Courts/Trusts--No Trespassing

This paper was delivered to the 'Children (NI) Order--Fit for Purpose?' conference, November 2002. It explores the relationship between the Health and Social Services Trusts and the Courts in Northern Ireland, when dealing with matters under the Children Order. The characteristics of children who come before the courts are examined, and the rise in the use of Interim Care Orders and the increase in Court disposal time are highlighted. The article cites many of the challenges facing child care professionals today and argues that 'enhanced assessment', particularly at the 'front' of the system, be developed, supported by 'enhanced quality assurance'. Underpinning the paper, the importance of respect for each other's disciplines is stressed in order to work for the best interests of the child.     

Increased erbB-2 gene copies and expression in multiple stages of breast cancer

In order to examine the role of the erbB-2 oncogene in human breast cancer, gene amplification and expression were examined in multiple stages of tumor progression. Gene amplification ranging from 2-fold to 32-fold was found in 30 (29%) of 130 cases analyzed. Expression of the receptor-like gene product was determined by a combination of Western immunoblotting and immunohistochemistry. In each case of gene amplification, there was high level overexpression (+ + +) of the protein product. In an additional 29 of 111 cases in which expression was studied (26%), there was moderate level overexpression (+ +) of erbB-2 in the absence of gene amplification. Amplification and overexpression of the erbB-2 gene were found in early clinical stages of breast cancer as well as in more advanced cases. In 23 patients, gene number and level of gene expression were equivalent in the primary tumor site compared with single or multiple metastatic sites in regional lymph nodes. Using a combination of immunohistochemistry and in situ cytohybridization, high (+ + +) and moderate (+ +) level overexpression were homogeneously present in all malignant epithelial cells within histological sections of both primary and metastatic tumor. The intraductal component of carcinoma was identified in sections from 16 invasive primary tumors. erbB-2 gene expression in the intraductal lesions was equivalent to or exceeded expression in the infiltrating components of these tumors. Because erbB-2 alterations are (a) present in all clinical stages, (b) maintained during metastatic spread, (c) homogeneously present throughout tumor sections, and (d) present in the in situ as well as infiltrating component, we conclude that these alterations are selected for early and may be important in the initiation of certain mammary cancer.     

Myasthenia gravis associated with etanercept therapy

Etanercept is an antagonist of tumor necrosis factor alpha that was developed to treat rheumatoid arthritis. In this report we present a patient who developed myasthenia gravis while taking etanercept and had resolution of symptoms after stopping it. This is the first report of this potential side effect and is of additional interest, because etanercept has been proposed as a treatment for myasthenia gravis. Muscle Nerve, 2009     

Stellenwert einer allgemeinen chirurgischen Hochschulambulanz für die medizinische Patientenversorgung

Zusammenfassung Über den Zeitraum 2001 bis 2003 wurden alle in der allgemein-chirurgischen Hochschulambulanz der Universitätsklinik Heidelberg anfallenden Behandlungsfälle, Diagnosen und Prozeduren, sowie Daten zu Patientenherkunft und Zuweisercharakteristik, differenziert nach viszeral-, gefäßchirurgischen und traumatologischen Bereichen prospektiv aufgezeichnet. Weiterer Fokus wurde auf die Quantifizierung von zeitphasenabhängigen Variabilitäten der Leistungsvolumina und der resultierenden Belastungsschwankungen gesetzt. Zusätzlich wurde retrospektiv eine Aufwandsabschätzung in den Bereichen Forschung, Lehre und Krankenversorgung mittels strukturierten Fragebögen und Interviews durchgeführt. Die Daten verdeutlichen die dominierend medizinische Versorgungsfunktion einer allgemein-chirurgischen Hochschulambulanz mit Überlauffunktion für den ambulanten Sektor. Forschung und Lehre treten in der Bedeutung zurück und werden überwiegend in nachgeschalteten Spezialambulanzen realisiert. Allgemein-chirurgische Ambulanzen, können damit für integrierte medizinische Versorgungsmodelle eine gute Basis darstellen. Die Leistungsvergütung muss allerdings wegen der hohen Versorgungsvolumina und hohen Leistungsvorhaltungserfordernis durch immense Belastungsschwankungen zukünftig kostendeckender gestaltet werden.     

Quality of life in women with stress urinary incontinence

The objective of this study was to identify clinical and demographic factors associated with incontinence-related quality of life (QoL) in 655 women with stress urinary incontinence who elected surgical treatment. The following factors were examined for their association with QoL as measured with the Incontinence Impact Questionnaire (IIQ): number of incontinence (UI) episodes/day; self-reported type of UI symptoms (stress and urge); sexual function as measured by the Prolapse/Urinary Incontinence Sexual Questionnaire; symptom bother as measured by the Urogenital Distress Inventory; as well as other clinical and sociodemographic factors. A stepwise least-squares regression analysis was used to identify factors significantly associated with QoL. Lower QoL was related to the greater frequency of stress UI symptoms, increasing severity, greater symptom bother, prior UI surgery or treatment, and sexual dysfunction (if sexually active). Health and sociodemographic factors associated with lower incontinence-related QoL included current tobacco use, younger age, lower socioeconomic status, and Hispanic ethnicity. Supported by cooperative agreements from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional support from the National Institute of Child Health and Human Development and the Office of Research on Women’s Health, National Institutes of Health.