曲马多治疗糖尿病性神经病疼痛的双盲随机试验

目的：本研究旨在评价曲马多治疗糖尿病性神经病的有效性和安全性。背景：糖尿病性神经病疼痛是糖尿病患者的主要症状，其治疗和其它的末梢神经病变一样，不能令人满意。曲马多是作用于中枢的镇痛剂，用于治疗中到重度疼痛。方法：多中心、门诊病例、随机、双盲、安慰剂做对照、设置平行组的研究，包括药效消退期（在此期间停用所有镇痛剂）和一个为期42天的双盲治疗期。总共有131名患糖尿病性神经病疼痛的患者接受曲马多（n=65）或安慰剂胶囊治疗（n=66），每日4次。42天的治疗结束后或治疗中断后比较曲马多组和安慰剂组平均疼痛强度评分，进行初级药效分析。次级药效分析为疼痛缓解评分和根据日常活动和睡眠状况作出生活质量评估。结果：曲马多平均剂量为210mg／天，治疗糖尿病性神经病疼痛较安慰剂有显著疗效（P〈0．001）。曲马多组患者生理（P=0．02）和社会功能（P=0．04）的评分显著优于安慰剂组。未发现对睡眠有显著改善作用。曲马多最常见的不良事件是恶心、便秘、头疼和嗜睡。结论：安慰剂做对照的实验结果表明曲马多在治疗糖尿病性神经病疼痛上是安全和有效的。     

Stress-related responses after 3 years of exposure to terror in Israel: are ideological-religious factors associated with resilience?

BACKGROUND: The inhabitants of 3 different types of population centers in Israel were assessed as to stress-related symptomatology during 2003 and 2004. These centers have been exposed to 2 distinct forms of violence-sporadic, large-scale terror attacks in the metropolitan areas in the heart of Israel and daily "war-zone" conditions in the settlements beyond the 1967 borders of Israel. METHOD: A semistructured interview and questionnaire survey of a random sample of 314 inhabitants of a suburb of Tel-Aviv, a settlement in the West Bank (Kiryat-Arba), and the Gush-Katif settlement cluster in the Gaza Strip was performed. Symptoms of acute stress and chronic (posttraumatic) stress as well as symptoms of general psychopathology and distress were assessed. RESULTS: The inhabitants of Gush-Katif, in spite of firsthand daily exposure to violent attacks, reported the fewest and least severe symptoms of stress-related complaints, the least sense of personal threat, and the highest level of functioning of all 3 samples. The most severely symptomatic and functionally compromised were the inhabitants of the Tel-Aviv suburb, who were the least frequently and least directly affected by exposure to violent attacks. Because the Gush-Katif population is exclusively religious, the data were reassessed according to religiousness. The religious inhabitants of Kiryat-Arba had almost the same symptom profile as the Gush-Katif population, whereas secular inhabitants of Kiryat-Arba reported faring worse than did either population in the Tel-Aviv suburb. CONCLUSION: Deeply held belief systems affecting life-views may impart significant resilience to developing stress-related problems, even under extreme conditions. Religiousness combined with common ideological convictions and social cohesion was associated with substantial resilience as compared to a secular metropolitan urban population.     

Pediatric radiology at the millennium.

PURPOSE: To evaluate the current practice of and job market for pediatric radiologists in the United States and Canada with a 1998 survey and compare findings with those of surveys from 1980 and 1989. MATERIALS AND METHODS: Surveys were mailed to the 728 active members of the Society for Pediatric Radiology. Questions covered professional practice, subspecialization, and involvement in evolving technologies. A pediatric radiology help-wanted index was generated from a diagnostic radiology help-wanted index. RESULTS: Increasing involvement in the interpretation of computed tomographic, ultrasonographic, and magnetic resonance images was found among the 57% (411 of 728) of the members who responded. The attainment of a certificate of added qualification in pediatric radiology was found in nearly three-fourths of the membership, and 85% (348 of 408) had completed a fellowship. More than half of the respondents were involved in interventional procedures amid a continued increase in volume; 24% (100 of 409) of the membership, as compared with 7% in the 1980 survey, was practicing in a community or "other" setting. Subspecialization within pediatric radiology had diminished, and there was a larger percentage of female pediatric radiologists, particularly among the newest members. The job market was robust, having recovered substantially since the middle 1990s. CONCLUSION: The practice of pediatric radiology has evolved, with increasing involvement in advanced techniques and modalities, as well as a greater presence in community settings. The help-wanted index supports the recent discussions of a personnel shortfall.     

Effect of cotherapy reduction on tolerability of epilepsy add-on therapy: a randomized controlled trial

BACKGROUND: Adverse effects are the most common cause for failure of an antiepileptic drug (AED), especially when an AED is added to existing therapy. With the increased drug load, it may not be possible to titrate the newly added AED to effective doses. Reducing the dosage of AED cotherapy as the new drug is introduced may improve tolerability. OBJECTIVE: To evaluate reduction of AED cotherapy as a strategy to improve tolerability and patient retention when a new AED is added to existing therapy. METHODS: In a 20-week, randomized, open-label study, topiramate was initiated as add-on therapy in adults and adolescents (> or =12 y of age) with inadequately controlled partial-onset seizures. Patients were randomized to receive treatment in which adverse events could be managed by adjustments in AED cotherapy (flex-dose group) or treatment in which AED cotherapy dosages remained fixed (fixed-dose group). Topiramate could be adjusted as needed in both groups. In the flex-dose group, patients exited randomized treatment when topiramate was discontinued. In the fixed-dose group, patients exited when AED cotherapy was reduced due to adverse events or when topiramate was discontinued. The primary study outcome was the percentage of patients exiting randomized treatment due to adverse events. RESULTS: The flex-dose group comprised 297 patients; 302 patients were in the fixed-dose group. Significantly fewer patients in the flex-dose group exited the study due to adverse events (16% vs 23% in the fixed-dose group; p = 0.02). In the flex-dose group, 10% (17 of 168) of patients discontinued topiramate due to adverse events after AED cotherapy was reduced versus 22% (29 of 129) when AED cotherapy was not reduced. CONCLUSIONS: Reduction of AED cotherapy is a useful strategy to improve tolerability and retention when topiramate is initiated as adjunctive therapy.     

Easy removal of a large mucus plug with a flexible paediatric bronchoscope after administration of rhDNase (Pulmozyme)

Mucoid impaction and plastic bronchitis are relatively rare disorders affecting patients of any age. Here we report the case of mucoid impaction developing in a four-year-old child as a complication of pneumonic infection treated four weeks prior. p.a. chest X-ray and fiberoptic bronchoscopy showed atelectasis and the location of a mucus cast in the left upper lobe. After extraction of the cast via the suction channel of the bronchoscope had failed, we administered 2.5 mg of undiluted recombinant human deoxyribonuclease (rhDNase) instilled directly over the affected area of occlusion for 15 minutes. This mucolytic agent mobilized the cast by reducing viscoelasticity and adherence of mucus. Subsequent extraction of the mucus cast was easy, resulting in immediate reduction of atelectasis and discharge of the child the following day. Treatment of severe mucus plugging by direct instillation of rhDNase has been a safe and efficacious procedure for mobilising adherent mucus plugs and for facilitating bronchoscopic extraction.     

A case study of teaching presence in virtual problem-based learning groups

Interest in conducting problem-based learning (PBL) on-line has increased to meet student and physician schedules. Little research describes skills needed to facilitate PBL on-line. In this paper we studied teaching presence in asynchronous PBL groups. Two raters, with average inter-rater agreements of 0.80, used an existing code to measure teaching presence in 62 PBL case discussions facilitated by one instructor over five years. This instructor was selected because of consistently high teaching evaluations. Messages sent by the instructor in the on-line PBL discussion were coded into three categories: instructional design and organization, facilitating discourse and direct instruction. Instructional design indicators were most frequent averaging 22.5 (SD = 5.6)/discussion. Facilitating discourse and direct instruction were comparable, 19.5(SD = 7.4) and 19.5 (SD = 6.7), respectively. Messages and indicators of teacher presence rose across time with a decline during subsequent PBL cases with the same group.     

QUANTITATIVE STUDIES OF PHYTOHEMAGGLUTININ-INDUCED DNA AND RNA SYNTHESIS IN NORMAL AND AGAMMAGLOBULINEMIC LEUKOCYTES

Leukocytes from nine patients with acquired agammaglobulinemia were studied in vitro. Synthesis of deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) induced by phytohemagglutinin was measured by determination of the degree of incorporation of labeled precursor. Synthesis of both DNA and RNA was decreased in the agammaglobulinemic cells. The presence of an inhibitor in the patients' sera could not be demonstrated. These results suggest that the basic defect in agammaglobulinemia is cellular rather than humoral.     

The role of government agencies in the development of cancer policy

OBJECTIVES: To provide a review of federal government agencies that most directly affect cancer care and research and how cancer policy can be indirectly shaped or affected by federal and state programs. DATA SOURCES: Government reports and internet sources. CONCLUSIONS: The US government's role in cancer policy has grown substantially and involves ongoing dialogue among Congress, government agencies, and stakeholders in the cancer community. The government can be a powerful catalyst for progress or a seeming insurmountable barrier to high-quality cancer care and research. Working together can make a significant difference in the outcome of cancer policy. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses are an important voice in the development of legislation, regulation, and other national policies for cancer care. It is important for cancer care professionals to be aware of these federal programs and participate in deliberations.