Screening by nurses and junior doctors to detect malnutrition when patients are first assessed in hospital

Four hundred and fifty four ward nurses and 319 junior doctors in 70 hospitals were interviewed about the last patient they had admitted, using a brief questionnaire. The availability of weighing scales and height measuring equipment was assessed by observers who visited the wards of 107 hospitals. Two thirds of nurses and doctors asked patients about recent food intake; half of the nurses and three quarters of the doctors asked about unintentional weight loss. Answers to the questions were recorded in the notes on 52-80 per cent of occasions. Two thirds of nurses weighed the patient, but only 11 per cent (%) measured height; approximately 80% of results were recorded. Most nurses and doctors who asked no questions about nutrition and made no measurements failed to do so because they regarded them as unimportant. Weighing scales were adequately provided, but height measuring equipment was available in only 17% of wards.     

Estrogen replacement therapy among elderly women: results from the 1995 medicare current beneficiary survey

Research Objectives: To develop population-based estimates of estrogen replacement therapy use rates in 1995 among women over age 65 living in the community; to estimate the impact of socioeconomic and health characteristics on estrogen use. Method: Estimates are based on a large, nationally representative sample of Medicare beneficiaries; detailed self-report data were merged with Medicare claims. Results: Overall, 13.1% of women reported use of estrogen replacement therapy in 1995. Estrogen users were more likely to be white, age 65–74, with private insurance, high income, history of osteoporosis and heart problems, no history of breast cancer, and a patient of gynecologists. Conclusions: Estrogen use was substantially lower among the socioeconomically disadvantaged, controlling for medical history variables, suggesting considerable inequity in access to estrogen replacement therapy treatment.     

Modelling the dynamic ventilatory response to hypoxia in humans

A two-component dynamic model was used to describe the ventilatory response to sustained hypoxia in humans. One component (X_s) represents the stimulating effects of hypoxia and the other component (X_d), the hypoxic ventilatory decline. The total ventilatory response to hypoxia is represented by the sum of the two components. A nonlinearity is included to account for the nonlinear steady-state ventilatory response to hypoxia. A sensitivity analysis of the model indicates that, with a step change in as the input, all the parameters can be estimated from the data except for the nonlinearity. The relative sensitivity of the parameters from the model analysis was confirmed in an experimental study. However, comparing steps into hypoxia versus steps out of hypoxia we found a decrease in the gains of both components. The most likely explanation for the decrease in the gains is that the combination of X_s and X_d is not entirely additive. Other models may be required to completely describe the ventilatory response to inputs more complex than steps.     

Tirapazamine, Cisplatin, and Radiation versus Fluorouracil, Cisplatin, and Radiation in patients with locally advanced head and neck cancer: a randomized phase II trial of the Trans-Tasman Radiation Oncology Group (TROG 98.02).

PURPOSE: To select one of two chemoradiotherapy regimens for locally advanced squamous cell carcinoma (SCC) of the head and neck as the experimental arm for the next Trans-Tasman Radiation Oncology Group phase III trial. PATIENTS AND METHODS: One hundred twenty-two previously untreated patients with stage III/IV SCC of the head and neck were randomized to receive definitive radiotherapy (70 Gy in 7 weeks) concurrently with either cisplatin (75 mg/m(2)) plus tirapazamine (290 mg/m(2)/d) on day 2 of weeks 1, 4, and 7, and tirapazamine alone (160 mg/m(2)/d) on days 1, 3, and 5 of weeks 2 and 3 (TPZ/CIS), or cisplatin (50 mg/m(2)) on day 1 and infusional fluorouracil (360 mg/m(2)/d) on days 1 through 5 of weeks 6 and 7 (chemoboost). RESULTS: Three-year failure-free survival rates were 55% with TPZ/CIS (95% CI, 39% to 70%) and 44% with chemoboost (95% CI, 30% to 60%; log-rank P = .16). Three-year locoregional failure-free rates were 84% in the TPZ/CIS arm (95% CI, 71% to 92%) and 66% in the chemoboost arm (95% CI, 51% to 79%; P = .069). More febrile neutropenia and grade 3 or 4 late mucous membrane toxicity were observed with TPZ/CIS, while acute skin radiation reaction was more severe and prolonged with chemoboost. Compliance with protocol treatment was satisfactory on both arms. CONCLUSION: Both regimens are feasible and are associated with significant but acceptable toxicity profiles in the cooperative group setting. Based on the promising efficacy seen in this trial, TPZ/CIS is being evaluated in a large phase III trial.     

Fetal biophysical profile scoring: selective use of the nonstress test

The fetal biophysical profile score was modified by selective use of the nonstress test. In 2712 study patients (7851 tests) the incidence of nonstress test was reduced to 2.7% with no measurable effect or test accuracy. The nonstress test was most useful in evaluation of abnormal ultrasound monitored variables.     

The Effect of Inert Atmospheric Packaging on Oxidative Degradation in Formulated Granules

No HeadingPurpose. Oxidative degradation of drug substances in pharmaceutical products is well documented and is thought to occur in many cases via autoxidative processes involving headspace molecular oxygen in the primary package. Reducing the headspace oxygen concentration inside a package could thus be an option for reducing oxidative degradation in pharmaceutical products. The purpose of this study is to examine the effect of headspace oxygen concentration and relative humidity (RH) on the oxidative degradation of a model pharmaceutical formulation.Methods. Model formulations, including a drug substance known to exhibit oxidative degradation, at two different drug/excipient ratios were packaged in stoppered glass vials maintained at different oxygen concentrations, (from 0% to 20.9%) and headspace relative humidities and were stored at 40°C. The oxidative degradation was quantified as a function of time.Results. The results clearly show dependence of oxidative degradation on headspace oxygen concen-tration, relative humidity, drug loading and time.Conclusions. The results provided insight into the effectiveness of inert atmospheric packaging (IAP) for protecting oxidation-labile products. In light of these observations, a few strategies for practically implementing inert atmosphere packaging are also presented.     

Protease inhibitor therapy and fetal growth potential in HIV-positive women

Our objective was to test if protease inhibitors (PIs) increase the incidence of fetal growth restriction (FGR). Human immunodeficiency (HIV)-seropositive women were studied. At birth the neonatal weight percentile was assigned by predicted growth potential (GP), accounting for race, parity, weight, height, gestational age, birthweight, and gender (Gardosi, 1992). FGR was defined as GP < 10% percentile. Maternal age, CD4 count, viral load, weight gain, prenatal care, tobacco, alcohol, substance abuse, and PI use were related to FGR using chi-square and multiple regression analysis. Ninety-three of 191 women received PI. In these, FGR occurred in 27 (29%) compared with 15 (15.3%) in the non-PI group ( P = 0.02). Maternal CD4 count ( P < 0.0001) was the primary determinant, and smoking ( P = 0.037) was an independent cofactor for FGR (Nagelkerke r2 = 0.24). Twenty-six of 82 (31.7%) smokers had FGR, versus 16 of 109 (14.7%) of nonsmokers (odds ratio, 2.69; 95% confidence interval, 1.33 to 5.46; P = 0.005). After exclusion of the CD4 count, PI became a cofactor for FGR ( P = 0.021 and Nagelkerke r2 = 0.104). We concluded that maternal HIV status and smoking determine the risk for FGR. Although PIs increase the risk for FGR, this effect appears to depend on maternal disease severity.     

Coexistent Thyroid Pathologies and High Rate of Papillary Cancer in Patients with Primary Hyperparathyroidism: Controversies About Minimal Invasive Parathyroid Surgery

Thyroid carcinoma and benign thyroid diseases associated with primary hyperparathyroidism (PHPT) may cause difficulties in the diagnosis, localization and therapy of PHPT. In this study, we analysed coexistent thyroid pathologies in 51 patients who underwent neck exploration with a diagnosis of PHPT between 1999-2002. Five hundred thirteen patients who underwent thyroidectomy for nodular thyroid disease without a parathyroid pathology in histopathological examination served as controls. In patients with PHPT there were 43 cases (84.3%) of coexistent thyroid pathology. Nine patients (17.6 %) had coexistent papillary thyroid cancer. Nine patients (17.6 %) had lymphocytic thyroiditis, two (3.9%) had benign thyroid adenoma and 24 (47%) had nodular hyperplasia. In one patient (2%), there was intrathyroidal metastasis from a parathyroid cancer. One patient had coexistent lymphocytic thyroiditis and multifocal papillary cancer. One of the two cases with thyroid adenomas was Hürthle cell type. In the control group only 28 patients (5.5%) had thyroid malignancy (27 papillary cancer and one follicular cancer). In conclusion, the coexistent thyroid pathologies are highly prevalent in patients with PHPT and pre-and intra-operative thyroid examination should be performed to avoid overlooking important thyroid pathologies.