Variation of Cadmium Concentration in Swedish Wheat and Barley

In order to evaluate whether or not an increase in daily cadmium intake may be taking place, 75 wheat samples (spring wheat and fall wheat) harvested from the same “nonpolluted” farm fields between the years 1916 and 1972 were analyzed.

The individual scatter was large but a significant (P<.05) tendency toward increasing concentration with time was evident for fall wheat. A similar tendency was found for spring wheat, though not a statistical significance. This increase may be explained by general air contamination or the cumulative effect of fertilizers.

There was a clear covariation in cadmium concentrations of different genotypes of wheat and barley harvested in the same year despite yearly variations in average concentration.     

Surveillance of multidrug resistance of two Gram-positive pathogenic bacteria in a teaching hospital and in vitro efficacy of 30 ethnomedicinal plants used by an aborigine of India

ObjectiveTo record hospital- and community-acquired accounts of multidrug resistance (MDR) of two Gram-positive pathogens, Staphylococcus aureus (S. aureus) and Enterococcus faecalis (E. faecalis), by surveillance, and to evaluate antibacterial potencies of 30 plants with information on ethnomedicinal uses for infectious ailments by the aborigine Kandha tribe of Kalahandi district, Odisha (India), against both pathogens.MethodsOver a period of 6 months bacteria/ strains of S. aureus and E. faecalis were isolated from clinical samples in a teaching hospital and their antibiograms were ascertained using 17 antibiotics of 9 different groups. S. aureus strains were further tested for confirmation if they were methicillin and vancomycin resistant, similarly, E. faecalis strains for vancomycin resistance. Concentrated aqueous and ethanolic extracts of leaves/barks of 30 plants were used for monitoring their antimicrobial potencies, by the agar-well diffusion method, along with qualitative phytochemical analyses.ResultsFrom the surveillance, both pathogens were found MDR and it was evident that the distribution of MDR strains was more in hospital-acquired than community-acquired samples. Both aqueous and ethanolic extracts of plants, Diospyrous melanoxylon, Woodfordia fruticosa (W. fruticosa), Oroxylum indicum (O. indicum), Dalbergia paniculata and Lantana camara had the most significant in vitro controlling capacity against MDR strains of both bacteria. Further, extracts of Holarrhena antidysenterica, Aspidopterys tomentosa and Argyreia speciosa had moderate antibacterial activities. Ethanolic extracts of L. camara, O. indicum and W. fruticosa contained all the phytochemicals, alkaloids, glycosides, terpenoids, reducing sugars, saponins, tannins, flavonoids and steroids, which could be attributed to the recorded significant antibacterial activity.ConclusionS. aureus strains have been found as the most widely prevailing pathogens in nosocomial settings, than in community. Plants, L. camara. W. fruticosa, O. indicum and P. santalinus, particularly could be useful for a use as complementary/ supplementary/alternative therapeutic agents against Gram-positive pathogens.     

Are patients' decision‐making preferences being met?

Objective To investigate the information and decision‐making expectations of general practice patients during real life consultations. Design Post‐consultation, quantitative patient preference and enablement questionnaire. Setting and participants Patients attending for routine appointments in general practice surgeries in Oxfordshire, UK. Results Thirteen Oxfordshire general practitioners (GPs) volunteered to take part and a total of 171 patients completed and returned the questionnaire. Between a quarter and one‐third of patients reported receiving less information than they desired, particularly in relation to the risks and benefits of medical treatments. Patients who preferred the doctor to make decisions for them (35%), were more likely to have their preferences met (64%) compared with patients wishing to share decisions (47%) or make their own (18%) who were less likely to achieve this role (52 and 41%, respectively). However, it could not be demonstrated unequivocally that these differences were statistically significant. In total, 61% of patients perceived that they achieved their preferred decision‐making role. No significant differences were found in post‐consultation enablement scores between any of the decision preference groups. Patients' assessments indicated that some doctors were more successful at achieving congruence than others. Conclusion The decision‐making preferences of general practice patients tend to vary. However, there was a substantial mismatch between the stated preferences of patients for the role they wanted to have in decision‐making and what they felt actually took place in their consultation. Therefore, it remains a challenge for doctors to match their consultation style to the decision‐making preferences of individual patients.     

Normothermia: Ideal temperature for cardio pulmonary bypass

Background Hypothermic systemic perfusion has remained as an integral part of Cardiopulmonary bypass (CPB). Myocardial and Cerebral protection has been claimed as advantage of hypothermia. Normothermic CPB has been proved to be a safe alternative with good myocardial and cerebral protection. Material & Methods From March 2000 to Oct 2003, 346 cases were done under CPB with normothermic Systemic and myocardial perfusion. The age range being 7 months to 80 years with a mean of 43.69±20.41 years. The M:F ratio is 236∶110. (2.14∶1). The procedures performed include congenital heart disease, valve procedures, coronary artery bypass grafting and others. The following peri- and postoperative data were analysed statistically to evaluate the efficacy of Normothermic CPB. Total CPB time was 101.24±50.45 minutes, time interval between onset of CPB and aortic cross clamp was 5.23±2.31 minutes and release of cross clamp and off CPB was 7.34±3.85 minutes. Arrhythmia occurred during weaning off CPB in 5 (1.44%) patients. Ionotropes used during weaning from CPB in 93 (26.87%) patients of which 76 (21.96%) cases required only dopamine. Vasodilators required during weaning off CPB in 15 (4.33%) patients. Development of systemic hyperthermia during rewarming was in 1 (0.28%) case & difference of central and peripheral blood pressure in 7 (2.03%) cases. Postoperative ventilation duration was 5.04±4.79 hours. Total bleeding was 237±115 mls, re-exploration was done in 6 (1.73%) cases. Postoperative neurological complication in 2 (0.57%), renal impairment requiring dialysis in 2 (0.57%) & GI bleed in 2 (0.57%) cases. Mortality was in 6 cases of which 1 (0.28%) was due to inability to wean off from CPB. Conclusion We conclude normothermic systemic and myocardial perfusion during CPB is physiological, reduces morbidity and is a safe alternative to hypothermic CPB.     

Self-reported use of shared decision-making among breast cancer specialists and perceived barriers and facilitators to implementing this approach

BACKGROUND: Physicians are increasingly urged to practice shared decision-making with their patients. Using a cross-sectional survey, we explored the extent to which Ontario breast cancer specialists report practising shared decision-making with their patients, their comfort level with this approach, and perceived barriers and facilitators to implementation. PARTICIPANTS AND METHODS: All Ontario surgeons and oncologists (radiation and medical) treating women with early-stage breast cancer were eligible for this study. Likert scales were used to measure physicians' comfort level with and self-reported use of different treatment decision-making approaches as well as perceived barriers and facilitators to treatment decision-making with patients. RESULTS: The response rate was 79% for oncologists and 72% for surgeons. More physicians from each specialty (87% of oncologists and 89% of surgeons) expressed high levels of comfort with clinical example 4 (designed to illustrate a shared approach) than with any of the other examples presented (e.g. the informed and paternalistic approach). Similarly, more oncologists and surgeons reported that their usual approach to treatment decision-making was like example 4 than like any other approach presented (56% of oncologists and 69% of surgeons, respectively). Comfort levels with example 4 for oncologists and surgeons were 31% and 20% higher, respectively, than the reported use of this approach. Lack of time and patient anxiety, patient lack of information and/or misinformation, and patient unwillingness or inability to participate were perceived by a substantial minority of both oncologists and surgeons as barriers to patient involvement in treatment decision-making. Key facilitators identified included patients' emotional readiness, support, information and trust in the physician. More research is needed to identify contextual, physician, patient, and interaction factors that will facilitate shared decision-making in the medical encounter and help both parties create an environment conducive to implementing this approach to the extent desired.     

Development of an information source for patients and the public about general practice services: an action research study

OBJECTIVE: The publication of information about the performance of health-care providers is regarded as central to promoting greater accountability and empowering patients to exercise choice. The evidence suggests that the public is not very interested in accessing or using current sources of information. This study aimed to explore the information needs of patients in the context of UK primary care and to develop an information source about general practice services, designed to be usable by and useful to patients. DESIGN: An action research study making use of data from formal and informal interviews, focus groups, participant observation and document review. SETTING: The geographical areas covered by two Primary Care Trusts in the north of England and two Local Health Boards in south Wales. PARTICIPANTS: A partnership between 103 members of the public, general practice staff from 19 practices, NHS managers from four Primary Care Organizations and the research team. RESULTS: The public would like to know more about the quality and range of general practice services but current sources of information do not meet their needs. The public do not like league tables comparing the performance of practices and only a small number of people want to use comparative information to choose between practices. They seem to be more interested in the context and availability of services and the willingness of practices to improve, than in the practice's absolute or relative performance. They want to be clear about the source of the information so that they can make personal judgements about its veracity. Information is most likely to be useful if it adheres to the basic principles of cognitive science in terms of its structure, content and presentation format. Using these findings, paper and electronic prototype versions of a guide to general practice services have been developed. CONCLUSIONS: In order to maximize the potential use of performance information by the public it is necessary to move beyond provider-led and professionally constructed approaches to information provision and ensure that the public is actively involved in the development of information sources. Such involvement produces a different kind of information to that currently available to the public. The findings of this study have important implications for policy. Most importantly, it seems that the traditional consumerist model underlying a policy of making comparative performance information available to the public to enable them to exercise choice between primary care providers may not be appropriate. An alternative model of information provision, which recognizes the public's commitment to their practice and is integrated with 'soft' sources of knowledge is more likely to engage and be of use to the public.