Dental examinations for quality control: peer review versus self-assessment.

This paper reports the dental care norms for restorative dentistry collected from examinations of 1,466 patients in 105 dental offices in Washington State during 1976. These results are part of a larger study, "Assessment of Care and Continuing Dental Education," being conducted by the University of Washington with the endorsement and cooperation of the Washington State Dental Association. Treatments in volunteer offices were evaluated either by colleagues (peer review) or by the practitioner himself (self-assessment). Two hundred twenty-four of 1,196 eligible dentists volunteered for the study. Patients from the practitioners' offices were randomly selected from office files by project staff. The study tests the proposition that, using standardized clinical evaluation procedures and comparable samples of treatment, dentists will be more critical of their own work than that of others. Results suggest a generally high level of care provided by volunteer practitioners and that self-assessments were significantly more critical than peer review.     

Results of interposition "H" grafts for portal hypertension.

During the past nine years, 54 patients underwent interposition graft shunting for variceal bleeding in 48 and intractable ascites in six, either electively (35 instances) or as an emergency (13 instances). Autogenous jugular was used in 41 instances, homologous vena cava in nine and Dacron in five. The interposition graft was placed between superior mesenteric vein and vena cava in 36 instances and the portal vein and vena cava in 19. Using Child's Clinical Classification 44 were Class C and 10 Class B. There were six (11%) operative deaths with one (2.4%) in the elective and five (38%) in the emergency group. Encephalopathy was seen in 4 (10%) of those surviving more than one year. Two Dacron and two homografts thrombosed. Eight of the autografts were patent at autopsy, 18 on angiography and 15 assumed to be patent because patients were asymptomatic. Only one of 12 late deaths was related to grafts failure. Apparently the operation controls ascites and the autogenous jugular vein is the ideal material. Interposition "H" grafting is a simple safe procedure that can be used for portal decompression in patients with bleeding varices.     

Induction of labour with prostaglandin gel in patients with unfavourable cervices.

151 primigravid patients with Bishop scores of 4 or less were induced with prostaglandin E2 gel using an initial dose of 2 mg followed by 1 mg or 2 mg at 6 hours. Eighty one patients (53.6 per cent) were in established labour or had delivered by 12 hours, and a further 31 (20.5 per cent) had achieved successful ripening of the cervix. Ninety per cent and 64.5 per cent respectively achieved vaginal delivery and although 39 patients failed to respond to this regime, 72 per cent delivered vaginally after augmentation. No case of hypertonus was recorded and only one patient had abdominal delivery for "failed induction". This regime provides an effective means of induction of labour for a difficult group of patients with little worry of overstimulation and low "failed induction" rates.     

“Amnesia” for Summer Camps and High School Graduation: Memory Work Increases Reports of Prior Periods of Remembering Less

Claims regarding amnesia for childhood sexual abuse have often been based on studies of adults' responses to questions of the form, “Was there ever a period of time when you remembered less of the abuse than you do now?” In this experiment, 43 adult (mean age = 42) participants rated their current and prior memories of several nontraumatic childhood/adolescent events. Reports of prior periods of less memory were fairly common. Participants then engaged in “reminiscence” or “enhanced” retrieval activities directed toward remembering more about a selected target event. Following retrieval, 35% of the reminiscence condition participants reported prior poor memory for the target event, as did 70% of the enhanced condition. These results highlight the need for appropriate control conditions in retrospective studies of amnesia for childhood trauma.     

Doctor or nurse? The patients' choice

This project's aim was to assess patients perceived need for a specialist nurse in inflammatory bowel disease. A letter was sent to 64 patients with a summary of the potential role of a specialist nurse. Patients were asked to complete a questionnaire of 10 scenarios on who would be their preferred provider on the range of issues. There were 35 (55%) replies. When comparing the results between the consultant and the specialist nurse patients preferred to see a specialist nurse significantly in four scenarios, and patients preferred to see the consultant significantly in two scenarios. The results indicate that patients feel specialist nurses would have more time to discuss issues and they do not want to bother the busy doctors with them. But they do want doctors to carry out the medical aspects of their care.     

Advances in computer-assisted single-photon emission computed tomography (SPECT) for epilepsy surgery in children

Epilepsy surgery has emerged as an important option in the treatment of children with epilepsy that is refractory to antiepileptic drug management. The cornerstone of successful surgery is accurate localization of the brain region of seizure onset. Traditional techniques of seizure onset localization, e.g. surface electroencephalography (EEG) recording and magnetic resonance imaging (MRI), allow accurate localization in a significant number of patients. When the focus of seizure onset is not apparent from these non-invasive techniques, other methods of localization, e.g. intracranial EEG recording, may be needed before resection of the focus. Single-photon emission computed tomography (SPECT) is a nuclear medicine blood-flow technique that has been used to identify a region of epileptogenic brain associated with low blood flow in the resting state (interictal SPECT) or increased blood flow at the time of seizure activity (ictal SPECT). This report describes the validation and utility of a computer-assisted method of subtracting the interictal from the ictal SPECT scans and co-registering the difference image on the MRI. This method, called subtraction ictal SPECT co-registered on MRI (SISCOM), is used in guiding the location and the extent of intracranial electrode implantation, or in obviating the need for the implantation in some cases.     

Female circumcision (female genital mutilation): a problem for brachytherapy in cervical cancer

Female circumcision is a traditional practice common in African countries. It involves partial or total removal of external female genitalia. It has led to many complications, in particular, the scarring of the external genitalia. The consequence is a very narrow introitus making the intracavitary brachytherapy treatment component difficult when these women develop cancer of cervix. We present two such cases from our institution. Our aim is to make the radiation and gynecological oncologists, both in developed and developing countries, aware of this practice and the problems they can encounter in the management of such cases. Intracavitary brachytherapy is an important component in the potentially curative role of radiation therapy for cervical cancer. Every effort should be made to ensure that the sequelae of genital mutilation does not deprive these women of the same standard of care as the general population.     

Phenylalanine kinetics are associated with tardive dyskinesia in men but not in women

Rationale: An association between tardive dyskinesia (TD) and severely impaired metabolism of the large neutral amino acid (LNAA), phenylalanine (Phe) was defined in a group of mentally retarded patients. Subsequently, an altered kinetics of Phe was associated with TD in men with schizophrenia based on plasma analyses subsequent to the ingestion of a protein meal. Methods: In the present study, a standardized oral challenge of pure Phe (100 mg/kg in 170 ml orange juice) was administered to psychiatric patients of both sexes (n = 312), with and without TD after an overnight fast. Plasma LNAA levels were assayed both fasting and 2 h subsequent to the ingestion of the challenge. The extent of the increase in plasma Phe levels 2 h following a standardized challenge is determined by the sum of the kinetic processes of plasma absorption, tissue distribution, metabolism and elimination. Results: The study hypothesis, that TD would be associated with significantly higher post-challenge plasma Phe indices of an absolute plasma Phe level and plasma Phe/LNAA ratio (a brain availability measure), was verified for the study men (n = 209), but not for the study women (n = 103). Conclusions: The demonstrated altered kinetics of Phe in men with TD indicates a greater availability of Phe to the brain in these men. We suggest that the disorder may be related to the effects of this greater availability. Such effects could be the direct neurotoxic effects of Phe and its metabolites and/or the modulating effects of these compounds on the synthesis of the monoamine neurotransmitters. The fact that TD (Yes/No) group differences in post-challenge plasma Phe indices were not seen for the study women suggests the possibility of a sex difference in the biology of TD that we propose may be reflective of the young age of the study sample. Received: 28 January 1998/Final version: 14 December 1998