Cost-effectiveness and pain medicine

The specialty of pain medicine, as noted by Lippe,“… justifies itself as a unique medical specialty by virtue of a distinct body of knowledge and a well-defined scope of practice. In common with other medical specialties, it is founded on an infrastructure of scientific research, education, and clinical practice [1].“ The traditional methods of education for healthcare providers, such as medical schools, nursing schools, physical therapy schools, and clinical psychology programs, do not prepare their students adequately for the delivery of evaluation and treatment services to patients experiencing pain. Also apparent, as evidenced by the dearth of medical literature, is that the traditional methods of educating pain specialists do not adequately prepare students for an effective approach to the realities of healthcare economics in their respective fields.The result of a lack of significant education in the economics of pain medicine can be financially devastating to a new practitioner who is practicing “good” medicine yet not meeting the financial obligations incipient in the operation of a multidisciplinary pain center or even a solo practice. One important concept in the study of healthcare economics is the issue of cost-effectiveness [2].     

Is schizophrenia genetically transmitted?

Clinicians and researchers alike have questioned and studied the origin of schizophrenia for decades. Since the early 1900s, a genetic hypothesis has been suggested. This article reviews studies on a possible genetic cause of schizophrenia by use of various methods of comparison: twins, adoption, family history, family studies, and studies of biologic markers. Most researchers conclude that schizophrenia is likely caused by a genetic predisposition coupled with environmental influences.     

Parapapillary diameter of retinal vessels. I. Estimating the size of the optic papilla (a papillometric study of over 264 normal eyes)

The diameter of the temporal superior and inferior retinal artery and vein were measured at the optic disk border and 2 mm from the disk center in 264 nonselected normal eyes on the basis of photographs, with correction of magnification. Additionally, the individual ocular magnification factor was determined by Littmann's method. The mean caliber of the artery was 0.113 +/- 0.019 mm at the disk border and 0.118 +/- 0.023 2 mm from the disk center. The corresponding values for the vein were 0.149 +/- 0.026 mm and 0.159 +/- 0.026 mm. The correlations between vessel caliber and disk size were not significant, but the relationship between disk size and the quotient of vessel diameter divided by disk size was highly significant (p less than 0.0001). Vessel diameter can therefore be taken as an independent unit for determining optic disk size in relative and approximately also in absolute units. Thus, mean horizontal disk diameter (1.77 +/- 0.33 mm) corresponded to 16.3 +/- 3.5 artery and 12.3 +/- 2.6 vein diameters (measured at the optic disk border). The mean individual ocular magnification factor was 0.302 +/- 0.017, with a Gauss standard distribution. If the optical characteristics of a photographed eye are not known and the ocular magnification factor is assumed to be 0.302, then 68.3% of all eyes will be covered with an inaccuracy of 5.6% and 95.5% of all eyes with an inaccuracy of 11.2%.     

Effects of accumbens DALA microinjections on brain stimulation reward and behavioral activation in intact and 6-OHDA treated rats

The effects of bilateral nucleus accumbens microinjections ofd-ala-met-enkephalinamide (DALA) were assessed in behavioral activation and lateral hypothalamic self-stimulation (LHSS) rate-frequency curve-shift paradigms in normal and accumbens 6-OHDA (4.0 µg) treated rats. Microinjections of DALA (2.5 µg/µl) in the behavioral activation paradigm had little effect on normal activity; however, DALA administered to 6-OHDA treated rats produced a significant overall increase in locomotion. The 6-OHDA DALA-induced locomotion effect peaked at 2 weeks after 6-OHDA treatment and then returned to baseline levels by week 5 posttreatment. Using LHSS, DALA tested over a range of doses (2.5, 5, 10, 20 µg/µl) displayed a weak biphasic reward effect only at the highest dose, which was characterized by an initial suppression followed by an elevation. DALA significantly depressed initial operant motor/performance in LHSS in a dose dependent fashion. Micro-injections of the normally ineffective low dose of DALA (2.5 µg/µl) following accumbens 6-OHDA treatment produced a significant LHSS reward decrease 2 weeks posttreatment, while LHSS motor/performance was relatively unaffected. Results are discussed in terms of opiate-dopamine and limbic-motor interactions.     

Autoregulation of beat frequency in respiratory ciliated cells. Demonstration by viscous loading

As opposed to the virtually constant load exerted by water on the cilia of ciliated protozoa, the hydrodynamic load on respiratory cilia can undergo broad variations because of changes in the rheologic properties of mucus. When water-rowing ciliated cells are exposed to increased viscosity (1 to 50 cP), their beat frequency decreases exponentially. According to Newton's fluid dynamic theory, this outcome is expected for an engine that generates constant force. However, the findings reported here indicate that when mucus-propelling respiratory ciliated cells are exposed to high viscous loads, ranging from 12 to 150 cP, the frequency of ciliary beat decreases only slightly, whereas the beat amplitude remains virtually constant. These observations suggest that ciliated cells of the respiratory tract have a functional reserve that allows them to autoregulate their mechanical output in response to the changes in viscosity to which they are normally exposed in the airway.     

Dietary fat intake and plasma lipid levels in adolescents.

The relationship between dietary fat intake and fasting plasma lipid levels was assessed in 35 female and 19 male adolescents recruited from two local education authority schools in Norwich, UK. Dietary intakes were assessed using a 7-day weighed dietary record method, coupled with the collection of duplicate diets. Fat and energy intakes calculated using food composition tables were compared with values obtained by direct analysis of duplicate diets. Fasting plasma lipid levels (total, HDL and LDL cholesterol and triglycerides) were measured and compared with total dietary lipids and fatty acid intakes. The average proportion of energy consumed as fat was higher than is currently considered desirable but lower than previous studies have reported for adults. Mean serum total cholesterol values were 4.2 (SEM 0.1) mmol for females and 4.5 (SEM 0.2) mmol for males; this difference was not statistically significant. In male subjects the dietary fatty acid profiles were significantly correlated with several parameters of plasma lipid status which are thought to be risk factors for coronary heart disease, and in particular with the ratio of total:HDL cholesterol.     

Elbow hemiarthroplasty with 20-year follow-up study. A case report and literature review

Hemiarthroplasty of the elbow with an endoprosthesis has been reported very infrequently; only about 20 cases have been reported previously in the literature. This case merits reporting because of the youth of the patient (age 19), the uniqueness of the prosthetic component, and the long-term follow-up observation. The patient had posttraumatic bony ankylosis of the elbow with a painful supracondylar pseudoarthrosis and loss of bone from the proximal metaphysis. A custom humeral endoprosthesis was inserted, and anatomic reconstitution of the sigmoid notch of the ulna was provided. Reasonably good, painless, stable motion was achieved, which has not deteriorated in the subsequent 21 years of observation. The clinical significance of this case is that in a nonweight-bearing hinged joint, endoprosthesis arthroplasty can be an excellent option when given the proper indications and carried out with meticulous planning.     

Maternal and fetal plasma vitamin E to total lipid ratio and fetal RBC antioxidant function during gestational development

Placental transfer of vitamin E was investigated from 19 to 35 weeks of gestation by analysis of fetal and maternal blood samples for total tocopherol, total lipids, and fetal red blood cell antioxidant reserves. Fifty-two fetal blood samples were obtained under ultrasonographic guide by percutaneous umbilical blood sampling. Thirteen were from fetuses with gestational age less than or equal to 22 weeks (x serum vitamin E = 0.4 +/- 0.14 mg/dl), 12 were from fetuses at 23-27 weeks gestation (x serum vitamin E = 0.4 +/- 0.21 mg/dl), and 27 were from fetuses with gestational age 28-38 weeks (x serum level = 0.37 +/- 0.18). Total lipid levels ranged from 140 to 216 mg/dl. Maternal plasma vitamin E concentrations correlated significantly with concurrent values in the fetus. There were no significant differences in serum vitamin E levels or vitamin E to total lipid ratio in samples from early, mid, or late gestation in either the mother or fetus. Red blood cell antioxidant reserve on samples from 18 fetuses were grossly abnormal by three different functional assays. On the basis of these data, placental transfer of vitamin E appears to be relatively constant through advancing gestation. Red blood cell antioxidant reserve is uniformly low.     

Victim Help Seeking: Differences Between Intimate Terrorism and Situational Couple Violence

Abstract: Research indicates that two major forms of partner violence exist, intimate terrorism (IT) and situational couple violence (SCV). The current study (N= 389) used a subgroup of women who responded to the Chicago Women’s Health Risk Study to examine whether type of violence experienced is differentially related to formal (e.g., police, medical agencies, counseling) and informal (e.g., family, friends/neighbors) help seeking. IT victims were more likely to seek each type of formal help but were equally or less likely to seek informal help. Findings can inform both family violence research and the development and implementation of social service programs.