Radiological evidence of constipation in urinary tract infection

Little objective evidence has been published to support the claim that constipation is an important contributory factor in recurrent urinary tract infection (UTI) in childhood. Using a radiological scoring system, two observers assessed faecal loading from abdominal radiographs of children with proved UTIs. There was a significant increase in the degree of faecal loading in children with UTI when compared with controls (r = 0.237). This difference was mainly accounted for by girls with recurrent (greater than five) UTIs. This study confirms an association between recurrent UTI and faecal loading. Further studies are needed to establish if there is a causal relationship and benefits from treatment.     

Thermodynamic resolution of periosteal reaction and taphonomic change

New bone formation (e.g., periosteal reaction) is one component of bone and joint disease diagnosis. Its application in the archeologic record has been compromised by lack of standardization. An objective technique for validating observations seems especially valuable when visual examination of a single data set results in widely disparate perspectives. Such discrepancies as to presence or absence of periosteal reaction are amenable to objective analysis. Bone, as any other form of matter, has a variety of properties. Some are characterized by weight or volume and are referred to as colligative. Some are related to its intrinsic nature, independent of mass. The latter are referred to as non-colligative. Non-colligative properties of matter provide an opportunity to assess structure, independent of quantity. Study of one such property, entropy, revealed that taphonomic changes can confidently be distinguished from bone surface reaction. Contrasted with the homogeneous entropy of normal bone, the loss of surface bone inherent in taphonomy results in reduced entropy. Contrasted with the homogenous patterns of normal bone, specific non-homogenous patterns allow periosteal reaction to be recognized, independent of variety of periosteal reaction or its origin. Thermographic approach allows observational techniques to be independently validated. Such validation allows for greater facility in interobserver archeologic site sample comparisons.     

How long should patients with psychotic depression stay on the antipsychotic medication?

BACKGROUND: Patients who have major depression with psychotic features have greater morbidity and mortality than patients with nonpsychotic major depression. In particular, relapse and recurrence have been reported to occur more frequently in patients with psychotic depression than nonpsychotic depression. Despite the frequent relapse and recurrence in major depression with psychotic features, there are few studies of the efficacy of continuation and maintenance treatments. METHOD: Forty patients with a diagnosis of unipolar DSM-III-R major depression with psychotic features were treated with fluoxetine and perphenazine for 5 weeks after granting written informed consent. The patients who responded to treatment continued to receive the combination for an additional 3 months. If a patient was stable for 4 months on treatment with the combination, the patient was then gradually tapered off perphenazine treatment. For patients who exhibited impending relapse, perphenazine was restarted. Impending relapse was defined as any of the following: (1) symptoms meeting DSM-IV criteria for major depressive disorder (with or without psychotic features), (2) a total score of > or = 17 on the HAM-D, or (3) the presence of any psychotic symptoms. After 1 year of taking fluoxetine, patients were tapered off fluoxetine treatment. Data were gathered from 1992 to 1997. RESULTS: Thirty patients responded to the initial 5 weeks of treatment with perphenazine and fluoxetine. After taper of perphenazine following 4 months of treatment with fluoxetine and perphenazine, 22 (73%) of the 30 patients exhibited no signs of relapse over the next 11 months (8 months of fluoxetine monotherapy followed by a taper of fluoxetine and 3 additional months of assessment). Patients who showed signs of relapse after taper of the antipsychotic were more likely to have had a longer duration of the current episode and a history of more frequent past episodes and were more likely to be younger (under the age of 30 years). CONCLUSION: The data from this study suggest that a majority of patients who have major depression with psychotic features do not require treatment with antipsychotic medication for more than 4 months.     

Clinician Use of a Palmtop Drug Reference Guide

Objective: Problems involving drug knowledge are one of the most common causes of serious medication errors. Although the information that clinicians need is often available somewhere, retrieving it expeditiously has been problematic. At the same time, clinicians are faced with an ever-expanding pharmacology knowledge base. Recently, point-of-care technology has become more widely available and more practical with the advent of handheld, or palmtop, computing. Therefore, the authors evaluated the clinical contribution of a drug database developed for the handheld computer. ePocrates Rx (formerly known as qRx; ePocrates, San Carlos, California) is a comprehensive drug information guide that is downloadable free from the Internet and designed for the Palm OS platform align="right".Design: A seven-day online survey of 3,000 randomly selected ePocrates Rx users was conducted during March 2000.Measurements: User technology experience, product evaluation and usage patterns, and the effects of the drug reference database on information-seeking behavior, practice efficiency, decision making, and patient care.Results: The survey response rate was 32 percent (n=946). Physicians reported that ePocrates Rx saves time during information retrieval, is easily incorporated into their usual workflow, and improves drug-related decision making. They also felt that it reduced the rate of preventable adverse drug events.Conclusions: Self-reported perceptions by responding clinicians endorse improved access to drug information and improved practice efficiency associated with the use of handheld devices. The clinical and practical value of using these devices in clinical settings will clearly grow further as wireless communication becomes more ubiquitous and as more applications become available.Medical knowledge is growing exponentially,¹ especially in the field of therapeutics. Pharmacologic advances have resulted in an ever-increasing variety of medications for clinicians to employ in patient care. Medications frequently have complex dosing regimens, changing indications, unique contraindications, and multiple drug–drug interactions and can cause serious adverse reactions. Because of the limitations of human memory,^2,3 it has become increasingly difficult for clinicians to keep up to date on the prescribing requirements of drugs, especially recently approved drugs.⁴Inquiries about drugs are one of the most frequent questions that clinicians have.⁵ This makes point-of -care technology—which can provide prescribing information at the bedside, on the hospital ward, and in the office examining room—especially attractive.⁶ Such technology has the potential to reduce the information search times of physicians, and such access may reduce the likelihood of incorrect and harmful drug-prescribing behavior.⁷Adverse drug events (ADEs), or injuries due to drugs, are frequent in a variety of patient care settings. Many are preventable and may be associated with significant patient injury.^8–11 Data suggest that drug knowledge deficiencies are the single most common systems cause of serious medication errors in inpatients.¹² Recent publicity has encouraged public and private support for patient safety improvements, including building safer medication practices.^10,11,13Several drug reference guides designed for use on handheld, or palmtop, computers have recently become commercially available, including ePocrates Rx (formerly known as qRx; ePocrates, San Carlos, California), a comprehensive drug information application. We sought to survey physician users to assess their experience incorporating handheld electronic drug reference guides into routine patient care.     

Clues to recognition of kidney disease in archaeologic record: characteristics and occurrence of leontiasis ossium

The possible osseous effect of kidney dysfunction was evaluated in a modern skeletal population for future use in assessment of archaeologic samples. Frequency and distribution on the bones of cysts, articular surface alterations, subperiosteal resorption, porosity, osteochondritis, digital tuft alteration and periosteal reaction were recorded in 94 individuals with known kidney failure in the Hamann-Todd collection. Independent radiologic analysis was also pursued. The results were compared with a control sample. The pattern of joint surface alteration and periosteal reaction may facilitate recognition of chronic renal disease in the osseous record. Subtle manifestations of leontiasis ossium are present in the form of cranial thickening and increased cranial size and weight, but teeth spacing are rare. Pseudo osteomatous lesions are common. This study perhaps explains the apparent rarity of actual leontiasis ossium.     

The pancake phenomenon contributes to the inaccuracy of margin assessment in patients with breast cancer

BACKGROUND: To determine the effect on margin evaluation for patients with breast cancer, we prospectively quantified the "flattening" of the breast specimen after surgical removal. METHODS: The volume and height of 100 consecutive breast biopsy specimens were recorded independently by the operating surgeon and the pathologist. Five factors were analyzed that were thought to contribute to changes in specimen dimensions: patient age, breast tissue density, mammographic lesion type, specimen size, and the use of compression during specimen radiography. RESULTS: After surgical removal, mean volume and height of the breast specimens decreased from 46 cm(3) to 29 cm(3) (30%) and from 2.6 cm to 1.4 cm (46%), respectively. Flattening of the breast specimens occurred in all subgroups studied. CONCLUSIONS: Breast specimens are flattened after surgical removal, losing almost 50% of their original height. This "pancake" phenomenon has important implications for the accuracy of margin analysis.     

An evaluation of alcohol attendances to an inner city emergency department before and after the introduction of the UK Licensing Act 2003

Background  

The Licensing Act 2003 (The Act) was implemented on the 24th November 2005 across England and Wales. The Act allowed more flexible and longer opening hours for licensed premises. We investigated the effect of The Act on alcohol related attendances to an inner city emergency department in Birmingham, UK.