians in childcare and nursery facilities with over 100 children under the enforcement of Infant Care Act of 1991; regulation for nutrition improvement program stated in the National Health Promotion Act of 1995; enforcement regulation for the placement of dietitians in public health centers under the Regional Public Health Act of 1997; amendment of School Meal Act and Primary and Secondary Education Act in 2003 stating that school shall have the nutrition education teacher who is dietitian qualified and passed national

teacher qualifying examination; amendment of the Ministry of Health and Welfare Notification in 2003 enabled clinical dietitians at hospitals to bill a medical nutrition therapy service fee officially to patients with the following diseases: diabetes, hypertension, cardiac disease, and cancer; and amendment of the Justice Department and its Affiliates Notification in 2006 stating dietitians are placed at correction facilities. Newly introduced nutrition teachers who have tasks of nutrition education and meal service management were arranged at 4,134 schools of public or national primary and secondary as well as special schools for the handicapped in September, 2007. Publication Types: •

Review

PMID: 18296377 [PubMed - indexed for MEDLINE] 13: Isr Med Assoc J. 2008 Mar;10(3):219-23. Related Articles, Links

Knowledge and attitudes of internists compared to medical students regarding acupuncture. Shani-Gershoni Z, Freud T, Press Y, Peleg R. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. BACKGROUND: Acupuncture and public interest in this modality have increased over recent years in Israel and throughout the western world. OBJECTIVES: To compare the knowledge and attitudes of physicians to medical students with regard to acupuncture. METHODS: An anonymous questionnaire was completed by internists and medical students at the Soroka Medical Center. RESULTS: There were 122 respondents in all, 57 of them women (46.7%). The study sample included 40 physicians (33%), 39 fifth year medical students (32%) and 43 second year medical students (35%). The majority of participants (93.4%) had never received training in acupuncture and 84.4% had never undergone acupuncture therapy themselves. In these variables there were no significant differences between the physicians and the students. The participants' level of knowledge of acupuncture was very low, with 40% unable to answer even one question (of eight) correctly. Despite the poor level of knowledge and the lack of personal exposure to acupuncture, 90 participants (74%) believed that acupuncture has more than a placebo effect, and 57 (42%) believed it was important to include acupuncture in medical education. There were no statistically significant differences in the attitudes of physicians and medical students to acupuncture. CONCLUSIONS: The level of knowledge and exposure of

physicians and medical students to acupuncture is low. However, both groups have relatively positive attitudes to this modality as an acceptable treatment for health problems and were open to its inclusion in the medical school curriculum. PMID: 18494236 [PubMed - indexed for MEDLINE] 14: BMC Med Ethics. 2008 May 20;9:10. Related Articles, Links

Informed consent in Sri Lanka: a survey among ethics committee members. Sumathipala A, Siribaddana S, Hewage S, Lekamwattage M, Athukorale M, Siriwardhana C, Murray J, Prince M. Kings College, University of London, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. [email protected] BACKGROUND: Approval of the research proposal by an ethical review committee from both sponsoring and host countries is a generally agreed requirement in externally sponsored research.However, capacity for ethics review is not universal. Aim of this study was to identify opinions and views of the members serving in ethical review and ethics committees in Sri Lanka on informed consent, essential components in the information leaflet and the consent form. METHODS: We obtained ethical approval from UK and Sri Lanka. A series of consensus generation meetings on the protocol were conducted. A task oriented interview guide was developed. The interview was based on open-ended questionnaire. Then the participants were given a WHO checklist on informed consent and requested to rate the items on a three point scale ranging from extremely important to not important. RESULTS: Twenty-nine members from ethics committees participated. Majority of participants (23), believed a copy of the information leaflet and consent form, should accompany research proposal. Opinions about the items that should be included in the information leaflets varied. Participants identified 18 criteria as requirements in the information leaflet and 19 for the consent form.The majority, 20 (69%), believed that all research need ethical approval but identified limited human resource, time and inadequate capacity as constraints. Fifteen (52%) believed that written consent is not required for all research. Verbal consent emerged as an alternative to written consent. The majority of participants rated all components of the WHO checklist as important. CONCLUSION: The number of themes generated for the consent form (N = 18) is as many as for the information leaflet (N = 19) and had several overlaps. This suggests that the consent form should be itemized to reflect the contents covered in the information leaflet. The participants' opinion on components of the information leaflets and consent forms proved to be similar with WHO checklist on informed consent.

Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18489793 [PubMed - indexed for MEDLINE] PMCID: PMC2413248

15: J Health Organ Manag. 2008;22(1):23-35. Related Articles, Links

Pay-for-performance programs in P4P programs Israeli sick funds. Gross R, Elhaynay A, Friedman N, Buetow S. Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel. [email protected] PURPOSE: This paper aims to analyze the development of "pay-forperformance" (P4P) programs implemented by Israel's two largest sick funds, insuring 78 percent of the population. DESIGN/METHODOLOGY/APPROACH: Analysis of the main features and their evolution over time, the observed outcomes and concerns related to implementing these programs. FINDINGS: Our analysis revealed that although implementation has been successful, both managers and physicians have voiced concerns regarding the effect of measuring clinical performance such as focusing attention on the measured areas while neglecting other areas, and motivating a statistical approach to patient care instead of providing patient-centered care. ORIGINALITY/VALUE: The Israeli case provides an interesting example of nation-wide, long-term implementation of the pay-for-performance program. Therefore, it provides other countries with the opportunity to assess features that may facilitate successful implementation, as well as highlighting issues related to the outcomes of P4P programs. Publication Types: •

Comparative Study

PMID: 18488517 [PubMed - indexed for MEDLINE] 16: Surg Neurol. 2008 Jun;69(6):652-6; discussion 656. Related Articles, Links

One year of neurosurgery in the eastern region of Nepal. Agrawal A, Kumar A, Agrawal CS, Pratap A. Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal. [email protected] BACKGROUND: This article briefly discusses about the present status, future strategies, and perspectives of neurosurgery in the eastern region of Nepal. METHODS: B.P. Koirala Institute of Health Sciences, Dharan, Nepal, is the only tertiary referral center responsible for patient care as well as training of postgraduate students and paramedical staff including health care workers in the eastern region of Nepal. We analyzed the data from January 2006 to January 2007 regarding patient care and their outcomes. At the same time, we also evaluated our limitations regarding resources and their impact on patient care. Strategies are suggested to overcome the barriers to establish effective neurosurgical centers in developing countries. RESULTS: At present in the BPKIHS, neurosurgical facilities are being provided as a specialty unit in the department of surgery. From January 2006 to January 2007, a total 1120 patients were treated for different neurological and neurosurgical conditions. At present, there are 8 beds allotted to neurosurgical services in the general surgery ward. In addition, there are 8 ICU beds catering to the needs, including neurosurgery, of the hospital. No vascular, epilepsy surgery or functional neurosurgery has been performed due to lack of resources. The only imaging facility for neurosurgery that is available in the hospital is CT scan. CONCLUSIONS: The study concludes that in a developing country, the neurosurgical unit can be structured in a manner that will fulfill most of the objectives required for better clinical outcome. This structured program may also benefit substantially in training health professionals as well. PMID: 18486707 [PubMed - indexed for MEDLINE] 17: BMC Health Serv Res. 2008 May 18;8:105. Related Articles, Links

Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals. Koh SS, Manias E, Hutchinson AM, Donath S, Johnston L. School of Nursing, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia. [email protected] BACKGROUND: Theories of behavior change indicate that an analysis of

barriers to change is helpful when trying to influence professional practice. The aim of this study was to assess the perceived barriers to practice change by eliciting nurses' opinions with regard to barriers to, and facilitators of, implementation of a Fall Prevention clinical practice guideline in five acute care hospitals in Singapore. METHODS: Nurses were surveyed to identify their perceptions regarding barriers to implementation of clinical practice guidelines in their practice setting. The validated questionnaire, 'Barriers and facilitators assessment instrument', was administered to nurses (n = 1830) working in the medical, surgical, geriatric units, at five acute care hospitals in Singapore. RESULTS: An 80.2% response rate was achieved. The greatest barriers to implementation of clinical practice guidelines reported included: knowledge and motivation, availability of support staff, access to facilities, health status of patients, and, education of staff and patients. CONCLUSION: Numerous barriers to the use of the Fall Prevention Clinical Practice Guideline have been identified. This study has laid the foundation for further research into implementation of clinical practice guidelines in Singapore by identifying barriers to change in acute care settings. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18485235 [PubMed - indexed for MEDLINE] PMCID: PMC2422837

18: Trop Anim Health Prod. 2008 Apr;40(3):193-200. Related Articles, Links

Risk factors associated with camel brucellosis in Jordan. Al-Majali AM, Al-Qudah KM, Al-Tarazi YH, Al-Rawashdeh OF. Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, Jordan University of Science and Technology, P. O. Box 3030, Irbid 22110, Jordan. [email protected] During the period between February, 2004 and December, 2006, a cross-sectional study was performed to investigate some epidemiological aspects related to camel brucellosis in Jordan. Four hundred twelve camel sera from 37 herds were randomly collected and analyzed using Rose Bengal plate test and complement fixation test. A structured pre-tested questionnaire was administered to collect information on camel herd health and management. A multivariable logistic regression model was constructed to investigate risk factors associated with

seropositivity to Brucella antigens. Moreover, the incidence of Brucella-specific abortion was investigated in 7 camel herds located in different locations in Southern Jordan. The true prevalence of Brucella-seropositive in camels was 12.1%. Thirteen (35.1%) herds had at least one positive camel. The seroprevalence ofbrucellosis in camels was significantly higher in the southern part of Jordan than that in central or northern Jordan. The multivariable logistic regression model on both individual and herd levels revealed large herds and contact with small ruminants as risk factors for Brucella seropositivity. On the other hand, using disinfectants was identified as a protective factor (OR = 0.8; 95% CI: 0.1, 0.9) only on the camel herd level. The incidence of Brucella-caused abortion was 1.9%. Brucella melitensis biotype 3 was isolated from 4 aborted camel fetuses. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18484121 [PubMed - indexed for MEDLINE] 19: Nurs J India. 2007 Dec;98(12):271-2. Related Articles, Links

Rehabilitation of cancer breast patients after mastectomy. Mann B. A study to evaluate the effectiveness of a planned teaching programme on rehabilitation of cancer breast patients after mastectomy in terms of knowledge and expressed practices of nursing personnel working in a selected hospital of Delhi. Publication Types: •

Evaluation Studies

PMID: 18481447 [PubMed - indexed for MEDLINE] 20: Nurs Inq. 2008 Jun;15(2):158-68. Related Articles, Links

Challenges in providing breast and cervical cancer screening services to Vietnamese Canadian women: the healthcare providers'

perspective. Donnelly TT. Faculty of Nursing, Faculty of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. [email protected] Breast cancer and cervical cancer are major contributors to morbidity and mortality among Vietnamese Canadian women. Vietnamese women are at risk because of their low participation rate in cancer-preventative screening programmes. Drawing from the results of a larger qualitative study, this paper reports factors that influence Vietnamese women's participation in breast and cervical cancer screening from the healthcare providers' perspectives. The women participants' perspective was reported elsewhere. Semistructured interviews were conducted with six healthcare providers. Analysis of these interviews reveals several challenges which healthcare providers encountered in their clinical practice. These include the physicians' cultural awareness about the private body, patient's low socioeconomic status, the healthcare provider-patient relationship, and limited institutional support. This is the first Canadian study to identify the healthcare providers' perspective on giving breast and cervical cancer preventive care to the Vietnamese immigrant women. The insight gained from these healthcare providers' experiences are valuable and might be helpful to healthcare professionals caring for immigrant women of similar ethno-cultural backgrounds. Recommendations for the promotion of breast cancer and cervical cancer screening among Vietnamese women include: (i) effort should be made to recruit Vietnamese-speaking female healthcare professionals for breast and cervical health-promotion programmes; (ii) reduce woman-physicians hierarchical relationship and foster effective doctor-patient communication; (iii) healthcare providers must be aware of their own cultural beliefs, values and attitudes that they bring to their practice; and (iv) more institutional support and resources should be given to both Vietnamese Canadian women and their healthcare providers. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18476858 21: Int Heart J. 2008 Mar;49(2):193-203. Related Articles, Links

The Japanese national health screening and intervention program aimed at preventing worsening of the metabolic syndrome.

Kohro T, Furui Y, Mitsutake N, Fujii R, Morita H, Oku S, Ohe K, Nagai R. Department of Translational Research for Healthcare and Clinical Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. Similar to the healthcare systems in other industrialized countries, the Japanese healthcare system is facing the problem of increasing medical expenditure. In Japan, this situation may be primarily attributed to advanced technological developments, an aging population, and increasing patient demand. Japan also faces the problem of a declining youth population due to a low birth rate. Taken together, these problems present the healthcare system with a very difficult financial situation. Several reforms have been undertaken to contain medical expenditure, such as increasing employee copayment for health insurance from 10% to 20% in 1997 and from 20% to 30% in 2003 in order to curb unnecessary visits to medical institutions. Since the aging of the Japanese population is inevitable, a suitable method to contain medical expenditure may be to screen individuals who are likely to develop lifestyle-related diseases and conduct early intervention programs for them to prevent the development of diseases such as myocardial infarction or stroke that are costly to treat. If this goal is attained, it may contribute to the containment of medical expenditure as well as to improving the quality of life of the elderly. Therefore, the Japanese Ministry of Health, Labor and Welfare has decided to introduce a nationwide health screening and intervention program specifically targeting the metabolic syndrome commencing April 2008. Here, we discuss (1) the background of the Japanese healthcare system and the problems facing it, (2) the underlying objective and details of the new screening program, and (3) the expected impact of the program. Publication Types: • •

Research Support, Non-U.S. Gov't Review

PMID: 18475019 [PubMed - indexed for MEDLINE] 22: Expert Opin Pharmacother. 2008 Jun;9(8):1271-7. Related Articles, Links

Long-term adherence to antihypertensive therapy: a survey in four primary care clinics. Vinker S, Alkalay A, Hoffman RD, Elhayany A, Kaiserman I, Kitai E. Central District, Clalit Health Services, Department of Family Medicine, Rishon

LeZion, Israel. [email protected] BACKGROUND: Many hypertensive patients have suboptimal control of their blood pressure. One of the most common causes is poor adherence with treatment. AIM: To identify factors associated with poorer adherence to antihypertensive treatment. METHODS: The study was conducted in four urban clinics of Clalit Health Services (Israel's largest Health management organization): 3799 patients aged > 20 years with hypertension in whom a new antihypertensive medicine was started in a 3-year period were included. Data included: age; gender; chronic diseases; type of antihypertensive medicine; and adherence with treatment. Reasons for non-adherence had been evaluated in a random sample of 453 of the medical records. RESULTS: Of the patients, 2234/3799 (58.8%) stopped >or= 1 medicine. Lower adherence was associated with female gender, new immigration, ischemic heart disease and being a non-diabetic. Adherence was related to the type of medicine. The highest rates of adherence were found with the use of angiotensin receptor blockers (59.1%) and selective beta-blockers (59%), and the lowest with non-selective beta-blockers (30.1%). There was no documentation of the reason to medicine cessation in 183/453 (40.4%) of the medical records. In 20.1% of cessations, the physician continued to prescribe the drug, despite the fact that the patient had stopped purchasing it. Common reasons for treatment cessation were side effects (15%) and lack of blood pressure control (5.5%). CONCLUSIONS: Adherence with antihypertensive treatment declines with time and is associated with the type of medicine, and sociodemographic and clinical backgrounds. Family physicians must increase their documentation and awareness to medicine adherence. PMID: 18473702 [PubMed - indexed for MEDLINE] 23: Natl Med J India. 2008 Jan-Feb;21(1):31-4. Related Articles, Links

Registering clinical trials in India: a scientific and ethical imperative. Tharyan P, Ghersi D. Professor B V Moses Centre for Research and Training in Evidence Based Health Care (ICMR Centre for Advanced Research), Christian Medical College, Vellore 632002, Tamil Nadu, India. [email protected] The Clinical Trials Registery-India is an online, primary register of the WHO's International Clinical Trials Registry Platform. It was launched on 20 July 2007, and is now open to the prospective registration of clinical trials of any intervention conducted in India involving human participants. Registration is voluntary and free, and the register is searchable free of charge. Public disclosure of all 20 items in the WHO Trial Registration Data Set is mandatory for a valid

registration number to be allocated. This number is required if the results are to be published in journals that endorse the International Committee of Medical Journal Editors' position on prospective trials registration. Trials in the Clinical Trials Registery-India will be included in the central repository of the WHO's International Clinical Trials Registry Platform search portal. In addition to the 20 items, the Clinical Trials Registery-India also requires mandatory disclosure of details of ethics committee and regulatory clearances. Further items pertaining to the methods that improve the internal validity of the trial are optional and serve as a template to improve trial design and the reliability of results. The success of this endeavour depends on the cooperation of the pharmaceutical industry, academic institutions, medical associations, ethics committees and medical journal editors in India. In the absence of legislation, ethics committees and medical journal editors have an important role in ensuring prospective registration of trials. Publication Types: • •

Research Support, Non-U.S. Gov't Review

PMID: 18472701 [PubMed - indexed for MEDLINE] 24: J Coll Physicians Surg Pak. 2008 Jan;18(1):58-63. Related Articles, Links

Postgraduate medical training in Pakistan: observations and recommendations. Biggs JS. Coast City Country Training, Australia. [email protected] An appraisal of postgraduate training under the aegis of the Higher Education Commission in 2006-2007 showed strong input of supervisors and enthusiasm of trainees. Problems were evident however, beginning with the virtual absence of training for family doctors. Early moves in provision of this training are applauded. Greater undergraduate contact with primary care may help to raise its status but a trained workforce is necessary to make student placements practicable. Some uncertainties about specialist qualifications need to be resolved. Trainees' concerns focussed on the absence of stipend for many; inadequate supervision due in part to insufficient faculty; the poor condition and maintenance of some teaching hospitals; difficulties with aspects of College of Physicians and Surgeons processes; and the lack of career paths. All trainees should receive payment for their clinical duties and responsibilities; there should be a national review of faculty numbers; the management and suitability of hospital facilities should be examined. It is pleasing to know that problems at the College are being

addressed; and the provision of career paths including post-fellowship experience should be a priority matter. Medical workforce planning is addressed and a call made for better data. Overcoming deficiencies will mean an increased budget for health, presently among the lowest in the region. PMID: 18452674 [PubMed - indexed for MEDLINE] 25: J Ayub Med Coll Abbottabad. 2007 Jul-Sep;19(3):25-9. Related Articles, Links

Comparision between bed side testing of blood glucose by glucometer vs centralized testing in a tertiary care hospital. Baig A, Siddiqui I, Jabbar A, Azam SI, Sabir S, Alam S, Ghani F. Section of Chemical Pathology, Department of Pathology & Microbiology, Aga Khan University Karachi, Pakistan. [email protected] BACKGROUND: To determine the accuracy, turnaround time and cost effectiveness of bedside monitoring of blood glucose levels by non-laboratory health care workers and centralized testing of blood glucose by automated analyzer in a tertiary care hospital. METHODS: The study was conducted in Section of Chemical Pathology, Department of Pathology and Microbiology and Section of Endocrinology Department of Medicine, Aga Khan University and Hospital Karachi, from April 2005 to March 2006. One hundred and ten patients were included in the study. The blood glucose levels were analyzed on glucometer (Precision Abbott) by finger stick, using Biosensor Technology. At the same time venous blood was obtained to analyze glucose in clinical laboratory on automated analyzer (SYNCHRON CX7) by glucose oxidase method. RESULTS: We observed good correlation between bed side glucometer and laboratory automated analyzer for glucose values between 3.3 mmol/L (60 mg/dl) and 16.7 (300 mg/dl). A significant difference was observed for glucose values less than 3.3 mmol/L (p = 0.002) and glucose values more than 16.67 mmol/l (p = 0.049). Mean Turnaround time for glucometer and automated analyzer were 0.08 hours and 2.49 hours respectively. The cost of glucose testing with glucometer was 48.8% lower than centralized lab based testing. CONCLUSION: Bedside glucometer testing, though less expensive does not have good accuracy in acutely ill patient with either very high or very low blood glucose levels. Publication Types: •

Comparative Study

PMID: 18444586 [PubMed - indexed for MEDLINE]

26: Health Care Women Int. 2008 May;29(5):539-50. Related Articles, Links

Provider perceptions of reproductive health service quality in jordanian public community health centers. Al-Qutob R, Nasir LS. Faculty of Medicine, Department of Family and Community Medicine, University of Jordan, Amman, Jordan. Enhancing the quality of reproductive health care delivery in developing countries is a key prerequisite to increased utilization and sustainability of these services in the target population. Our objective was to assess the perception of quality of reproductive health (RH) care services provided by Jordanian Ministry of Health community-based centers from the perspective of service providers in these settings. A purposeful nationwide sample of 50 primary health care providers took part in five focus group discussions with the purpose of exploring their perceptions of the quality of care provided by their centers and perceived barriers to the provision of quality RH care. Health care providers felt that the quality of RH care provided by their centers was suboptimal. Focus group participants reported numerous barriers to the provision of high quality-care in the clinical setting. These included issues related to patient overload, patient and physician characteristics, as well as problems inherent to supervisory and administrative functions. Exploring and aligning goals and expectations of RH care providers and administrators may result in improvements in the quality of RH care service delivery and morale in public health settings in Jordan, which is a requirement for public sector reform. PMID: 18437599 [PubMed - indexed for MEDLINE] 27: J Med Assoc Thai. 2007 Oct;90 Suppl 1:98-108. Related Articles, Links

The effect of the public or private status of health care facility in acute coronary syndrome: data from Thai ACS Registry. Hutayanon P, Sarakarn P, Buakhamsri A, Boonsom W, Yamwong S. Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani 12120, Thailand. [email protected] BACKGROUND: Few data showed the differences between public and private hospitals in management practices and outcomes of patients with acute coronary syndrome. Furthermore, no data is available in Thailand. OBJECTIVE: To

determine the patients' characteristics, management practices, and in-hospital outcomes differences between public and private hospitals in Thailand for patients with acute coronary syndrome. MATERIAL AND METHOD: Data from the Thai Acute Coronary Syndrome Registry (TACSR), which was a prospective observational study on ACS in Thailand from 2003 to 2005, was used. This registry provided clinical characteristics, medical management and outcomes of patients with ACS during hospitalization. All data were then compared based on type of admitting hospitals; public and private hospitals. To determine the relationship between type of hospital and major cardiac outcomes, multivariate logistic regression analysis was performed and represented as odd ratio (OR) and 95% confidence interval (95%CI). RESULTS: Eight thousand one hundred sixty four patients were admitted to public hospitals (n = 13), and 1,209 were admitted to private hospitals (n = 4). Patients in public hospitals were older (65.4 +/- 12.1 vs. 63.4 +/- 13.3 years, p < 0.001) and more female gender (41.7% vs. 30.1%, p < 0.001). Diagnosis of acute ST-elevation myocardial infarction were lower in public hospitals compared to private hospitals (39.6% vs. 50%, p < 0.001). After adjusting for baseline patient characteristics and management, in-hospital outcomes were higher in public hospitals for total mortality (13.6% vs. 5.9%, OR 2.3, 95%CI 1.76-3.12, p < 0.001), cardiac mortality (10.6% vs. 4.8%, OR = 2.1, 95%CI 1.55-2.91, p< 0.001) and major bleeding (6.3% vs. 3.2%, OR = 2.1, 95%CI 1.48-3.23, p < 0.001). Compared with the patients in the public hospital, patients in the private hospitals were more likely to undergo coronary angiography, percutaneous coronary intervention and coronary bypass grafting. CONCLUSION: In Thailand, management of patients with acute coronary syndrome is influenced by the public or private status of the hospitals. Patients were more likely to undergo coronary angiography and coronary revascularization procedures in private hospitals. The length of hospital stays and in-hospital mortality was higher in public hospitals. Publication Types: • • •

Comparative Study Multicenter Study Research Support, Non-U.S. Gov't

PMID: 18431892 [PubMed - indexed for MEDLINE] 28: J Med Assoc Thai. 2007 Oct;90 Suppl 1:74-80. Related Articles, Links

In-hospital invasive strategy and outcomes in non-ST elevation acute coronary syndrome management from Thai Acute Coronary Syndrome Registry. Phrommintikul A, Kuanprasert S, Limpijankit T, Hengrassamee K.

Cardiovascular Division, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand. [email protected] BACKGROUND: The management guideline of acute coronary syndrome has been changed in recent years, especially in the group of non-ST elevation acute coronary syndrome (NSTE-ACS). Presently, there is no existing guideline in Thailand. Additionally, several different management factors of health care from Western countries being used. OBJECTIVE: Evaluate the real management strategy, including the utilization of invasive management and pharmacotherapy of NSTE-ACS Thai patients in the absence of official clinical management guideline. MATERIAL AND METHOD: Thai Acute Coronary Syndrome (Thai ACS) Registry is a large, observational prospective, population-based registry designed to collect the data of "real-life" patient management. The full details of methods have been published in the present supplement. RESULTS: Five thousand five hundred and thirty-seven consecutive patients were registered between August 1, 2002 and July 31, 2005. Among these patients, 3,548 (64.1%) were diagnosed with non-ST elevation myocardial infarction (NSTEMI) and 1,989 (35.9%) with unstable angina. Coronary angiography was performed during hospitalization in 2,476 patients (44.7%). From 2,476 patients who underwent coronary angiogram, 405 (16.4%) had revascularization within 2 days and 1,019 (42.9%) after 2 days. Overall, in-hospital mortality was 9.5% and cardiac mortality was 6.3%. Patients with NSTEMI had more than 4 times the mortality of patients with unstable angina (13.1 vs. 3.0%, p < 0.001). Patients who received only medical treatment without coronary angiogram had the highest mortality rate. The in-hospital outcomes were not different between patients who received early or delayed revascularization. CONCLUSION: Mortality rate of NSTEACS in the authors' registry was very high. NSTEMI had the worse prognosis. Invasive strategy is associated with better in-hospital outcome but is underutilized. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18431889 [PubMed - indexed for MEDLINE] 29: J Med Assoc Thai. 2007 Oct;90 Suppl 1:21-31. Related Articles, Links

Costs of payment in Thai acute coronary syndrome patients. Moleerergpoom W, Kanjanavanit R, Jintapakorn W, Sritara P. Cardiology Unit, Department of Medicine, Police General Hospital, Pratumwan, Bangkok 10330, Thailand. [email protected]

BACKGROUND: Acute coronary syndrome (ACS) is a major health care syndrome that can financially burden patients throughout the world, including Thailand. Few studies purposed estimating the costs of treatment. The data from the ACS registry database represented the costs of hospital charges paid by ACS patients. Although these were not the actual treatment costs, the authors can approximately estimate the total expenditure for the first admission. OBJECTIVES: First, calculate the cost of ACS to the patients, including diagnostic, demographic data, treatment modalities, type of payers, hospital profile, and outcomes. Second, find the appropriate model to identify the independent factors for predicting the treatment costs. MATERIAL AND METHOD: The present study collected data from the second and third phase of a national multicenter prospective registry of ACS in Thailand, Thai ACS registry (TACSR). 3,552 patients with new onset of ACS were analyzed. RESULTS: Median age was 67 years (range 26.5-105.5) with predominately male and median length of stay (LOS) was 7 days (range, 1-184). 42% referred from other hospitals. The median cost of the total population was 47,908 baht (range, 6331,279,679). When classified into those of STEMI, NSTEMI, and UA, the costs were 82,848.5, 40,531 and 26,116 baht respectively, p < 0.0001. Patients in the government hospital had to pay the total cost with PCI and CABG, 152,081161,374 baht and 203,139-223,747 baht respectively, while the private hospital charged almost twice as much. For the types of payers, private insurance including private employee security fund paid significantly more than others. Costs in patients paid by "30 baht na tional health scheme and social security fund" were significantly less than those of others. For modality of treatment in STEMI, primary PCI was significantly more costly than thrombolytics and no reperfusion therapy, 161,096.5 vs. 60,043.0 and 33,335.0 baht respectively p < 0.0001. Early invasive groups in NSTEMI/UA had much higher median costs 145,794.0 baht when compared to those of the conservative group, 47,908 baht, p < 0.0001. Two multiple linear regression models according to the diagnostic group identified the independent factors for predicting cost. PCI, LOS, CABG, admission in a private hospital, Death, GPIIb/IlIa inhibitors use, major bleeding, coronary angiogram, thrombolytics use, age and diabetes were independent predictors for the cost in STEMI patients, R2 = 0.58. For those of NSTEMI/UA, the independent predictors for the cost were PCI, LOS, CABG, admission in a private hospital, death, GP IIb/IIIa inhibitors use, major bleeding, coronary angiogram, age, ventricular arrhythmia, CHF and referred patients, R2 =0.62. CONCLUSION: Costs in ACS patients were markedly different among diagnostic groups. The clinical risk factors were hospital type, type of payers, referred system, treatment procedures, drugs used and complications including outcome. Some of these factors could independently predict the costs. Publication Types: • •

Multicenter Study Research Support, Non-U.S. Gov't

PMID: 18431883 [PubMed - indexed for MEDLINE] 30: Singapore Med J. 2008 Apr;49(4):328-32. Related Articles, Links

Should clinical normality be examined in medical course? Tiong TS. Faculty of Medicine & Health Sciences, Universiti Malaysia Sarawak, Lot 77 Sect 22, Jalan Tun Ahmad Zaidi Adruce, Kuching 93150, Malaysia. [email protected] INTRODUCTION: In medical practice, some patients consult doctors for reassurance of normality, e.g. patients with throat discomfort. Therefore, medical graduates should be competent in diagnosing clinical normality. One way to assess clinical competence is by the objective structured clinical examination (OSCE). METHODS: In 2002-2006, five batches of medical students who completed their otorhinolaryngology posting in Universiti Malaysia Sarawak were examined with the same OSCE question on clinically normal vocal cords. There were five subquestions concerning structures, clinical features, diagnosis and management. All students had prior slide show sessions regarding normal and abnormal laryngeal conditions. RESULTS: The total number of students in 2002, 2003, 2004, 2005 and 2006 was 25, 41, 20, 30 and 16, respectively, and 100 percent responded. The average percentage of students with correct answers was 19.4, 2.4, 2.2, 21.2, and 2.4, in the subquestions 0.1 to 0.5, respectively, leaving the remaining relatively larger percentages with incorrect answers of various clinical abnormalities. A reason for these findings is examination fever by the students, who also assumed that all the stations had clinical abnormalities and required differentiating abnormalities from abnormalities, and not from normality. Without clinical normality OSCE questions, the assessment of the undergraduates' clinical competence in real life would seem incomplete. CONCLUSION: This study showed that a significantly large percentage of students answered incorrectly in the clinical normality OSCE. This may mean that more clinical normality OSCE questions should be included in the undergraduate medical examination to help undergraduates practise the need to look for, and become competent in, clinical normality in real life. PMID: 18418526 [PubMed - indexed for MEDLINE] 31: Ind Health. 2008 Apr;46(2):158-65. Related Articles, Links

A pilot study testing the dimensions of safety climate among Japanese nurses. Kudo Y, Satoh T, Kido S, Watanabe M, Miki T, Miyajima E, Saegusa Y, Tsunoda M, Aizawa Y. Department of Preventive Medicine and Public Health, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. To investigate the dimensions of safety climate among Japanese nurses, an anonymous self-administered questionnaire survey was conducted. The subjects involved in the survey included 293 full-time nurses (registered nurses and licensed practical nurses) working in a public hospital, excluding directors of nursing. A total of 221 of the 293 nurses answered the questionnaires. Among 221 questionnaires, the questionnaires, which had missing values in the question items used in this study, were excluded from the analyses. Consequently, a total of 201 questionnaires were analyzed. The average age of the subjects was 34.7 yr. As a result of exploratory factor analysis, 5 factors were extracted as follows: intellectual development regarding medical safety among nurses, accumulated fatigue, nursing conditions, supervisors' attitudes, and communication with physicians. All the values of Cronback's coefficient alpha among these 5 factors were between 0.804 and 0.892. As a result of the confirmatory factor analysis of the 5 factors, the value of the GFI (Goodness of Fit Index) was 0.868. The value of the CFI (Comparative Fit Index) was 0.943. The value of the RMSEA (Root Mean Square Error of Approximation) was 0.062. The results of this study will contribute to the investigation of the dimensions of a nurses' safety climate scale in the future. The associations between the dimensions of the safety climate and the motivation to work toward improving patients' safety among Japanese nurses will need to be examined, as will those between the dimensions of the safety climate and actual clinical mistakes. PMID: 18413969 [PubMed - indexed for MEDLINE] 32: BMC Pediatr. 2008 Apr 15;8:12. Related Articles, Links

International survey of diagnostic services for children with Fetal Alcohol Spectrum Disorders. Peadon E, Fremantle E, Bower C, Elliott EJ. Australian Paediatric Surveillance Unit, The Children's Hospital at Westmead, Locked Bag 4001, 2145 Westmead, Australia . [email protected]

BACKGROUND: Early diagnosis and intervention for children with Fetal Alcohol Spectrum Disorder (FASD) reduces the risk of developing a range of secondary social, emotional and behavioural problems and provides an opportunity for prevention of further alcohol exposed pregnancies. The objective of this study was to describe specialist clinical service provision for the diagnosis and assessment of children exposed to alcohol in pregnancy. METHODS: Fetal Alcohol Spectrum Disorder (FASD) diagnostic clinics were identified through literature and internet searches. Clinics were sent a questionnaire asking for information on the clinic population, clinic staff, assessment process and other services provided. RESULTS: Questionnaires were completed for 34 clinics: 29 were in North America, 2 in Africa, 2 in Europe and 1 in South America. No clinics were identified in Asia or Australasia. There was a variety of funding sources, services offered, clinic populations, staff and methods of assessment. Thirty-three clinics had a multi-disciplinary team. In 32 clinics, at least one member of the team had specialist training in assessment of FASD. Neurobehavioural assessment was completed in 32 clinics. Eleven clinics used more than one set of diagnostic criteria or an adaptation of published criteria. CONCLUSION: Diagnostic services are concentrated in North America. Most responding clinics are using a multidisciplinary approach with neurobehavioural assessment as recommended in published guidelines. Agreement on diagnostic criteria would enable comparison of clinical and research data, and enhance FASD research particularly for intervention trials. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18412975 [PubMed - indexed for MEDLINE] PMCID: PMC2377245

33: Fam Process. 2008 Mar;47(1):115-30. Related Articles, Links

Incorporating family therapy into asthma group intervention: a randomized waitlist-controlled trial. Ng SM, Li AM, Lou VW, Tso IF, Wan PY, Chan DF. Centre on Behavioral Health, University of Hong Kong, G/F Pauline Chan Bldg., 10 Sassoon Rd., Pokfulam, Hong Kong, China. [email protected] Asthma psychoeducational programs have been found to be effective in terms of

symptom-related outcome. They are mostly illness-focused, and pay minimal attention to systemic/familial factors. This study evaluated a novel asthma psychoeducation program that adopted a parallel group design and incorporated family therapy. A randomized waitlist-controlled crossover clinical trial design was adopted. Children with stable asthma and their parents were recruited from a pediatric chest clinic. Outcome measures included, for the patients: exhaled nitric oxide (eNO), spirometry, and adjustment to asthma; and for the parents: perceived efficacy in asthma management, Hospital Anxiety and Depression Scale anxiety subscale, Body Mind Spirit Well-being Inventory emotion subscale, and Short Form 12 health-related quality of life scale. Forty-six patients participated in the study. Attrition rates were 13.0% and 26.0% for the active and control groups, respectively. Repeated-measures ANOVA revealed a significant decrease in airway inflammation, as indicated by eNO levels, and an increase in patient's adjustment to asthma and parents' perceived efficacy in asthma management. Serial trend analysis revealed that most psychosocial measures continued to progress steadily after intervention. Significant improvements in both symptomrelated measures and mental health and relationship measures were observed. The findings supported the value of incorporating family therapy into asthma psychoeducation programs. Publication Types: • •

Clinical Trial Randomized Controlled Trial

PMID: 18411833 [PubMed - indexed for MEDLINE] 34: Value Health. 2008 Mar;11 Suppl 1:S43-51. Related Articles, Links

Cost-effectiveness analysis of thiazolidinediones in uncontrolled type 2 diabetic patients receiving sulfonylureas and metformin in Thailand. Chirakup S, Chaiyakunapruk N, Chaikledkeaw U, Pongcharoensuk P, Ongphiphadhanakul B, Roze S, Valentine WJ, Palmer AJ. Department of Pharmacy Practice, School of Pharmacy, Naresuan University, Phitsanulok, Thailand. OBJECTIVE: The national essential drug committee in Thailand suggested that only one of thiazolidinediones be included in hospital formulary but little was know about their cost-effectiveness values. This study aims to determine an incremental cost-effectiveness ratio of pioglitazone 45 mg compared with

rosiglitazone 8 mg in uncontrolled type 2 diabetic patients receiving sulfonylureas and metformin in Thailand. METHODS: A Markov diabetes model (Center for Outcome Research model) was used in this study. Baseline characteristics of patients were based on Thai diabetes registry project. Costs of diabetes were calculated mainly from Buddhachinaraj hospital. Nonspecific mortality rate and transition probabilities of death from renal replacement therapy were obtained from Thai sources. Clinical effectiveness of thiazolidinediones was retrieved from a meta-analysis. All analyses were based on the government hospital policymaker perspective. Both cost and outcomes were discounted with the rate of 3%. Basecase analyses were analyzed as incremental cost per quality-adjusted life year (QALY) gained. A series of sensitive analyses were performed. RESULTS: In base-case analysis, the pioglitazone group had a better clinical outcomes and higher lifetime costs. The incremental cost per QALY gained was 186,246 baht (US$ 5389). The acceptability curves showed that the probability of pioglitazone being cost-effective was 29% at the willingness to pay of one time of Thai gross domestic product per capita (GDP per capita). The effect of pioglitazone on %HbA1c decrease was the most sensitive to the final outcomes. CONCLUSIONS: Our findings showed that in type 2 diabetic patients who cannot control their blood glucose under the combination of sulfonylurea and metformin, the use of pioglitazone 45 mg fell in the cost-effective range recommended by World Health Organization (one to three times of GDP per capita) on average, compared to rosiglitazone 8 mg. Nevertheless, based on sensitivity analysis, its probability of being cost-effective was quite low. Hospital policymakers may consider our findings as part of information for the decisionmaking process. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18387067 [PubMed - indexed for MEDLINE] 35: Psychopathology. 2008;41(4):245-53. Epub 2008 Apr 11. Related Articles, Links

Possession states in Northern Sri Lanka. Somasundaram D, Thivakaran T, Bhugra D. Department of Psychiatry, University of Jaffna, Jaffna, Sri Lanka. [email protected] BACKGROUND: Possession states are still commonly seen in developing societies as acceptable cultural phenomena in normal persons as well as in those

with psychiatric illness. 'Possession' is defined here as the experience of being taken over, controlled or occupied by another spirit or force. SAMPLING AND METHODS: This is a descriptive cross-sectional study of possession states among psychiatric patients, general population and popular adepts in Northern Sri Lanka, using semi-structured questionnaires and clinical observations. RESULTS: Thirty psychiatric patients were identified as having possession states. They were compared with 30 controls each from the general population admitted to a general hospital outpatient department and selected popular adepts in the community. The latter are individuals who are well known as having possession states. An analysis of social factors and other variables showed that education, marital status, age, employment, strength of belief, alterations in personality, past or family psychiatric history, previous exposure to similar phenomena, help-seeking behavior and treatment outcome differed between the three groups. Religion of the subjects or recent changes in values showed no correlation with possession while monetary gain from possession states showed only a partial correlation. Western medical treatment was of value only when possession states were seen as part of psychotic illness. DISCUSSION: Possession is a spectrum of experiential and behavioral phenomena seen in culturally acceptable form in normal people, popular adepts, as well as manifestations of psychotic illness. Possession states which fit normal cultural stereotypes could, if necessary, be better managed by traditional methods. However, clinicians need to be familiar with culturally abnormal forms of possession which are manifestations of psychotic illness that benefit from western psychiatric treatment. (c) 2008 S. Karger AG, Basel PMID: 18408420 [PubMed - indexed for MEDLINE] 36: Oncology. 2007;73(3-4):154-61. Epub 2008 Apr 11. Related Articles, Links

Determinants of compliance in a cluster randomised controlled trial on screening of breast and cervix cancer in mumbai, India. 2. Compliance to referral and treatment. Dinshaw K, Mishra G, Shastri S, Badwe R, Kerkar R, Ramani S, Thakur M, Uplap P, Kakade A, Gupta S, Ganesh B. Tata Memorial Hospital, Mumbai, India. OBJECTIVES: The study aims to investigate the efficacy of screening by lowcost technology in down-staging and reduction of mortality due to breast and cervix cancer. METHODS: The present trial is a community-based, cluster randomised controlled cohort study on screening for breast and cervix cancers (clinical breast examination and visual inspection of the cervix after application of 4% acetic acid). Univariate and multivariate logistic regression analyses are conducted to identify the predictors of compliance to referral among screen-

positive women and to treatment among cancer cases. RESULTS: The compliance to diagnostic investigations is 73% among screen-positive women referred for breast cancer and 79% among women referred for cervix cancer. Younger women, women working in service or being self-employed, school leveleducated women, mother tongue Marathi, participation in screening in all 3 rounds and women referred as screen positive for cervix cancer had higher compliance to diagnostic investigations. The compliance to treatment completion is higher in women diagnosed with breast cancer, at 95%, compared to 86% for cervix cancers and 81% for cervix pre-cancers. CONCLUSIONS: Good compliance rates along with a proper system of referral, further investigations, confirmation of diagnosis and treatment as demonstrated in this trial are crucial for successful screening programmes. (c) 2008 S. Karger AG, Basel Publication Types: • • •

Randomized Controlled Trial Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

PMID: 18408402 [PubMed - indexed for MEDLINE] 37: Indian J Med Res. 2008 Feb;127(2):159-64. Related Articles, Links

Diagnosis of common mental disorders by using PRIME-MD Patient Health Questionnaire. Avasthi A, Varma SC, Kulhara P, Nehra R, Grover S, Sharma S. Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India. [email protected] BACKGROUND & OBJECTIVE: Primary care physicians in their clinical settings usually fail to diagnose common mental disorders (CMDs). Primary Care Evaluation of Mental Disorders (PRIME-MD) Patient Health Questionnaire (PHQ) has been shown to facilitate diagnosis of most CMDs seen in primary health care. Its utility in Indian setting has not been evaluated. We carried out this study in Indian setting to evaluate the extent of psychiatric morbidity as measured by PRIME-MD PHQ. METHODS: A total of 500 consenting patients attending Medical outpatient department were recruited. All subjects were first assessed by the physician for presence of any physical illness and psychiatric disorder and their socio-demographic data were collected. Subjects were asked to fill the PRIMEMD PHQ. Illiterate subjects were assisted by the research worker in filling up the questionnaire. RESULTS: At initial evaluation physicians opined that 30.4

per cent of the subjects had psychological disorder, the most common diagnostic category was of anxiety disorders (15.8%), followed by depression (6%) and somatoform disorders (5.6%). On PHQ 42 per cent subjects had at least one psychiatric diagnosis. The most common psychiatric diagnosis was panic disorder (18.4%), followed by other anxiety disorders (16.6%). On comparing the diagnosis of physicians and PHQ, out of 152 cases (30.4%) suspected to have any psychological disorder by the physicians in the initial evaluation, 105 were found to have PHQ diagnosis. Of the 348 cases in which physicians did not suspect any psychiatric diagnosis, 243 were also negative in PHQ screening. There was a significant correlation between physicians and PHQ diagnosis. INTERPRETATION & CONCLUSION: There is a high psychiatric morbidity in the general medical practice and in many cases psychiatric morbidity is either missed or is misdiagnosed and by the physicians. Our results showed that PHQ could be a valuable screening instrument for psychiatric morbidity in primary care and general medical practice. PMID: 18403794 [PubMed - indexed for MEDLINE] 38: N Y State Dent J. 2008 Jan;74(1):63-7. Related Articles, Links

Drug utilization pattern in dental outpatients in tertiary care teaching hospital in western Nepal. Palaian S, Shankar PR, Hegde C, Hegde M, Ojha P, Mishra P. Department of Hospital and Clinical Pharmacy, Manipal Teaching Hospital/Manipal College of Medical Sciences, Pokhara, Nepal. [email protected] A high incidence of dental disease has been reported in Nepal. Previous studies, both in the Manipal Teaching Hospital, Pokhara, Nepal, and other centers revealed problems in the use of medicines in dentistry. A number of initiatives to improve prescribing have been carried out. The study presented here was undertaken to assess the impact of these initiatives on drug utilization among dental outpatients. The study was conducted among patients attending the dental outpatient department of the hospital over a six-month period. Demographic details were studied. The drug classes and individual drugs prescribed were recorded. The cost of drugs was calculateS using the outpatient pharmacy price list. The prescriptions were analyzed using the WHO/INRUD prescribing indicators. Anomalies were noted in prescribing. Improvement was noted in certain parameters compared to previous studies. The educational initiatives should be strengthened. Managerial interventions can be considered. Further studies are required. Publication Types:

•

Comparative Study

PMID: 18402382 [PubMed - indexed for MEDLINE] 39: Brain Nerve. 2008 Mar;60(3):211-7. Related Articles, Links

[Idiopathic normal pressure hydrocephalus--overviews and pathogenesis] [Article in Japanese] Ishikawa M. Department of Neurosurgery, Kitano Hospital, Kita-ku, Osaka 530 8480, Japan. Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome of gait disturbance, dementia and urinary incontinence without any preceding disorders in elderly patients. Rapid increase of elderly population in Japan prompted us to make guidelines for diagnosis and management of iNPH. The Japanese guidelines were published in 2004 and their characteristics were summarized as follows; 1) Simple and treatment-oriented, 2) Three diagnostic levels: possible, probable and (definite); Shunt surgery is indicated for probable iNPH only, 3) Clinical significance of gait disturbance as the most frequent and treatable symptom, 4) CSF tap test as a keystep of diagnosis, 5) Recommend the use of a programmable valve for prevention of overdrainage, and 6) Flow-charts for diagnosis, shunt indication and prevention of shunt complication. The International guidelines of iNPH were published in 2005. They were created based on evidence-based medicine, but there are some differences. Major differences were in the concept of iNPH, age, range of CSF pressure, MRI findings, and evaluation of CSF tap test, outflow resistance measurement and continuous CSF drainage. This difference would be derived from the weight of the accuracy, popularity and invasiveness of diagnostic tests. At present the pathogenesis of iNPH is not known. A new proposal in which CSF is mainly absorbed in the capillaries in all of the central nervous system may contribute to clarify the pathogenesis in iNPH. Publication Types: • •

English Abstract Review

PMID: 18402067 [PubMed - indexed for MEDLINE]

40: Eur J Dent Educ. 2008 Feb;12 Suppl 1:176-83. Related Articles, Links

Summary of the Global Congress and the challenges posed. Shanley D, Manogue M, Valachovic R. University of Dublin, Trinity College, Dublin, Ireland. [email protected] Publication Types: •

Congresses

PMID: 18289280

41: J Med Assoc Thai. 2008 Feb;91(2):166-72. Related Articles, Links

Pulmonary arterial hypertension in Thai patients with systemic sclerosis. Wangkaew S, Kasitanon N, Phrommintikul A, Sukitawut W, Wichainun R, Louthrenoo W. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. OBJECTIVE: Study the clinical features of pulmonary arterial hypertension (PAH) in Thai patients with systemic sclerosis (SSc), and compare these features between those with limited (lc) SSc and diffuse (dc) SSc. MATERIAL AND METHOD: The medical records of SSc patients attending the Division of Rheumatology, Chiang Mai University were reviewed. PAH was defined by pulmonary arterial systolic pressure (PASP) > 35 mmHg, determined by Doppler echocardiography. RESULTS: Among 275 patients with SSc, 66 had Doppler echocardiography measurement. Thirty-nine patients (59.1%) had PAH. Among the PAH-SSc patients, 36 (92.3%) presented with dyspnea on exertion, and 37 (94.8%) were in a New York Heart Association functional class of II and III. Twenty-four of 39 patients (61.5%) had interstitial lung disease. Diffuse SSc patients had a significantly higher proportion of males, and shorter disease duration between SSc and PAH diagnosis than lcSSc patients. CONCLUSION: PAH was not uncommon in Thai patients with SSc. Interstitial lung disease might have been the cause associated with over half of these cases. Annual routine Doppler echocardiography screening for PAH in patients with SSc may detect

preclinical PAH, and lead to early management and improved functional outcome. Publication Types: •

Comparative Study

PMID: 18389980 [PubMed - indexed for MEDLINE] 42: Med Care. 2008 Mar;46(3):293-302. Related Articles, Links

The association between patient satisfaction and quality of life in Chinese lung and liver cancer patients. Wong WS, Fielding R. Health Behavioral Research Group, Department of Community Medicine and Unit for Behavioral Sciences, School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong. BACKGROUND: Patient satisfaction has been accorded increased importance in evaluating the quality of health care. However, only a few studies have examined factors associated with patient satisfaction in cancer populations, with no data currently available in Chinese oncology populations. OBJECTIVES: We sought to examine the longitudinal course of the relationship between patient satisfaction and quality of life (QoL) in Chinese cancer patients. METHODS: A total of 253 liver cancer patients and 334 lung cancer patients were assessed during their first outpatient visit (baseline) and at 2 follow-up interviews (FU1 and FU2). QoL was measured by the Chinese version of the Functional Assessment of Cancer Therapy-General Scale [FACT-G (Ch)]. Patient satisfaction was assessed by the Nine-Item Chinese Patient Satisfaction Questionnaire (ChPSQ-9) and the cognitive subscale of the Medical Interview Satisfaction Scale (MISS-Cog). Linear mixed effects (LME) models were fitted to identify predictors of patient satisfaction and QoL. RESULTS: Results of LME analyses showed no significant between-group differences in psychosocial, satisfaction, and QoL measures over time (all P > 0.05). Age [beta = -0.001, 95% confidence interval (CI): -0.03 to 0.00, P < 0.05] and optimism (beta = 0.20, 95% CI: 0.10 to 0.30, P < 0.001) predicted MISS-Cog and ChPSQ-9, respectively. After adjusting for sociodemographic and psychosocial variables, only ChPSQ-9 (beta = 0.12, 95% CI: 0.06 to 0.18, P < 0.001) predicted QoL scores. No significant association between MISS-Cog and QoL was found. CONCLUSIONS: General emotional support from health professionals (ChPSQ-9) was a more effective predictor of QoL than was a measure of informational support (MISS-Cog) among these patients. Because expectations of clinical care likely vary by culture, and nature

and stage of disease, measures of patient satisfaction that address both informational and care expectations are important. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18388844 [PubMed - indexed for MEDLINE] 43: J Am Acad Nurse Pract. 2008 Apr;20(4):172-80. Related Articles, Links

Predisposing factors to phlebitis in patients with peripheral intravenous catheters: a descriptive study. Uslusoy E, Mete S. Health Science Institute, Dokuz Eylul University, Balçova, Izmir, Turkey. PURPOSE: The purpose of this study was to investigate the predisposing factors in the development of phlebitis in peripheral intravenous (IV) catheterization sites in patients treated with a variety of IV infusion solutions and drugs. DATA SOURCES: Systematic observation of 568 IV sites inserted for fluid infusion and drug administration in 355 patients in the Department of General Surgery of a University Hospital in Turkey. A data collection tool was based on standards established by the Infusion Nurses Society. Patients' infusion sites were monitored every 24 h during treatment and for 48 h after discontinuation of the IV. CONCLUSIONS: In contrast to the usual findings in the literature, the authors found that infusion through an infusion pump and insertion of catheters in the veins around the elbow increased the risk of phlebitis. Also, the number of times infusions were started led to an increased rate of phlebitis. However, conflicting results were obtained about the relation between phlebitis, gender, and catheter size. IMPLICATIONS FOR PRACTICE: Phlebitis causes sepsis, pain, additional diagnostic investigations, and treatments, and may lead to increased duration of hospitalization, patient's stress level, and financial burden, as well as increasing staff workload. Advanced practice nurses need to be aware of the factors that increase the likelihood of phlebitis and take appropriate measures to prevent it. PMID: 18387013 [PubMed - indexed for MEDLINE] 44: Int Rev Psychiatry. 2008 Apr;20(2):121-6. Related Articles, Links

An international perspective on pediatric psychopharmacology. Vitiello B. National Institute of Mental Health, Bethesda, MD 20892-9633, USA. [email protected] The use of pharmacotherapy for children and adolescents with mental disorders varies widely across countries. More than 80% of the world use of stimulant medications occurs in the USA. The use of antidepressants and antipsychotics is many times greater in the USA than in other countries. Factors likely to influence the pediatric use of psychotropic medications are here examined and discussed. Variability in use reflects differences in diagnostic systems, clinical practice guidelines, drug regulation, health services organization, availability and allocation of financial resources, and cultural attitudes towards childhood behavioral and emotional disturbances. Cultural context seems to exert a greater influence on the identification and management of psychiatric disorders than on other areas of medicine. It is currently unknown if the heterogeneity in treatment approaches results in differential clinical outcomes and prognosis. A better understanding of the factors underlying international variability may help clarify the process of diagnosis and treatment selection in child and adolescent psychiatry. Publication Types: •

Review

PMID: 18386201 [PubMed - indexed for MEDLINE] 45: J Prev Med Pub Health. 2008 Mar;41(2):74-9. Related Articles, Links

[Current state and challenges of pharmacoeconomic evaluation in Korea] [Article in Korean] Choi SE. Seoul National University, College of Pharmacy, Seoul, Korea. [email protected] Since the positive listing system for prescription drug reimbursement has been

introduced in Korea, the number of pharmacoeconomic evaluation studies has increased. However it is not clear if the quality of pharmacoeconomic evaluation study has improved. Due to the lack of randomized clinical studies in Korean health care setting, Korean economic evaluation studies have typically integrated the local cost data and foreign clinical data. Therefore methodological issues can be raised in regard to data coherence and consistency. But the quality of data was not questiened and the potential bias has not been investigated yet. Even though changes in policy have encouraged the undertaking of pharmacoeconomic evaluations, there is few public-side funding for validation study of costeffectiveness models and data. Several companies perform economic evaluation studies to be submitted on behalf of their own products, but do not want the study results to be disclosed to the academic community or public. To improve the present conduct of pharmacoeconomic evaluations in Korea, various funding sources need to be developed, and, like other multidisciplinary areas, the experts in different fields of study should collaborate to ensure the validity and credibility of pharmacoeconomic evaluations. Publication Types: •

English Abstract

PMID: 18385546 [PubMed - indexed for MEDLINE] 46: J Bone Joint Surg Am. 2008 Apr;90(4):849-61. Related Articles, Links

Orthopaedic care aboard the USNS Mercy during Operation Unified Assistance after the 2004 Asian tsunami. A case series. Sechriest VF 2nd, Lhowe DW. Clinical Investigation Department, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 5, San Diego, CA 92134-1005, USA. [email protected] Publication Types: •

Case Reports

PMID: 18381323 [PubMed - indexed for MEDLINE] 47: J Nurs Educ. 2008 Mar;47(3):118-23.

Related Articles,

Links

Students' opinions about and expectations of effective nursing clinical mentors. Elcigil A, Sari HY. Dokuz Eylul University School of Nursing, Mithatpasa Street, Inciralti, Izmir, Turkey 35340. [email protected] Nursing practice is an integral part of nursing education in which clinical mentors play an important role. Mentors' attitudes, experience, and knowledge influence nursing students and help them to complete their nursing practice with success. The purpose of this qualitative study was to determine nursing students' opinions about and expectations of effective nursing clinical mentors. Focus group interviews were used to obtain data from 24 students after completion of their third year of nursing school. The students, who had nursing practice experience in internal diseases, surgery, gynecology, pediatrics, psychiatry, and public health, were divided into three groups of 8 students. The students noted that effective clinical mentors should be able to communicate without prejudice, give positive feedback, have empathy, require students to do their own research, and offer the students information. PMID: 18380265 [PubMed - indexed for MEDLINE] 48: J Eval Clin Pract. 2008 Jun;14(3):416-21. Epub 2008 Mar 24. Related Articles, Links

Comparisons of risk-adjusted clinical outcomes for patients with aneurysmal subarachnoid haemorrhage across eight teaching hospitals in Japan. Ishizaki T, Imanaka Y, Sekimoto M, Fukuda H, Mihara H; Treatment of Subarachnoid Hemorrhage Expert Group.Collaborators (8) Itamoto K, Koizumi T, Eguchi T, Higashi S, Nakamura T, Hayashi J, Yamagata S, Natori Y. Department of Healthcare Economics and Quality Management, School of Public Health, Kyoto University Graduate School of Medicine, Kyoto, Japan. OBJECTIVES: To assess predictive value of patient characteristics and severity of aneurysmal subarachnoid haemorrhage (SAH) patients for clinical outcomes, and thereby estimate risk-adjusted clinical outcomes and compare the outcomes

across hospitals. METHODS: We selected 256 aneurysmal SAH patients from eight teaching hospitals in Japan. The clinical outcomes of patients at the time of discharge were assessed by the Glasgow Outcome Scale (GOS). A multiple logistic regression analysis was performed to identify predictors for the GOS status at the time of discharge. The risk-adjusted proportion of patients with a favourable GOS outcome was then estimated for each facility and compared across hospitals. RESULTS: The logistic regression analysis revealed that younger age (P < 0.001), patients with good World Federations of Neurological Surgeons grade at admission (P < 0.001) and absence of chronic renal failure or ischaemic heart disease as a comorbid condition (P < 0.001) were identified as significant predictors for favourable GOS outcome at the time of discharge among aneurysmal SAH patients (C statistic = 0.88). We found that one hospital had significantly better outcomes than the others. CONCLUSION: After comparison of risk-adjusted values across hospitals, the clinical management methods of the hospital that showed the best performance were examined and shared among providers. Publication Types: • •

Comparative Study Research Support, Non-U.S. Gov't

PMID: 18373576 [PubMed - indexed for MEDLINE] 49: BMC Pregnancy Childbirth. 2008 Mar 12;8:10. Related Articles, Links

Obstetric near miss and deaths in public and private hospitals in Indonesia. Adisasmita A, Deviany PE, Nandiaty F, Stanton C, Ronsmans C. Centre for Family Welfare, Faculty of Public Health, University of Indonesia, Depok, Indonesia. [email protected] BACKGROUND: Falling numbers of maternal deaths have stimulated an interest in investigating cases of life threatening obstetric morbidity or near miss. The purpose of this study was to document the frequency and causes of near miss and maternal deaths in four hospitals in West Java, Indonesia. METHODS: Cross sectional study in four hospitals in two districts in Banten province, Indonesia. We reviewed registers and case notes to identify the numbers and causes of near miss and death between November 2003 and October 2004. Near miss cases were defined based on organ dysfunction, clinical and management criteria. Near miss were categorized by whether or not the woman was at a critical state at admission

by reviewing the final signs at admission. RESULTS: The prevalence of near miss was much greater in public than in private hospitals (17.3% versus 4.2%, p = 0.000). Hemorrhage and hypertensive diseases were the most common diagnoses associated with near miss, and vascular dysfunction was the most common criterion of organ dysfunction. The occurrence of maternal deaths was 1.6%, with non-obstetric complications as the leading cause. The majority (70.7%) of near miss in public hospitals were in a critical state at admission but this proportion was much lower in private hospitals (31.9%). CONCLUSION: This is the first study to document near miss in public and private hospitals in Indonesia. Close to a fifth of admissions in public hospitals were associated with near miss; and the critical state in which the women arrived suggest important delays in reaching the hospitals. Even though the private sector takes an increasingly larger share of facility-based births in Indonesia, managing obstetric emergencies remains the domain of the public sector. Publication Types: • •

Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18366625 [PubMed - indexed for MEDLINE] PMCID: PMC2311270

50: Int Dent J. 2008 Feb;58(1):36-40. Related Articles, Links

Relationship between obesity and periodontal status in a sample of young Iranian adults. Sarlati F, Akhondi N, Ettehad T, Neyestani T, Kamali Z. Faculty of Dentistry, Azad University of Iran, Tehran. [email protected] AIM: To examine the possible relationship between body weight and periodontal disease in a sample of the young Iranian population. DESIGN: An analytical (Case-Control) study. PARTICIPANTS: Eighty individuals aged 18 to 34 years (40 normal and 40 overweight and obese subjects) were evaluated in this study. METHODS: The periodontal examination consisted of: Plaque Index (PLI), Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL). Body Mass Index (BMI) and Waist circumference (WC) were used as measures of overall and abdominal fat content. Socio-demographic variables and periodontal disease risk factors (age, gender, education, time elapsed since last dental visit, smoking and diabetes) were evaluated as covariates. The statistical tests used were:

Kolmogorov-Smirnov, Independent Samples T-test, ANOVA, Exact fisher, ChiSquare test and Spearman's rank correlation (Rsp). RESULTS: PPD and CAL were significantly higher in the case group compared to control (2.82 +/- 0.4 versus 2.56 +/- 0.36, P < 0.002 and 1.98 +/- 0.5 versus 1.63 +/- 0.335, P < 0.000 respectively). Subjects with a high waist circumference had significant differences of PPD and CAL when compared to normal waist circumference subjects (P < 0.000).There were also positive correlations between measures of overall fat content BMI and PPD (Rsp = 0.33), CAL (Rsp = 0.39) and age (Rsp = 0.42) on one side and the measure of WC and PPD (Rsp = 0.32), CAL (Rsp = 0.44), age (Rsp = 0.48) and PLI (Rsp = 0.3) on the other. CONCLUSION: The results indicate that overall and abdominal obesity were associated with the extent of periodontal disease in a sample of Iranian young individuals and therefore prevention and management of obesity may be an additional factor for improving periodontal health. PMID: 18350852 [PubMed - indexed for MEDLINE] 51: J Nurs Care Qual. 2008 Apr-Jun;23(2):170-6. Related Articles, Links

Increasing nurses' knowledge and behavior changes in nonpharmacological pain management for children in China. He HG, Vehviläinen-Julkunen K, Pietilä AM, Pölkki T. Department of Nursing Science, University of Kuopio, Kuopio, Finland. [email protected] This study implemented pain education for Chinese nurses using a pre-post test design and compared their use of nonpharmacological methods in children's postoperative pain management. Results show that nurses' use of most of these methods for pain relief increased significantly, which helped to improve the quality of care for children. This study enriches nurses' knowledge in children's pain management and develops evidence for practice by demonstrating the need for hospitals to provide continuous pain education to nurses. Publication Types: • •

Evaluation Studies Research Support, Non-U.S. Gov't

PMID: 18344784 [PubMed - indexed for MEDLINE] 52: MMWR Morb Mortal Wkly Rep. 2008 Mar 14;57(10):262-7.

Related Articles,

Links

Progress toward measles mortality reduction and elimination-Eastern Mediterranean Region, 1997-2007. Centers for Disease Control and Prevention (CDC). In 2005, the World Health Assembly set a goal of achieving a 90% reduction in global measles mortality by 2010, compared with levels in 2000. Eight years earlier, in 1997, the 22 countries in the World Health Organization (WHO) Eastern Mediterranean Region (EMR) had resolved to eliminate measles from their region by 2010. To reach these two goals, the WHO Regional Office for the Eastern Mediterranean developed a four-pronged strategy: 1) achieve and maintain > or =90% vaccination coverage of children with the first dose of measles-containing vaccine (MCV1) in every district of each country through routine immunization services, 2) achieve > or =90% vaccination coverage with the second dose of measles-containing vaccine (MCV2) in every district either through a routine 2-dose vaccination schedule or through supplementary immunization activities (SIAs), 3) establish case-based surveillance with investigation and laboratory testing of all suspected cases of measles, and 4) provide optimal clinical-case management, including supplementation of diets with vitamin A. This report summarizes the progress made in the EMR during 1997-2007 toward reducing mortality from measles and eliminating measles from the region. Countries in the EMR reduced the number of measles-related deaths by approximately 75% from 2000 to 2007. However, large measles outbreaks continue to occur throughout the region, suggesting that much work remains to eliminate measles in the EMR. PMID: 18340334 [PubMed - indexed for MEDLINE] 53: Am J Trop Med Hyg. 2008 Mar;78(3):393-9. Related Articles, Links

Nonmalarial acute undifferentiated fever in a rural hospital in central India: diagnostic uncertainty and overtreatment with antimalarial agents. Joshi R, Colford JM Jr, Reingold AL, Kalantri S. Division of Epidemiology, School of Public Health, University of California, Berkeley, California 94720, USA. [email protected] Nonmalarial acute undifferentiated fever (NMAUF) refers to a febrile illness with no indication of an organ-specific disease after diagnosis of malaria has been

excluded. In developing countries, the empirical treatment of NMAUFs with antimalarial drugs continues even in the era of highly specific rapid diagnostic tests (RDTs) for malaria. We carried out a retrospective review of patients with fever admitted to a rural teaching hospital in central India. We categorized patients with NMAUF into different clinical syndromes and determined their demographic profile, inhospital course, and the pattern of antimalarial use. The study sample included 1,197 adult patients who were investigated for malaria; 1,053 (88%) of them had NMAUF, and use of further diagnostics in this group was limited. Despite one or more negative tests for malaria, many patients (39.9%, 95% CI 37.0-43.3) received antimalarial drugs. These results suggest a need for guidelines and training to improve empirical treatment of NMAUF. Publication Types: •

Research Support, N.I.H., Extramural

PMID: 18337332 [PubMed - indexed for MEDLINE] 54: Natl Med J India. 2007 Nov-Dec;20(6):307-10. Related Articles, Links

Health information management: an introduction to disease classification and coding. Mony PK, Nagaraj C. Institute of Population Health and Clinical Research (IPHCR), St John's National Academy of Health Sciences, Koramangala, Bangalore 560034, Karnataka, India. [email protected] Morbidity and mortality data constitute an important component of a health information system and their coding enables uniform data collation and analysis as well as meaningful comparisons between regions or countries. Strengthening the recording and reporting systems for health monitoring is a basic requirement for an efficient health information management system. Increased advocacy for and awareness of a uniform coding system together with adequate capacity building of physicians, coders and other allied health and information technology personnel would pave the way for a valid and reliable health information management system in India. The core requirements for the implementation of disease coding are: (i) support from national/institutional health administrators, (ii) widespread availability of the ICD-10 material for morbidity and mortality coding; (iii) enhanced human and financial resources; and (iv) optimal use of informatics. We describe the methodology of a disease classification and codification system as also its applications for developing and maintaining an effective health information management system for India.

Publication Types: •

Review

PMID: 18335800 [PubMed - indexed for MEDLINE] 55: J Med Syst. 2008 Feb;32(1):31-5. Related Articles, Links

A decision support system for telemedicine through the mobile telecommunications platform. Eren A, Subasi A, Coskun O. Faculty of Engineering, Electronics Engineering Department, Biomedical Engineering Division, Erciyes University, Kayseri, Turkey. In this paper we have discussed the application of artificial intelligence in telemedicine using mobile device. The main goal of our research is to develop methods and systems to collect, analyze, distribute and use medical diagnostics information from multiple knowledge sources and areas of expertise. Physicians may collect and analyze information obtained from experts worldwide with the help of a medical decision support system. In this information retrieval system, modern communication tools such as computers and mobile phones can be used efficiently. In this work we propose a medical decision support system using the general packet radio service (GPRS). GPRS, a data extension of the mobile telephony standard Global system for mobile communications (GSM) is emerging as the first true packet-switched architecture to allow mobile subscribers to benefit from high-speed transmission rates and run JAVA based applications from their mobile terminals. An academic prototype of a medical decision support system using mobile device was implemented. The results reveal that the system could find acceptance from the medical community and it could be an effective means of providing quality health care in developing countries. PMID: 18333403 [PubMed - indexed for MEDLINE] 56: Ann Acad Med Singapore. 2008 Feb;37(2):118-27. Related Articles, Links

Bridging the gap between primary and specialist care--an integrative model for stroke.

Venketasubramanian N, Ang YH, Chan BP, Chan P, Heng BH, Kong KH, Kumari N, Lim LL, Phang JS, Toh MP, Widjaja S, Wong LM, Yin A, Cheah J. Department of Neurology, National Neuroscience Institute, Jalan Tan Tock Seng, Singapore. [email protected] Stroke is a major cause of death and disability in Singapore and many parts of the world. Chronic disease management programmes allow seamless care provision across a spectrum of healthcare facilities and allow appropriate services to be brought to the stroke patient and the family. Randomised controlled trials have provided evidence for efficacious interventions. After the management of acute stroke in a stroke unit, most stable stroke patients can be sent to their family physician for continued treatment and rehabilitation supervision. Disabled stroke survivors may need added home-based services. Suitable community resources will need to be harnessed. Clinic-based stroke nurses may enhance service provision and coordination. Close collaboration between the specialist and family physician would be needed to right-site patients and also allow referrals in either direction where necessary. Barriers to integration can be surmounted by trust and improved communication. Audits would allow monitoring of care provision and quality care enhancement. The Wagner model of chronic care delivery involves self-management support, shared clinical information systems, delivery system redesign, decision support, healthcare organisation and community resources. The key and critical feature is the need for an informed, activated (or motivated) patient, working in collaboration with the specialist and family physician, and a team of nursing and allied healthcare professionals across the continuum of care. The 3-year Integrating Services and Interventions for Stroke (ISIS) project funded by the Ministry of Health will test such an integrative system. PMID: 18327347 [PubMed - indexed for MEDLINE] 57: J Health Serv Res Policy. 2008 Jan;13(1):26-32. Related Articles, Links

The effect of age and procedure on resource use for patients with cerebrovascular disease. Kuwabara K, Matsuda S, Imanaka Y, Fushimi K, Hashimoto H, Ishikawa K. Department of Health Care Administration and Management, Graduate School of Medicine, Kyushu University, Maidahi Higashiku, Fukuoka, Japan. [email protected] OBJECTIVE: Many studies have described the impact of population ageing on health care expenditures, but few have assessed its impact on specific diseases

adjusted for severity and procedure. This study examined the relationship between an ageing population and resource use in patients with cerebrovascular disease (CVD). METHODS: A total of 13,856 CVD patients were treated in 82 academic and 92 community hospitals. Demographic variables, clinical variables, length of stay (LOS) and total charges were analysed by age group (under 65 years, 65-74 years and 75 years or older). The independent effects of age on LOS and total charge were determined using multivariate analysis. RESULTS: There were 5172 (37%) patients under 65 years of age, 4096 (30%) 65-74 years and 4588 (33%) 75 years or older. Intracranial infarction or ischaemia was diagnosed in 69% of the patients, haemorrhage in 23% and subarachnoid haemorrhage in 9%. The overall mortality was 6% (5% in under 65 years, 5% in 65-74 years and 9% in 75 years or older; P<0.001). There were significant differences in the proportion of procedures performed in each age category. Age and procedure were significantly associated with LOS, particularly the latter. Age had no significant association with total charge, but procedure was highly associated. CONCLUSIONS: Ageing has no significant impact on total charge. Instead policy-makers should acknowledge the effect of procedures on health care costs, conduct economic evaluations and monitor use of procedures. PMID: 18325153 [PubMed - indexed for MEDLINE] 58: J Nurs Manag. 2008 Apr;16(3):246-56. Related Articles, Links

Predictors of career commitment and job performance of Jordanian nurses. Mrayyan MT, Al-Faouri I. Faculty of Nursing, The Hashemite University, Zarqa, Jordan. [email protected] BACKGROUND AND AIMS: Few studies focused on nurses' career commitment and nurses' job performance. This research aimed at studying variables of nurses' career commitment and job performance, and assessing the relationship between the two concepts as well as their predictors. METHODS: A survey was used to collect data from a convenient sample of 640 Registered Nurses employed in 24 hospitals. RESULTS: Nurses 'agreed' to be committed to their careers and they were performing their jobs 'well'. As a part of career commitment, nurses were willing to be involved, in their own time, in projects that would benefit patient care. The highest and lowest means of nurses' job performance were reported for the following aspects: leadership, critical care, teaching/collaboration, planning/evaluation, interpersonal relations/communications and professional development. Correlating of total scores of nurses' career commitment and job performance revealed the presence

of a significant and positive relationship between the two concepts. Stepwise regression models revealed that the explained variance in nurses' career commitment was 23.9% and that in nurses' job performance was 29.9%. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should promote nursing as a career and they should develop and implement various strategies to increase nurses' career commitment and nurses' job performance. These strategies should focus on nurse retention, staff development and quality of care. CONCLUSIONS: Nurses' career commitment and job performance are inter-related complex concepts that require further studies to understand, promote and maintain these positive factors in work environments. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18324983 [PubMed - indexed for MEDLINE] 59: J Nurs Manag. 2008 Apr;16(3):227-36. Related Articles, Links

Job stress, recognition, job performance and intention to stay at work among Jordanian hospital nurses. AbuAlRub RF, Al-Zaru IM. College of Nursing, Jordan University of Science and Technology, Irbid, Jordan. [email protected] PURPOSE: To investigate: (1) relationships between job stress, recognition of nurses' performance, job performance and intention to stay among hospital nurses; and (2) the buffering effect of recognition of staff performance on the 'stressintention to stay at work' relationship. BACKGROUND: Workplace stress tremendously affects today's workforce. Recognition of nurses' performance needs further investigation to determine if it enhances the level of intention to stay at work and if it can buffer the negative effects of stress on nurses' intention to stay at work. DESIGN AND METHODS: The sample of the present study was a convenience one. It consisted of 206 Jordanian staff nurses who completed a structured questionnaire. RESULTS: The findings of the study indicated a direct and a buffering effect of recognition of nurses' performance on job stress and the level of intention to stay at work. CONCLUSION: The results of the study indicated the importance of recognition for outstanding performance as well as achievements. Implications for nursing management The results of this study support the need to focus on the implementation of recognition strategies in the workplace to reduce job stress and enhance retention.

PMID: 18324981 [PubMed - indexed for MEDLINE] 60: Acta Med Okayama. 2008 Feb;62(1):15-20. Related Articles, Links

A prototype model using clinical document architecture (CDA) with a Japanese local standard : designing and implementing a referral letter system. Yong H, Jinqiu G, Ohta Y. Department of Medical Informatics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan. [email protected] Since clinical document architecture (CDA) became an American National Standards Institute (ANSI)-approved health level seven (HL7) Standard, many countries have begun making an effort to make local standards conform to CDA. In order to make CDA compatible with the many different local standards existing in different countries, we designed a prototype model using HL7 CDA R2 with medical markup language (MML), a Japanese medical data exchange standard. Furthermore, a referral letter system based on this model was developed. Archetypes were used to express medical concepts in a formal manner and to make 2 different standards work collaboratively. We share herein the experience gathered in designing and implementing a referral letter system based on HL7 CDA, Release 2 (CDA R2). We also outline the challenges encountered in our project and the opportunities to widen the scope of this approach to other clinical documents. PMID: 18323867

61: J Clin Oncol. 2008 Mar 10;26(8):1302-9. Related Articles, Links

Job loss and re-employment of cancer patients in Korean employees: a nationwide retrospective cohort study. Park JH, Park EC, Park JH, Kim SG, Lee SY. Division of Cancer Policy and Management, National Cancer Control Research Institute, National Cancer Center, Gyeonggi-do 410-769, Korea.

PURPOSE: The aim of this study was to investigate whether a diagnosis of cancer has an impact on the cancer patients' job loss and re-employment and to identify the factors affecting job loss and re-employment during 6 years of follow-up of Korean employees with cancer. PATIENTS AND METHODS: All employees except for the self-employed in Korea who were diagnosed with cancer during the 2001 calendar year (n = 5,396) were identified as the first baseline patients and were followed every 3 months over 6 years to estimate the time taken to job loss. Patients who lost their job within the first year after a diagnosis of cancer (n = 1,398) were identified as the second baseline patients and were followed up over 5 years to estimate the time taken to re-employment using the National Health Insurance claims data. Patient demographic, socioeconomic, and clinical variables were investigated as factors that affected job loss and re-employment. RESULTS: Among the first baseline cancer patients, 47.0% lost their job, and among the second baseline patients, 30.5% were re-employed over 69 to 72 months of follow-up. Female sex, younger age and older age, company employee, lower income, blood cancer, and brain and CNS, lung, and liver cancer were significant predictors of early job loss or delayed re-employment. CONCLUSION: The diagnosis of cancer affects cancer patients' employment status differently according to different factors: sex, age, type of job, income, and cancer site. Efforts should be made to support re-employment and reduce unnecessary work cessation and disparity between different demographic and socioeconomic groups of cancer survivors. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18323554 [PubMed - indexed for MEDLINE] 62: J Ethnopharmacol. 2008 Apr 17;117(1):84-91. Epub 2008 Feb 2. Related Articles, Links

Frequency and pattern of Chinese herbal medicine prescriptions for chronic hepatitis in Taiwan. Chen FP, Kung YY, Chen YC, Jong MS, Chen TJ, Chen FJ, Hwang SJ. Center for Traditional Medicine, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan. ETHNOPHARMACOLOGICAL RELEVANCE: Chinese herbal medicine (CHM) has been commonly used in treating liver diseases in Asian countries. AIM OF STUDY: To conduct a large-scale pharmacoepidemiological study and evaluate the frequency and pattern of CHM prescriptions in treating chronic

hepatitis. MATERIALS AND METHODS: We obtained the database of traditional Chinese medicine outpatient claims from the national health insurance in Taiwan for the whole 2002. Patients with chronic hepatitis were identified by the corresponding diagnosis of International Classification of Disease among claimed visiting files. Corresponding prescription files were analyzed, and association rule were applied to evaluate the co-prescription of CHM in treating chronic hepatitis. RESULTS: Among the 91,080 subjects treated by CHM for chronic hepatitis, the peak age was in the 40 s, followed by 30 s and 50 s. Male/female ratio was 2.07:1. Long-dan-xie-gan-tang and Saliva miltiorrhiza (Dan-shen) were the most commonly prescribed Chinese herbal formula and single herbal drug, respectively. The most common two-drug prescription was Jiawei-xia-yao-san plus Saliva miltiorrhiza, and the most common three-drug prescription was Jia-wei-xia-yao-san plus Saliva miltiorrhiza and Artemisia capillaries (Yin-chen-hao). CONCLUSIONS: This study showed the utilization pattern of Chinese herbal drugs or formulae in treating chronic hepatitis. Further researches and clinical trials are needed to evaluate the efficacy of these Chinese herbs or its ingredients in treating chronic hepatitis. PMID: 18321671 [PubMed - indexed for MEDLINE] 63: J Clin Nurs. 2008 Apr;17(7):876-83. Related Articles, Links

Fatigue experience and coping strategies in Taiwanese lung cancer patients receiving chemotherapy. Lee YH, Tsai YF, Lai YH, Tsai CM. Hong Cheng Company, Taipei, Taiwan. AIMS: The aim of this cross-sectional study was to explore fatigue levels and fatigue-coping strategies in Taiwanese lung cancer patients receiving chemotherapy. BACKGROUND: Lung cancer is now recognized as one of the most common cancers in Taiwan, with a high prevalence of mortality. As chemotherapy progresses, fatigue is a common cause of symptom distress. METHODS: Data on demographic and disease-related characteristics were gathered from the medical record, and data on fatigue and coping strategies were gathered by questionnaires administered to 101 lung cancer patients receiving chemotherapy. RESULTS: The mean fatigue score for the total sample was 8.0 (SD = 5.0, range = 0-20), indicating light-to-moderate fatigue. The majority of patients (n = 76, 75.2%) had a baseline haemoglobin level of 12 g/dl (6.2 SD 5.7). Fatigue levels were significantly higher in patients receiving a third course of chemotherapy than in those receiving a first course (F = 3.7, p = 0.03). The most commonly used management category

was energy conservation (n = 659), and the most commonly used strategy was sitting (n = 101) and lying down (n = 98). However, participants rated exercise (mean = 3.9), sleep (mean = 3.8) and walking (mean = 3.6) as the most effective. CONCLUSION: This study highlighted the management of fatigue problems in lung cancer patients receiving chemotherapy, especially in respecting patients' self-report of fatigue-management strategies. Relevance to clinical practice. Health care providers should carefully assess patients for fatigue while they are receiving chemotherapy. These patients and their caregivers should be taught to notice fatigue and encouraged to choose coping strategies that reduce fatigue level, thus improving their quality of life. PMID: 18321286 [PubMed - indexed for MEDLINE] 64: J Dent Educ. 2008 Mar;72(3):364-9. Related Articles, Links

Assessing the competency of University of Malaya dental graduates: employers' and graduates' perceptions. Razak IA, Latifah RR, Jaafar N, Abu Hassan MI, Ab Murat N. Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia. A survey was conducted to assess competencies of dental graduates of the Faculty of Dentistry, University of Malaya, as perceived by the graduates and their employers, based on the five-year undergraduate curriculum introduced in 1995. All senior dental officers in the Ministry of Health (MOH), representing employers, and all 164 dental graduates of the years 2000, 2001, and 2002 were sent a self-administered questionnaire covering eight areas of competency. The respondents had to rate these areas on a scale of 1 (very poor) to 4 (very good). The responses for each area were then dichotomized into poor (1 and 2) and good (3 and 4). If less than 60 percent of the respondents rated an area as good, then it was categorized as needing attention; 60-69 percent as satisfactory; and 70 percent and above as excellent. One hundred and six graduates (64.6 percent) and twenty-nine employers (96.7 percent) responded; of the graduates, 73.6 percent were working in the MOH and 22.6 percent in private practice. About 57.1 percent of employers reported that at least five graduates have worked under them. Graduates (85.7 percent) and employers (83.3 percent) agreed that graduates have excellent skills in communication. Although all graduates perceived their competency to be excellent in the four areas (treatment planning; community-based skills; management, administrative skills, and personal management; and professional development skills), employers felt that these are the areas that are of concern and needed attention. In conclusion, whilst generally the graduates' level of competency in almost all areas is acceptable or good, there are areas of concern that need to be addressed to further improve the five-year

curriculum at the University of Malaya. Publication Types: •

Comparative Study

PMID: 18316541 [PubMed - indexed for MEDLINE] 65: Basic Clin Pharmacol Toxicol. 2008 Apr;102(4):408-11. Epub 2008 Feb 29. Related Articles, Links

Developing an adverse drug reaction reporting system at a teaching hospital. Baniasadi S, Fahimi F, Shalviri G. Pharmaceutical Care Unit, TB and Lung Disease Research Center, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University, Tehran, Iran. Adverse drug reactions (ADRs) are a frequent cause for hospitalization and occur often in hospitalized patients. The objective of this study was to establish an ADR reporting and monitoring system at a teaching hospital. The pharmacovigilance unit of Masih Daneshvari hospital was established by a clinical pharmacist and a clinical pharmacologist. Healthcare professionals were encouraged to report any suspected ADRs encountered in in-patients. The incidence, pattern, seriousness, severity and preventability of the reported ADRs were analysed. During the period of 12 months, for 6840 patients, 112 spontaneous reports were received. The most frequently reported reactions were due to anti-infective agents (58.2%). Ceftriaxone accounted for the highest number of the reported ADRs among antiinfective agents. The skin and appendages system was the most frequently affected system (32.5% of all reactions). Seventeen per cent of the ADRs were reported as serious reactions. Although the incidence of ADRs reported by physicians and nurses was found to be low, this programme was useful as a preliminary programme in initiating a culture of ADR reporting among healthcare professionals. Improved communication between the physicians and nurses with the pharmacovigilance centre in the hospital is suggested. PMID: 18312492 [PubMed - indexed for MEDLINE] 66: Nephron Clin Pract. 2008;108(3):c202-6. Epub 2008 Mar 3. Related Articles, Links

Renal involvement in childhood vasculitis.

Cakar N, Ozçakar ZB, Soy D, Uçar Y, Fitöz S, Kara N, Uncu N, Atakan C, Ekim M, Yalçinkaya F. Ministry of Health Diskapi Children's Hospital, Division of Pediatric Nephrology, Ankara, Turkey. BACKGROUND/AIMS: Renal involvement comprises one of the major organ involvements in childhood vasculitis and has also an important role in the long term prognosis. The aim of this retrospective study was to analyze the demographic, clinical, laboratory features, and the treatment modalities of patients with vasculitis who had renal involvement. METHODS: Patients with the diagnosis of vasculitis who had been followed in two pediatric nephrology centers between 1990 and 2005 were analyzed retrospectively.Patients with renal involvement were selected and further evaluated. RESULTS: The study population consisted of 152 of 816 patients with vasculitis. Renal involvement was seen in 134 patients (17%) with Henoch-Schonlein purpura(HSP), 14 patients (45%) with polyarteritis nodosa(PAN), 3 patients with Takayasu arteritis (TA) (50%) and in 1 Wegener granulomatosis (WG) patient. The mean age of patients with renal involvement was 9.2 +/- 0.91 years in the HSP group. Hematuria with proteinuria was the most common renal finding and joint manifestations were seen less in this group. During the follow-up, only 1 patient developed chronic renal failure. Proteinuria, hematuria and aneurysms were seen in 26, 35 and 57% respectively in the PAN group. Only 1 patient (3.2%) had developed chronic renal failure.All 3 patients with TA had bilateral renal arterial involvement. CONCLUSION: Renal involvement constitutes an important part of childhood vasculitides. With the institution of early and aggressive immunosuppressive treatment significant improvement in the long-term survival of these patients can be achieved. Copyright 2008 S. Karger AG, Basel. Publication Types: •

Multicenter Study

PMID: 18311085 [PubMed - indexed for MEDLINE] 67: Pediatrics. 2008 Mar;121(3):e581-9. Related Articles, Links

A guide for monitoring child development in low- and middleincome countries. Ertem IO, Dogan DG, Gok CG, Kizilates SU, Caliskan A, Atay G, Vatandas N, Karaaslan T, Baskan SG, Cicchetti DV.

Developmental-Behavioral Pediatrics Unit, Department of Pediatrics, Ankara University School of Medicine, Cebeci, Ankara, 06100 Turkey. [email protected] OBJECTIVE: In low- and middle-income countries, methods for clinicians to address difficulties in language, social-emotional, cognitive, behavioral, or neuromotor development during early childhood are lacking. To fill this gap, we designed, in Turkey, the Guide for Monitoring Child Development, which aims to aid clinicians in monitoring and supporting child development and the early detection and management of developmental difficulties. The Guide for Monitoring Child Development monitoring component is a practical, open-ended interview that catalyzes communication between clinicians and caregivers and obtains a portrayal of the child's development. We report on the development and psychometric properties of the Guide for Monitoring Child Development monitoring component for children aged 0 to 24 months. METHODS: We examined the ages of attainment of Guide for Monitoring Child Development milestones and internal consistency in a cross-sectional study of healthy children receiving well-child care (study 1). In 2 clinical samples, we studied the interrater reliability between medical students and a child development specialist administering the guide (study 2), as well as the concurrent validity of the guide administered during a health visit and a comprehensive developmental assessment (study 3). RESULTS: In study 1 (N = 510), item-total scale correlations ranged from 0.28 to 0.91. An age-dependent attainment pattern was seen in all of the milestones. In study 2 (N = 92), interrater reliability between medical-student pairs and between the child development specialist and students was high (kappa scores were 0.83-0.88). In study 3 (N = 79), the sensitivity, specificity, and positive and negative predictive values were 0.88, 0.93, 0.84, and 0.94, respectively. CONCLUSIONS: The Guide for Monitoring Child Development is an innovative method for monitoring child development that is designed specifically for use by health care providers in low- and middle-income countries. Studies in Turkey provide preliminary evidence for its reliability and validity. Publication Types: •

Research Support, N.I.H., Extramural

PMID: 18310178 [PubMed - indexed for MEDLINE] 68: Hepatology. 2008 Apr;47(4):1233-40. Related Articles, Links Comment in:

•

Hepatology. 2008 Apr;47(4):1105-7.

Universal screening for biliary atresia using an infant stool color card in Taiwan. Hsiao CH, Chang MH, Chen HL, Lee HC, Wu TC, Lin CC, Yang YJ, Chen AC, Tiao MM, Lau BH, Chu CH, Lai MW; Taiwan Infant Stool Color Card Study Group.Collaborators (29) Fang SB, Wen WH, Wang YH, Wang KS, Shih CS, Yu CH, Lee KM, Lee IH, Lin LH, Lin WT, Lin YC, Chou YK, Shih HH, Chang PF, Fan CH, Hsu YC, Huang CF, Huang IF, Huang ML, Tang KT, Yeung CY, Yeh JN, Chen MH, Chen HW, Chen SM, Chen TJ, Lai MK, Tsai YH, Hsieh TK. Department of Pediatrics, Cardinal Tien Hospital Yung Ho Branch, Taipei, Taiwan. Biliary atresia is the most common cause of death from liver disease in children. Although the Kasai operation before 60 days of age can significantly improve prognosis, delay in referral and surgery remains a formidable problem worldwide because of difficulties in differentiating it from benign prolonged neonatal jaundice. We established a universal screening system using an infant stool color card to promote the early diagnosis and treatment of biliary atresia. After a pilot regional study in 2002-2003, a national stool color screening system was established by integrating the infant stool color card into the child health booklet given to every neonate in Taiwan since 2004. Within 24 hours of the discovery of an abnormal stool color, this event is reported to the registry center. The annual incidence of biliary atresia per 10,000 live births in 2004 and 2005 was 1.85 (40/216,419) and 1.70 (35/205,854), respectively. The sensitivity of detecting biliary atresia using stool cards before 60 days of age was 72.5% in 2004, which improved to 97.1% in 2005. The national rate of the Kasai operation before 60 days of age increased from 60% in 2004 to 74.3% in 2005. The jaundice-free rate (<2 mg/dL) at 3 months after the Kasai operation among infants with biliary atresia in 2004-2005 was 59.5% (44 of 74), significantly higher than the historical data of 37.0% in 1976-2000 before the stool card screening program (P = 0.002). Conclusion: Universal screening using the stool color cards can enhance earlier referral, which may ultimately lead to timely performance of the Kasai operation and better postoperative outcome in infants with biliary atresia. Publication Types: • •

Clinical Trial Research Support, Non-U.S. Gov't

PMID: 18306391 [PubMed - indexed for MEDLINE] 69: BMC Public Health. 2008 Feb 27;8:77. Related Articles, Links

Japanese cancer patient participation in and satisfaction with treatment-related decision-making: A qualitative study. Watanabe Y, Takahashi M, Kai I. Department of Social Gerontology, School of Public Health, University of Tokyo, Tokyo, Japan. [email protected] BACKGROUND: Over the last decade, patient involvement in treatment-related decision-making has been widely advocated in Japan, where patient-physician encounters are still under the influence of the long-standing tradition of paternalism. Despite this profound change in clinical practice, studies investigating the actual preferences of Japanese people regarding involvement in treatment-related decision-making are limited. The main objectives of this study were to (1) reveal the actual level of involvement of Japanese cancer patients in the treatment-related decision-making and their overall satisfaction with the decision-making process, and (2) consider the practical implications of increased satisfaction in cancer patients with regard to the decision-making process. METHODS: We conducted semi-structured interviews with 24 Japanese cancer patients who were recruited from a cancer self-help group in Tokyo. The interviews were qualitatively analysed using the approach described by Lofland and Lofland. RESULTS: The analyses of the patients' interviews focused on 2 aspects: (1) who made treatment-related decisions (the physician or the patient), and (2) the informants' overall satisfaction with the decision-making process. The analyses revealed the following 5 categories of decision-making: 'patient as the active decision maker', 'doctor selection', 'wilfully entrusting the physician', 'compelled decision-making', and 'surrendering decision-making'. While the informants under the first 3 categories were fairly satisfied with the decisionmaking process, those under the latter 2 were extremely dissatisfied. Informants' views regarding their preferred role in the decision-making process varied substantially from complete physician control to complete patient control; the key factor for their satisfaction was the relation between their preferred involvement in decision-making and their actual level of involvement, irrespective of who the decision maker was. CONCLUSION: In order to increase patient satisfaction with regard to the treatment-related decision-making process, healthcare professionals in Japan must assess individual patient preferences and provide healthcare accordingly. Moreover, a better environment should be created in hospitals and in society to facilitate patients in expressing their preferences and appropriate resources need to be made available to facilitate their decision-making process.

PMID: 18302800 [PubMed - indexed for MEDLINE] PMCID: PMC2291463

70: J Ren Care. 2007 Oct-Dec;33(4):187-90. Related Articles

Taking care of the caregiver: support groups for nephrology nurses. Chayu T, Zur R, Kreitler S. Rabin Medical Center, Israel. The purpose of the study was to examine the need for support groups in nephrology nurses (NN) in Israel. A questionnaire with 10 questions and demographic background information was administered to nephrology nurses in different hospitals and different parts of the country. Out of 350 distributed questionnaires, 305 nurses responded. The findings showed that there is a need for support groups among NN in Israel. Conclusions--It is necessary to organise support groups for nurses in every dialysis unit. PMID: 18298038 [PubMed - indexed for MEDLINE] 71: Leuk Lymphoma. 2008 Mar;49(3):488-94. Related Articles, Links Comment in: •

Leuk Lymphoma. 2008 Mar;49(3):373-6.

Clinical outcome of children with newly diagnosed acute lymphoblastic leukemia treated in a single center in Shanghai, China. Gu LJ, Li J, Xue HL, Tang JY, Chen J, Zhao HJ, Ye H, Chen J, Pan C. Department of Hematology/Oncology, Xin-Hua Hospital/Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine (Formerly Shanghai Second Medical University), Shanghai, People's Republic of China. Aim of the study is to determine the clinical outcome of 158 cases of childhood acute lymphoblastic leukemia (ALL) treated with a risk-directed protocol in

Shanghai, China. One hundred fifty eight consecutive newly diagnosed patients were enrolled in the ALL-XH-99 protocol. The Kaplan - Meier method was used to estimate survival rates and comparisons were made by using the 2-sided logrank test. Of all the 158 patients evaluated, 153 (96.8%) achieved complete remission (CR) in a median time of 33 days. The 5-year event-free survival (EFS) rate was 66.9% +/- 13.1%. Relapse occurred in 15 patients with isolated hematologic relapse in 13 and isolated central nervous system relapse in 2. Seven patients died of treatment-related complications. The medical cost for each patient does not exceed 25,000 USD. Contemporary risk-directed therapy can cure approximately two thirds of patients with ALL at relatively low cost. The challenge is to extend curative treatment to less privileged patients having fewer financial resources. Publication Types: • •

Clinical Trial Research Support, Non-U.S. Gov't

PMID: 18297525 [PubMed - indexed for MEDLINE] 72: Antiviral Res. 2008 Apr;78(1):64-8. Epub 2007 Nov 20. Related Articles, Links

The Southeast Asian Influenza Clinical Research Network: development and challenges for a new multilateral research endeavor. Higgs ES, Hayden FG, Chotpitayasunondh T, Whitworth J, Farrar J. Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA. [email protected] The Southeast Asia Influenza Clinical Research Network (SEA ICRN) (www.seaclinicalresearch.org) is a recently developed multilateral, collaborative partnership that aims to advance scientific knowledge and management of human influenza through integrated clinical investigation. The partnership of hospitals and institutions in Indonesia, Thailand, United Kingdom, United States, and Viet Nam was established in late 2005 after agreement on the general principles and mission of the initiative and after securing initial financial support. The establishment of the SEA ICRN was both a response to the re-emergence of the highly pathogenic avian influenza A(H5N1) virus in Southeast Asia in late 2003 and an acknowledgment that clinical trials on emerging infectious diseases require prepared and coordinated research capacity. The objectives of the Network also

include building sustainable research capacity in the region, compliance with international standards, and prompt dissemination of information and sharing of samples. The scope of research includes diagnosis, pathogenesis, treatment and prevention of human influenza due to seasonal or novel viruses. The Network has overcome numerous logistical and scientific challenges but has now successfully initiated several clinical trials. The establishment of a clinical research network is a vital part of preparedness and an important element during an initial response phase to a pandemic. PMID: 18295355 [PubMed - indexed for MEDLINE] 73: Nippon Naika Gakkai Zasshi. 2007 Dec 10;96(12):2715-21. Related Articles, Links

[Effects of the new clinical training system. 5. From the viewpoint of an intern] [Article in Japanese] Horinouchi H. PMID: 18293552 [PubMed - indexed for MEDLINE] 74: Integr Cancer Ther. 2008 Mar;7(1):24-32. Related Articles, Links

Clinical encounter experiences of patients with nasopharyngeal carcinoma. Lee EW, Twinn S, Moore AP, Jones MP, Leung SF. Department of Physiotherapy, Prince of Wales Hospital, Shatin, Hong Kong. edwinlee @cuhk.edu.hk Nasopharyngeal carcinoma (NPC) is a commonly occurring cancer among Hong Kong Chinese, especially in the relatively young population group. Since the disease carries a favorable prognosis, sequelae following treatment have become an important concern for patients suffering from NPC, particularly because of the strong interplay of psychological, social, and biological issues during their rehabilitation. In this qualitative study, in-depth, semistructured audiotaped interviews were undertaken with 32 patients receiving rehabilitation at the physiotherapy department of a regional teaching hospital in Hong Kong. The objective of the study was to examine the rehabilitation experiences of NPC survivors to identify factors that contributed to a satisfying clinical encounter

experience. During the study, data collection and analysis using a grounded theory approach were concurrently conducted. The 3 main themes that shaped the rehabilitation experiences of NPC survivors were the patient-clinician relationship, participation in therapeutic alliance, and quality rehabilitation service provision. These, together with the identified needs of the participants, contributed to the participants' perceived health-related quality of life. A constructive clinical experience was perceived when their needs were met. The findings highlight the importance of patient-centeredness in the treatment delivery and a multifaceted role of clinicians in meeting the needs of this group of cancer survivors. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18292592 [PubMed - indexed for MEDLINE] 75: Prev Vet Med. 2008 Jun 15;85(1-2):1-8. Epub 2008 Mar 4. Related Articles, Links

Seroprevalence of, and risk factors for, peste des petits ruminants in sheep and goats in Northern Jordan. Al-Majali AM, Hussain NO, Amarin NM, Majok AA. Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan. [email protected] Peste des petits ruminants (PPR) is an economically important disease that affect sheep and goat industry in Asia and Africa. In this study, we investigated the seroprevalence, and risk factors, of PPR in sheep and goat flocks from five different governorates (Irbid, Jarash, Ajloun, Mafraq and Zarka) located in Northern Jordan. Serum samples from 929 and 400 sheep and goats, respectively, corresponding to 122 sheep flock and 60 goats flock were collected. Seroprevalence was determined using PPR competitive ELISA. Health status and management information were collected using a semi-structured pre-tested questionnaire. The individual true prevalence of PPR in sheep and goats was 29 and 49%, respectively. The flock level true prevalence of PPR was 60 and 74% in sheep and goats, respectively. In both sheep and goat flocks, large flock size, visiting live animals market and inadequate veterinary services were identified as risk factors for PPR seropositivity. Mixed (sheep and goats) raising was identified as a risk factor for PPR seropositivity in sheep flocks only.

Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18291541 [PubMed - in process] 76: East Mediterr Health J. 2007 Sep-Oct;13(5):1212-5. Related Articles, Links

Epidemic of cutaneous leishmaniasis: 109 cases in a population of 500. Anwar M, Hussain MA, Ur-Rehman H, Khan I, Sheikh RA. Department of Dermatology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan. [email protected] In February 2004, 4 patients aged 10-15 years presented at the Pakistan Institute of Medical Sciences with non-healing multiple ulcers on exposed parts. On the basis of history, clinical assessment and fine needle aspiration cytology, they were diagnosed as having cutaneous leishmaniasis. We were informed that several similar cases were present in their village. A team of doctors and technicians visited the area. A survey was conducted and another 105 cases with various morphological presentations were identified. The area was visited several times to find the vector, reservoirs and source of infection and to advise on controlling the epidemic. PMID: 18290416 [PubMed - indexed for MEDLINE] 77: J Occup Health. 2008 Jan;50(1):86-91. Related Articles, Links

Actual conditions of the mixing of antineoplastic drugs for injection in hospitals in Osaka Prefecture, Japan. Yoshida J, Kosaka H, Nishida S, Kumagai S. Department of Environmental Health, Osaka Prefectural Institute of Public Health, Osaka, Japan. [email protected] We conducted a questionnaire survey in order to grasp the actual conditions under which antineoplastic drugs are mixed for injection in hospitals. Questionnaires

were sent to all 155 hospitals with 100 or more beds for general patients in Osaka Prefecture, Japan. The response rate was 69.0%. Mixing of antineoplastic drugs was done in 81.3% of the hospitals. The questionnaire was answered by doctors in 17.2% of the hospitals with antineoplastic drugs, nurses in 11.5%, and pharmacists in 70.1%. Mixing of antineoplastic drugs was done by doctors in 58.6% of the hospitals, nurses in 44.8%, and pharmacists in 63.2% (multiple answers). Occupational exposure to antineoplastic drugs was recognized in 97.7% of the hospitals. The mean frequency of the mixing operation was 8.8 d per month per worker. The mean number of antineoplastic drugs handled was 7.4 types. Guidelines for the safe handling of antineoplastic drugs were used in 52.8% of the hospitals and a biological safety cabinet was available in 57.4%. Gloves, mask, gown and goggles were used in 82.7, 69.0, 62.1 and 36.8% of the hospitals, respectively, but no personal protective equipment was used in 10.1%. The safety precautions of the hospitals in which the number of beds was small tended to be fewer than those of the hospitals in which the number of beds was large. Used vials and ampoules were disposed of as clinical, infectious or exclusive antineoplastic drug waste by 74.7% of the hospitals. Safety measures for handling the excrement of patients treated with antineoplastic drugs were performed in 8.0% of the hospitals. In 43.7% of the hospitals, the responders had experienced accidents during antineoplastic drug preparation, such as drugs adhering to hands or eyes, drug leakage, accidental injection and cutting by ampoules. Because of the adverse effects of antineoplastic drugs, all hospitals in which the healthcare workers handle them should promote safety precautions. Publication Types: •

Multicenter Study

PMID: 18285651 [PubMed - indexed for MEDLINE] 78: Asia Pac J Public Health. 2007;19 Spec No:60-8. Related Articles, Links

Crisis into opportunity: setting up community mental health services in post-tsunami Aceh. Jones LM, Ghani HA, Mohanraj A, Morrison S, Smith P, Stube D, Asare J. International Medical Corps, Santa Monica, California, USA [email protected] The Asian Tsunami killed more than 130,000 people and made 400,000 homeless in Aceh, an area in Indonesia already affected by over thirty years of conflict. This paper examines an approach taken by an International Non-Governmental Organisation (INGO) to address emergency mental health and psychosocial needs

in an integrated way, by providing a continuum of care incorporating psychosocial support for the wider community and clinical services for the more severely affected. The model included outreach to the indigenous system. Psychosocial activities were developed in partnership with the local communities. Community-based clinical mental health services were established by identifying and building locally-based capacity at the primary health care level, and potentially sustainable services were established in collaboration with the Ministry of Health. By December 2005, four hundred and eighty three patients had been seen. More than one third suffered from serious mental disorders that predated the Tsunami. Thus, crisis provided an opportunity to address longstanding community mental health needs. The lessons learned from this approach are also discussed. Publication Types: • •

Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18277530 [PubMed - indexed for MEDLINE] 79: Int Nurs Rev. 2008 Mar;55(1):62-7. Related Articles, Links

Burnout in hospital nurses: a comparison of internal, surgery, psychiatry and burns wards. Sahraian A, Fazelzadeh A, Mehdizadeh AR, Toobaee SH. Psychiatry Research Center, Hafez Gospital, Shiraz University of Medical Sciences, Shiraz, Iran. INTRODUCTION: Burnout is a phenomenon in which the cumulative effects of a stressful work environment gradually overwhelm the defenses of staff members, forcing them to withdraw psychologically. This study compared the levels of burnout among nurses in different nursing specialties. MATERIALS and METHODS: The sample of the study consisted of all the nurses working in all public hospitals in Shiraz, Iran who were graduates of either technological educational institutions or universities and had experienced clinical nursing practice for at least 1 year. Using Maslach Burnout Inventory and General Health Questionnaire (28-item version), we identified the psychiatric morbidity and burnout among nurses. RESULTS: Study results indicated that nurses of psychiatry wards showed significantly higher levels of emotional exhaustion and depersonalization in comparison with nurses working in other wards, and burn wards nurses showed significantly higher levels of personal accomplishment.

Also, nurses who were single were more emotionally exhausted. CONCLUSION: Different clinical working environments appear to have an impact on the development of nurses' burnout. Publication Types: • •

Comparative Study Research Support, Non-U.S. Gov't

PMID: 18275537 [PubMed - indexed for MEDLINE] 80: J Prev Med Hyg. 2007 Sep;48(3):103-8. Related Articles, Links

Molecular epidemiology and case-control approaches for management of an outbreak of hepatitis A in Liguria, Italy. Ansaldi F, Marensi L, Puppo S, Rosselli R, Turello V, Zoppi G, Carloni R, Oreste P, Riente R, Valle L, Orsi A, Sticchi L, Durando P, Icardi G. Department of Health Sciences, University of Genoa, Italy. [email protected] INTRODUCTION AND METHODS: Hepatitis A remains an important public health problem in low endemicity areas, because of the social and economic high burden of cyclical outbreaks. In this study we described an outbreak of HAV infection occurred in the city of Genoa and in its proximity and the viral circulation in the post-epidemic period. In order to identify risk factors associated to the illness and to determine the source of infection and the dynamics of virus evolution, we conducted an epidemiological and molecular investigation by a case-control study and by sequence analysis of high variable regions of the genome. RESULTS: From May to October 2005, 58 HAV hepatitis cases were notified. The case-control study showed that beach establishment attending is strongly associated with HAV hepatitis (OR = 24.5, p-value < 0.01), at multivariate analysis. The profile of epidemic curve, the clinical onset of primary cases who occurred in few weeks and the geographic distribution of cases clearly indicated a common exposure to a point source: the outbreak can be probably associated with a contaminated food product dispensed in the affected area. The outbreak has been mainly caused by a single variant, confirming the common exposure to a point source; this variant previously circulated within homosexual man (MSM) network in Northern Europe. During the outbreak and in the following months, different variants originating from Southeast Asia, Southern America and Northern Africa, have co-circulated: all these cases were related to international travel and none of these had determined secondary cases. DISCUSSION: The epidemiological picture of hepatitis A in Liguria is

characterized by a wide heterogeneity of circulating HAV strains. This pattern could be associated with the increase of imported cases and transmission within network of persons with similar risk factors. Molecular approach coupled to descriptive and analytical epidemiological studies appeared un-replaceable tools for management and control of HAV outbreaks, because of their capacity to recognize infection origin, transmission patterns and dynamics of virus evolution. PMID: 18274347

81: Nurs Forum. 2008 Jan-Mar;43(1):24-37. Related Articles, Links

Career commitment and job performance of Jordanian nurses. Mrayyan MT, Al-Faouri I. Faculty of Nursing, Hashemite University, Zarqa, Jordan. [email protected] BACKGROUND: Career commitment and job performance are complex phenomena that have received little attention in nursing research. DESIGN AND SAMPLE: A survey was used to assess nurses' career commitment and job performance, and the relationship between the two concepts. Predictors of nurses' career commitment and job performance were also studied. A convenience sample of 640 Jordanian registered nurses was recruited from 24 teaching, governmental, and private hospitals. RESULTS: Nurses "agreed" on the majority of statements about career commitment, and they reported performing "well" their jobs. Using total scores, nurses were equal in their career commitment but they were different in their job performance; the highest mean was scored for nurses in private hospitals. Using the individual items of subscales, nurses were willing to be involved, on their own time, in projects that would benefit patient care. The correlation of the total scores of nurses' career commitment and job performance revealed the presence of a significant and positive relationship (r = .457). Nurses' job performance, gender, and marital status were the best predictors of nurses' career commitment: they explained 21.8% of variance of nurses' career commitment. Nurses' career commitment, time commitment, marital status, and years of experience in nursing were the best predictors of nurses' job performance: they explained 25.6% of variance of nurses' job performance. CONCLUSIONS: The lowest reported means of nurses' job performance require managerial interventions. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18269441 [PubMed - indexed for MEDLINE] 82: J Intellect Disabil Res. 2008 Mar;52(Pt 3):230-43. Related Articles, Links

Enhancing staff attitudes, knowledge and skills in supporting the self-determination of adults with intellectual disability in residential settings in Hong Kong: a pretest-posttest comparison group design. Wong PK, Wong DF. Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong. [email protected] BACKGROUND: The ecological perspective recognizes the critical role that is played by rehabilitation personnel in helping people with intellectual disability (ID) to exercise self-determination, particularly in residential settings. In Hong Kong, the authors developed the first staff training programme of its kind to strengthen the competence of personnel in this area. The purpose of this study was to examine the effectiveness of staff training in enhancing residential staff's attitudes, knowledge and facilitation skills in assisting residents with ID to exercise self-determination. METHODS: A pretest-posttest comparison group design was adopted. Thirty-two participants in an experimental group attended a six-session staff training programme. A 34-item self-constructed scale was designed and used for measuring the effectiveness of the staff training. RESULTS: The results showed that the experimental group achieved statistically significant positive changes in all domains, whereas no significant changes were found in the comparison group. CONCLUSIONS: The findings provided initial evidence of the effectiveness of staff training that uses an interactional attitudeknowledge-skills model for Chinese rehabilitation personnel. The factors that contributed to its effectiveness were discussed and recommendations for future research were made. Publication Types: • •

Comparative Study Evaluation Studies

PMID: 18261022 [PubMed - indexed for MEDLINE] 83: J Palliat Care. 2007 Winter;23(4):255-61. Related Articles, Links

Nurse-physician collaboration in pain management for terminally ill cancer patients treated at home in Japan. Ishikawa H, Kawagoe K, Kashiwagi M, Yano E. Department of Hygiene & Public Health, Teikyo University School of Medicine, Tokyo, Japan. Collaboration between nurses and physicians is essential for successful pain management, especially in home care settings. This study describes how physicians collaborate with nurses for the pain management of terminally ill cancer patients treated at home in Japan, and evaluates the use of standing orders in pain management. Self-administered questionnaires were sent to all 565 institutions listed in a nationwide database of home care service providers for terminally ill cancer patients; 177 responding institutions were analyzed. In general, institutions caring for fewer patients per year were less likely to make specific efforts to collaborate with nurses and less likely to use standing orders in pain management. Given that many institutions provide home palliative care services on a small scale, a standard protocol for care should be developed and applied across all institutions to ensure the availability of quality home palliative care throughout the country. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18251443 [PubMed - indexed for MEDLINE] 84: Bangladesh Med Res Counc Bull. 2007 Apr;33(1):21-30. Related Articles, Links

Effect of standard treatment guidelines with or without prescription audit on prescribing for acute respiratory tract infection (ARI) and diarrhoea in some thana health complexes (THCs) of Bangladesh. Chowdhury AK, Khan OF, Matin MA, Begum K, Galib MA. Department of Pharmacy, Dhaka University, Dhaka. Inappropriate prescribing for ARI and diarrhoea is a serious health problem in many developing countries including Bangladesh. A baseline retrospective prescribing survey for ARI and diarrhoea have been conducted in randomly selected 60 thana health complexes (THCs) of Dhaka division of Bangladesh. In

the 38 of 60 THCs, the prescribers did not comply with the standard treatment guidelines (STG) for ARI. They are marked as 'unsatisfactory performers'. In these THCs unnecessary antibiotics were prescribed in more than 50% of the encounters. The study further revealed that in 26 THCs, comprising 41.6% of the 38 THCs, the situation was even worse regarding the indiscriminate use of antibiotics. In these THCs antibiotics were prescribed in > or =72% of the encounters. For diarrhoea, only in 8.3% of the THCs antibiotics were prescribed in > or =50% of the encounters. Encouragingly, most of the prescribers prescribed ORS. So the diarrhoea cases were dropped from the intervention. The 24 out of 26 worse performing THCs for ARI management, were grouped into three groups: Group-I (implementing STG+ Audit), Group-II (STG) and Group-III (no intervention, control). The prescribers of the THCs belonging to Group-I and Group-II received STG+Audit and STG only respectively as intervention(s). On the contrary, the prescribers of the THCs of Group-III (control) did not receive any intervention. It was observed that after the implementation of interventions the use of the unnecessary antibiotics to treat ARI was significantly reduced (p<0.01) compared to pre-intervention period in Group-I (STG+Audit). In this group highly significant (p<0.000) reduction in antibiotics use was achieved in 6 out of 8 THCs. The average reduction in antibiotic use in terms of encounters was 23.7 and 15.2% in the Group-I and Group-II respectively owing to the intervention(s). Significant reduction in antibiotic use in terms of THCs was 3 (out of 8 THCs) and 2 (out of 8 THCs) belonging to the Group-II and Group-III respectively. When compensated for the change in the control group, the reduction of antibiotic use in terms of encounters was 15.2 and 6.9% in the THCs of the Group-I and Group-II respectively due to introduction of the interventions. The study concludes that STG supported by prescription audit are highly effective interventions to change the prescribing behaviour of the prescribers for ARI in the THCs. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18246731 [PubMed - indexed for MEDLINE] 85: Asian Cardiovasc Thorac Ann. 2008 Jan;16(1):81-5. Related Articles, Links

Coronary heart disease service framework for revascularization in Pakistan. Elahi MM, Khan JS. Department of Cardiac Surgery, Punjab Institute of Cardiology, Jail Road,

Lahore, Pakistan. [email protected] Many centers across the country have used collaborative techniques to identify problems and come up with innovative solutions. Excellent improvements have been made in every aspect of the patient's journey through the cardiac surgery services, such as decreased length of stay, reduced clinical variation and costs, and improved outcome. We looked at how the cardiac surgical team at our center is helping to improve services for patients undergoing coronary revascularization. Improvements are not just focused on waiting lists or operating rooms but reflect the wider experience of patients and their families. Publication Types: •

Review

PMID: 18245716 [PubMed - indexed for MEDLINE] 86: Am J Vet Res. 2008 Feb;69(2):252-60. Related Articles, Links

Assessment of the likelihood of the introduction of foot-and-mouth disease through importation of live animals into the MalaysiaThailand-Myanmar peninsula. Wongsathapornchai K, Salman MD, Edwards JR, Morley PS, Keefe TJ, Van Campen H, Weber S. Animal Population Health Institute, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA. OBJECTIVE: To assess the likelihood of an introduction of foot-and-mouth disease (FMD) into the Malaysia-Thailand-Myanmar (MTM) peninsula through terrestrial movement of livestock. ANIMALS: 89,294 cattle and buffalo legally moved into the MTM peninsula. PROCEDURES: A quantitative risk assessment was conducted by use of a stochastic simulation. Patterns of livestock movement were ascertained through review of relevant governmental records and regulations and by interviewing farmers, traders, and local officers when the records did not exist. Parameters identified in the process were the probabilities of livestock having FMD and of FMD infection going undetected during import processes. The probability of an animal accepted for import having FMD was also assessed. Sensitivity analysis was performed to determine the effects that each parameter had on the model. RESULTS: The simulation yielded an average consignment prevalence of 10.95%. Typically, each animal in a quarantine facility had a 2.7% chance of having an inapparent form of FMD infection; hence, it was likely an

animal would not be identified as infected. Findings revealed that the mean probability of an animal accepted for import having FMD was 2.9%, and the risk was as high as 11%. CONCLUSIONS AND CLINICAL RELEVANCE: Results of the model allowed for the evaluation of movement regulations currently imposed in the MTM peninsula. Evidence from the study suggested that current practices in animal movement were far from efficient in preventing introduction of FMD-infected animals into the MTM region, and additional measures will be necessary. Publication Types: • •

Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18241023 [PubMed - indexed for MEDLINE] 87: Am J Vet Res. 2008 Feb;69(2):240-51. Related Articles, Links

Use of epidemiologic risk modeling to evaluate control of foot-andmouth disease in southern Thailand. Wongsathapornchai K, Salman MD, Edwards JR, Morley PS, Keefe TJ, Van Campen H, Weber S, Premashthira S. Animal Population Health Institute, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA. OBJECTIVE: To assess the impacts of the introduction of foot-and-mouth disease (FMD) and various FMD control programs in southern Thailand. ANIMALS: A native population of 562,910 cattle and 33,088 buffalo as well as 89,294 animals legally transported into southern Thailand. PROCEDURES: A quantitative risk assessment was used to ascertain the probability of FMD introduction, and an intrinsic dynamic model was used to assess impacts. Value for the transmission rate (beta) was estimated. Five scenarios created to assess the impacts of nonstructural protein (NSP) testing, mass vaccination, and culling were examined. Impacts were assessed through an examination of the estimated annual cumulative incidence (ACI) of FMD. The ACIs of various scenarios were compared by use of the Tukey Studentized range technique. RESULTS: beta was estimated at 0.115. Approximately 35,000 cases of FMD would be expected from the baseline situation. A 30% reduction of ACI was detected with the introduction of NSP antibody testing. Prophylactic vaccination resulted in an 85% reduction of ACI. Concurrent use of NSP antibody testing and vaccination reduced the ACI by 96%, and the addition of an eradication policy resulted in a slightly greater decrease in

the ACI (98%). CONCLUSIONS AND CLINICAL RELEVANCE: The study used epidemiologic models to investigate FMD control interventions. Results suggested that vaccination has more impact than the use of NSP testing. Use of the NSP test reduced ACI during peak seasons, whereas vaccination diminished the underlying incidence. The best mitigation plan was an integrated and strategic use of multiple control techniques. PMID: 18241022 [PubMed - indexed for MEDLINE] 88: Indian J Public Health. 2007 Apr-Jun;51(2):107-11. Related Articles, Links

Glycated hemoglobin--a public health perspective. Venkataraman K, Kannan AT, Kalra OP, Gambhir JK. Department of Community Medicine, UVMS & GTB Hospital, Delhi. [email protected] The burden of diabetes mellitus across the world especially in India is substantial, and much of the morbidity and mortality is due to development of diabetic complications. Control of blood glucose is important to reduce occurrence of these complications. Measurement of glycated haemoglobin values provides valuable information about long term glycemic control, and is recommended for routine monitoring by several clinical guidelines on diabetes. Monitoring and appropriate management have been shown to improve outcomes in patients with diabetes in other parts of the world. However, the adoption of glycated hemoglobin as part of routine monitoring of diabetes patients in India will need to answer issues of availability, affordability and accessibility. PMID: 18240471 [PubMed - indexed for MEDLINE] 89: Med Teach. 2007 Sep;29(7):699-705. Related Articles, Links

The outcomes of global minimum essential requirements (GMER) pilot implementation in China. Schwarz MR, Wojtczak A, Stern D. Division of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. Defining global standards for medical education in the form of competencies and the methods to evaluate whether an individual student possesses these

competencies at graduation has long been a dream of some medical educators. The development of such standards, the methods to assess their presence and the pilot test study of the standards in graduating students at eight medical schools in China, as well as the process for establishing student and school performance "cut points", has been previously described. This paper reports on the performance of a single student who went through the assessment process, the performance of all students at one of the eight medical schools and the collective performance of all students at all eight medical schools. The actual quantitative data is presented, as is the conclusion of where the student, the school and all schools had strengths, where they were borderline in performance and/or where they need improvement. The results are serving as a blueprint for medical education reform in China. Implications of the pilot test and the entire process are discussed, as is the potential for global adoption of outcome based assessments. PMID: 18236258 [PubMed - indexed for MEDLINE] 90: Med Teach. 2007 Sep;29(7):683-90. Related Articles, Links

Participatory identification of learning objectives in eight medical schools in Vietnam. Hoat LN, Yen NB, Wright EP. Faculty of Public Health, Hanoi Medical University, Hanoi, Vietnam. The advantages of outcome-based education for medical students have been recognised for several years and in several countries. Until recently in Vietnam, as in many countries, the curriculum for medical doctors was a broad framework that individual teachers filled in according to their own ideas and experience. During the past few years, the main eight medical schools in Vietnam have worked together to develop detailed learning objectives within the framework from the Ministries of Health and of Education and Training. The process was planned in an innovative and participatory way that involved more than one thousand teachers and other experts and resulted in a book listing the expected outcome in the form of the knowledge, attitudes and skills expected of a medical doctor graduating from any medical school in Vietnam. The process of identifying the objectives was followed by revision of the curriculum to be more communityoriented and to include more focus on teaching of skills, and by production of teaching, learning and assessment materials to fit the new curriculum. The process is described as an example of a comprehensive and bottom-up approach to curriculum development that could provide an example for other disciplines and schools in Vietnam or elsewhere. PMID: 18236256 [PubMed - indexed for MEDLINE]

91: J Clin Microbiol. 2008 Apr;46(4):1418-25. Epub 2008 Jan 30. Related Articles, Links

Diagnostic approach to acute diarrheal illness in a military population on training exercises in Thailand, a region of campylobacter hyperendemicity. Tribble DR, Baqar S, Pang LW, Mason C, Houng HS, Pitarangsi C, Lebron C, Armstrong A, Sethabutr O, Sanders JW. Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-5119, USA. [email protected] High rates of Campylobacter fluoroquinolone resistance highlight the need to evaluate diagnostic strategies that can be used to assist with clinical management. Diagnostic tests were evaluated with U.S. soldiers presenting with acute diarrhea during deployment in Thailand. The results of bedside and field laboratory diagnostic tests were compared to stool microbiology findings for 182 enrolled patients. Campylobacter jejuni was isolated from 62% of the cases. Clinical and laboratory findings at the time of presentation were evaluated to determine their impact on the posttest probability, defined as the likelihood of a diagnosis of Campylobacter infection. Clinical findings, the results of tests for inflammation (stool occult blood testing [Hemoccult], fecal leukocytes, fecal lactoferrin, plasma C-reactive protein), and the numbers of Campylobacter-specific antibodysecreting cells in peripheral blood failed to increase the posttest probability above 90% in this setting of Campylobacter hyperendemicity when these findings were present. Positive results by a Campylobacter-specific commercial enzyme immunoassay (EIA) and, less so, a research PCR were strong positive predictors. The negative predictive value for ruling out Campylobacter infection, defined as a posttest probability of less than 10%, was similarly observed with these Campylobacter-specific stool-based tests as well the fecal leukocyte test. Compared to the other tests evaluated, the Campylobacter EIA is a sensitive and specific rapid diagnostic test that may assist with diagnostic evaluation, with consideration of the epidemiological setting, logistics, and cost. Publication Types: • •

Evaluation Studies Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18234869 [PubMed - indexed for MEDLINE]

PMCID: PMC2292976 [Available on 08/01/08]

92: Br J Anaesth. 2008 Mar;100(3):404-10. Epub 2008 Jan 29. Related Articles, Links

Perioperative tobacco use interventions in Japan: a survey of thoracic surgeons and anaesthesiologists. Kai T, Maki T, Takahashi S, Warner DO. Department of Anesthesiology and Critical Care Medicine, Kyushu University, Fukuoka, Japan. BACKGROUND: Tobacco use interventions in surgical patients who smoke could benefit both their short-term outcome and long-term health. Anaesthesiologists and surgeons can play key roles in delivering these interventions. This study determined the practices, attitudes, and beliefs of these physicians regarding tobacco use interventions in Japan. METHODS: Questionnaires were mailed to a national random sampling of Japanese anaesthesiologists and thoracic surgeons (1000 in each group). RESULTS: The survey response rate was 62%. More than 80% of respondents agreed or strongly agreed with the statements affirming the benefits of abstinence to surgical patients. However, only 26% of surgeons and 6% of anaesthesiologists reported almost always providing help to their patients to quit smoking. Compared with anaesthesiologists, surgeons were more likely to perform the elements of current recommendations for brief intervention, and to have attitudes favourable to tobacco use interventions. The most significant barrier to intervention identified by both groups was a lack of time to perform counselling. Compared with nonsmokers, physicians who smoked were less likely to perform each of the recommended tobacco interventions CONCLUSIONS: Although current rates of intervention provided by anaesthesiologists and surgeons are low, there is considerable interest among these physicians in learning more about interventions. Given the relatively high prevalence of smoking in Japan and the potential for surgery to serve as a 'teachable moment' to promote abstinence from smoking, leadership by these specialists in the area of tobacco control could have a major impact on public health in Japan. Publication Types: • •

Multicenter Study Research Support, Non-U.S. Gov't

PMID: 18234680 [PubMed - indexed for MEDLINE]

93: Nurs J India. 2006 Oct;97(10):223-4. Related Articles, Links

Nurses and protection of patient's rights. Kunjumon BP. College of Nursing, Amrita Institute of Medical Sciences & Research Centre, Elamakkara, Kochi, Kerala. Assessment of the knowledge and practice of trained nurses in protecting the patient's rights and factors which interfere in protecting the patient's rights. PMID: 18232184 [PubMed - indexed for MEDLINE] 94: Indian J Public Health. 2007 Oct-Dec;51(4):244-5. Related Articles, Links

A study on clinico-social factors for sexually transmitted diseases among urban males. Pant B, Chaturvedi M, Bansal R, Tiwari R, Parashar P. Community Medicine, Subharti Medical College, Meerut. [email protected] This health center based study was conducted to find out the proportion and distribution of clinico-social factors for sexually transmitted diseases among male OPD attanders of urban health centre, Subharti Medical College, Meerut. Out of the total 150 male cases of genital diseases from January to June 2005, 42 were found to be symptomatic for STDs according to syndromic approach. The most common symptom was urethral discharge (35.7%). Illiteracy, trucker's occupation, multiple sex partners, extra marital relationship and non-usage of condom were found to be important socio-clinical factors for STDs. PMID: 18232168 [PubMed - indexed for MEDLINE] 95: Indian J Public Health. 2007 Oct-Dec;51(4):228-30. Related Articles, Links

Awareness of diabetic retinopathy among physicians and optometrists in a district of West Bengal.

Ghosh S, Mukhopadhyay S, Maji D, Halder D. Regional Institute of Ophthalmology, Kolkata. [email protected] A cross sectional study was done to ascertain the current knowledge among physicians and optometrists regarding diabetic retinopathy in a district of West Bengal. We obtained response from 242 physicians and 36 optometrists working in government health units. The questionnaire comprised of three sections covering magnitude of problem, risk factors and management. The responses were analysed and graded. In different sections, knowledge of 74 - 78% physicians and 83 - 86% optometrists was graded as not acceptable. Existing lack of knowledge among physicians and optometrists regarding diabetic retinopathy needs correction. PMID: 18232163 [PubMed - indexed for MEDLINE] 96: Nurse Educ Today. 2008 May;28(4):494-500. Epub 2008 Jan 28. Related Articles, Links

Factors influencing student nurses' career choices after preceptorship in a five-year junior nursing college in Taiwan. Shih WM, Chuang SH. Chang-Gung Institute of Technology, Doctoral student in National Taipei College of Nursing and Job Placement, Room 1117, 261 Wen-Hua 1st Road, Kwei-Shan, Tao-Yuan 33333, Taiwan. [email protected] This study was conducted to explore the influence factors of a preceptorship in career choices following student nurses' graduations. A total number of 326 student nurses in their fifth year of junior nursing college were selected as participants. A validated and reliable questionnaire was used in this study. Data were analyzed by the Statistical Package for the Social Science (SPSS) for windows for percentage, mean, standard deviation, and Pearson's correlation. The results showed that: (1) the first five factors influencing student nurses' career choices were good unit environment, nurse's professional role, self-professional knowledge deficiency, nurse's professional knowledge, and patient's and family's good feedback; (2) the correlation between the chosen field of practice and willingness to work after graduation showed a strong relationship in all areas. Notably, the preceptorship had an impact on student nurses selecting a nursing career. These results can give nurse educators guidance in preparing student nurses as they enter the work force. Publication Types:

•

Evaluation Studies

PMID: 18226842 [PubMed - indexed for MEDLINE] 97: J Obstet Gynaecol Res. 2008 Feb;34(1):67-72. Related Articles, Links

Ureteral catheter placement for prevention of ureteral injury during laparoscopic hysterectomy. Tanaka Y, Asada H, Kuji N, Yoshimura Y. Department of Obstetrics and Gynecology, Yazaki Hospital, Kanagawa, Japan. [email protected] AIM: Ureteral injury is among the most devastating complications of gynecologic surgery. Estimated incidence of ureteral injury during laparoscopic hysterectomy is 2.6-35 times (0.2-6.0%) that in abdominal hysterectomy. We investigated preoperative ureteral catheter (UC) placement as a way to prevent ureteral injury in laparoscopic hysterectomy. METHODS: Clinical records of 94 women who underwent laparoscopic hysterectomy between February 2006 and January 2007 in Yazaki Hospital, Kanagawa, Japan, were reviewed retrospectively. Thirty-four patients between February and June 2006 underwent the surgery without ureteral catheterization and 60 patients between July 2006 and January 2007 underwent surgery with ureteral catheterization. Clinical outcomes were statistically compared between the two groups. RESULTS: The average time required for catheter insertion was 9.35 min. The ureter in which the catheter was placed was visualized clearly. In one patient, whose left ureter was deviated by a massive myoma, catheter insertion was not possible. No complications arose from catheter placement except for minor complaints including low back pain, urinary discomfort, and transient hematuria. While one injury occurred in a patient without ureteral catheterization (1/34), no ureteral injury occurred in any patient with ureteral catheterization (0/60). Operative time, total blood loss, and hospital stay were not significantly different between the two groups. CONCLUSIONS: UC placement is simple, helping to prevent ureteral injury during laparoscopic hysterectomy and enhancing safety of this procedure. PMID: 18226132 [PubMed - indexed for MEDLINE] 98: Nurs Crit Care. 2008 Jan-Feb;13(1):12-24. Related Articles, Links

Workplace stressors, coping, demographics and job satisfaction in Chinese intensive care nurses. Li J, Lambert VA. Department of Nursing, Tongji Medical School, Huazhong University of Science & Technology, Wuhan, China. BACKGROUND: Prior research has suggested that certain workplace stressors, coping strategies and demographic characteristics are related to job satisfaction in nurses. Most of the research in this area has been conducted within western culture countries, with little research being carried out in Asian culture countries, especially China. It remains unclear if the findings of the research conducted in western culture countries are applicable to Chinese nurses, especially intensive care nurses. AIMS AND OBJECTIVES: Therefore, the aims of this study were to examine, in Chinese intensive care nurses, the most often occurring workplace stressor; the most frequently used coping strategy; and the relationships among workplace stressors, coping strategies, demographic characteristics and job satisfaction. Design: The study design was a survey using four self-report questionnaires. METHODS: One hundred and two intensive care nurses, from four hospitals located in two major cities in central China, were administered four self-report questionnaires. RESULTS: Findings suggested that the most frequently cited workplace stressor was workload, while the most commonly used coping strategy was planning. Two hundred and twelve significant positive and negative correlations were found among the various workplace stressors, coping strategies, demographic characteristics and the different factors comprising job satisfaction. CONCLUSIONS: These findings identify factors that need to be considered when addressing workplace stress, coping strategies and demographic characteristics as they relate to job satisfaction in Chinese intensive care nurses. RELEVANCE TO CLINICAL PRACTICE: It is important for both hospital and nursing administrators to address factors contributing to job satisfaction, so that retention of qualified ICU nurses, within the workforce, will be facilitated. Publication Types: •

Multicenter Study

PMID: 18226051 [PubMed - indexed for MEDLINE] 99: Tuberk Toraks. 2007;55(4):323-8. Related Articles, Links

[Follow-up hemoglobin concentrations in ICU: relationship between diagnostic blood loss and daily fluid balance] [Article in Turkish] Pazarli P, Yarkin T, Karakurt Z, Yetis Duman D, Saltürk C, Celik B, Baran R. School of Health, Sakarya University, Sakarya, Turkey. [email protected]. To evaluate DeltaHb (daily changes of hemoglobin concentrations) in nonbleeding critically ill patients, and to investigate its relation with diagnostic blood loss (DBL) and fluid balance (FB). Hospital records of 34 nonseptic patients who stayed in respiratory intensive care unit (RICU) at least 72 hours with no evidence of acute bleeding, renal failure and bleeding diathesis, were evaluated retrospectively. Demographics, clinical features, acute physiology assessment and chronic health evaluation (APACHE) II scores, daily Hb levels, DBL and FB were recorded. Correlation statistics was performed between DeltaHb and DBL and FB. We compared the patients with DeltaHb > or =0.5 g/dL/day (group A) and the patients with DeltaHb < 0.5 g/dL/day (group B) in the first three days. The mean age was 55 +/- 14, Hb level was 13.2 +/- 1.7 g/dL at admission and 12.6 +/- 2.3 g/dL at discharge from RICU. DBL was 25.2 +/- 7.4 mL/d, and FB was 251 +/- 1783 mL/d for the first day in intensive care unit. DBL was lesser in subsequent days than in the first day but it wasn't significant. DeltaHb was -0.54 +/- 1.5 g/dL for the first three days, while it was -0.23 +/- 1.5 g/dL for subsequent four days (p= 0.9). DeltaHb in the first three days has no correlation with DBL and FB. Age, sex, APACHE II score, clinical features, DBL and FB were not differed between Group A and Group B. CONCLUSION: No relation was found between DeltaHb and DBL, and also FB; but studies like this are important to indicate that Hb concentrations may decrease in critically ill patients without any reason such as bleeding. Publication Types: • •

English Abstract Evaluation Studies

PMID: 18224498 [PubMed - indexed for MEDLINE] 100: Indian J Med Res. 2007 Dec;126(6):509-17. Related Articles, Links

Financial burden of health services for people with HIV/AIDS in India. Kumarasamy N, Venkatesh KK, Mayer KH, Freedberg K. YRG Centre for AIDS Research & Education, Voluntary Health Services, Chennai, Tamil Nadu, India. [email protected] In resource-limited settings, illness can impose a major financial burden on patients and their families. With the advent and increasing accessibility of antiretroviral therapy, HIV/AIDS has now become a fundamentally chronic treatable disease with far reaching economic and social consequences, and hence it is crucial to also examine the long-term financial impact of HIV healthcare. Beyond the direct costs of medications, monitoring, and medical care, additional costs include the long-term lost earnings of HIV-infected individuals as well as of their household members who also provide care. A clearer understanding of the financial burden of healthcare for HIV-infected Indians can allow policy makers and planners to better allocate limited resources. This article reviews the financial consequences of HIV care and treatment on individuals and their households by examining current treatment options, HIV monitoring, the clinical course of HIV disease, and the roles of the private and public sector in providing HIV care in India. Future studies should more thoroughly examine the financial impact of HIV-related costs incurred by households over time and examine household responses to these costs. Publication Types: •

Review

PMID: 18219077

101: J Eval Clin Pract. 2008 Feb;14(1):131-40. Related Articles, Links

Pharmaceutical care of patients with gestational diabetes mellitus. Elnour AA, El Mugammar IT, Jaber T, Revel T, McElnay JC. Al Ain Hospital, United Arab Emirates, and Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK.

RATIONALE, AIMS AND OBJECTIVE: To investigate whether the introduction of a programme of optimising drug treatment, intensive education and self-monitoring of patients diagnosed with gestational diabetes mellitus (GDM) at an early stage (<20 gestational weeks), will improve management outcomes as determined by objective measures of patient knowledge about diabetes, glycaemia control, maternal/neonatal complications, and health-related quality of life. METHODS: The study was a randomized, controlled, longitudinal, prospective clinical trial performed at Al-Ain Hospital, Al-Ain, United Arab Emirates. Over an 18-month period, patients diagnosed with GDM were recruited and were randomly assigned to either an intervention or a control group, in a ratio of 3:2. Intervention patients received a structured pharmaceutical care service (including education and introduction of intensive self-monitoring) while control patients received traditional services. Patients were followed up from time of recruitment until 6 months postnatally at scheduled outpatient clinics. A range of clinical and humanistic outcome measures, including maternal and neonatal complications, were used to assess the impact of the intervention. RESULTS: A total of 165 patients (99 intervention, 66 control) completed the study. The intervention patients exhibited a range of benefits from the provision of the programme when compared with control group patients. Statistically significant (P < 0.05) improvements were shown in the intervention group for knowledge of diabetes, health-related quality of life (as determined by the SF36), control of plasma glucose and HbA(1c), maternal complications [e.g. decreased incidence of pre-eclampsia (5.1% vs. 16.7%), eclampsia (1.0% vs. 7.6%), episodes of severe hyperglycaemia (3.0% vs. 19.7%) and need for Caesarean section (7.1% vs. 18.2%)], and neonatal complications [e.g. decreased incidence of neonatal hypoglycaemia (2.0% vs. 10.6%), respiratory distress at birth (4.0% vs. 15.2%), hyperbilirubinaemia (1.0% vs. 12.1%) and large for gestational age (9.0% vs. 22.7%)]. CONCLUSION: The research provides clear evidence that provision of pharmaceutical care adds value to the management of GDM as exemplified by improved maternal and neonatal outcomes. Publication Types: •

Randomized Controlled Trial

PMID: 18211656 [PubMed - indexed for MEDLINE] 102: J Eval Clin Pract. 2008 Feb;14(1):116-20. Related Articles, Links

Measuring the process of quality of care for ST-segment elevation acute myocardial infarction through data-mining of the electronic discharge notes.

Chang SN, Lin JW, Liu SC, Hwang JJ. Cardiovascular Division, Department of Internal Medicine, NTUH, Taipei City, Taiwan. BACKGROUND: Measuring parameters in the management of acute myocardial infarction (AMI) has been used as the standard for evaluating quality of care (QC). The purpose of this study was to elucidate the completeness of information retrieval from electronic discharge notes (EDN) as well as to measure QC for AMI in Taiwan. METHODS: All the narrative reports in EDN in the clinical information systems (CIS) of National Taiwan University Hospital from 2002 to 2004 were retrieved, and the patients who presented to the emergency room (ER) with AMI were identified. Ten parameters related to QC for AMI were measured through data-mining of EDN alone as well as through an extensive search of the CIS and paper medical records. RESULTS: Information retrieval from EDN alone could obtain some parameters with a high recall, such as the use and timing of reperfusion therapy and the prescription of medication at discharge. Other parameters, such as the early management at ER and lipid profile after discharge, could not be retrieved from EDN. The use of medication and early reperfusion therapy was comparable to the US standards, while lipid control at and after discharge were suboptimal. CONCLUSIONS: This study has demonstrated that information retrieval from EDN alone could faithfully extract sufficient measures of QC for AMI in some aspects, as well as could quantify the current process of QC for AMI in Taiwan. PMID: 18211653 [PubMed - indexed for MEDLINE] 103: Crit Care Nurs Clin North Am. 2008 Mar;20(1):13-22, v. Related Articles, Links

Skill set requirements for nurses deployed with an expeditionary medical unit based on lessons learned. Whitcomb JJ, Newell KJ. Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA. [email protected] Based in Kuwait 3 years apart, the authors recount how nurses and corps staff, along with their physician counterparts, came together to form well-run medical facilities under adverse circumstances. Their respective hospitals became competent organizations because of specific formulas for success, along with preparation, identification of required skill sets, and making improvements based on experience. This article describes the training of medical, nursing, and corps staff, the facilities and resources required for managing casualties, and some of

the more commonly encountered combat injuries and conditions. PMID: 18206580 [PubMed - indexed for MEDLINE] 104: J Clin Nurs. 2008 Feb;17(4):558-9; discussion 559-62. Related Articles, Links Comment on: •

J Clin Nurs. 2006 Aug;15(8):998-1006.

Commentary on Hsiao FH, Klimidis S, Minas H & Tan ES (2006) Cultural attribution of mental health suffering in Chinese societies: the views of Chinese patients with mental illness and their caregivers. Journal of Clinical Nursing 15, 998-1006. Chan S. The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. [email protected] Publication Types: •

Comment

PMID: 18205685 [PubMed - indexed for MEDLINE] 105: J Clin Nurs. 2008 Feb;17(4):509-18. Related Articles, Links

Investigating factors associate to nurses' attitudes towards perinatal bereavement care. Chan MF, Lou FL, Arthur DG, Cao FL, Wu LH, Li P, Sagara-Rosemeyer M, Chung LY, Lui L. School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China. [email protected] AIM: The purpose of this study was to explore nurses' attitudes towards perinatal bereavement care and to identify factors associate with such attitudes.

BACKGROUND: Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and nurses with positive attitude to bereavement care can help bereaved parents to cope during their grieving period. METHOD: Data were collected through a structured questionnaire; 334 nurses were recruited (63% response rate) from the Obstetrics and Gynaecology unit in five hospitals in Hong Kong during May-August 2006. Outcome measures including attitudes towards perinatal bereavement care, importance on hospital policy and training support for bereavement care. RESULTS: Majority of nurses in this study held a positive attitude towards bereavement care. Results showed that only 39.3% (n = 130) of nurses had bereavement related training. By contrast, about 89.8% of nurses (n = 300) showed they need to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88.0% (n = 296) would share experiences with colleagues and seek support when feeling under stress. Regression model showed that age, past experience in handling grieving parents and nurses' perceived attitudes to hospital policy and training provided for bereavement cares were factors associate with nurses' attitudes towards perinatal bereavement care. CONCLUSIONS: Hong Kong nurses emphasized their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care. RELEVANCE TO CLINICAL PRACTICE: These findings may be used for health policy makers and nursing educators to ensure delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula respectively. PMID: 18205683 [PubMed - indexed for MEDLINE] 106: J Clin Nurs. 2008 Feb;17(4):482-90. Related Articles, Links

Institutionalized elders with dementia: collaboration between family caregivers and nursing home staff in Taiwan. Lau WY, Shyu YI, Lin LC, Yang PS. Department of Nursing, Cardinal Tien Hospital, Hsintien, Taipei, Taiwan. AIMS AND OBJECTIVES: To explore the process of development of collaborative relationship between family caregivers of institutionalized elders with dementia and nursing home staff in Taiwan. BACKGROUND: Evidence suggests that family members are continuously involved in the lives of loved ones and have not given up their roles as caregivers after the institutionalization of a family member. Little is known, however, about how family caregivers develop a collaborative relationship with nursing home staff, particularly in Asian countries.

DESIGN AND METHODS: Grounded theory methodology was used. Data were collected via interviews and observations from 11 family caregivers of patients who were suffering from dementia and living in an institution for persons with dementia in northern Taiwan. Data were analysed by constant comparative analysis. RESULTS: Findings revealed that 'institutional social penetration' was the process most used by family caregivers to achieve an harmonious collaborative relationship with the nursing home staff. Institutional social penetration is a dynamic process, which includes three components: selfdisclosure, evaluation of care and penetration strategies. Family caregivers, who had developed a 'socially penetrating' relationship with the nursing home staff, were more likely to disclose information in more breadth and depth, to receive positive care evaluations and to adopt multiple effective penetration strategies. CONCLUSIONS: Institutional social penetration between family caregivers and nursing home staff can sensitize healthcare providers to meet the family's needs during the placement of their loved one and provide a basis for developing intervention strategies. RELEVANCE TO CLINICAL PRACTICE: Findings of this study may help healthcare providers to understand the ways in which collaborative relationships develop between the families of elders with dementia and nursing home staff. Interventions can be developed to facilitate selfdisclosure of both the family members and nursing home staff through timely feedback and familiarising family caregivers with different penetration strategies. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18205680 [PubMed - indexed for MEDLINE] 107: Singapore Med J. 2008 Jan;49(1):37-41. Related Articles, Links

Survey of attitudes of mental health professionals in Singapore towards at-risk mental states. Tor PC, Poon LY. Early Psychosis Intervention Programme, Institute of Mental Health, 10 Buangkok View, Singapore 539747. [email protected] INTRODUCTION: Schizophrenia is a severe, chronic mental illness with a worldwide prevalence of about one percent. It is possible to define at-risk mental states (ARMS) that predict conversion to schizophrenia in up to 40 percent of help-seeking individuals within a year of screening. Treatment of ARMS is

controversial due to difficulties with diagnosis and uncertainties of treatment effectiveness. There is currently no consensus among psychiatrists in Singapore or internationally, regarding the diagnosis of ARMS, or its treatment. This survey was conducted to assess current attitudes of Singaporean psychiatrists towards ARMS. METHODS: An anonymous survey containing a clinical vignette and questions related to the diagnosis and management of ARMS was sent out to all registered psychiatrists and psychiatric trainees in Singapore. RESULTS: There was a response rate of 62.1 percent (87/140). 60.9 percent of respondents were fully-trained psychiatrists. 44.8 percent versus 43.7 percent of respondents diagnosed ARMS versus psychosis, respectively. 74.4 percent (29/39) of respondents who diagnosed ARMS would treat the patient with active management rather than watchful waiting. 64.4 percent felt that there was no consensus regarding the management of ARMS. There was no significant relationship between responses and age, gender, training or place of practice. CONCLUSION: There is currently clinical equipoise with regard to both diagnosis and management of ARMS in Singapore. Most psychiatrists would manage ARMS actively rather than with watchful waiting. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18204767 [PubMed - indexed for MEDLINE] 108: Patient Educ Couns. 2008 Mar;70(3):395-402. Epub 2008 Jan 16. Related Articles, Links

Attitudes toward integration of complementary and alternative medicine in primary care: perspectives of patients, physicians and complementary practitioners. Ben-Arye E, Frenkel M, Klein A, Scharf M. Department of Family Medicine, Israel. [email protected] OBJECTIVE: Our study explored the attitudes of patients toward complementary and alternative medicine (CAM) use, their family physicians' role regarding CAM, and models for CAM referral and treatment. We compared patients' perspectives regarding integration of CAM into primary care with attitudes of primary care physicians (PCPs) and CAM practitioners. METHODS: We conducted a comprehensive literature review and focus group discussions to develop a questionnaire, which we gave to three groups: a random sample of patients receiving care at an academic family medicine clinic and PCPs and CAM practitioners employed in the largest health maintenance organization in Israel.

RESULTS: A total of 1150 patients, 333 PCPs, and 241 CAM practitioners responded to our questionnaire. Compared with PCPs, patients expected their family physician to refer them to CAM, to have updated knowledge about CAM, and to offer CAM treatment in the clinic based on appropriate training. When asked about CAM integration into medical care, more patients expected to receive CAM in a primary care setting compared to PCPs' expectations of prescribing CAM (62% vs. 30%; p=0.0001). Patients, CAM practitioners, and PCPs expected family practitioners to generate CAM referrals in an integrative primary care setting (85.6% vs. 82.4% vs. 62.6%; p<0.0001). Patients supported CAM practitioners providing CAM treatments in the primary care setting, regardless of whether the practitioner held a medical degree (MD). Also, more patients than PCPs or CAM practitioners expected their family physician to provide CAM (28.2% vs. 14.5% vs. 3.8%; p<0.0001). CONCLUSION: Patients, PCPs, and CAM practitioners suggested that family physicians play a central role in CAM referral and, to a lesser extent, that they actually provide CAM treatment themselves. PRACTICE IMPLICATIONS: PCPs need to be aware of their present and future role in informed referral to CAM and, to a lesser degree, in providing CAM in integrative primary care clinics. With the increasing use of CAM, patients may expect their family physician to be more knowledgeable, skillful, and have a balanced approach regarding CAM use. In addition, practitioners should learn how to communicate effectively and better collaborate with CAM practitioners to the benefit of their patients. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18201857 [PubMed - indexed for MEDLINE] 109: J Clin Lab Anal. 2008;22(1):29-38. Related Articles, Links

Clinical and laboratory evaluation of idiopathic male infertility in a secondary referral center in India. Abid S, Maitra A, Meherji P, Patel Z, Kadam S, Shah J, Shah R, Kulkarni V, Baburao V, Gokral J. Department of Molecular Endocrinology and Reproductive Endocrinology, National Institute for Research in Reproductive Health (ICMR), Parel, Mumbai, India. The genetic basis of infertility has received increasing recognition in recent years, particularly with the advent of assisted reproductive technology. It is now

becoming obvious that genetic etiology for infertility is an important cause of disrupted spermatogenesis. Y-chromosome microdeletions and abnormal karyotype are the two major causes of altered spermatogenesis. To achieve biological fatherhood, intracytoplasmic sperm injection (ICSI) is performed in cases of severe infertility with or without genetic abnormalities. There is a concern that these genetic abnormalities can be transmitted to the male progeny, who may subsequently have a more severe phenotype of infertility. A total of 200 men were recruited for clinical examinations, spermiograms, hormonal profiles, and cytogenetic and Yq microdeletion profiles. Testicular biopsy was also performed whenever possible and histologically evaluated. Genetic abnormalities were seen in 7.1% of cases, of which 4.1% had chromosomal aberrations, namely Klinefelter's mosaic (47XXY) and Robertsonian translocation, and 3.0% had Yq microdeletions, which is very low as compared to other populations. Follicle stimulating hormone (FSH) and luteinizing hormone (LH) were significantly increased in men with nonobstructive azoospermia (NOA) as compared to severe oligoasthenozoospermia (P<0.0001), whereas testosterone levels were significantly decreased in men with microdeletions as compared to men with no microdeletions (P<0.0083). Low levels of androgen in men with microdeletions indicate a need to follow-up for early andropause. Patients with microdeletions had more severe testicular histology as compared to subjects without deletions. Our studies showed a significant decrease (P<0.002) in the serum inhibin B values in men with NOA, whereas FSH was seen to be significantly higher as compared to men with severe oligoasthenozoospermia (SOAS), indicating that both the Sertoli cells as well the germ cells were significantly compromised in cases of NOA and partially affected in SOAS. Overall inhibin B in combination with serum FSH would thus be a better marker than serum FSH alone for impaired spermatogenesis. In view of the genetic and hormonal abnormalities in the group of infertile men with idiopathic severe oligozoospermia and NOA cases, who are potential candidates for ICSI, genetic testing for Y-chromosome microdeletions, karyotype, and biochemical parameters is advocated. (c) 2008 Wiley-Liss, Inc. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18200580 [PubMed - indexed for MEDLINE] 110: Aust N Z J Psychiatry. 2008 Feb;42(2):154-8. Related Articles, Links

Impact of the priority follow-up system on quality of life in Chinese schizophrenia patients.

Xiang YT, Leung CM, Tang WK, Ungvari GS. Department of Psychiatry, Shatin Hospital, Shatin NT, Hong Kong. [email protected] OBJECTIVE: Priority follow up (PFU) is a particular aspect of mental health care in Hong Kong whereby psychiatric patients with a history of violence or suspected proclivity to violence are identified and their management is closely monitored. The aim of the present study was to determine the impact of a PFU system on quality of life (QOL) in schizophrenia patients. METHODS: Two hundred and sixty-seven clinically stable outpatients with schizophrenia were randomly selected and interviewed in Hong Kong using standardized assessment instruments that covered their clinical condition and QOL. RESULTS: Patients with PFU status constituted 8.2% of the sample. PFU patients were more likely to be men, have a history of violence, and were poorer in the physical, psychological, social and environmental QOL domains than their non-PFU counterparts even after controlling for the effects of potential confounding variables. CONCLUSIONS: More effective measures should be taken to improve QOL in PFU schizophrenia patients who are prone to violent behavior. Publication Types: •

Comparative Study

PMID: 18197511 [PubMed - indexed for MEDLINE] 111: J Nurs Educ. 2007 Dec;46(12):553-61. Related Articles, Links

Action research on the development of a caring curriculum in Taiwan: Part II. Lee-Hsieh J, Kuo CL, Turton MA, Hsu CL, Chu HC. Nursing Department, Fooyin University, 151 Chin Hsueh Road, Ta-Liao, Kaohsiung 831, Taiwan. [email protected] This article presents the development, design, implementation, and evaluation of the third-year course of a caring curriculum being developed for a 5-year associate degree nursing program in Taiwan. The course, titled Application of Caring Concepts, was taught to more than 800 students by 16 instructors recruited from various departments. The instructors attended workshops and seminars on caring and then developed the course materials and teaching strategies. Instructional strategies included role modeling, dialogue, discussions, journaling, simulations, readings, and projects that involved students' applying caring skills

outside of the classroom. Students were evaluated by patients in clinical practice using the Caring Behavior Measurement, developed in a previous study, and the course was evaluated by qualitative analysis of student feedback. Student responses to course content and instructional strategies were positive. Patients generally indicated that students always or normally performed caring behaviors. The study showed that with an appropriate curriculum and learning strategies, students can learn caring skills. Publication Types: • •

Evaluation Studies Research Support, Non-U.S. Gov't

PMID: 18196839 [PubMed - indexed for MEDLINE] 112: J Adv Nurs. 2008 Jan;61(2):181-7. Related Articles, Links

Health promotion and health education practice: nurses' perceptions. Whitehead D, Wang Y, Wang J, Zhang J, Sun Z, Xie C. School of Health Sciences, College of Humanities and Social Sciences, Massey University, Palmerston North, New Zealand. [email protected] AIM: This paper is a report of a study to explore nurses' perceptions of health promotion and health education practice in a Chinese provincial hospital. BACKGROUND: Health promotion and health education practices are based on universal constructs. Therefore, such practices should share common principles. To date, most nursing-related studies have been conducted in Europe or in North America. METHOD: A Husserlian phenomenological approach was adopted. Interviews were conducted in 2006 with a sample of eight nursing students and eight senior nurses. The interviews were audio-recorded and transcribed from Mandarin to English. Data analysis adhered to the framework developed by Giorgi. RESULTS: Reported health education and health promotion-related practices showed results similar to those reported in Europe and North America. Hospital-based nurses were often aware of what health promotion is, but did not have the scope or opportunity to implement it in practice. Instead, they were likely to conduct more limited forms of health education. Actual understanding of health promotion and health education constructs was high with most participants, underpinned by active clinical-based educational support. Some participants were able to conduct broader health promotion activities on a voluntary basis in their own communities. CONCLUSION: Health education and health promotion are

universal health-related constructs. Thus, there is an expectation that all nurses will implement these in a similar fashion. Where possible, hospital-based nurses should strive to improve their health education practices and further embrace wider perspectives of health promotion practice. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18186910 [PubMed - indexed for MEDLINE] 113: Ann Acad Med Singapore. 2007 Dec;36(12):980-6. Related Articles, Links

Measuring the quality of care of diabetic patients at the specialist outpatient clinics in public hospitals in Singapore. Toh MP, Heng BH, Sum CF, Jong M, Chionh SB, Cheah JT. Health Services and Outcomes Research, National Healthcare Group, Singapore. [email protected] INTRODUCTION: This study aims to measure the quality of care for patients with diabetes mellitus at selected Specialist Outpatient Clinics (SOCs) in the National Healthcare Group. MATERIALS AND METHODS: The cross-sectional study reviewed case-records of patients from 6 medical specialties who were on continuous care for a minimum of 15 months from October 2003 to April 2005. Disproportionate sampling of 60 patients from each specialty, excluding those comanaged by Diabetes Centres or primary care clinics for diabetes, was carried out. Information on demographic characteristics, process indicators and intermediate outcomes were collected and the adherence rate for each process indicator compared across specialties. Data analysis was carried out using SPSS version 13.0. RESULTS: A total of 575 cases were studied. The average rate for 9 process indicators by specialty ranged from 47.8% to 70.0%, with blood pressure measurement consistently high across all specialties (98.4%). There was significant variation (P <0.001) in rates across the specialties for 8 process indicators; HbA1c, serum creatinine and lipid profile tests were over 75%, while the rest were below 50%. The mean HbA1c was 7.3% +/- 1.5%. "Optimal" control of HbA1c was achieved in 51.2% of patients, while 50.6% of the patients achieved "optimal" low-density lipoprotein (LDL)-cholesterol control. However, 47.3% of patients had "poor" blood pressure control. Adherence to process indicators was not associated with good intermediate outcomes. CONCLUSIONS: There was large variance in the adherence rate of process and clinical outcome indicators across specialties, which could be improved further.

PMID: 18185877 [PubMed - indexed for MEDLINE] 114: J Ayub Med Coll Abbottabad. 2007 Apr-Jun;19(2):32-4. Related Articles, Links

Pattern of fetal deaths at a university hospital of Sindh. Khaskheli M, Baloch S, Khushk IA, Shah SS. Department of Obstetrics and Gynaecology, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro. [email protected] BACKGROUND: Perinatal mortality is a significant public health problem throughout the world. Its prevalence is quite high in the developing countries on account of number of factors. Most of the causes are treatable and fetal outcome can be improved by provision of good health care facilities during antepartum and intrapartum periods and through public education regarding reproductive health and better utilization of health services. OBJECTIVE: To determine the pattern of intrauterine fetal deaths before or in the process of labor in our tertiary care set up. METHODS: This descriptive case series was conducted at Department of Obstetrics and Gynaecology (unit-IV) at Liaquat University Hospital, Jamshoro, Sindh,from April 2002 to October 2003. In total, 50 intrauterine fetal deaths from 24 weeks of gestation to full term pregnancy were analyzed. The case records of all the women were evaluated and data collected regarding their age, period of gestation, clinical features, antenatal records, previous obstetrical history, labor, mode of delivery as well as complications during or after the labor. RESULTS: Out of 697 deliveries, 50 (7.17%) babies were still born. Of these 84% were fresh still born. The commonest factors were antepartum hemorrhage (30%), mismanaged labor (26%), premature rupture of membranes (26%) and congenital anomalies (16%). CONCLUSION: Majority of fetal deaths in our set up are due to avoidable factors. Hence, there is strong need to improve the quality of care by proper antenatal care, identification of high risk cases and referral to tertiary care hospitals for proper management to prevent morbidity and mortality in this regard. PMID: 18183715 [PubMed - indexed for MEDLINE] 115: Saudi Med J. 2008 Jan;29(1):98-101. Related Articles, Links

Quality improvement of diabetes care using flow sheets in family health practice. Moharram MM, Farahat FM.

Department of Family Medicine, Al-Hada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia. OBJECTIVE: To show that the use of a flow sheet would improve performance of family physicians in diabetes care. METHODS: This is a one-year intervention study conducted in 7 family practice clinics in Taif Armed Forces Hospitals, Taif, Saudi Arabia from March 2006 to June 2007. Diabetic flow sheet was developed based on the clinical practice guidelines of Canada for the management of type 2 diabetes. Patients' records were selected by systematic random sampling technique. RESULTS: Four hundred and fourteen medical records of patients with type 2 diabetes were included in the study. Compliance with the quality indicators was audited using 9 quality improvement indicators. Significant improvement was detected in the indicators of body mass index, glycosylated hemoglobin, microalbuminuria, lipid profile, retinoscopy, foot examination, and peripheral neuropathy examination. CONCLUSION: Flow sheet can be effective in improving quality of care not only for diabetes but also for other chronic conditions. PMID: 18176682 [PubMed - indexed for MEDLINE] 116: Intern Med. 2008;47(1):25-31. Epub 2008 Jan 1. Related Articles, Links

Prospective health diary study for new onset chest symptoms in the Japanese general population. Tokuda Y, Ohde S, Takahashi O, Shakudo M, Yanai H, Shimbo T, Fukuhara S, Hinohara S, Fukui T. Department of Medicine, St. Luke's International Hospital. [email protected] OBJECTIVES: Our aim was to analyze the incidence of new onset chest symptoms for the period of a month and to evaluate the possible association of these chest symptoms with demographic, socioeconomic or clinical characteristics. DESIGN: Prospective observational cohort study using a selfreported health diary among subjects without baseline chest diseases. SETTING: A nationally representative sample of households in Japan. PARTICIPANTS: Of a total 3,568 subjects from the study recruitment sample, 3,477 participants completed the diary; of these, 127 participants with active chest diseases at baseline were excluded and the remaining 3,350 participants were analyzed. MEASUREMENTS AND RESULTS: The mean number of episodes of chest symptoms was 1.19 with 95% confidence interval (CI) of 1.0-2.0 and the incidence was 21% (95% CI, 10-30%). Cough was the most frequent chest

symptom with the mean number of episodes of 1.14 and the prevalence of 20%. Chest pain, dyspnea, palpitation, and wheezing were identified in less than 1%. Associated factors for cough were younger age, unemployment, and poor physical quality of life. Associated factors for chest pain included older age, living in smaller cities, unemployment, higher educational attainment, and poor physical and mental quality of life. CONCLUSIONS: Chest symptoms are common in the Japanese general population. Cough is the most frequent symptom, followed by chest pain. Younger age, unemployment, and poor physical quality of life are significantly associated with cough. PMID: 18176001 [PubMed - indexed for MEDLINE] 117: J Dent Educ. 2008 Jan;72(1):110-5. Related Articles, Links

Professionalization and its effect on health locus of control among Indian dental students. Acharya S. Department of Community Dentistry, Manipal College of Dental Sciences, Manipal University, Manipal, India. [email protected] The objectives of this study were to assess the effect of different stages of professionalization on the health locus of control of students in an Indian dental school and to describe possible factors that may influence the health locus of control among dental students. The multidimensional health locus of control (MHLC) scale was distributed to 372 undergraduate dental students at one school in India, and 325 students returned completed forms. Comparison of the mean scores for the three MHLC subscales (Internal, Chance, and Powerful Others) from first year to final year showed that the mean Internal score remained unchanged in the first and second year, but decreased in the third year and rose sharply in the final year. The mean score for the Internal subscale was consistently higher, followed by the mean scores for Powerful Others in all the years of study. No significant differences were observed between mean scores of the MHLC subscales when compared with gender, previous treatment histories, and missing appointments. Those with self-perceived oral problems were found to have a lower internal locus of control than those who did not report any. The findings of this study provided credible support for the MHLC model in assessing changing health attitudes and may provide a basis for dental educators to effect changes in the locus of control among students. PMID: 18172241 [PubMed - indexed for MEDLINE]

118: J Dent Educ. 2008 Jan;72(1):81-6. Related Articles, Links

Clinical decision making in restorative dentistry, endodontics, and antibiotic prescription. Zadik Y, Levin L. Zrifin Central Dental Institute, and Center for Health Promotion and Preventive Medicine, Medical Corps, Israel Defense Forces, Jerusalem, Israel. The purpose of this study was to evaluate the influence of geographic location of graduation (Israel, Eastern Europe, Latin America) on decision making regarding management of dental caries, periapical lesions, and antibiotic prescribing routines. A questionnaire was given to ninety-eight general practitioners regarding demographic and work habits. Photographs of lesions were shown on a screen. Participants reported recommended treatment and whether they would routinely prescribe antibiotics following regular endodontic treatment, retreatment, and impacted third molar surgical extraction in healthy patients. There was a 94 percent (n=92) response rate, of which eighty-five responses were used in the data analysis. Surgical treatment of asymptomatic enamel caries lesions was not recommended by most of the subjects, and surgery was recommended for DEJ caries lesions in low or moderate caries risk patients, both without significant differences between geographic regions of dental school graduation. Israelis had a lower frequency of retreatment in asymptomatic teeth that demonstrated periapical radiolucency with post restoration (without crown) compared to Latin Americans and East Europeans. Most of the participants would not retreat asymptomatic teeth that demonstrated periapical radiolucency with post and crown. After third molar surgery, 46 percent of participants routinely prescribed antibiotics. Significantly more Latin American graduates prescribed antibiotics following endodontic treatment, retreatment, and third molar extractions (p<0.05). Overmedication (antibiotics) and overtreatment (caries) among young practitioners reflect failure of undergraduate education in proper use of antibiotics and management of the carious lesions according to the patient's clinical presentation and caries risk assessment rather than routinely undertaking surgical caries treatment. Publication Types: •

Comparative Study

PMID: 18172239 [PubMed - indexed for MEDLINE]

119: J Clin Nurs. 2008 Jan;17(2):282-3; author reply 283. Related Articles, Links Comment on: •

J Clin Nurs. 2006 Jun;15(6):710-7.

Commentary on Wong MY-F & Chan SW-C (2006) The qualitative experience of Chinese parents with children diagnosed of cancer. Journal of Clinical Nursing 15, 710-717. Hallström I. Division of Nursing, Department of Health Sciences, The Vårdal Institute, Lund University, Lund, Sweden. [email protected] Publication Types: •

Comment

PMID: 18171398 [PubMed - indexed for MEDLINE] 120: J Clin Nurs. 2008 Jan;17(2):274-81. Related Articles, Links

Taking leave from work: the impact of culture on Japanese female nurses. Mizuno-Lewis S, McAllister M. School of Nursing and Midwifery and Research Centre for Clinical Practice Innovation, Griffith University, Nathan Campus, Queensland, Australia. [email protected] AIMS AND OBJECTIVES: This paper provides an overview of nurses' working conditions in Japan, exploring tensions between nurses' rights to take leave from work to fulfil family and personal needs and their actual ability to take such leave. It also considers possible effects of being restricted from taking such leave. BACKGROUND: Little has been written on the specific needs of nurses who are mothers in the Japanese work environment. Research has focussed on the effects of heavy, stressful workloads and long working hours leading to burnout, death

from overwork and suicides in Japanese culture. However, research that considers unique cultural and female issues in Japan affecting nursing work has not been published. METHOD: Discursive. CONCLUSION: The paper shows that there are many overlapping, complex issues affecting nurses working in Japan and their needs need to be considered and addressed in order to promote a healthier work environment, as well as a more humanistic environment. RELEVANCE TO CLINICAL PRACTICE: Workplace issues are relevant to recruitment and retention and better conditions are likely to improve hospital functioning. Publication Types: •

Review

PMID: 18171397 121: J Clin Nurs. 2008 Jan;17(2):259-65. Related Articles, Links

The quality and suitability of written educational materials for patients*. Demir F, Ozsaker E, Ilce AO. Department of Surgical Nursing, School of Nursing, Ege University, Izmir, Turkey. [email protected] AIM: In this study, the quality and suitability of written educational materials being used for the education of patients in surgical departments of hospitals were studied. BACKGROUND: In the literature, it is stated that most of the educational materials for patients are not suitable from the aspects of contents, structure, design, composition and language. METHOD: In this descriptive type study, which was carried out between March and May 2006, 59 examples of written educational material used for patient education at 138 surgical clinics were evaluated for quality and suitability. The written educational materials obtained were evaluated independently by researchers from the aspect of quality and suitability. The DISCERN measuring instrument was used in the evaluation of the reliability of the written educational materials and the Evaluation of the Suitability of Written Materials form was used in the evaluation of suitability. RESULTS: It was determined that the educational materials received low scores for reliability and information quality. It was determined that the total scores for the written educational materials were average for suitability. CONCLUSION: It was determined that there were no written educational materials in more than half of the surgical units included in the study. It was also found that the educational materials had serious deficiencies. RELEVANCE TO CLINICAL PRACTICE:

This study showed that there was no adequate written patient educational material at the clinics. This deficiency in written educational materials could be eliminated by having them prepared by health professionals in accordance with guidebooks and taking the target group into account. Publication Types: •

Evaluation Studies

PMID: 18171395 [PubMed - indexed for MEDLINE] 122: Clin Infect Dis. 2008 Jan 15;46(2):165-71. Related Articles, Links Comment in: •

Clin Infect Dis. 2008 Jan 15;46(2):172-3.

Plasmodium knowlesi malaria in humans is widely distributed and potentially life threatening. Cox-Singh J, Davis TM, Lee KS, Shamsul SS, Matusop A, Ratnam S, Rahman HA, Conway DJ, Singh B. Malaria Research Centre, Faculty of Medicine and Health Sciences, University Malaysia Sarawak, Kuching, Sarawak, Malaysian Borneo. [email protected] BACKGROUND: Until recently, Plasmodium knowlesi malaria in humans was misdiagnosed as Plasmodium malariae malaria. The objectives of the present study were to determine the geographic distribution of P. knowlesi malaria in the human population in Malaysia and to investigate 4 suspected fatal cases. METHODS: Sensitive and specific nested polymerase chain reaction was used to identify all Plasmodium species present in (1) blood samples obtained from 960 patients with malaria who were hospitalized in Sarawak, Malaysian Borneo, during 2001-2006; (2) 54 P. malariae archival blood films from 15 districts in Sabah, Malaysian Borneo (during 2003-2005), and 4 districts in Pahang, Peninsular Malaysia (during 2004-2005); and (3) 4 patients whose suspected cause of death was P. knowlesi malaria. For the 4 latter cases, available clinical and laboratory data were reviewed. RESULTS: P. knowlesi DNA was detected in 266 (27.7%) of 960 of the samples from Sarawak hospitals, 41 (83.7%) of 49 from Sabah, and all 5 from Pahang. Only P. knowlesi DNA was detected in archival blood films from the 4 patients who died. All were hyperparasitemic and developed marked hepatorenal dysfunction. CONCLUSIONS: Human infection

with P. knowlesi, commonly misidentified as the more benign P. malariae, are widely distributed across Malaysian Borneo and extend to Peninsular Malaysia. Because P. knowlesi replicates every 24 h, rapid diagnosis and prompt effective treatment are essential. In the absence of a specific routine diagnostic test for P. knowlesi malaria, we recommend that patients who reside in or have traveled to Southeast Asia and who have received a "P. malariae" hyperparasitemia diagnosis by microscopy receive intensive management as appropriate for severe falciparum malaria. Publication Types: • •

Case Reports Research Support, Non-U.S. Gov't

PMID: 18171245 [PubMed - indexed for MEDLINE] 123: J UOEH. 2007 Dec 1;29(4):469-84. Related Articles, Links

[Expertise level of occupational health physician, implementation of occupational safety and health management system (OSHMS) and occupational safety and health activity level in Japan in the companies listed on Tokyo Stock Exchange first section] [Article in Japanese] Ikeda Y, Kameda T, Shirakawa C, Nagata T, Zama S, Kayashima K, Kobayashi Y, Mori K. Safety and Health Office, Fuji-Susono Research Park, Canon Inc. Susono, Shizuoka 410-1196, Japan. By enforcement of the revised Japanese Industrial Safety and Health Law on April, 2006, the implementation of OSHMS seems to be expanding and encouraged. In OSHMS of Japan, however, the occupational health aspects have not been put into operated, while only occupational safety aspects have been prioritized. To clarify the issues to deploy OSHMS with occupational health aspects, we conducted a mail survey of 1,581 companies listed on the Tokyo Stock Market First Section in December, 2004. The effective responses were 267 (16.9%). The number of companies which had installed OSHMS, those that planned to install OSHMS and those had no plan for OSHMS were 62 (23.2%), 82 (30.7%) and 123 (46.1%), respectively. Only 12 companies include the complete OH activities in the installed OSHMS. A significant relationship was observed among expertise of OH physicians, actual role and responsibility of OH

physicians, installation of OSHMS and OH services quality level. To deploy OSHMS well-balanced for health and safety aspects in present Japan, it was suggested that the education regarding OH operation in OSHMS was necessary to the person in charge of OSHMS in each company, and the participation by OH physicians to operate OSHMS, especially OH physicians with expertise, was essential. Publication Types: • •

English Abstract Research Support, Non-U.S. Gov't

PMID: 18170967 [PubMed - indexed for MEDLINE] 124: J UOEH. 2007 Dec 1;29(4):457-67. Related Articles, Links

[Clinical trial work at Hospital of UOEH] [Article in Japanese] Mizuyama N, Takahashi K, Tamari K, Koya A, Takeuchi A, Nakamura T. Department of Pharmacy, Hospital of University of Occupational and Environmental Health, Japan. A clinical trial management room was established in the pharmacy at UOEH hospital in June, 2001, and we support the clinical trials in our hospital. Meanwhile, the number of clinical trials and CRC have increased as a result of this. Moreover, there have been changes in the work contents due to the introduction of the electronic clinical record system. At this time, we will report on the various current activities, and discuss the future problems. Publication Types: •

English Abstract

PMID: 18170966 [PubMed - indexed for MEDLINE] 125: Pharmacoepidemiol Drug Saf. 2008 Mar;17(3):306-11. Related Articles, Links

Antibiotic use in five children's hospitals during 2002-2006: the impact of antibiotic guidelines issued by the Chinese Ministry of Health. Zhang W, Shen X, Wang Y, Chen Y, Huang M, Zeng Q, Wei J, Lu Q, Wang G, Deng L, Wang X, Yao K, Yu S, Yang Y. Beijing Children's Hospital, Capital Medical University, Beijing, China. PURPOSE: To investigate the pattern of antibiotic use in five Chinese children's hospitals from 2002 to 2006. To see if the Guidelines to encourage rational use of antibiotics issued by the Ministry of Health in October 2004 have any impact on the use. METHODS: The Anatomical Therapeutic Chemical Classification/Defined Daily Doses (ATC/DDD) methodology was used. Aggregate data on antibiotic use (ATC code-J01) were expressed in numbers of DDD/100 bed-days for inpatients. RESULTS: Total 56 different substances of systemic antibiotics were used. The overall consumption of antibiotic drugs was 68.2, 58.4, 65.8, 65.6 and 49.9 DDD/100 bed-days for the years 2002-2006, respectively. The top antibiotics used were third-generation cephalosporins. There was considerable variation in both type and amount of antibiotics used in the five hospitals. In 2002, some hospitals had twice the antibiotic use compared to others. While the overall antibiotic use in 2005 was largely unchanged compared with previous years, by 2006 antibiotic use had decreased by 22.6% and the variation in use between hospitals was also reduced. CONCLUSIONS: The ATC/DDD methodology proved useful for studying overall antibiotic usage in children's hospitals. The decline in antibiotic usage found in 2006 (and the reduced variation between hospitals) may be attributed to the impact of the Ministry of Health guidelines which took some time to be promulgated to individual staff members. Further research will focus on compliance of antibiotic use in these five hospitals with particular guideline recommendations for specific clinical problems such as bacterial resistance and surgical antibiotic prophylaxis. Copyright 2007 John Wiley & Sons, Ltd. Publication Types: • •

Comparative Study Research Support, Non-U.S. Gov't

PMID: 18165944 [PubMed - indexed for MEDLINE] 126: Ophthalmic Epidemiol. 2007 Nov-Dec;14(6):381-9. Related Articles, Links

Lens opacities in adults in Pakistan: prevalence and risk factors. Shah SP, Dineen B, Jadoon Z, Bourne R, Khan MA, Johnson GJ, De Stavola B, Gilbert C, Khan MD. International Centre for Eye Health, Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London. [email protected] PURPOSE: To investigate the prevalence and risk factors for lens opacity (LO) amongst a nationally representative sample of the adult population of Pakistan. METHODS: This national study of blindness and visual impairment (adults > or =30 years) used multistage, stratified, cluster random sampling. Grading of LO was conducted using the Mehra/Minassian classification system. LO, partly or wholly obscuring the red reflex, or previous cataract surgery were indicators of opacity. RESULTS: 16,402 (94.7%) adults were included in this analysis (study conducted 2002-2003). A total of 4,096 (standardized prevalence 20.9%, 95%CI: 20.3, 21.5%) adults were found to have LO. The highest prevalence of LO was found in Punjab province (22.2%), the lowest in Balochistan Province (18.0%). Significant positive associations were increasing age (multivariable odds ratio (OR) 3.2: 95%CI: 3.1, 3.4), hypertension (OR 1.2, 95%CI: 1.1, 1.3), history of diabetes (OR 2.6: 95%CI 2.0, 3.2) and smoking (OR 1.3: 95%CI: 1.1, 1.5). Higher body mass index (BMI) (OR 0.8: 95%CI 0.7, 0.9, heavy vs. normal BMI) and attendance to school (OR 0.6: 95%CI: 0.5, 0.8) were associated with lower risk of LO. Individuals in districts classified as hot were at significantly increased risk (OR 1.3: 95%CI: 1.1, 1.5), and those in wet districts (> 600 mm annual rainfall) had lower odds than individuals living in dry districts (OR 0.7: 95%CI: 0.6, 0.8). CONCLUSIONS: Almost a fifth of the adult population had LO. Significant positive associations were age, smoking status, hypertension, diabetes, and increased deprivation level. Protective factors included high BMI and educational achievement. The climatic associations offer novel hypothesis for further research into cataractogenesis. Publication Types: • •

Comparative Study Research Support, Non-U.S. Gov't

PMID: 18161612 [PubMed - indexed for MEDLINE] 127: Am J Hosp Palliat Care. 2008 Feb-Mar;25(1):33-8. Epub 2007 Dec 26. Related Articles, Links

Identification of quality indicators of end-of-life cancer care from medical chart review using a modified Delphi method in Japan. Miyashita M, Nakamura A, Morita T, Bito S. Department of Adult Nursing/Palliative Care Nursing, The University of Tokyo, Tokyo, Japan. [email protected] End-of life care is one of the principle components of cancer care. Measurement of the quality of care provided for end-of-life cancer patients is an important issue. The aim of this study was to identify the quality indicators (QIs) for end-oflife cancer care for Japanese patients using a medical chart review. A modified Delphi method for the development of QIs was adopted. Seventeen multiprofessional specialists participated by rating the appropriateness and feasibility of potential QIs. Thirty QIs for end-of-life cancer care were ultimately identified within 4 domains: (1) symptom control, (2) decision-making and preference of care, (3) family care, and (4) psychosocial and spiritual concerns. These QIs will be useful for monitoring and evaluating end-of-life care for Japanese cancer patients. The QIs are feasible for use in any clinical setting and cover a comprehensive area in accordance with the World Health Organization's (WHO) definition of palliative care including physical, psychosocial, and spiritual concerns. PMID: 18160547 [PubMed - indexed for MEDLINE] 128: Am J Hosp Palliat Care. 2007 Dec-2008 Jan;24(6):493-8. Epub 2007 Dec 26. Related Articles, Links

Mini-Suffering State Examination: suffering and survival of end-oflife cancer patients in a hospice setting. Adunsky A, Zvi Aminoff B, Arad M, Bercovitch M. Geriatric Division, Sheba Medical Center, Tel-Hashomer, Israel. [email protected] The objective of this study was to evaluate suffering of end-of-life cancer patients during their final hospice stay and the possible interrelations with survival. A cohort of consecutive patients hospitalized in an inpatient cancer hospice of a tertiary hospital was used for this study. Patients were evaluated upon admission and once weekly by the Mini-Suffering State Examination (MSSE). The distribution of patients for each MSSE score group, changes in MSSE scores (total and for each item of scale), and MSSE interrelation with clinical parameters

associated with patients' condition during hospitalization were studied. In addition, the interrelation of MSSE score and survival was examined. Documentation of a high suffering level by the MSSE scale helps in identifying end-of-life cancer patients expected to benefit from enrollment in a hospice setting, provides quantitative information about various symptom dimensions, and may improve medical management and facilitate communication between these patients and caregivers. Publication Types: •

Validation Studies

PMID: 18160543 [PubMed - indexed for MEDLINE] 129: Asian Pac J Cancer Prev. 2007 Jul-Sep;8(3):457-61. Related Articles, Links

Use of lay health workers in a community-based chronic disease control program. Winangnon S, Sriamporn S, Senarak W, Saranrittichai K, Vatanasapt P, Moore MA. Cancer Unit, Faculty of Medicine, Khon Kaen University, Bangkok Thailand 40002. [email protected] The increasing burden of non-communicable diseases in the developing world, and in particular diabetes, cancer and circulatory diseases, is an unfortunate fact of life. At the same time infection-related diseases, including sexually transmitted HIV-AIDS and HPV-dependent cervical cancer, remain important. One approach to alleviating the resultant stress on national health provision is to expand the knowledge base at the community level with contributions by lay health workers (LHWs). Here we take a brief look at the available literature and propose a model for intervention incorporating two way dialogue with the general populace to find effective means to package expertise in the medical/research community for lay consumption. Our argument is that particular attention should be paid to socioeconomic and behavioural aspects and to disease surveillance at the local level in order to be able to accurately assess the impact of interventions. For this purpose, we need to marshal volunteers from within communities taking account of their problems and motivations. Included are provision of assistance in setting up physical exercise programs, quit tobacco campaigns, alcohol awareness programs, running disease screening exercises and general help by providing advice as to risk and protective factors and clinical treatments, with an special focus on palliative care.

PMID: 18159987 [PubMed - indexed for MEDLINE] 130: Med Teach. 2007 Nov;29(9):872-7. Related Articles, Links

Twelve tips for effective international clinical placements. Balandin S, Lincoln M, Sen R, Wilkins DP, Trembath D. Disability Initiative, Faculty of Health Sciences, The University of Sydney, Australia. [email protected] As universities adopt an increasingly international focus, student health professionals are keen to gain clinical experiences in other countries. Such clinical placements provide students with the opportunity to share their knowledge and at the same time acquire new clinical and cultural skills. The experience gained will not only enhance their clinical practice overseas, but will also enhance it in their home country where they are likely to work with people from culturally, linguistically and clinically diverse backgrounds. Careful preparation and adequate supports are critical if students and the host institutions are to gain maximum benefit from cross-cultural clinical placements. The tips below are based on an ongoing collaboration between the Indian Institute of Cerebral Palsy, Kolkata, India and The University of Sydney, as well as recommendations from the burgeoning literature on international clinical placements. The authors are from both the sending and the receiving institutions, and have found that close collaboration between the home and host institutions along with student reflection, evaluation and the opportunity to integrate new knowledge with other clinical experiences are keys to a satisfactory outcome for all concerned. PMID: 18158656 [PubMed - indexed for MEDLINE] 131: Soc Sci Med. 2008 Feb;66(4):952-62. Epub 2007 Dec 26. Related Articles, Links

The Chinese health care regulatory institutions in an era of transition. Fang J. Institute for Health Sciences, Kunming Medical College, 191# Western Renmin Road, Kunming City, Yunnan Province 650031, China. [email protected] The purpose of this paper is to contribute to a better understanding of Chinese

health care regulation in an era of transition. It describes the major health care regulatory institutions operating currently in China and analyzes the underlying factors. The paper argues that in the transition from a planned to a market economy, the Chinese government has been employing a hybrid approach where both old and new institutions have a role in the management of emerging markets, including the health care market. This approach is consistent with the incremental reform strategy adopted by the Party-state. Although a health care regulatory framework has gradually taken shape, the framework is incomplete, with a particular lack of emphasis on professional self-regulation. In addition, its effectiveness is limited despite the existence of many regulatory institutions. In poor rural areas, the effectiveness of the regulatory framework is further undermined or distorted by the extremely difficult financial position that local governments find themselves in. The interpretations of the principle of 'rule of law' by policy makers and officials at different levels and the widespread informal network of relations between known individuals (Guanxi) play an important role in the operation of the regulatory framework. The findings of this paper reveal the complex nature of regulating health care in transitional China. PMID: 18158210 [PubMed - indexed for MEDLINE] 132: Nurs Ethics. 2008 Jan;15(1):73-86. Related Articles, Links

Older Korean people's desire to participate in health care decision making. Chang SJ, Lee KJ, Kim IS, Lee WH. Dept. of Clinical Nursing Science, College of Nursing, Yonsei University, Seoul, South Korea. [email protected] The purpose of this study was to identify how older Korean people seek information and their desire to participate in decision making about their health care. A total of 165 elderly people living in Seoul, South Korea, participated in the study. Data were collected during individual interviews using the Autonomy Preference Index. The mean information-seeking score was high. The mean score for their desire to participate with a physician in decision making was lower, but this was higher when family members were involved. The study indicates that many older people want to receive information about their health care. Families (or guardians), as well as older people themselves, should be included in the decision-making process. Nurses can encourage older people to express their wishes, while treating each individual with respect. PMID: 18096583 [PubMed - indexed for MEDLINE]

133: Nurs Ethics. 2008 Jan;15(1):28-39. Related Articles, Links

Nursing management of medication errors. Luk LA, Ng WI, Ko KK, Ung VH. Kiang Wu Nursing College of Macau, Macau, China. [email protected] Medication error is the most common and consistent type of error occurring in hospitals. This article attempts to explore the ethical issues relating to the nursing management of medication errors in clinical areas in Macau, China. A qualitative approach was adopted. Seven registered nurses who were involved in medication errors were recruited for in-depth interviews. The interviews were transcribed and analyzed using content analysis. Regarding the management of patients, the nurses acknowledged the mistakes but did not disclose the incidents to patients and relatives. Concerning management of the nurses involved by senior staff, most participants experienced fairness, comfort and understanding during the process of reporting and investigation. The ethical issues relating to the incidents were discussed, particularly in the Chinese context. There is a need for further study relating to the disclosure of medication incidents to patients and some suggestions were made. PMID: 18096579 [PubMed - indexed for MEDLINE] 134: Oncology. 2007;72 Suppl 1:2-15. Epub 2007 Dec 13. Related Articles, Links

Management of hepatocellular carcinoma in Japan: consensus-based clinical practice manual proposed by the Japan Society of Hepatology. Kudo M, Okanoue T; Japan Society of Hepatology. Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan. [email protected] Hepatocellular carcinoma (HCC) is one of the leading causes of cancer death not only in Japan but worldwide. Clinical Practice Guidelines for HCC were published in 2001 by the European Society of Study of the Liver (EASL) and in 2005 by the American Association for the Study of Liver Disease (AASLD). However, these guidelines have proven to be somewhat unsuitable for Japanese patients. In 2005, supported by the Japanese Ministry of Health, Labor and

Welfare, Evidence-Based Clinical Practice Guidelines for HCC were compiled. Based on 'evidence-based' guidelines and the consensus of an expert panel on HCC, the Japan Society of Hepatology (JSH) published the Consensus-Based Clinical Practice Manual in 2007. In this article, the content of this manual, especially issues on surveillance, diagnosis, staging, and treatment, is summarized. Copyright 2007 S. Karger AG, Basel. Publication Types: •

Review

PMID: 18087177 [PubMed - indexed for MEDLINE] 135: Agri. 2007 Jul;19(3):16-25. Related Articles, Links

[Pediatricians' and pediatric nurses' knowledge about pain in newborn infants and their practices in some provinces in Turkey] [Article in Turkish] Efe E, Altun E, Cetin H, Işler A. Akdeniz University Health School, Antalya, Turkey. [email protected] This research was conducted as a descriptive study for the purpose of determining the status of pediatricians and nurses who work on pediatric wards about their recognizing, evaluating, and using appropriate nonpharmacologic interventions to treat pain in newborn infants. The study was conducted between March and May 2005. A total of 198 nurses and physicians were included in the sample, 31 of whom were from Sivas 1st Izzettin Keykavus State Hospital, 76 from Akdeniz University Medical Faculty Hospital, 45 from Mersin University Medical Faculty Research, Mersin State and Taurus State Hospitals and 46 from Ege University Medical Faculty Hospital. The data were collected using a 16-question survey form. Five of the survey questions were regarding the nurses' and physicians' sociodemographic characteristics and 11 contained questions directed at obtaining physicians and nurses' information about pain in newborns. The results of the research showed that the physicians and nurses were knowledgeable about newborn pain. It was determined that the pediatric nurses used nonpharmacologic methods during invasive procedures in the newborns but the physicians did not. In conclusion it is recommended that this issue receive more discussion in continuing education programs at hospitals for the purpose of encouraging nurses and physicians to use nonpharmacologic methods during invasive procedures that are done in newborns to facilitate a multidisciplinary team approach for pain

management in newborn infants. Publication Types: • •

English Abstract Multicenter Study

PMID: 18095195 [PubMed - indexed for MEDLINE] 136: Diagn Interv Radiol. 2007 Dec;13(4):183-7. Related Articles, Links

Clinical outcome assessment in mammography: an audit of 7,506 screening and diagnostic mammography examinations. Tunçbilek I, Ozdemir A, Gültekin S, Oğur T, Erman R, Yüce C. Department of Radiology, Gazi University School of Medicine, Ankara, Turkey. [email protected] PURPOSE: To perform an audit of our routine mammographic practice and to compare our results to performance benchmarks. MATERIALS AND METHODS: We analyzed the outcomes of 7,506 consecutive examinations performed in 1 year. Screening and diagnostic cases were evaluated separately and mammographic assessments were based on the Breast Imaging Reporting and Data System (BI-RADS) classification. RESULTS: In 6,858 (91%) screening and 648 (9%) diagnostic cases, outcomes varied substantially. The recall rate was 10.9%. Estimated sensitivity and specificity were similar (100% vs. 98% and 88% vs. 94%) in the screening and diagnostic groups. Positive predictive values (PPV1, PPV2, and PPV3) were higher in the diagnostic group compared to the screening group (64%, 65%, and 68% vs. 4.9%, 33%, and 39%, respectively). Cancer outcomes in the screening and diagnostic groups were, respectively, as follows: cancer detection rate, 6.1 per thousand vs. 86.4 per thousand; mean invasive cancer size, 15.7 mm vs. 24.5 mm; minimal cancers, 38% vs. 19%; stage 0-1 cancers, 50% vs. 21%; and lymph node negativity, 76% vs. 29%. CONCLUSION: The measures of our screening outcomes were concordant with the literature and the performance benchmarks for screening mammography; however, in our diagnostic group, the reasons for the higher PPV, higher cancer detection rate, and the diagnosis of cancer in a more advanced stage compared to the performance benchmarks should be investigated with more detailed periodic audits. Publication Types:

•

Evaluation Studies

PMID: 18092288 [PubMed - indexed for MEDLINE] 137: Prehosp Disaster Med. 2007 Sep-Oct;22(5):396-405. Related Articles, Links

Measuring health program effectiveness in the field: an assessment tool. McDonnell SM, Yassin AS, Brown WG, Perry HN, Thacker SB. Institute for Health Policy and Clinical Practice, Center for Evaluative Clinical Sciences-Educational Programs, Dartmouth Medical School, Hanover, New Hampshire, USA. [email protected] To assist field workers in program evaluation and to explicitly discuss program strengths and weaknesses, a practical method to estimate the effectiveness of public health interventions within the existing program capacity was developed. The method and materials were tested in seven countries (Afghanistan, Zimbabwe, Tanzania, Uganda, Guatemala, the Philippines, and Ghana). In this method, four core components are assessed using a questionnaire: (1) the efficacy of the intervention; (2) the level of existing human resources (i.e., quality of recruitment, training, and continuing education); (3) the infrastructure (i.e., supplies, salary, transportation, and supervision); and (4) the level of community support (i.e., access and demand). Using the assessment tool provided, program staff can determine if all necessary elements are in place for a successful program that can deliver the specific intervention. Based on the results of the assessment program, weaknesses can be identified, explicitly discussed, and addressed. The usefulness of this tool in humanitarian relief may be twofold: (1) to assess the design and implementation of effective programs; and (2) to highlight the inevitable need for capacity building as the disaster situation evolves. Publication Types: • •

Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.

PMID: 18087908 [PubMed - indexed for MEDLINE] 138: Psychiatry Clin Neurosci. 2007 Dec;61(6):587-93. Related Articles, Links

Sociodemographic and clinical factors associated with relapse in schizophrenia. Chabungbam G, Avasthi A, Sharan P. Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India. The aim of the present study was to examine sociodemographic and clinical factors associated with relapse in schizophrenia. The study group consisted of a convenience sample of 40 schizophrenia patients (20 patients each in relapse and remission). Relapse and remission were defined based on clinical criteria (ICD-10 criteria, course since last episode, and duration of remission) and psychometric criteria (scores on Socio-Occupational Functioning Assessment Scale [SOFAS] and Positive and Negative Syndrome Scale for Schizophrenia [PANSS]). The index group was evaluated after the occurrence of current relapse but within 6 months of its onset. Sociodemographic, current psychopathology (PANSS) and functioning (SOFAS), and other (mainly retrospective) variables were assessed with a specifically designed clinical profile sheet, Schedule for Affective Disorders and Schizophrenia Lifetime version, Presumptive Stressful life Events Scale, and World Health Organization Life Chart Schedule for Assessment of Course and Outcome of Schizophrenia. Patients who had relapsed were more symptomatic and exhibited greater dysfunction in comparison to remitted patients. Relapse in schizophrenia was significantly associated with unemployment, number of psychotic episodes, side-effects of medication, and life events score. The present findings suggest that a severe illness (no. psychotic episodes, unemployment), psychological stress and inappropriate treatment (side-effects of medicines) may be causally related to relapse in schizophrenia. However, the possibility that these variables may be caused by relapse or may be explained by a common underlying variable needs to be assessed prospectively. PMID: 18081617 [PubMed - indexed for MEDLINE] 139: J Nurs Res. 2007 Dec;15(4):319-29. Related Articles, Links

Quality of life, symptom distress, and social support among renal transplant recipients in Southern Taiwan: a correlational study. Chen WC, Chen CH, Lee PC, Wang WL. Center for Quality Management, National Cheng Kung University Hospital. Quality of life is an important indicator for evaluating therapeutic outcomes and

mortality in patients with end-stage renal disease. Few studies have explored the impact of symptom distress and social support on quality of life in this population. A correlational study was designed to examine the influence of symptom distress, social support and demographic characteristics on quality of life in renal transplant recipients. A convenience sample of 113 renal transplant recipients was recruited from a medical center in Southern Taiwan. A structured questionnaire was used to collect data. This four-part tool included: Quality of Life Index-Kidney Transplant Version III, Physical Symptom Distress Scale, Social Support Scale, and demographic characteristics. Data were analyzed by descriptive and inferential statistics (SPSS 10.1 statistical package). Percentage, rank, mean and standard deviation, t-tests, chi-square, ANOVA, Pearson's correlation and multiple regression were computed. Results showed that renal transplant recipients had a moderate quality of life. Social support and symptom distress, age, employment status, and household income significantly explained 28.8% of the variance in quality of life. Findings suggest implications for interventional programming and research aimed toward improving quality of life, including individual and family-based approaches designed to enhance recipients' social support and address effective management of symptoms. Recruiting a transplant clinical nurse specialist to design and implement an intervention program also is recommended. PMID: 18080976 [PubMed - indexed for MEDLINE] 140: BMC Public Health. 2007 Dec 13;7:350. Related Articles, Links

The training needs of Turkish emergency department personnel regarding intimate partner violence. Aksan HA, Aksu F. Department of Public Health, Ege University Medical Faculty, Izmir, Turkey. [email protected] BACKGROUND: Violence against females is a widespread public health problem in Turkey and the lifetime prevalence of IPV ranges between 34 and 58.7%. Health care workers (HCW) sometimes have the unique opportunity and obligation to identify, treat, and educate females who are abused. The objective of this study was to evaluate the knowledge, attitudes, and experiences of the emergency department (ED) staff regarding intimate partner violence (IPV) at a large university hospital in Turkey. METHODS: A cross-sectional study was conducted in a large university hospital via questionnaire. The study population consisted of all the nurses and physicians who worked in the ED during a two month period (n = 215). The questionnaire response rate was 80.5% (41 nurses and 132 physicians). The main domains of the questionnaire were knowledge

regarding the definition of IPV, clinical findings in victims of IPV, legal aspects of IPV, attitudes towards IPV, knowledge about the characteristics of IPV victims and abusers, and professional and personal experiences and training with respect to IPV. RESULTS: One-half of the study group were females, 76.3% were physicians, and 89.8% had no training on IPV. The majority of the nurses (89.5%) and physicians (71.1%) declared that they were aware of the clinical appearance of IPV. The mean of the knowledge scores on clinical knowledge were 8.84 +/1.73 (range, 0-10) for acute conditions, and 4.51 +/- 3.32 for chronic conditions. The mean of the knowledge score on legal procedures and the legal rights of the victims was 4.33 +/- 1.66 (range, 0-7). At least one reason to justify physical violence was accepted by 69.0% of females and 84.7% of males, but more males than females tended to justify violence (chi square = 5.96; p = 0.015). However, both genders accepted that females who experienced physical violence should seek professional medical help. CONCLUSION: The study participants' knowledge about IPV was rather low and a training program is thus necessary on this issue. Attention must be given to the legal aspects and clinical manifestations of IPV. The training program should also include a module on gender roles in order to improve the attitudes towards IPV. PMID: 18078505 [PubMed - indexed for MEDLINE] PMCID: PMC2241616

141: Rheumatology (Oxford). 2008 Jan;47(1):88-91. Related Articles, Links

The epidemiology of total knee replacement in South Korea: national registry data. Kim HA, Kim S, Seo YI, Choi HJ, Seong SC, Song YW, Hunter D, Zhang Y. Hallym University Sacred Heart Hospital, Anyang, South Korea. [email protected] OBJECTIVE: Knee osteoarthritis (OA) is prevalent among the elderly in Asian countries; however, the utilization of total knee replacement (TKR) is unknown. Using data from a national registry, we sought to estimate the incidence of TKR by age and sex, and the trend for TKR utilization from 2002 to 2005 in South Korea. METHODS: Reimbursement records from all hospitals in South Korea were extracted from the Health Insurance Review Agency (HIRA) database. Records with both the procedure code corresponding to a TKR and the diagnosis code of knee OA were selected. We estimated the age- and sex-specific rates of TKR. To compare the rate of TKR between men and women, we calculated agestandardized risk ratios. A TKR registry from a single centre containing more

clinical information was analysed, and the differences in the clinical features between men and women were compared. RESULTS: From 2002 to 2005, 47 961 TKRs were performed in subjects over the age of 40 yrs due to OA. The rate of TKR has increased over the 4 yrs and was much higher in women than in men. Compared with men, the age-standardized rate ratios for TKR in women ranged from 7.4 to 8.0. The single-centre registry data revealed that there was no difference in age, disease duration and the Kellgren-Lawrence grade at the time of surgery between men and women. CONCLUSION: Using a national database, we found that the rate of TKR increased steadily from 2002 to 2005 in South Korea. The TKR rate in women was much higher than that in men. Risk factors that account for such disparity in TKR utilization need to be further investigated. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 18077497 [PubMed - indexed for MEDLINE] 142: Reprod Toxicol. 2008 Jan;25(1):124-8. Epub 2007 Oct 25. Related Articles, Links

Fetal exposure to isotretinoin-an international problem. Garcia-Bournissen F, Tsur L, Goldstein LH, Staroselsky A, Avner M, Asrar F, Berkovitch M, Straface G, Koren G, De Santis M. Division of Clinical Pharmacology & Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Canada. BACKGROUND: Isotretinoin is a known teratogen. Pregnancy prevention programs aimed at minimizing isotretinoin exposure in pregnancy have been implemented in North America with limited success. OBJECTIVE: To compare the management of fetal risk of isotretinoin in three countries, including information given to women, implementation of contraceptive methods, and pregnancy outcomes. METHODS: Pregnant women exposed to isotretinoin who called teratogen information services (TIS) in Israel, Italy and Canada between July 1998 and October 2006 were interviewed at the time of initial consultation and after the expected day of delivery. RESULTS: Fifty-three pregnant women exposed to isotretinoin contacted the TIS. Only 41% reported using a birth control method. Just one patient reported using two different forms. Forty-five percent of exposed pregnancies were terminated before delivery and 22% delivered healthy babies. Two babies were born with malformations. CONCLUSIONS: Since isotretinoin-exposed pregnancies still occur, there is a need for more effective strategies, which should take into account the cultural differences.

Publication Types: • • •

Comparative Study Multicenter Study Research Support, Non-U.S. Gov't

PMID: 18077132 [PubMed - indexed for MEDLINE] 143: Tohoku J Exp Med. 2007 Dec;213(4):369-72. Related Articles, Links

Mood change tendency and fasting plasma glucose levels in a Japanese female population. Kotani K, Shimohiro H, Sakane N. Division of Health Administration and Promotion, Faculty of Medicine, Tottori University, Yonago, Japan. [email protected] Internal stress can modify values in blood examinations such as glucose. Mood change releases us from the stress state, and the mood change tendency (MCT) may show individual differences. However, little is known about whether individual mood change tendencies in daily life affect fasting plasma glucose (FPG) levels. We investigated the effects of clinical characteristics including age, body mass index (BMI), smoking, alcohol habits and self-reported MCT (an answer to the inquiry on their daily MCT: good, average, or poor) on FPG values among 272 Japanese females (mean age 48.4 +/- 9.3 years). Subjects with normal to impaired fasting glucose levels (less than 7.0 mmol/L) were included in this study. The mean FPG levels in subjects with good, average and poor MCT were 5.32 +/- 0.48, 5.36 +/- 0.50 and 5.58 +/- 0.69 mmol/L, respectively. A significant difference was noted between subjects with good and poor MCT (p = 0.02). There was no significant difference in BMI levels among MCT-based groups. Pearson's rank correlation and multiple regression analysis, using FPG levels and other variables, demonstrated a significant relationship between FPG levels and MCT (p < or =0.01), along with age and BMI. These results suggest slight but significant effects of individual MCT on FPG, and that a consideration of MCT may occasionally be needed in the interpretation and management of FPG levels in the Japanese female population. PMID: 18075241 [PubMed - indexed for MEDLINE] 144: Endoscopy. 2007 Dec;39(12):1046-52.

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Can we predict spontaneous capsule passage after retention? A nationwide study to evaluate the incidence and clinical outcomes of capsule retention. Cheon JH, Kim YS, Lee IS, Chang DK, Ryu JK, Lee KJ, Moon JS, Park CH, Kim JO, Shim KN, Choi CH, Cheung DY, Jang BI, Seo GS, Chun HJ, Choi MG; Korean Gut Image Study Group. Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea. BACKGROUND AND STUDY AIMS: Although capsule endoscopy has become a central diagnostic tool for small-bowel evaluation, retention of a capsule remains a major concern. This study attempted to investigate the incidence and clinical outcomes of capsule retention, and to determine the factors predictive of spontaneous capsule passage after retention. PATIENTS AND METHODS: Through a nationwide multicenter survey, we retrospectively reviewed the records of 1291 patients who had a capsule endoscopy between February 2002 and July 2006 in Korea. Clinical and procedural characteristics and postprocedural outcomes were analyzed for the cases with capsule retention. RESULTS: Capsule retention occurred in 2.5 % of total cases (32/1291). The major diseases accompanying capsule retention were Crohn's disease, malignant tumors, and tuberculous enterocolitis, in decreasing order. In 11 of the 32 patients (34.4 %), early surgical or endoscopic interventions were instituted for diagnosis or treatment of diseases before retention symptoms developed. The remaining 21 (65.6 %) patients initially received medical treatments. Of these, 10 (31.3 %) ultimately underwent surgical intervention due to the development of symptoms of intestinal obstruction or medical treatment failure. The other 11 (34.4 %) eventually passed the capsule. The presence of a larger lumen diameter (greater than two-thirds of the capsule diameter) at the stricture site was associated with spontaneous passage. CONCLUSIONS: Our large-scale study suggests that retention occurs infrequently during capsule endoscopy. Moreover, a retained capsule might indicate the best intervention for the offending pathology, or it may spontaneously pass in the long run, particularly in patients with less small bowel stricture. Publication Types: • •

Multicenter Study Research Support, Non-U.S. Gov't

PMID: 18072054 [PubMed - indexed for MEDLINE]

145: AIDS Care. 2007 Nov;19(10):1266-73. Related Articles, Links

Unhealthy behaviours for self-management of HIV-related peripheral neuropathy. Nicholas PK, Voss JG, Corless IB, Lindgren TG, Wantland DJ, Kemppainen JK, Canaval GE, Sefcik EF, Nokes KM, Bain CA, Kirksey KM, Eller LS, Dole PJ, Hamilton MJ, Coleman CL, Holzemer WL, Reynolds NR, Portillo CJ, Bunch EH, Tsai YF, Mendez MR, Davis SM, Gallagher DM. Brigham and Women's Hospital, Boston, MA, USA. [email protected] The prevalence of peripheral neuropathy is frequent in HIV disease and is often associated with antiretroviral therapy. Unhealthy behaviours, particularly substance-use behaviours, are utilized by many HIV-positive individuals to manage neuropathic symptoms. As part of a larger study on self-care for symptoms in HIV disease, this study analyzed the prevalence and characteristics of unhealthy behaviours to self-manage peripheral neuropathy in HIV disease. Sociodemographic and disease-related correlates and unhealthy behaviours were examined in a convenience sample of 1,217 respondents who were recruited from data collection sites in several US cities, Puerto Rico, Colombia, and Taiwan. Results of the study indicated that respondents with peripheral neuropathy (n=450) identified a variety of unhealthy self-care behaviours including injection drug use, oral drug use, smoking cigarettes and alcohol ingestion. Specific unhealthy behaviours that participants reported to alleviate peripheral neuropathy included use of marijuana (n=67), smoking cigarettes (n=139), drinking alcohol (n=81) and street drugs (n=30). A subset of those individuals (n=160), who identified high levels of neuropathy (greater than five on a scale of 1-10), indicated significantly higher use of amphetamines and injection drug use in addition to alcohol use and cigarette smoking. For participants from Norway, substance use (using alcohol: 56%) was one of the most frequent selfmanagement strategies. Implications for clinical practice include assessment and education of persons with HIV for self-care management of the complex symptom of peripheral neuropathy. Publication Types: •

Multicenter Study

PMID: 18071970 [PubMed - indexed for MEDLINE] 146: Ann Acad Med Singapore. 2007 Nov;36(11):930-6. Related Articles, Links

Development of a core curriculum on tuberculosis control for Philippine medical schools. Atienza MA, Roa CC Jr, Sana EA. National Teacher Training Center for the Health Professions, University of the Philippines Manila, Padre Faura Street corner Ma. Orosa Street, Ermita, Manila, Philippines 1000. [email protected] INTRODUCTION: As of 2001, the Philippines ranks 7th among the world's 22 countries with a heavy tuberculosis (TB) burden. As the country accelerates its campaign to control the global epidemic, the Philippine Tuberculosis Initiatives for the Private Sector (PhilTIPS) joined the efforts to combat it through the Directly Observed Treatment Short-course (DOTS) strategy and brought it to the level of medical schools. PhilTIPS commissioned this work to develop an evidence-based medical curriculum with strong and conscious integration of TBDOTS. MATERIALS AND METHODS: In the needs assessment, curricula, sample tests, and syllabi were reviewed. Deans and curriculum committee chairs were also asked to answer a questionnaire dealing with how TB, TB control and DOTS were taught. Based on the needs assessment, the TB control-DOTS core curriculum was developed. Ten months after its implementation, a monitoring evaluation was conducted through questionnaires, review of records and key informant interviews. DISCUSSION: Representative samples of 18 out of 32 schools participated in the needs assessment and monitoring phase. Data revealed that the biomedical and clinical aspects of TB are emphasised in all schools. But only 7 out of 18 (38.89%) actually dealt with DOTS. A competency-based, integrated, and interactive TB-DOTS curriculum was then developed. The competencies around which the curriculum was designed were: (1) a thorough understanding of TB as a biomedical and social phenomenon; (2) the management of TB patients; and (3) an adherence to DOTS in managing TB patients. The curriculum was reviewed by local and international panelists, and implemented in 2003 to 2004. Monitoring evaluation 10 months later revealed that this curriculum was minimally to moderately integrated by medical schools. The study exhorts all medical schools to empower their graduates with competence in TB-DOTS. PMID: 18071604 [PubMed - indexed for MEDLINE] 147: Gen Thorac Cardiovasc Surg. 2007 Dec;55(12):483-92. Epub 2007 Dec 11. Related Articles, Links

An attempt to analyze the relation between hospital surgical volume and clinical outcome.

Committee for Scientific Affairs, Kazui T, Osada H, Fujita H. First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan. [email protected] OBJECTIVES: The aim of this study was to investigate the relation between hospital volume and clinical surgical outcome for 10 cardiac, lung, and esophageal surgical procedures. METHODS: The Committee for Scientific Affairs of the Japanese Association for Thoracic Surgery collected the pooled data on cardiac, lung, and esophageal surgical procedures between 2000 and 2004 from the annual reports. The relation between operative mortality (30-day or inhospital mortality) and hospital volume was analyzed using a logistic regression model. The surgical procedures studied were surgery for acquired cardiac diseases [coronary artery bypass grafting (CABG), valve procedures, acute type A dissection surgery], total CABG (elective + emergency), elective CABG, emergency CABG, single-valve surgery, acute type A dissection surgery, open heart surgery for the newborn, open heart surgery for the infants, lung cancer surgery, and esophageal cancer surgery. The data used in this study were not riskadjusted. RESULTS: The data on the relation between hospital volume and operative mortality generally tended to show an inverse correlation for all 10 cardiac, lung, and esophageal surgical procedures; that is, the higher was the volume the lower was the mortality. However, wide variations in operative mortality were noted among the very-low-volume hospital groups. CONCLUSION: An inverse correlation was noted between hospital volume and operative mortality in the present study, although wide variations in clinical outcome were noted among the very low-volume hospitals. Further analysis is warranted using risk-adjusted data. Publication Types: •

Evaluation Studies

PMID: 18066639 [PubMed - indexed for MEDLINE] 148: Nurs Outlook. 2007 Nov-Dec;55(6):318-26. Related Articles, Links

Evaluating work ability and quality of life for clinical nurses in Taiwan. Chiu MC, Wang MJ, Lu CW, Pan SM, Kumashiro M, Ilmarinen J. Department of Industrial Engineering and Engineering Management, National Tsing Hua University, Hsinchu, Taiwan, 300, ROC.

This study investigated the work ability and its relationship with quality of life for the clinical nurses in Taiwan. The survey was of 1534 nursing professionals from 8 different hospitals. Work ability of nursing professionals varied by age, work experience, working departments and hospital types. Work ability of nurses increased with age until after the age of 45. Personal health condition and physical workload were the main factors contributing to the decline of the perceived work ability for senior nurses. For young nurses, the mental demands of work were a critical influence on their work ability. Moreover, work ability of nurses varied among hospital type and department. The work ability of nurses was strongly associated with the quality and safety of the work environment and leisure time management. For improving and maintaining the work ability of nurses, countermeasures such as enhancing the ability to cope with the job's mental demands for young nurses, and improving the job design to reduce physical workload for senior nurses are recommended. PMID: 18061017 [PubMed - indexed for MEDLINE] 149: Med Princ Pract. 2008;17(1):27-31. Related Articles, Links

Self-monitoring of blood pressure and the role of community pharmacists in Kuwait. Matowe WC, Abahussain EA, Awad A, Capps PA. Department of Pharmacy Practice, Faculty of Pharmacy, Health Science Center, Kuwait University, Kuwait. [email protected] OBJECTIVE: To determine the types of devices for self-monitoring of blood pressure available to consumers in Kuwait and the pharmacists' knowledge and level of information provided to consumers when purchasing such devices. MATERIALS AND METHODS: It was possible to contact 196 of the 230 eligible pharmacies from five governorates in Kuwait. Ten of these were used to pretest the questionnaire and six declined to participate. Another six did not carry any blood pressure monitoring devices and hence were excluded. Data was then collected from pharmacists at the 174 remaining community pharmacies via faceto-face structured interview of the respondents at their work sites. RESULTS: Of the 174 pharmacists, 173 (99.4%) claimed to offer or provide advice to clients at the time of purchasing devices, 117 (67.1%) of them stating that they did so even if the patients did not ask. Although 147 (84.5%) respondents correctly identified the mercury sphygmomanometer as the most reliable device for measuring blood pressure, less than half (86, 49.4%) claimed to know how to check the accuracy of the devices they sold. Only 25 (14.4%) pharmacists could actually identify the correct procedure for checking the accuracy of the devices and only 25 (14.4%)

pharmacists could correctly identify cutoff points for systolic and diastolic blood pressure delineating clinical hypertension. Only 1 pharmacist could correctly name a reference source for blood pressure measurement. CONCLUSION: There is a need for improvement of community pharmacists' competence in supporting patients and in providing them with information regarding devices for measuring blood pressure in Kuwait. (c) 2007 S. Karger AG, Basel. PMID: 18059097 [PubMed - indexed for MEDLINE] 150: Med Princ Pract. 2008;17(1):14-9. Related Articles, Links

Evaluation of the impact of the Kuwait Diabetes Care Program on the quality of diabetes care. Al-Adsani A, Al-Faraj J, Al-Sultan F, El-Feky M, Al-Mezel N, Saba W, Aljassar S. Working Group of the Diabetes Care Program, Central Department of Primary Health Care, Ministry of Health, Al-Sabah Hospital, Kuwait. [email protected] OBJECTIVES: To evaluate the impact of the Kuwait Diabetes Care Program on the quality of care provided for diabetic patients in the Primary Health Care setting. MATERIALS AND METHODS: The Kuwait Diabetes Care Program developed, published and disseminated clinical practice guidelines, conducted training courses, standards for diabetes care, and introduced a monitoring and evaluation system. Four audits (September 1999, October 2001, 2002 and 2003) were carried out at five diabetic clinics. September 1999 referred to in this study as first (baseline) audit was prior to the introduction of the clinical practice guidelines. The three other audits were performed to assess adherence with the guidelines in the administrative management of patients' records and implementation of the standards. Two hundred and fifty patients were involved in the study. RESULTS: The proportion of patients with organized, structured files increased significantly from 60.0 to 100.0% (p < 0.001), and recording of patients' demographic data increased from 38.6 to 95.6% (p < 0.001). Use of structured visit sheets, proper fixation of the laboratory and prescription sheets had also improved significantly. The prevalence of smoking assessment, fundus examination, and foot examination increased significantly from 2.8 to 27.2% (p < 0.001); 2.4 to 31.6% (p < 0.001); 0.4 to 40.4% (p < 0.001), respectively. The prevalence of measuring urinary microalbumin, serum creatinine and HbA(1c) increased significantly from 4.4 to 26.4% (p < 0.001); 16.0 to 78.4% (p < 0.001), and 10.4 to 60.8% (p < 0.001), respectively. The prevalence of measuring serum total cholesterol, triglycerides, HDL-C, and LDL-C levels increased significantly from 16.4 to 80.0% (p < 0.001); 14.4 to 80.0% (p < 0.001); 2.4 to 32.8% (p <

0.001), and 2.4 to 24.0% (p < 0.001), respectively. CONCLUSION: This audit shows that a national diabetes program was associated with improved processes of diabetes care. Further, support from health authorities, provision of manpower resources, a continuing monitoring and evaluation system, and conduction of structured education programs may lead to further improvements in the quality of diabetes care. (c) 2007 S. Karger AG, Basel. Publication Types: •

Evaluation Studies

PMID: 18059095