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Selected AbstractsDehydroepiandrosterone Combined with Exercise Improves Muscle Strength and Physical Function in Frail Older WomenJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2010Anne M. Kenny MD OBJECTIVES: To investigate the effects of dehydroepiandrosterone (DHEA) combined with exercise on bone mass, strength, and physical function in older, frail women. DESIGN: Double-blind, randomized, placebo-controlled trial. SETTING: A major medical institution. PARTICIPANTS: Ninety-nine women (mean age 76.6 ± 6.0) with low sulfated DHEA (DHEAS) levels, low bone mass, and frailty. INTERVENTION: Participants received 50 mg/d DHEA or placebo for 6 months; all received calcium and cholecalciferol. Women participated in 90-minute twice-weekly exercise regimens. MEASUREMENTS: Hormone levels, bone mineral density (BMD), bone turnover markers, body composition, upper and lower extremity strength, physical performance. RESULTS: Eighty-seven women (88%) completed 6 months. There were no significant changes in BMD or bone turnover markers. DHEA supplementation resulted in gains in lower extremity strength (from 459 ± 121 N to 484 ± 147 N; P=.01). There was also improvement in Short Physical Performance Battery score, a composite score that focuses on lower extremity function, in those taking DHEA (from 10.1 ± 1.8 to 10.7 ± 1.9; P=.02). There were significant changes in all hormone levels, including DHEAS, estradiol, estrone, and testosterone, and a decline in sex hormone-binding globulin levels in those taking DHEA. CONCLUSION: DHEA supplementation improved lower extremity strength and function in older, frail women involved in a gentle exercise program of chair aerobics or yoga. No changes were found in BMD either due to small sample size, short duration of study or no effect. The physical function findings are promising and require further evaluation as frail women are at high risk for falls and fracture. [source] Errors in completion of referrals among older urban adults in ambulatory careJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2010Michael Weiner MD MPH Abstract Rationale, aims and objectives, Clinical care often requires referrals, but many referrals never result in completed evaluations. We determined the extent to which referral-based consultations were completed in a US medical institution. Factors associated with completion were identified. Method, In a cross-sectional analysis, we analysed billing records and electronic and paper-based medical records for patients aged 65 years or older receiving health care between July 2000 and June 2002 in an integrated, urban, tax-supported medical institution on an academic campus. All referrals in ambulatory care, scheduling of consultation within 180 days, and completion were assessed. We conducted a multivariate survival analysis to identify factors associated with completion. Results, We identified 6785 patients with encounters. Mean age was 72 years, and, of the participants, 66% were women, 55% were African-American and 32% were Medicaid eligible. Of the 81% with at least one primary-care visit in ambulatory care, 63% had at least one referral. About 8% of referrals required multiple orders before an appointment was scheduled. Among 7819 orders for specialty consultation in ambulatory care, 71% led to appointments, and 70% of appointments were kept (completed = 0.71*0.70 or 50%). Scheduling of consultations varied (12% to 90%) by specialty. Medicare, singular orders, location of referral and lack of hospitalization were independently significantly associated with scheduling of appointments. Conclusions, Among older adults studied, half of medical specialty referrals were not completed. Multiple process errors, including missing information, misguided referrals and faulty communications, likely contribute to these results. Information systems offer important opportunities to improve the referrals process. [source] An epidemiological survey of overactive bladder symptoms in JapanBJU INTERNATIONAL, Issue 9 2005Yukio Homma OBJECTIVE To report an epidemiological survey of lower urinary tract symptoms (LUTS) to determine the prevalence of overactive bladder (OAB) symptoms (defined as a symptom complex of daily urinary frequency of eight or more times and urgency once or more per week) in Japan. SUBJECTS AND METHODS A self-administered questionnaire was mailed to 10 096 Japanese men and women aged ,,40 years selected by a two-stage randomized process. Survey questions, developed by members of the Japan Neurogenic Bladder Society Committee, covered four areas: demographic characteristics, LUTS, health-related quality of life (HRQoL), and hospital attendance. RESULTS The responses from 4570 respondents (mean age 61 years) were analysed. The estimated prevalence of OAB was 12.4% (men 14%, women 11%). Prevalence rates for OAB with and without urgency incontinence (one or more episode/week) were 6.4% and 6.0%, respectively. Prevalence rates increased with age; 5% of respondents aged 40,49 and 37% of those aged ,,80 years had OAB. HRQoL was compromised in 53% of respondents with OAB symptoms, specifically emotions (42%), sleep/vitality (37%), physical limitation (34%), role limitation (29%), and social limitation (22%). Among those whose HRQoL was affected, 23% (men 36%, women 8%) had visited a medical institution because of their urinary problems. CONCLUSION The results from this survey indicate that the prevalence of OAB was high and increased with age, but the rate of hospital attendance was low. Public awareness of OAB should be increased so that there can be optimum management of this condition. [source] Newly Developed Ultrasonic Probe With Ropeway System for Transpapillary Intraductal Ultrasonography of the Bilio,Pancreatic Ductal SystemDIGESTIVE ENDOSCOPY, Issue 3 2000Naotaka Fujita Background: Intraductal ultrasonography of the bile/pancreatic duct using a thin-caliber ultrasonic probe (IDUS) provides excellent images of these ducts and the surrounding structures. Insertion of the device through the papilla of Vater is essential to carry out this examination. We developed a new probe with a ropeway system (XUM5RG-29R; Olympus, Tokyo) for transpapillary IDUS. Its usefulness such as ease of application and safety were prospectively evaluated. Patients and methods: During the period of October 1997 to April 1998, transpapillary IDUS using the probe was performed in 194 patients at seven medical institutions. The success rates of insertion of the probe into the bile/pancreatic duct, observation of the area of interest, and the incidence of complications were evaluated. Results: Passage of the probe through the papilla was successful without difficulty in all the patients. Successful introduction of the probe into the pancreatic duct, bile duct and both of the ducts was achieved in 98.4, 100 and 85% of the patients, respectively. Once the probe was introduced into the aimed duct, it was possible to obtain IDUS images of the area of interest in all but five patients. Mild acute pancreatitis developed in eight patients (4.1%), all of whom recovered with conservative therapy only. Conclusions: It is possible to introduce the new ultrasonic probe into the desired duct once a guide wire has been inserted. This type of ultrasonic probe is quite useful when performing transpapillary IDUS of the bile and/or pancreatic duct. [source] Perceived need for emergency medicine training in Pakistan: A survey of medical education leadershipEMERGENCY MEDICINE AUSTRALASIA, Issue 2 2009Junaid A Razzak Abstract Objective: To assess the perception of leaders of the academic medical institutions regarding the need for specialty training in emergency medicine. Methods: A cross-sectional survey was conducted in all medical colleges of Pakistan in September 2005. Our sample included all academic leaders of recognized medical colleges in Pakistan. A questionnaire was designed and sent (mailed and faxed) to vice chancellors, deans, principals or medical directors of the institutions. Reminders were sent through faxes and emails wherever available, followed by phone calls if responses were not available after several attempts. Results: At the time of study, there were 39 medical colleges recognized by Pakistan Medical and Dental Council. Of these, responses were received from 26 teaching institutions in the country. A majority of the respondents (85%) were not satisfied with the care provided in the ED of their primary teaching hospital, and three-fourth (74%) thought that doctors specialized in other disciplines, like internal medicine and family medicine, cannot adequately manage all emergencies. When asked if Pakistan should have a separate residency training programme in emergency medicine, 96% responded in affirmative, and many (85%) thought that they will start a residency programme in emergency medicine if it was approved as a separate specialty. Conclusion: This survey shows significant support for a separate local training programme for emergency medicine in the country. [source] Surgical outcomes of partial nephrectomy for renal cell carcinoma: A joint study by the Japanese Society of Renal CancerINTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2007Yutaka Senga Objective: A joint study was undertaken by the Japanese Society of Renal Cancer to investigate the present status of partial nephrectomy in Japan and to speculate about what may be the indications for partial nephrectomy in patients with renal cell carcinoma. Methods: Data were tabulated for 469 patients from participating medical institutions and various clinical factors were investigated with regard to disease progression (local recurrence and distant metastasis). Results: Disease progression was observed in 21 patients (4.5%). No significant relation to disease progression was observed for sex, laterality, tumor histology, grade and tumor size. Although patients with solitary tumors displayed excellent prognosis irrespective of tumor diameter, patients with multiple tumors displayed a high likelihood of disease progression. Patients older than 77 years old and patients with imperative indication were found to have a poorer prognosis. Conclusion: In patients with solitary tumors, partial nephrectomy can be actively performed, even if the patient displays elective indications and the tumor is >4 cm in diameter. In patients displaying multiple tumors with imperative indications, the decision whether to perform partial nephrectomy should be made by the patients and their physicians after considering the impact on curability and the quality of life. [source] Serum Insulin-Like Growth Factor-1 Binding Proteins 1 and 2 and Mortality in Older Adults: The Health, Aging, and Body Composition StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2009Donglei Hu PhD OBJECTIVE: To evaluate the relationship between serum insulin-like growth factor 1 (IGF-1), IGF-1 binding protein 1 (IGFBP-1), and IGF-1 binding protein 2 (IGFBP-2) and fasting insulin, fasting glucose, adiposity, and mortality in older adults. DESIGN: A prospective cohort study with mean follow-up of 6.2 years. SETTING: Participants were recruited and followed at two centers affiliated with academic medical institutions. PARTICIPANTS: Six hundred twenty-five men and women aged 70 and older and in good health at the time of enrollment. MEASUREMENTS: Serum IGF-1, IGFBP-1, and IGFBP-2; fasting serum insulin; fasting serum glucose; visceral fat; and total percent fat. RESULTS: Higher IGFBP-1 and higher IGFBP-2 were significantly associated with lower fasting insulin, lower fasting glucose, and lower adiposity, but higher IGFBP-1 and IGFBP-2 were associated with greater mortality. In multivariate adjusted models, the hazard ratio for all-cause mortality was 1.48 (95% confidence interval (CI)=1.14,1.92) per standard deviation (SD) increase in IGFBP-2 and 1.34 (95% CI=1.01,1.76) per SD increase in IGFBP-1. No association was found between IGF-1 and all-cause mortality. CONCLUSIONS: Higher IGFBP-1 and IGFBP-2 are associated with lower adiposity and decreased glucose tolearance but also with greater all-cause mortality. Higher levels of serum IGF-1 binding protein (IGFBP) may indicate greater IGF-1 activity and thus represent an association between higher IGF-1 activity and mortality in humans. [source] Life of the mind: The interface of psychopharmaceuticals, domestic economies, and social abandonmentAMERICAN ETHNOLOGIST, Issue 4 2004João Biehl ABSTRACT In this article, I address the embroilment of medical science in the lifeworlds of the urban poor in Brazil, particularly the place of psychopharmaceuticals within households. I explore how psychiatric diagnostics and treatments are integrated into a domestic "dramaturgy of the real" and how family members use them to assess human value and to mediate the disposal of persons considered unproductive or unsound. I focus on the life of Catarina, who was deemed mad and left by her family in an asylum in southern Brazil. Disabled and abandoned, Catarina began to compile a "dictionary" of words that have meaning for her. By tracing Catarina's words back to the people, households, and medical institutions that she had once been a part of, I illuminate the complex network in which her abandonment and pathology took form as well as the edges of human imagination that she keeps expanding. From this examination, one comes to understand how economic globalization, state and medical reform, and acceleration of claims over human rights and citizenship coincide with and impinge on a local production of social death. One also sees how mental disorders gain form at the juncture between the subject, her biology, and the technical and political coding of her sense of being alive. Hers is not just bare life, though: Thinking through her condition, Catarina anticipates social ties and one more chance. This is also a story of the methodological and ethical challenges I faced as I supported Catarina's search for consistency and her demands for continuity. [source] Quality of life of young adults with congenital hypothyroidismPEDIATRICS INTERNATIONAL, Issue 1 2009Hirokazu Sato Abstract Background:, The aim of the present study was to investigate health-related quality of life (HRQOL) and the living conditions of young adults with congenital hypothyroidism (CH) detected on newborn screening. Method:, Among medical institutions that care for CH patients in Japan and were approached to in the present study, 78 institutions agreed to participate. The World Health Organization Quality of Life-26 (WHO/QOL-26) was used for measurement of HRQOL. CH patients who gave consent after receiving an explanation from their physicians filled in questionnaires at home and sent them by mail. This survey involved 51 CH patients (15 male; 36 female) whose mean age was 21.1 ± 2.7 years (±SD; range, 18,27 years). The data from WHO/QOL-26 forms completed by 43 patients (12 male; 31 female) were compared with those for healthy individuals. Results:, Mean WHO/QOL-26 scores were 3.51 ± 0.43 for male patients and 3.59 ± 0.42 for female patients, and there were no significant differences between them and healthy individuals (men, 3.32 ± 0.42; women, 3.35 ± 0.49). No significant difference was observed between patients and healthy individuals on any domain of the WHO/QOL-26. Their degree of educational attainment was not poor. Conclusions:, The HRQOL of young adults with CH detected on newborn screening was not poor. [source] Nurturing of surgical careers by the wellington surgical interest clubANZ JOURNAL OF SURGERY, Issue 4 2009Sanket Srinivasa The Royal Australasian College of Surgeons (RACS) has recently introduced the new Surgical Education and Training programme. The purpose of this was, in part, to help address the anticipated shortage of surgeons in the future, by streamlining the surgical training programme. The formation of the Wellington Surgical Interest Club (WSIC), a student-led initiative, had several complementary goals. These included the desire to identify potential candidates for a career in surgery, promote a surgical career to students especially women, help students acquire basic surgical skills early, inform students about surgical careers, promote student involvement in surgical research and to create an effective mentorship model during undergraduate and junior surgical training. The strengths of WSIC are its goals, which are similar to those of the RACS with regard to promoting surgery as a career option; its easy reproducibility at other medical institutions; its ability to focus on issues of relevance to both students and junior doctors; and being a bridging solution at a time when early exposure to surgical specialties is both desired and necessary. [source] |