Intensive versus standard blood glucose awareness training (BGAT) with insulin-dependent diabetes: mechanisms and ancillary effects

Insulin-dependent diabetes mellitus (IDDM) patients make critical daily self-care decisions on the basis of what they estimate their blood glucose (BG) levels to be. This study: a) replicated efficacy of Standard Blood Glucose Awareness Training (BGAT), b) evaluated the relative efficacy of an Intensive Blood Glucose Awareness Training (BGAT) to enhance patient accuracy of BG estimation, and c) evaluated the mechanisms and ancillary effects of BGAT. Thirty-nine subjects were randomly assigned to one of three groups. Compared with Control, both Standard and Intensive BGAT improved accuracy (p less than 0.001). Intensive BGAT post-treatment accuracy relative to Standard BGAT did not reach statistical significance (p = 0.177). Greater improvement in accuracy was associated with poorer pretreatment accuracy. Only Intensive BGAT improved metabolic control (glycosylated hemoglobin), and this improvement was associated with poorer pretreatment control. The effects of BGAT were highly specific, affecting only accuracy and metabolic control, and not affecting fear of hypoglycemia, diabetes knowledge, of frequency of blood glucose monitoring.     

Analysis of trauma intubations

The timing of trauma patient intubation is dependent on clinical presentation and clinician judgment. We sought to correlate the timing of intubation with the presenting of physiologic parameters and clinical outcome to identify potential quality assurance audit filters. Patients (n = 82) were grouped by timing of intubation: PREHOSPITAL, paramedic intubation; IMMEDIATE, within 10 minutes of arrival; DELAYED, beyond 10 minutes but within 2 hours of arrival; and NONURGENT, beyond 2 hours or at the time of surgery. While mean revised trauma scores and Glasgow Coma Scale (GCS) scores differed for the groups, the mean length of hospital stay and the incidence of aspiration pneumonia were not significantly different. In the DELAYED group, 80% of those who developed aspiration pneumonia had a GCS < or = 13. Patients in the NONURGENT group were older and commonly presented with tachypnea. The survival rate for the NONURGENT group was lower than predicted by the TRISS method (P = .004). A GCS < or = 13 and age greater than 50 years with presenting respiratory rates of more than 25 breaths/min represent potential trauma intubation audit filters.     

Age and gender effects in EEG coherence: III. Girls with attention-deficit/hyperactivity disorder.

OBJECTIVE: This study investigated intrahemispheric and interhemispheric EEG coherences as a function of age in girls with different DSM-IV subtypes of Attention-Deficit/Hyperactivity Disorder (AD/HD). It completes a series of 3 studies aimed at clarifying developmental and gender impacts on the coupling between brain regions in this disorder. METHODS: Three groups of 40 children (AD/HD combined type, AD/HD inattentive type, and normal controls) participated. Each group contained 8 females in each of 5, 1-year age bands from 8 to 12 years. EEG was recorded from 21 sites during an eyes-closed resting condition. Wave-shape coherence was calculated for 8 intrahemispheric electrode pairs (4 in each hemisphere), and 8 interhemispheric electrode pairs, within each of the delta, theta, alpha and beta bands. RESULTS: Developmental effects in intrahemispheric coherences at shorter and longer inter-electrode distances were not as predicted by Thatcher's two-compartment model, contrary to previous findings in boys. Females with AD/HD showed evidence of developmental delay and widespread anomalous elevations in coherence. Girls with AD/HD of the combined type showed similar but greater anomalies than girls with AD/HD of the inattentive type. CONCLUSIONS: Girls with AD/HD show coherence anomalies relative to age- and gender-matched controls, which differ substantially from those shown by boys with AD/HD. These coherence anomalies did not differ in nature between girls with different DSM-IV subtypes of AD/HD, suggesting that subtype differences in girls reflect only symptom severity. SIGNIFICANCE: The data reported here indicate qualitative differences in EEG coherences in girls with AD/HD compared with controls, and quantitative differences between girls with different subtypes of AD/HD. Both sets of effects differ in nature from those previously found in boys with AD/HD, showing the need to carefully consider gender in future studies of AD/HD.     

界定需要急诊入院的高危人群单纯依据既往的入院率会造成误导

预测哪些人可能因急性发病而需要急诊入院，已成为英国国家医疗卫生服务体系（NHS）的一个重要话题。卫生部门将那些患有复杂的慢性疾病，经常不定期地去二级医疗机构就医的人们视为高危人群。确定这些人之后，社区护理员或其他卫生人员将通过“个案管理”的方法照顾他们。“个案管理”此前被定义为“对疾病尚未控制或所需费用昂贵的患者进行加强医疗计划”。社区护理人员可来自任何护理部门，但一般认为社区护士更能胜任这一角色。此方法能够减少可避免的急诊入院患者数量，并有助于实现到2008年3月减少5％急诊住院床位日的公共医疗服务目标。但是，如何才能界定需要急诊入院的高危人群呢？     

Bremsstrahlung imaging using the gamma camera: factors affecting attenuation.

Quantitative imaging of bremsstrahlung from pure beta emitters is proposed as a means for in vivo management of antibody therapy. The method involves the use of high-energy collimation, an empirically selected broad photon energy window to enhance detector sensitivity, and a Wiener restoration filter to compensate for system blur. The measured and filtered data were obtained for an idealized scattering medium and isolated spherical sources. An effective linear attenuation coefficient of about 0.13 cm-1 was determined from the raw image data of 32P. A coefficient of 0.14 cm-1 was determined after the images were restored using the Wiener filter. The measured attenuation was not significantly dependent on the size of the region of interest or the size of the source. Its variation was within the experimental error of measurement (+/- 5%). The measured sensitivity (6 x 10(-6) cps/Bq) was sufficient for imaging therapy doses of 32P or 90Y.     

Nine Years of the Freebase Cocaine Epidemic in the Bahamas

Nine years after the beginning of the epidemic of freebase (crack) cocaine abuse in the Bahamas, this historical study was done to characterize the natural course of the epidemic and to estimate the effectiveness of control measures. The authors' data include the incidence of new cases at the only psychiatric hospital in the Bahamas and at the primary community psychiatric clinic in the nation. The Bahamian response included 1) demand reduction, 2) supply reduction, and 3) reduction of money laundering. The annual number of new cases of crack abuse presenting for treatment declined from 1987 to mid-1991 in both facilities, but in 1992 it began rising again in the inpatient setting only. The changes in recent years have been accompanied by an increase in violent crimes against persons, especially robberies. (American Journal on Addictions 1994; 3:14–24)     

RESULTS OF EXTERNAL BEAM RADIOTHERAPY IN 448 PATIENTS WITH CLINICALLY LOCALIZED ADENOCARCINOMA OF THE PROSTATE

The results of external beam radiotherapy for clinically localized adenocarcinorna of the prostate in 448 patients treated in the period 1980–90 were reviewed. The average follow up was 4.9 years. The patients were aged 44–87 years (median 69 years) and all had histopathological evidence of adenocarcinoma by needle biopsy or transurethral resection of prostate. The histopathological grading was: 127 G₁; 154 G₂; 127 G₃; 12 G₄; 28 G_x. Clinical staging according to TNM (American Urological Association) was: 29 T₀ (A2); 4 T₁ (B1); 173 T₂ (B2); 176 T₃ (C1); 63 T₄ (C2); 3 T_x. Routine surgical pelvic lymph node staging was not performed but patients had radiological (computerized tomography scan or lymphogram) nodal staging: 350 N₀; 22 N₁; 12 N₂; 64 N_x. High energy linear accelerator external beam radiotherapy was given by multiple fields to total doses of 50–70 Gy (median 60 Gy). The majority of patients (307, 69%) was treated by a uniform policy under the care of one radiation oncologist (HM). The rates of local and distant failure at 5 years were 10% (s.e. = 2%) and 42% (s.e. = 3%), respectively. The late complication rate at 5 years was 25% (s.e. = 2%), comprising mild 16%, moderate 7% and severe 1.3%. The 5 year overall survival rate was 64% (s.e. = 2%) and the cancer-specific survival rate was 74% (s.e. = 3%). Both histological grade and clinical stage were strongly predictive of overall survival and distant failure. Only histological grade was predictive of local failure. Treatment with external beam radiotherapy for this common cancer resulted in survival and disease control rates that compare favourably with other published radiotherapy series and has been accompanied by acceptably low morbidity.