Survey of spinal therapeutic procedures in the United Kingdom

The type and frequency of spinal therapeutic work being undertaken in the United Kingdom (UK) by clinicians with an interest in the surgcial treatment of disorders of the spine (primary and secondary subspecialty interest) were evaluated by means of a postal questionnaire. The willingness of respondents to take part in postgraduate spinal training was determined along with issues regarding accessibility of spinal services to non-specialist physicians in the health service in the UK. The results of 450 respondents provided insight into the types of procedures taking place, for example: primary spinal decompression was regularly carried out by 76% of surgeons, while at least 20% of respondents regularly carried out 66% of the procedures surveyed. We found that 10% of surgeons indicated that they were prepared to participate actively in postgraduate spinal surgical training.     

Allotransplantation of canine pancreatic islets.

The complications of diabetes continue to present significant health risks despite improvements in conventional insulin therapy. Transplantation of pancreatic islet tissue has the potential to provide more precise glucose regulation and possibly minimize these implications. Recent advances in pancreatic islet isolation technology have facilitated investigation of islet allograft function in large animal models. These studies are fundamental to the development of methods for transplantation of allogeneic or xenogeneic islets in diabetic patients. This paper reviews the approaches which have been taken to prevent rejection and allow assessment of islet allograft function in the pancreatectomized dog model. These approaches include immunosuppression, immunomodulation of the donor tissue and isolation of allogeneic tissue within an immunoprotective membrane.     

The profile and incidence of cancer in Down syndrome

Background Down syndrome is one of the commonest causes of intellectual disability. As life expectancy improves with early and more intensive surgical and medical treatments, people with the disorder are more likely to exhibit classic morbidity and mortality patterns and be diagnosed with diseases such as cancer. Methods A profile of cancer cases among people with Down syndrome has been compiled, based on the analysis of a linked data set that included information from the Disability Services Commission of Western Australian and the State Cancer Registry. Results and conclusions Although the total age‐ and sex‐standardized incidence ratios (SIRs) for people with Down syndrome were similar to that for the general population, SIRs for leukaemia were significantly higher while the incidence of certain other types of cancers was reduced. Overall, there was a lower incidence of solid tumours in Down syndrome, possibly reflecting the age profile of the study cohort.     

A Bayesian approach to aid in formulary decision making: incorporating institution-specific cost-effectiveness data with clinical trial results.

Pharmacy and therapeutics committees commonly cite a lack of generalizability as a reason for not incorporating cost-effectiveness information into decision making. To address this concern, many committees undertake site-specific economic evaluations, which are often limited by small sample sizes and nonrandomized designs. We show how 2 complementary approaches were used to minimize these limitations in an economic evaluation of abciximab at 1 institution. Using a propensity score methodology, we selected patients who did not receive abciximab for the comparison cohort. Then, we adopted a Bayesian, hierarchical, random-effects model to integrate site-specific and clinical trial data. We applied the posterior distributions of effectiveness with local cost data in a traditional decision-analytic model. In 74% of the simulations, abciximab was cost-effective at 1 institution at the $50,000 per life year saved threshold, assuming a 50:50 split of patients undergoing coronary stenting and angioplasty. Among patients undergoing coronary stenting, the cost-effectiveness ratio of the addition of abciximab was at or below the $50,000 per life year saved threshold in 66.0% of the simulations.     

Comparison of chemically dependent and nondependent nurses on familial, personal and professional characteristics

The characteristics associated with professional impairment due to chemical dependency in nurses are examined. A sample of 139 recovering chemically dependent nurses was compared with a random sample of 384 registered nurses not identified as chemically dependent on familial, personal and professional characteristics. Respondents completed an extensive mailed questionnaire requesting information on demographic variables, family history (past and present), education, employment, medical history, lifestyle characteristics and alcohol- and drug-related behaviors. Significant differences between the two groups were found in gender, familial alcoholism and depression, sexual trauma and functioning, sexual preference, parenthood status, marital history, physical health, depressive illness and alcoholism in spouse. No differences were found in sibling rank, basic nursing education, nursing school class rank, highest educational degree held, academic achievement and length of nursing experience. Recommendations for future study include improved methodology, study of recovery variables and longitudinal follow-up of recovering nurses.