Resource implications for a population-based colorectal cancer screening program in Canada: a study of the impact on colonoscopy capacity and costs in London, Ontario.

OBJECTIVE: Cancer Care Ontario has recommended a population-based colorectal cancer (CRC) screening program using fecal occult blood testing. Patients who test positive should undergo further investigation, preferably colonoscopy. So far, no studies have been performed to quantify the costs or demands on the health care system at the community level. The number of consultations, colonoscopies and polypectomies, and the corresponding direct medical costs generated by the CRC screening program, between 2006 and 2015 in London, Ontario, were estimated using a decision analysis model in comparison with the population health model. METHODS: A faxed survey study was conducted to examine the current CRC screening practice among family physicians in London. Data from the survey and randomized studies were applied to a decision analysis model, which simulated the steps involved in population-based biennial and annual CRC screening between 2006 and 2015. The number of consultations, colonoscopies and polypectomies, and their associated costs were calculated. RESULTS: For a cohort population of 140,000, between 50 and 74 years of age, in 2006 to 2015, it is estimated that an average of 412 consultations, 463 colonoscopies and 174 polypectomies will be performed per 100,000 screen eligible population per year in biennial screening, and double in annual screening, reflecting an average of 8.7% or 17.6% increase annually in outpatient colonoscopies, respectively, compared with 2003. A mean of $285,000 or $562,000 per year would be required to support the extra consultation and endoscopic procedures generated by the biennial or annual screening. CONCLUSION: Population-based fecal occult blood testing screening for CRC appears to be a manageable strategy if a modest increase in endoscopic resources is allocated.     

Molecular subtyping of Vibrio cholerae O1 and O139 by pulsed-field gel electrophoresis in Hong Kong: correlation with epidemiological events from 1994 to 2002

Two hundred twenty isolates of Vibrio cholerae O1 and O139 collected from 1994 to 2002 in Hong Kong were analyzed by pulsed-field gel electrophoresis (PFGE). Chromosomal DNAs from all V. cholerae isolates in agarose plugs were digested with the restriction enzyme NotI, resulting in 20 to 27 bands. Sixty distinctive PFGE patterns in the range of 10 to 300 kb were noted among 213 isolates typeable by PFGE. By comparing the common PFGE patterns obtained from four well-defined outbreaks of V. cholerae O1 and O139 with those obtained from other, epidemiologically unrelated isolates during the study period, indistinguishable and similar PFGE patterns were identified, indicating their close relatedness, in agreement with the results of epidemiological investigations. Heterogeneous PFGE patterns (with four to six banding differences), however, were identified among strains that were imported from other parts of Asia, including Indonesia, India, and Pakistan. Correlations with epidemiological information further support the usefulness of PFGE as an epidemiological tool in laboratory investigations of suspected outbreaks. Standardization of PFGE methodology will allow international comparison of fingerprint patterns and will form the basis of a laboratory network for tracking V. cholerae.     

Can energy drinks reduce the depressor effect of ethanol? An experimental study in mice

Although the popularization of the combined use of alcoholic beverages and energy drinks (ED) containing caffeine, taurine and other substances has increased, there are no controlled experimental studies on the effects of ED alone or combined with ethanol. This work aimed at evaluating the effects of different doses of ED combined or not with ethanol, on the locomotor activity of Swiss mice. The administration of 3.57, 10.71 or 17.86 ml/kg of ED alone increased the locomotor activity of the animals in relation to a control group. Low doses of ethanol (0.5, 1.0 and 1.5 g/kg) alone or in combination with 10.71 ml/kg of ED did not affect their locomotor activity. However, the reduction of activity observed after 2.5 g/kg of ethanol was antagonized by 10.71 ml/kg of ED. Further studies on the mechanisms of this interaction are still needed.     

Linearity,symmetry and additivity of the human eye-movement response to maintained unilateral and bilateral surface galvanic (DC) vestibular stimulation

Recent studies have shown that, although responses to long-duration, constant-current surface galvanic vestibular stimulation (GVS) show substantial interindividual variability, individual subjects show a reliable, repeatable, idiosyncratic oculomotor response pattern to GVS. It follows that GVS may be a more reliable stimulus than may have been anticipated from the literature. The aim of the present study was to examine the metrics of 3D eye-movement responses to maintained (120 s), unilateral and bilateral surface GVS. Eye movements were measured using computerised video-oculography. Two experiments were conducted: Experiment 1 examined whether the normal response is linear over increasing levels of current; and Experiment 2 examined (1) whether the normal response to surface GVS is symmetrical when comparing stimulated sides, (2) whether the normal response to surface GVS is symmetrical when the polarity of the stimulating current was reversed, and (3) whether there is additivity in the normal response to combinations of unilateral/bilateral surface GVS. Five subjects participated in Experiment 1 and eight subjects participated in Experiment 2. In both experiments, the onset of stimulation produced characteristic eye-movement responses: changes in torsional position with the upper pole of both eyes rolling towards the anode and away from the cathode; together with horizontal and torsional nystagmus with slow phases towards the anode and away from the cathode; and negligible vertical nystagmus. These responses reversed direction at stimulus offset. In the fixation condition of Experiment 1, the magnitude of ocular torsional position (OTP) and torsional nystagmus responses showed a linear relationship over conditions of increasing current strength, as did OTP, torsional and horizontal nystagmus responses in darkness. The results of Experiment 2 showed that responses to unilateral stimulation are symmetrical between stimulated sides, symmetrical between stimulating polarities, and additive (with respect to responses to bilateral stimulation). The principles derived from these findings, as well as those of recent studies, provide a foundation for future work investigating eye-movement responses to surface GVS in patients with known types of vestibular dysfunction. Electronic Publication     

Trauma-Informed Pediatric Primary Care: Facilitators and Challenges to the Implementation Process

This article describes the process of integrating trauma-informed behavioral health practices into a pediatric primary care clinic serving low-income and minority families while facing barriers of financial, staffing, and time limitations common to many community healthcare clinics. By using an iterative approach to evaluate each step of the implementation process, the goal was to establish a feasible system in which primary care providers take the lead in addressing traumatic stress. This article describes (1) the process of implementing trauma-informed care into a pediatric primary care clinic, (2) the facilitators and challenges of implementation, and (3) the impact of this implementation process at patient, provider, and community levels. Given the importance of trauma-informed care, especially for families who lack access to quality care, the authors conceptualize this paper as a guide for others attempting to integrate best behavioral health practices into pediatric clinics while working with limited resources.

     

Disposition of quinine in rats with induced renal failure

Aetiologically different models of experimental acute renal failure were induced in rats by the administration of glycerol, mercuric chloride and gentamicin, respectively, to different groups. Quinine levels in plasma and urine of the rats with induced renal failure were determined and pharmacokinetic parameters (eliminationt _1/2, CL _p ,V, CL_R AUC_0–) of the drug were derived and compared with values obtained from control rats following intraperitoneal administration of a 10 mg/kg body-weight dose of quinine. Results showed that each of the three compounds caused an up to 25-fold increase in the plasma levels of the drug and a marked decrease in the levels of the metabolite 3-hydroxyquinine. All the pharmacokinetic parameters determined for the rats with renal impairment were markedly different when compared to control. The high plasma quinine levels observed in the rats with renal failure could be largely due to the marked decrease inV and reduced metabolism. Also, in the rats with renal impairment, no correlation was observed between the increased plasma urea levels and plasma quinine levels or disposition of the drug. The results of the study suggest that quinine should be used with caution in patients with renal impairment. The plasma urea levels, as a measure of renal function, might not provide a suitable index for determining quinine dosage.     

Clitoral Avulsion Successfully Repaired with 2-Octylcyanoacrylate

IntroductionClitoral piercing is becoming more popular in the general populace, playing an aesthetic as well as likely sexual role. However, potential for injury also impacts future clitoral sexual function, thus highlighting the importance of proper repair.AimTo report a 29-year-old woman presented to the emergency department after a clitoral piercing injury. Examination revealed avulsion of most of the clitoral body. After the patient refused expectant and surgical management, reapproximation was performed using 2-octylcyanoacrylate.Methods2-Octylcyanoacrylate, commonly known as Dermabond® (Ethicon Inc., Somerville, NJ, USA), was used to reapproximate the clitoral laceration for this patient. It is a cyanoacrylate tissue adhesive, forming a strong bond between wound edges to allow for normal healing to occur below. Benefits of use are decreased time of repair, water-resistant flexible coating, and no need for suture removal.ResultsThe laceration was successfully reapproximated with 2-octylcyanoacrylate. The tissue held together satisfactorily and the patient was discharged to home. She was seen as an outpatient 3 days later, with a moderately tender and swollen clitoris, but with an intact repair and improved pain. A visit 8 weeks later showed a well-healed clitoris, and the patient reported resolution of pain and return of sexual function, with successful orgasms.ConclusionsThe delicacy of clitoral anatomy and the potential impact of its injury on future sexual function make it an intimidating area of repair for the general physician. The method of repair must be tailored to the injury, patient, and physician; however, 2-octylcyanoacrylate is a viable alternative to traditional surgical or expectant management, offering strength and flexibility while avoiding further trauma with suture. Berger A and Worly B. Clitoral avulsion successfully repaired with 2-octylcyanoacrylate.