Acute carcinoma of the breast

The timely discovery of curable carcinoma through screening and early treatment is compromised by the existence of acute carcinoma with adverse properties. The existence of an acute carcinoma must be considered in planning and promoting any public health program for the control of carcinoma of the breast. These carcinomas will surface under any contemporarily available screening or detection program through no physician or patient error. These carcinomas have identifiable properties, and their occurrence should not be the basis of a malpractice suit, since their evolution is not presently preventable. The available data on actual doubling times obviously provide truncated distributions, since they contain no data on the faster subsets of carcinomas that surface in the intervals between screenings too quickly to permit measurement of size and calculation of DT (act).     

Women, menopause, and (Ms.)information: communication about the climacteric

This research utilizes a communication perspective to examine the dissemination of information about menopause in terms of women's attitudes, beliefs, and knowledge. Specifically, this study uses a grounded theory approach (Glaser & Strauss, 1967) to explore the communicative processes of misinformation concerning women's lived experiences in relation to the climacteric. Five emergent themes extracted from premenopausal, perimenopausal, and postmenopausal women's discourse are identified and described through qualitative data analysis. Findings suggest that due to a lack of consistent communication, women are generally either unknowledgeable or misinformed about menopause and its related issues. Inaccurate information concerning a health-related experience that all women undergo has negative implications for women, their practitioners, and society. Moreover, a clearer understanding of women's experiences concerning menopause may enhance communication in physician-patient interactions (PPIs).     

Profiles of nursing home residents with HIV

Nursing homes are part of the long-term care continuum available to people with advanced HIV disease. The objective of this paper is to profile nursing home residents with HIV at the time of admission, using the Minimum Data Set (MDS). These resident profiles contain sociodemographic characteristics, health status measures, and special treatments and procedures. There are 5,115 admission assessments in the MDS for residents with HIV between June 22, 1998, and January 17, 2000, analyzed for this study. Newly admitted nursing residents with HIV are predominantly male (69.4 percent) and minority (75.4 percent black and Hispanic), relatively young (44.45 years), and heavily Medicaid dependent (70.5 percent). These residents are typically clinically complex and receive a range of special treatments, procedures, and programs. Nursing home residents with HIV are a distinct subset of nursing home residents, largely dependent on the state Medicaid programs to pay for their care.     

Clinical validation of methods of diagnosis of neuropathy in a field study of United Kingdom sheep dippers

Objectives: To investigate the reproducibility of measured indices of chronic peripheral neuropathy from a field study of sheep dippers when compared with similar measurements carried out in a clinical setting. Methods: A stratified random sample of field study subjects was invited to attend a clinic. Neuropathy was measured both in the field and at the clinic with a modified version of a standard symptoms questionnaire and quantitative sensory thresholds for hot, cold, and vibration. These were combined into a classification of the likelihood of neuropathy with a neuropathy scoring system. Indicators of sensory abnormality were based on comparison of sensory thresholds to age dependent reference values derived from an external reference group. Results: Only 51% of subjects were assigned similar classifications in the field and clinic based on the neuropathy scoring system. Of the component indices, grouped symptom scores, with 65% of subjects showing exact agreement, proved to be more reproducible than quantitative sensory test indicators. There were biases in the comparison of field and clinic measurements of hot and vibration sensations, but no evidence of greater variation between individual people in sensory thresholds in the field relative to at the clinic. Conclusions: The neuropathy scoring system proved to be of limited reproducibility, due in a large part to the lack of reproducibility of the indicators of sensory test abnormality caused by inadequate temperature control. However, the symptoms score and measured sensory thresholds could be used separately as indices of neuropathy in exposure-response analyses.     

Olanzapine effects on auditory sensory gating in schizophrenia

OBJECTIVE: New-generation antipsychotics have been proposed to normalize the P50 sensory gating index in patients with schizophrenia. In the context of a double-blind comparison of olanzapine and haloperidol, the authors examined the effect of olanzapine on P50 suppression. METHOD: P50 measurements were obtained at baseline while patients were being treated with fluphenazine and after 12 weeks of double-blind treatment with either olanzapine (N=12) or haloperidol (N=12). RESULTS: There were no treatment group differences in P50 amplitude, latency, or sensory gating ratio. CONCLUSIONS: These results suggest that there is not a significant differential effect of olanzapine and haloperidol on the P50 sensory gating index in schizophrenia.     

Severe chronic idiopathic thrombocytopenic purpura during childhood: definition, management, and prognosis

Chronic idiopathic thrombocytopenic purpura (ITP) can be categorized as mild, moderately severe, or severe. Severe chronic ITP during childhood is a rare disorder characterized by clinically significant mucocutaneous hemorrhage, usually in the setting of marked thrombocytopenia. It can cause substantial morbidity and rarely mortality. Many patients improve with time or even fully recover, but for those whose quality of life is negatively influenced by hemorrhage or side effects of conventional therapy (corticosteroids, intravenous immunoglobulin G, or anti-D), splenectomy is recommended. If splenectomy is unsuccessful or not feasible, other drug treatments are available, but few efficacy data exist, and the toxicity and cost of these treatments can be appreciable. Their use is best avoided outside of clinical trials conducted in specialty centers or in multi-institutional networks.     

Self-report treatment techniques used by dentists to treat dentally anxious children: a preliminary investigation

Summary. Objective. To investigate the extent to which dentists report their encouragement to dentally anxious children to blunt (distract from the procedure) or monitor (give information about the procedure) during treatment. Setting. British Society of Paediatric Dentistry conference. Subjects and methods. One hundred and two of 155 delegates (66% response rate) completed a Monitor Blunter Treatment Checklist (MBTC), which was included in their conference pack. Participants were asked to tick all of the 10 statements (five monitoring and five blunting) that reflected how, in general, they would treat a dentally anxious child. Results. Dentists chose significantly more monitoring than blunting statements. Treatment strategies relating to explaining procedures were endorsed by the majority of dentists, while distraction was chosen by less than a third. Conclusion. Dentists tend to use monitoring strategies that adhere generally to the principles of the Tell‐Show‐Do technique. This may have implications if the anxious child has a ‘blunting’ coping style.     

Sir James Paget (1814-1894)

Sir James Paget (Fig. 1) formed with William Fergusson (1808–1862)and Sir Benjamin Brodie (1783–1762) a triumvirate of surgical‘greats' in England in the nineteenth century [1]. Pagetwas born in Great Yarmouth, Norfolk, England, and until 20 yrof age had not ventured further than a few miles from his birthplace.His father, Samuel, was a prosperous businessman who unfortunatelywent bankrupt, so that James after his elementary school educationin Great     

Analyses of the minimum data set: comparisons of nursing home residents with multiple sclerosis to other nursing home residents

This research compares nursing home residents with multiple sclerosis (MS) at admission to other nursing home residents using the minimum data set (MDS). These comparisons include sociodemographic characteristics and health status measures, as well as treatments and procedures received. We analysed 14,009 admission assessments in the MDS for residents with MS between June 22, 1998 and December 31, 2000. We also analysed 440,642 MDS admission assessments for all residents admitted to nursing homes during the year 2000, with any admission assessments for residents with MS excluded from this comparison group. Residents with MS were significantly younger at admission than other recently admitted residents. In addition, residents with MS tended to be significantly more physically disabled and also less cognitively impaired than other residents at admission, based on analyses of several measures of physical disability and cognitive performance. Nursing homes caring for residents with MS should provide services and programs, including mental health care, that address the needs of these younger, more physically disabled, and more cognitvely intact residents.     

The eye of the beholder: ratings of risk using a reliable instrument and identical clinical material

Risk management is increasingly seen as a task for health professionals. However little is known about how different professionals perceive and rate risk. The purpose of this study was to see if professional background and experience influence how an assessor rates risk. Psychiatric staff were presented with identical clinical information about one case. They were then asked to score the HCR-20. This is a structured clinical assessment and gives a score of between 0 and 40. Higher scores indicate increased risk of future violence. There was a twofold variation in the score from 15 to 30. There was no difference between medical and non-medical staff. However there was a significant difference between different grades of psychiatrists. Senior psychiatrists scored the clinical and risk items significantly lower when compared with junior psychiatrists. There was no significant difference in the scoring of historical items. The twofold variation in the score on the HCR-20 emphasises that risk assessment is a two-way process. Individual differences of assessors may be very important. Our findings suggest that senior psychiatrists score risks as lower. Possible explanations are discussed.