A procedure for the digital removal of faeces

This article describes the development of an evidence-based procedure for the digital removal of faeces (DRF) and the problems and barriers encountered--not least the absence of primary evidence. The procedure for DRF that evolved is based on the best evidence available. It sets out the criteria for performing DRF and directs the practitioner's actions, while still being adaptable to the individual patient's situation. It should help to ensure that nurses performing DRF do so within the remit of their professional and legal responsibilities, and that patients receive the most effective care grounded in the current state of knowledge.     

Phase II trial of vinorelbine for relapsed ovarian cancer: a Southwest Oncology Group study

OBJECTIVES: To assess the activity of vinorelbine in women with recurrent or resistant epithelial ovarian cancer following treatment with platinum and paclitaxel in terms of survival rate at 6 months, objective response rate (in the subset of patients with bidimensionally measurable disease), and health-related quality of life. METHODS: Seventy-nine evaluable patients with progressive ovarian cancer following platinum and taxane therapy received vinorelbine 30 mg/m(2) days 1 and 8 of a 21-day treatment cycle. RESULTS: Six-month survival rate for the entire group was 65% (95% CI: 54-75%) and median survival was 10.1 months (95% CI: 7.7-13.6 months). In the 71 women with measurable disease, 0 complete and 2 partial responses were observed (RR = 3%) (95% CI: 0.3-10%). Patients reported substantial symptom-related distress at baseline, which persisted, but did not worsen, during treatment. Patients also had impaired physical functioning at baseline and this continued to decline during treatment. CONCLUSIONS: The 6-month survival rate achieved with salvage vinorelbine is comparable to the results obtained with other salvage therapies in patients with relapsed ovarian cancer. During the initial 10 weeks of treatment, vinorelbine did not appear to be effective in alleviating the symptom-related distress or progressive impairment of physical functioning associated with this disease.     

Placental infection by Plasmodium falciparum in an urban area of Senegal

OBJECTIVES: This study aimed at describing the burden of malaria at delivery in a urban maternity in Senegal. We measured the prevalence of placental malaria infection. We described the association between placental malaria and low birth weight and the impact of chemoprophylaxis. STUDY AREA: Guediawaye is the most important suburb of the city of Dakar, Senegal, surrounded by a permanent marsh (niayes). Malaria in this area is hypo endemic transmission: 1 infective bite/person/year. An. arabiensis is the principal vector and P. falciparum (98%) the most frequent species. The Maternité Roi Baudoin in Guediawaye is the gynecologic and obstetrical reference centre of this area with more than 6000 deliveries/year. METHODS: We carried out an exhaustive survey from August 98 to December 99 at the maternité Roi Baudoin in Guediawaye. The socio-demographic data, the clinical data and information about prophylaxy were collected by questionnary. For each woman at delivery, one placental apposition was carried out. Presence of trophozo?tes or schizontes indicated malaria placental infection. RESULTS: 8310 women were included in the study. They were from 13 to 49 years old with an average age of 26.1; 28% were primigravidae. The prevalence of placental malaria infection was 8.1% (674/8310) [Ic95: 7.4-8.8%]. Schizontes were present in 80.5% of infected placenta. The prevalence was 8.8% within primigravidae group and 7.4% in the other parity groups, p = 0.28 (NS). Placental infection was present all the year long. However, there were important seasonal variations. The risk of placental infection increased during seasonal transmission (> 10%) compared to the period of low transmission (3%). The prevalence of placental malaria was lower in the group of women who declares regular chloroquine intake compared with those who declared taking no prophylaxy or irregular prophylaxy (RR = 0.78 [0.62-0.98]). The risk of low birth weight was of 1.9 [1.6-2.1] when the placenta was infected compared with non infected placenta. CONCLUSION: This study indicates that placental malaria infection is frequent in this low transmission area where more than 70% of women declared taking regular chloroquine. This observation could be explained by a resistance of P. falciparum to chloroquine or a poor observance of chemoprophylaxis.     

Role of preoperative plasma CA 15-3 and carcinoembryonic antigen levels in determining histopathologic conventional prognostic factors for breast cancer

Abstract Breast cancer is one of the leading causes of cancer death among women all over the world, with about one million new breast cancer cases diagnosed per year. This large number of cases make the diagnosis, treatment, and determination of the factors affecting the survey extremely important. The aim of this study was to evaluate the importance of the preoperative plasma CA 15-3 and carcinoembryonic antigen (CEA) levels when determining the conventional histopathologic prognostic factors (tumor grade, lymphatic infiltration, stromal invasion, vessel invasion, tumor necrosis, elastosis, and number of positive lymph nodes in levels I and II). We believe that with this protocol doctors can add to their knowledge about the prognosis of patients. After examining the serum tumor marker levels and the histopathology results of 29 patients and submitting them to statistical calculations, we strongly believe that preoperative serum CA 15-3 levels can be taken into consideration when evaluating the prognosis because the CA 15-3 level is directly and positively correlated with the gold standard prognostic factor: the number of level I and II positive lymph nodes. Electronic Publication     

A case of pneumonia following human infection with avian influenza a (H5N1)

The H5N1 infection was diagnosed in 12 patients in Turkey and confirmed by the WHO. Of these 12 patients so far, 8 have been published. In this case, we are presenting a case of pneumonia that developed following avian influenza infection in Eskisehir. Our case is one of the 4 patients who were not reported previously.     

Anticholinergic drugs,bladder retraining and their combination for urge urinary incontinence: a pilot randomised trial

Bladder retraining and anticholinergic drugs in women with urge urinary incontinence need to be compared. Women with urge urinary incontinence were recruited by advertisements, from primary care and from a urogynaecology clinic. Women were randomised using a web page to bladder retraining, anticholinergic drugs or both and followed up at 3 and 12 months. No blinding was attempted. The primary outcomes were the trial process and the Overactive Bladder Questionnaire (OAB-q) quality-of-life measure. Recruitment was much slower than anticipated. There were no differences in the OAB-q at 12 months (87.9 SD 11.6 bladder retraining, 81.6 SD 19.3 drug therapy and 88.9 SD 9.9 combination) but dry mouth was more common in those taking drugs. It is feasible to run a pragmatic randomised trial with 12-month follow-up for women with urinary urge incontinence. This will require about 500 participants per arm. Trial registration  This trial was registered as ISRCTN 66713401.     

The satisfaction, motivation, and future of community preceptors: the North Carolina experience.

PURPOSE: To measure satisfaction and motivation of community-based preceptors, and to examine differences between degree groups of physicians, pharmacists, advanced-practice nurses (nurse practitioners and certified nurse midwives), and physician assistants. METHOD: In spring 2005, the authors mailed a four-page, 24-item survey to all 2,061 community-based primary care preceptors served by the North Carolina Area Health Education Centers system. The survey measured preceptor satisfaction, likelihood of continuing as a preceptor, influence of having students, motivation for teaching, satisfaction in professional practice, satisfaction with incentives, and value of incentives. RESULTS: Response rate was 69.3%, or 1,428 preceptors. Most preceptors (93.0%) reported high satisfaction with their precepting experience, and 90.9% indicated high likelihood of continuing to precept for the next five years. Almost all preceptors (93.7%) reported they were satisfied with their professional life. Many community preceptors (57.2%) were satisfied with incentives. They placed greater value on the intrinsic reasons for precepting (i.e., enjoyment of teaching) rather than extrinsic rewards (such as no-cost online library resources). Degree groups placed differing values on intrinsic and extrinsic rewards. Physicians reported more negativity about the influence of students and regarding aspects of their professional lives. CONCLUSIONS: Tailoring support to better meet individual degree groups' preferences can maximize resources and may encourage preceptor retention. Special attention to physicians' needs may be warranted to avoid decreased preceptor numbers in this at-risk group. Future studies are needed to determine whether these findings are unique to North Carolina, which has a strong infrastructure to support preceptors.     

Surgical correction of hallux valgus deformity in children with cerebral palsy

Objective

This study aimed to present a treatment algorithm for the correction of the hallux valgus deformity in Cerebral Palsy (CP) patients and to discuss the outcomes based on our clinical and radiological results.