The human alkaline phosphatases: what we know and what we don't know

A review of the human alkaline phosphatases dealing specifically with (1) the gene loci, (2) characterization and discrimination of the various enzymes, (3) polymorphism at the enzyme level, (4) cDNA and gene structures, (5) membrane binding, (6) the carbohydrate moieties, (7) hypophosphatasia, (8) alkaline phosphatases in malignancies, (9) function.     

Pregnancy following partner rape: what we know and what we need to know

Despite more than 30 years of research on violence against women and scores of publications on intimate partner violence during pregnancy and consequences for maternal and infant health, little is known about the incidence and outcomes of pregnancies that follow partner rape. The occurrence and consequences of partner rape and violence during pregnancy are reviewed as well as the one study identified on the characteristics and consequences of pregnancy following partner rape. Literature on unintended pregnancy and violence against women is also reviewed. Directions for future research are explored, including the need for studies that explore women's control of their sexuality within the context of intimate partner relationships, how and when to ask women about partner rape, and how to include males as the solution to ending rape.     

Universal donor education and consent: what we know and where we should go

Each day thousands of blood donors across the country are given educational materials and sign a consent form, thus fulfilling two blood collection accreditation requirements. Very few donors will experience a documented adverse event, although a disproportionate number of these events occur in the youngest donor cohort. The literature reflects this disproportion and suggests mitigation strategies. Studies describe subjective, undocumented donor reactions and decreased donor return rates after a documented or subjective reaction. Additionally, studies have shown donor consent form variability among blood collection facilities and that donor comprehension of the educational materials and consent is limited. There are few standardized donor education materials or consent documents. Current accreditation standards for educational materials are limited to aspects of transfusion‐transmitted diseases and for donor consent process and documentation are vague and nonspecific. Recent experiences with young donors and current research compel our community to engage in creating standardized, expanded donor educational materials and standardized donor consent processes and documents.     

Syphilis and blood donors: What we know, what we do not know, and what we need to know

The lack of transfusion-transmitted syphilis in the United States in the past 30 years has led us to question the rationale for continued syphilis testing of blood donors. In addition, the significance of a confirmed positive syphilis test result in a blood donor is not clear. The following 2 questions have been raised: (1) Are we detecting any truly infectious donors? and (2) If not, what is the significance of a confirmed positive test for syphilis in contemporary blood donors? This review will summarize what is and what is not known about syphilis testing in blood donors and will discuss the need for further research to answer these questions.     

Effects of education on return-to-work status for people with fear-avoidance beliefs and acute low back pain

BACKGROUND AND PURPOSE: People with acute low back injury and fear-avoidance beliefs are at risk for remaining off work for an extended period of time. However, the effectiveness of intervention strategies for improving return-to-work status in people with acute low back pain and fear-avoidance beliefs has not been reported. The objective of this study was to determine whether education and counseling on pain management, physical activity, and exercise could significantly decrease the number of days that people with low back injury are off work. SUBJECTS: Thirty-four people who were unable to return to work following a work-related episode of low back pain and who exhibited fear-avoidance beliefs participated in this study. METHODS: Participants who scored 50 points or higher on the Fear-Avoidance Beliefs Questionnaire were alternately assigned to an education group or a comparison group. Both groups received conventional physical therapy intervention. Participants in the education group were given education and counseling on pain management tactics and the value of physical activity and exercise. The effectiveness of the interventions was measured by the number of days before people returned to work without restrictions. RESULTS: All participants in the education group returned to regular work duties within 45 days. One third of the participants in the comparison group remained off work at 45 days. There was a statistically significant difference between the groups with regard to the number of days before returning to work. DISCUSSION AND CONCLUSION: Education and counseling regarding pain management, physical activity, and exercise can reduce the number of days off work in people with fear-avoidance beliefs and acute low back pain.     

Antimicrobial susceptibility of Borrelia burgdorferi sensu lato: What we know, what we don't know, and what we need to know

Human Lyme borreliosis is a multisystem disorder that can progress in stages and is transmitted by ticks of the Ixodes ricinus complex infected with the spirochete Borrelia burgdorferi sensu lato. Today, Lyme borreliosis is regarded as the most important human tickborne illness in the northern hemisphere. Soon after the causative agent was correctly identified and successfully isolated in 1982, antibiotic treatment was shown to be effective and since then a variety of in vitro and in vivo studies have been performed to further characterize the activity of antimicrobial agents against B. burgdorferi s.l. Although many antimicrobial agents have been tested for their in vitro activity against borreliae, the full spectrum of antibiotic susceptibility in B. burgdorferi s.l. has not been defined for many compounds. Moreover, our current understanding of possible antimicrobial resistance mechanisms in B. burgdorferi s.l. is limited and is largely founded on in vitro experiments on relatively few borrelial isolates. This review will summarize what is and what is not known about antimicrobial resistance in B. burgdorferi s.l. and will discuss open questions that continue to fuel the current debate on treatment-resistant Lyme borreliosis.     

Connecting what we do with what we know: building a community of research and practice

How to think about, develop, maintain and optimize connections between research and practice remains a vexed and contested area in the increasingly complex multidisciplinary and inter-professional practice that constitutes contemporary healthcare and service delivery. A body of literature challenging linear and passive notions of research uptake has emerged which views research uptake as a dynamic, contextualized and active process. This paper explores the development of a successful and exciting community of research and practice involving a university and an aged care organization in Australia. The community of research and practice is premised on dynamic, contextual and active interaction between research and practice; where the categories of research and practice are not mutually exclusive or static; and where community is more than just a structure to facilitate collaborative research projects. It is proposed that the idea of a community of research and practice is a useful one in terms of seeking to better understand and provide strategies for knowledge translation between researchers and practitioners and those who are both.     

Isolated distal deep vein thrombosis: what we know and what we are doing

Summary. Thromboses that are restricted to the infra‐popliteal deep veins of the lower limbs (isolated distal deep vein thrombosis, IDDVT) are frequently diagnosed in subjects with suspected pulmonary embolism (PE; 7–10%) or DVT (4–15%), accounting for 31–56% of all diagnosed leg DVTs. Despite their frequency, IDDVTs still remain one of the most debated issues in the field of venous thromboembolism (VTE). Conflicting clinical results have resulted in differing opinions on the need to test for IDDVTs and how to treat them. Due to discordant results, the real risk of IDDVT‐associated PE is not well established. IDDVTs are associated with (i) lower risk of recurrence when compared with other VTEs, and (ii) fewer late sequelae than proximal DVT. Diagnosis of IDDVT is based on ultrasound examination of all calf veins, which is more operator‐dependent and less sensitive than proximal vein examination. A series of studies has shown, however, that a single complete ultrasound strategy in symptomatic patients has comparable clinical results to serial proximal ultrasound, allowing approximately 15% better DVT diagnosis. Optimal treatment of IDDVT is still controversial. Guidelines recommend anticoagulation for 12 weeks, although 6 weeks may be sufficient. There is, however, insufficient data to support the diagnosis and treatment of all IDDVTs, and the necessary criteria to identify subjects at higher risk of complication are lacking. It also seems likely that different approaches may be better for unprovoked or secondary events and for deep or muscle veins. Specifically designed and adequately powered clinical studies addressing the issue of IDDVT need to be urgently undertaken.     

Why do people seek medical advice for back pain: a comparison of consulters and nonconsulters

Respondents with back pain who had answered affirmatively to the question about back pain in a population study were divided into two groups depending on whether they had consulted or had not consulted a physician due to their back pain. There were 17 nonconsulters and 37 consulters. The subjects participated in a stringent physical examination and in the following psychological tests: the Eysenck Personality Inventory (EPI), the rod and frame test (RFT), and the metacontrast technique (MCT). They also answered a pain questionnaire. Based on the results, we found that the nonconsulters differed from the consulters on many issues but had nevertheless rated their constant level of pain on two different occasions as being equally severe on a graphic rating scale (GRS). The groups differed as follows: The nonconsulters rated their work to be more stressful; had less frequently a spouse suffering or having suffered from chronic pain; had fewer abnormal pain drawings; woke up less frequently during the night; used sleeping pills less frequently; participated more often in sports; and had a higher frequency of repression on the MCT compared to a group of painless subjects.     

Do we know the costs of what we prescribe?

Objective: To evaluate the level of cost awareness of drugs and devices among intensive care unit (ICU) doctors with variable levels of experience (senior intensivists, junior intensivists, residents). Design: Interview-questionnaire. Setting: ICU of the University of Rome “La Sapienza”. Participants: 60 ICU doctors (40 specialists in anaesthesia and intensive care, 20 residents). Measurements and results: The estimated prices of drugs and devices were compared with the correct prices; responses within a range ± 20 % of the true price were arbitrarily considered correct; all the subgroups of doctors made inaccurate estimates of the prices, showing an absence of any impact of professional experience of cost awareness. Conclusion: The doctors in the study showed a high level of inacurrate cost awareness of drugs and devices. Received: 3 December 1997 Accepted: 24 August 1998     

Functional tricuspid regurgitation and the right ventricle: what we do not know is more than we know

The tricuspid valve (TV) lies in between the right atrium and the right ventricle (RV), consisting of annulus, leaflets, chords and papillary muscles. The RV appears triangular-shaped in a lateral view and crescent-shaped in a cross-section one. In normal conditions, the septum is concave toward the left ventricle (LV) in both systole and diastole and the RV volume is larger than the LV volume, although its mass is a third of the LV. The strict relationship between the TV apparatus and the RV underlies the physiological mechanism of TV functioning, and so, the RV plays an important role in case of functional tricuspid regurgitation. Nevertheless, the systematic assessment of RV is still not performed mainly due to lack of standardization. Hence, new echocardiographic guidelines have recently been proposed to standardize the RV assessment using transthoracic 2D?echocardiography. 3D-echocardiography and MRI are more useful to measure volumes and ejection fraction; in particular, MRI is able to provide a tissue evaluation. Today, surgical strategies are directed mainly to the annulus with fluctuating results because functional tricuspid regurgitation is not due only to the annulus but also to the RV, which is difficult to assess, due to its evolution being unpredictable and complicated by the interaction with LV.     

Physiotherapists' use of advice and exercise for the management of chronic low back pain: a national survey

The objective of the study was to establish the specific use of advice and exercise by physiotherapists, for the management of chronic low back pain (LBP). A questionnaire was mailed to a random sample of 600 members of the Irish Society of Chartered Physiotherapists. Open and closed questions were used to obtain information on treatments provided to chronic LBP patients. Respondents' treatment goals were also investigated, along with the typical methods used to assess treatment outcome. Four hundred and nineteen of the sample returned the questionnaire; 280/419 (67%) indicated that they currently treated LBP of which 76% (n=214) were senior grade therapists. Advice and exercise, respectively, were the treatments most frequently used for chronic LBP: advice was most commonly delivered as part of an exercise programme, with strengthening (including core stability) the most frequently used exercise type. Supervision of exercise and follow-up advice were underutilised with respect to the recommendations of relevant clinical guidelines. Pain relief was an important treatment goal. Emphasis on exercise programme supervision, incorporating reassurance that its safe to stay active and 'hurt does not mean harm', must be more effectively disseminated and promoted in practice. The influence of follow-up advice on exercise adherence warrants further investigation.