Anthelmintic use on Saskatchewan pig farms: results from a postal survey

Two surveys examining the prevalence and intensity of Ascaris suum were conducted at a Saskatchewan abattoir. In the first, 2500 livers from market weight animals were examined and scored for lesions consistent with ascarid migration. Forty-four percent displayed some degree of scarring with approximately 8% being severely damaged. In the second, both livers and intestinal contents from 500 market weight animals were examined. Seventeen percent were infected with intestinal A. suum (mean of 2.5 parasites per infected pig) and 50% had liver lesions typical of ascarid larval migration. Fifty-three percent of the animals in the second survey had some evidence of ascarid infection (adult parasites, hepatic lesions or both). The results are compared with those from a similar survey conducted in the late 1970s at the same abattoir as well as with surveys conducted elsewhere in Canada and in the UK.     

Aptitude of doctors about cardiopulmonary resuscitation--a survey

Cardiopulmonary resuscitation is applied to extremely moribund cases with cardiac or respiratory arrest. General practitioners are mostly resuscitator outside hospital. With the idea to see the aptitude of this manoeuvre, 16 prefixed questions on this manoeuvre were selected for answers among 50 general practitioners. Only 2(4%) answered all the questions correctly and most (80%) of them answered 4 questions correctly. The results evoked a worrisome outcome. So it is suggested to update the practical patient care training like cardiopulmonary resuscitation among the doctors and paramedical personnel.     

Case finding in the elderly: a postal questionnaire

AIMS: To evaluate a postal questionnaire designed to identify elderly persons in need of geriatric evaluation and intervention in the community. METHODS: A sample of elderly persons, over 75 years, was randomly selected from the age-sex register of four general practices in the Auckland area. All respondents filled out postal questionnaires and a blinded assessment was made in their own homes using validated geriatric assessment tools (the reference test). Objective evaluations were compared to self report questionnaire results and sensitivity, specificity, positive and negative predictive values were calculated. RESULTS: Sixty-four persons aged 75-93 were evaluated. Thirty-nine subjects (61%) answered the questionnaire in a way which indicated they had one or more unmet needs. Reference test evaluations showed that 23 persons (36%) had problems in one or more areas. Sensitivity for the questionnaire was 0.78 (18/23 correctly identified) and specificity was 0.49. Positive and negative predictive values were 46% and 80% respectively. CONCLUSIONS: A postal questionnaire may be a useful adjunct to health surveillance of the elderly in general practice in New Zealand.     

Responses to a postal survey on women''s health after birth: importance of repeated mailings and characteristics of non-respondents

The simulation of breast fields using an isocentric set-up technique can be a lengthy process involving the placement of the isocentre, the determination of the gantry angles, and the selection of the lung shields, which in our center is one of six standard blocks. We show that with a body contour taken through central axis, five measurements and a calculator program, it is possible to significantly decrease the amount of time required to simulate a breast patient. We have developed a program for an HP48GX handheld calculator to determine the gantry angles, the isocentre, the field width, the standard angled block, and the couch and collimator rotation. The calculations are based on measurements of the field length, the horizontal distance between midline and mid axillary line, and the vertical distances from the mid axillary line to the inferior and superior beam border and central axis at midline. We use spherical geometry to perform the calculations to reflect the true environment and do not make any assumptions about the average patient's shape. For the simulation process a jig was developed that is inserted into the tray holder of the simulator to show the optical and radiological shadow of the calculated shielding along the patient's midline for clinical assessment during simulation and on the simulation film. The jig also has a holder for an aluminum wedge to improve the image quality of the simulation film. We admit that the lung shield increases the dose to the contralateral breast because of increased scatter and transmission through the shield; however, the block decreases the volume of irradiated lung while keeping the beam edge along the midline of the patient. The technique has been in use for two years and has resulted in time savings of up to 30% per patient. It has proven to be an easy and accurate way of setting up isocentric treatments to the breast.     

How common is medical training in palliative care? A postal survey of general practitioners

BACKGROUND: General practitioners (GPs) have a central role in palliative care, yet research continues to reveal room for improvement in symptom control at home. There is a need to evaluate how well-prepared GPs are for this task of caring for the dying at home. AIM: To evaluate the training in palliative care GPs have received throughout their careers. METHOD: Postal survey of 450 randomly selected East Anglian GP principals, investigating training in five areas of palliative care (pain control, control of other symptoms, communication skills, bereavement care, use of syringe driver), as clinical students, junior hospital doctors, GP trainees (registrars), and GP principals. RESULTS: A response rate of 86.7% was obtained. While GPs were clinical students, training was uncommon, (32% reported no training in pain control, and 58% no training in bereavement care), although there has been a significant increase in more recent years. Training as junior doctors was particularly uncommon (over 70% report no training in communication skills or bereavement care); there was some evidence of an increase in more recent years. During the GP trainee year, training was much more common. For GP principals, most areas had been covered, although over 20% reported no training in communication skills and bereavement care. During the community-based years as trainee and principal, training was significantly more common than during the hospital-based years of training as clinical student and junior doctor. CONCLUSIONS: There is a continuing need for medical education in palliative care. Particular attention should be paid to the basic medical education of clinical students and the training of junior doctors, especially regarding communication skills and bereavement care.     

Comparison of adverse events associated with use of mefloquine and combination of chloroquine and proguanil as antimalarial prophylaxis: postal and telephone survey of travellers

OBJECTIVE: To compare the frequency of adverse events, particularly neuropsychiatric effects, from mefloquine and from chloroquine plus proguanil as used for malaria chemoprophylaxis. DESIGN: Retrospective questionnaire to travellers taking either regimen between November 1993 and February 1995; telephone interview with those reporting pronounced side effects. SETTING: Travellers from Britain who consulted an advisory helpline. SUBJECTS: 1214 adults taking mefloquine and 1181 taking chloroquine plus proguanil. MAIN OUTCOME MEASURES: Reported presence of and degree of disability from 12 neuropsychiatric and other symptoms, as assessed by the subjects and by referees and on the basis of behaviour change. RESULTS: There were equal rates of any side effects (40%) and of stopping or changing medication. Overall, neuropsychiatric adverse events were significantly more common in travellers taking mefloquine. In all, 333 neuropsychiatric adverse events were reported by 1214 travellers taking mefloquine, compared with 189 such events in 1181 travellers taking proguanil plus chloroquine (P < 0.001). In all, 0.7% of travellers taking mefloquine had disabling neuropsychiatric adverse effects, compared with 0.09% of those taking proguanil plus chloroquine (P = 0.021). Two travellers taking mefloquine (1 in 607) were admitted to hospital as a result of the adverse event, compared with 1 in 1181 travellers taking proguanil plus chloroquine. CONCLUSION: There is a significant excess of adverse neuropsychiatric events of intermediate degrees of severity associated with the use of mefloquine compared with proguanil plus chloroquine. This finding may also explain the discrepant findings between earlier studies and clinical experience.     

From zebra stripes to postal zones: deciphering patterns of gene expression in the cerebellum

The analysis of patterned gene expression has been an important tool for dissecting the molecular and developmental bases of functional compartmentalization in the mammalian cerebellum. In particular, sagittally-oriented cellular aggregates arranged along the mediolateral axis are the patterning element most commonly invoked to illustrate cerebellar compartmentalization, and these are revealed both by patterns of afferent projection and by a number of classical biochemical markers that are distributed in a pattern of'zebra stripes'. Compartmentation along both the mediolateral and rostrocaudal axes might be linked mechanistically to segmentation in the fruit fly, since early cerebellar development is especially dependent upon the expression of mammalian homologs of Drosophila segmentation genes. In addition, as has been demonstrated in the retinotectal system, some of these genes are likely to control positional information required for the sagittal organization of cerebellar afferent projections. However, in contrast to these global or macro zones, the cerebellum is also compartmentalized at the subcellular or micro level. This can be visualized by differential patterns of mRNA distribution within the sole cerebellar efferent system, the Purkinje cell, defining within such cells a number of distinct subcellular domains or 'postal zones'. The global versus subcellular levels of cerebellar compartmentalization are related since they both appear to be linked to patterns of afferent innervation.A major goal of cerebellar research will be to unravel the true nature of such a relationship, and its relevance to function and behavior.     

Development of a postal health status questionnaire to identify people with dyspepsia in the general population

OBJECTIVE: To develop and validate a postal health status questionnaire which will identify people with dyspepsia in the general population. DESIGN: Validation against telephone interview and post re-post determination of reliability. SETTING: A general practice population in the north of England. SUBJECTS: A random sample of adults aged 20-69 years inclusive chosen from the general population. MAIN OUTCOME MEASURES: Validity has been checked against telephone interview. A kappa statistic has been calculated for each question and clinical category. RESULTS: Compared with interview the questionnaire is a valid, comprehensive and easily understood record of symptomatology. The kappa statistics (mean value 0.92) indicate a very reliable questionnaire. CONCLUSION: The questionnaire accurately and reliably identifies people with dyspeptic symptoms.     

Making the best use of a department of clinical radiology--guidelines for doctors

A total of 17 patients with alimentary tract duplications underwent surgery at National Taiwan University Hospital from 1978 to 1994. Fifteen patients (88%) had gastrointestinal duplication and two (12%) had esophageal duplication. Common presenting symptoms of gastrointestinal duplication were melena and abdominal pain. The ileum was the most common site of duplication. Multiple duplications were seen in three patients. All duplications were cystic, except for one single appendiceal duplication. Ectopic gastric mucosa was detected in nine of the 16 nongastric duplications. One patient with ileal duplication had ectopic pancreatic tissue. Twelve patients received resection of the duplication with a segment of bowel and primary anastomosis, three patients underwent simple excision and two patients had partial resection of the duplication and stripping of the residual mucosa. Two patients had other associated congenital anomalies: one had ventricular septal defect and the other, imperforate anus and malrotation of intestine. There was no operative mortality or morbidity in this series.     

Elderly people's use of services: a survey

This article describes some of the findings of a longitudinal survey of three samples of older people living at home in East London and Mid Essex. It describes the service use and need for community services of the three samples at their baseline interviews, and then looks at how their patterns of use and need changed by the time of their follow-up interviews. It shows that older people are generally using services appropriately, but that there are still unmet needs. Service use was found to increase with age as health and functional ability declined. Further findings will be published shortly.     

Pediatric coin ingestion: a home-based survey

To improve understanding of the natural history of pediatric coin ingestions, an anonymous, home-based mail survey of parents followed by a five-physician private pediatric practice in suburban Maryland was conducted. Of 2,263 families surveyed, 798 (35.3%) responded, representing 1,510 children. Sixty-one (4.0%, 95% confidence interval: 3.1% to 5.1%) children had swallowed a coin, at a mean age of 2.8 years. Fifty-two (85%) coin ingestions were managed at home, usually without calling a physician or poison control center. Only 9 (15%) children were examined by a physician. No child (95% confidence interval: 0% to 4.9%) underwent a removal procedure or had an adverse outcome. Most coin ingestions were found to have been managed at home, often without calling a physician or poison control center. Hospital- or poison control center-based studies underestimate coin ingestion incidence and overestimate the frequency of complications.