Current concepts in the management of adult intraocular tumours

The management of intraocular tumours has come a long way since the days when enucleation was the only modality of treatment available to the ophthalmologist. Despite the fact that enucleation is still necessary in certain situations, the emphasis is currently on conservative management, thereby saving the eye and some amount of useful vision wherever possible. This review highlights the current trends in the management of adult intraocular tumours with emphasis on newer diagnostic modalities such as computed tomography, magnetic resonance imaging, and fine needle aspiration biopsy. Only those tumours that are most likely to be seen in clinical practice are included.     

Physicians' prevention-related practice behaviors in treating adult patients with asthma: results of a national survey

To improve the health outcome of adults with asthma, it is important to understand the current practice behaviors of physicians related to the prevention and treatment of asthma. A national survey was conducted to ascertain the practice behaviors of physicians in five specialty areas: internal medicine, pulmonary, allergy/immunology, occupational health, and family health. Similarities and differences in practice among the specialty areas are indicated. The data provide a basis for recommendations to improve the management of asthma by standardizing history taking, increasing the use of pulmonary function testing, and using effective counseling and patient education strategies.     

Interdisciplinary collaboration

This quasiexperimental study investigated interdisciplinary collaboration over a 16-month period on units using different collaborative practice strategies. Measures of collaboration and perceived physician involvement in collaborative practice were completed by 335 licensed staff members working on seven general adult units in an acute care hospital located in an academic medical center. Data were collected at two time points: in 1993 and 1995. A small but statistically significant decline in collaboration was found (p = 0.01) over the 16-month period. Analysis of variance revealed a significant difference (p = 0.03) in collaboration related to the method used to develop collaborative paths. Post hoc Tukey's test indicated that the presence of a case manager without collaborative paths did show higher levels of collaboration (p = 0.05). Regardless of the strategy used, perceived high physician involvement was related to greater collaboration than perceived low involvement with differences increasing over time (p = 0.02). These findings suggest the importance of perceived physician involvement in collaborative practice to interdisciplinary collaboration.     

Interdisciplinary teamwork

In recent years, the government of the People's Republic of China has been reporting the country's population as "nearly 800 million." A variety of evidence suggests that this approximation is the best currently available in China, and that it may be some time before further, more accurate, demographic data are produced. The paper presents and discusses alternate population estimates and projections by UN, US, and USSR specialists.     

Korean children's concepts of adult and peer authority and moral reasoning.

This study examined Korean children's judgments about authority commands regarding moral events bearing on property rights (dealing with lost property), distributive justice (sharing candy), and public welfare (disposing of trash). Sixty children from the 1st, 3rd, and 5th grades were presented with story variations in which an individual intervened, giving a command to children, or in which 2 different persons gave opposing commands. At all ages, children judged that a principal, a teacher, a class president, and a child who held no position of authority have legitimacy and should be obeyed when giving directives considered morally right. Children also accorded greater legitimacy to persons giving commands consistent with moral demands (a teacher, a class president, or a child with no position of authority) over a principal's command contrary to the moral evaluation. Justifications for their choices were based on rights, sharing, and welfare. The findings showed that Korean children do not take a unilateral orientation to adult authorities or unquestioningly accept authority directives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating and treating nutritional problems in older patients

Up to 65% of elderly hospitalized patients are protein-energy undernourished at admission or acquire nutritional deficits while hospitalized. For the elderly patient who requires nutritional support therapy, a strategy of intervention should be carefully formulated based on the results of a clinical assessment. While receiving nutritional support, the patient should be monitored carefully for complications and changing metabolic requirements. Modifications to the original regimen should be made to meet the patient's needs as necessary.     

Acquisition of new concepts by two amnesic patients

Two Korsakoff amnesics (A.G. and G.S.) and two control subjects were taught six new concepts. Each concept was composed of three parts: the name of the concept, the context in which the concept originated and its definition. The learning procedure consisted of two phases: (1) learning the concept names and definitions by means of the vanishing-cues method; (2) practice on examples of the concepts through a classification task: examples were either set in the same context as that given in the original definition or in mixed contexts (same and new contexts). Subjects were then tested after 24 hours, a week and a month on their ability to identify new examples as belonging to one of the conceptual rules studied (transfer tests). Both patients showed substantial learning. Patient A.G. was slow and dependent of the first letter cues in the vanishing-cues learning phase but nevertheless, she acquired a large and flexible conceptual knowledge and this was especially true for concepts that were practised by means of mixed-context examples. Patient G.S. easily learned to associate the definitions with the concept names but her conceptual knowledge remained more limited. These results confirm the existence of a semantic learning ability in amnesic patients. They also suggest that under appropriate learning conditions, amnesics may eventually acquire a new flexible conceptual knowledge.     

Symptom distress in adult patients with cancer

Symptom distress in the adult population with cancer is of concern to clinicians who care for these patients. Increased research has been directed toward the development and refinement of symptom distress scales, the identification of determinants of symptom distress, the investigation of symptom distress as a predictor, and the examination of the relationship between quality of life and symptom distress. Findings from this research have increased our understanding of symptom distress in adult patients with cancer. However, a major limitation of work to date has been a lack of consensus related to the definition and measurement of the symptom distress construct. The purpose of this article is to address existing conceptual and methodological challenges inherent in the study of symptom distress, and to make recommendations for further research in this area.     

Bone marrow transplantation in adult thalassemic patients

One hundred seven adult patients with thalassemia aged from 17 through 35 years and transplanted from HLA-identical siblings between November 1988 and September 1996 were evaluated on December 31, 1997. The outcome experience of 20 consecutive patients transplanted between November 13, 1988 and January 10, 1991 and reported in September 1992 is updated after 5 additional years. The experience on 87 patients transplanted between May 1991 and September 1996 is described and evaluated as of the end of December 1997. Of 107 patients, 69 survive between 1.5 and 9 years after transplantation. Sixty-six of these patients do not have thalassemia and are identified as ex-thalassemic after bone marrow transplantation. The youngest survivor is 20 years old, 6 are older than 30 years, and the oldest is 37 years of age. Patients with chronic active hepatitis at the time of transplant were significantly more likely to die than patients without (P =.05; relative risk, 2.05). Marrow transplantation is a valid treatment option for older patients with thalassemia who have suitable donors and show deterioration with conventional therapy.     

Noncancer deaths in white adult cancer patients

BACKGROUND: The cancer-specific death rate is a commonly used indicator in the assessment of progress against cancer. However, since the cause of death is often not substantiated and complete medical information is lacking, the validity of cancer-specific mortality rates is being questioned. PURPOSE: We investigated the validity of the cancer-specific death rate by examining noncancer deaths of cancer patients in a large patient population. METHODS: Data were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program on cancer patients diagnosed between 1973 and 1987, with follow-up complete through December 1987. The SEER database consists of 1.2 million records from nine population-based registries covering nine geographic regions of the United States. Rates of noncancer deaths in the U.S. population were obtained from the National Center for Health Statistics. Cancer mortality rates were subtracted from overall mortality rates to obtain noncancer death rates by sex and the 5-year age group for each calendar year. Excluded from the study were patients of races other than White and those diagnosed at age 85 years or more due to absence of noncancer death rate comparisons. Also excluded were cancer cases discovered at autopsy and in persons less than 20 years of age. The statistical analysis employed a log-linear model. RESULTS: The ratio of patient-to-general-population noncancer death rates, as calculated by dividing the number of patient noncancer deaths per year by the number found in the matched U.S. population data and referred to as the noncancer relative hazard, is considered significant with values greater than 1 for those with all cancers combined and for the common solid tumors examined. Of the 12 leading causes of death other than cancer in the patient population, the most common causes were circulatory and respiratory failures. The noncancer relative risk of death decreased rapidly after diagnosis and also decreased with the patient's age at diagnosis. It increased slightly with the calendar year of diagnosis. CONCLUSIONS: Because more noncancer deaths occurred shortly after diagnosis, it appears that this excess was caused by treatment of the cancer. Generally, cancer-specific death rates underestimate the mortality associated with a diagnosis of cancer. Therefore, because the degree of underestimation changes with time, an examination solely of cancer-caused mortality in assessing progress against the disease is incomplete.     

Interdisciplinary collaboration in outpatient practice.

Psychology has had a long history of collaboration with the medical profession. This collaboration has been greatly enhanced over the past decade or more as an increasing number of psychologists have become successful in applying the science and practice of psychology to the problems of health and illness. This article reviews and summarizes salient aspects of professional issues in practice that contribute to successful collaboration with physicians in primary and tertiary ambulatory health care settings. Practical strategies to enhance collaboration in independent practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The decoding of emotional concepts in patients with focal cerebral lesions

The effects of focal brain lesions on the decoding of emotional concepts in facial expressions were investigated. Facial emotions are hierarchically organized patterns comprising (1) structural surface features, (2) discrete (primary) emotional categories and (3) secondary dimensions, such as valence and arousal. Categorical decoding was measured using (1) selection of category labels and selection of the named emotion category; (2) matching one facial expression with two choice expressions. Dimensional decoding was assessed by matching one face with two different expressions with regard to valence or arousal. 70 patients with well documented cerebral lesions and 15 matched hospital controls participated in the study. 27 had left brain damage (LBD; 10 frontal, 10 temporal, 7 parietal); 37 had right brain damage (RBD; 15 frontal, 11 temporal, 11 parietal). Six additional patients had lesions involving both frontal lobes. Right temporal and parietal lesioned patients were markedly impaired in the decoding of primary emotions. The same patients also showed a reduced arousal decoding. In contrast to several patients with frontal and left hemisphere lesions, emotional conceptualization and face discrimination was not independent in these groups. No group differences were observed in valence decoding. However, right frontal lesions appeared to interfere with the discrimination of negative valence. Moreover, a distraction by structural features was noted in RBD when facial identities were varied across stimulus and response pictures in matching tasks with differing conceptual load. Our results suggest that focal brain lesions differentially affect the comprehension of emotional meaning in faces depending on the level of conceptual load and interference of structural surface features.     

Vesico-ureteric reflux in adult patients with spinal injury

OBJECTIVES: To review the incidence, aetiology, treatment and prognosis of vesico-ureteric reflux (VUR) in patients in a regional spinal injuries centre. PATIENTS AND METHODS: A retrospective review of radiological investigations revealed 34 of 447 (8%) patients with VUR on at least one study. The notes of these patients were examined to determine their management and outcome. RESULTS: Most patients developed VUR within 4 years of injury; the underlying intravesical pressure was high in half the patients studied. Patients were managed aggressively with a variety of medical and surgical techniques. The VUR of 15 patients resolved completely and in three patients there was some improvement. Renal function deteriorated in three patients as assessed by isotopic scanning. Two patients were transferred to our unit in end-stage renal failure associated with VUR and died within one year. CONCLUSIONS: VUR continues to be a problem in patients with spinal injury and remains potentially fatal through the effects of high transmitted pressure and infection. Renal failure does not always develop as a consequence of the combination of VUR and high intravesical pressure. No single aetiological factor for VUR was found. With active early treatment, the incidence of VUR can be minimized and long-term complications avoided.     

Hyperplasia of the sublingual glands in adult patients

Hyperplasia of the sublingual salivary glands in an entity of unknown cause not previously reported in the literature. The main clinical finding is a unilateral or bilateral painless sublingual enlargement of the sublingual gland without any recognized local or systemic associated factor.     

Population pharmacokinetics of vancomycin in Japanese adult patients

MICA is a new polymorphic gene in the HLA region expressed in epithelial cell lines and gastrointestinal epithelium. Little is yet known about the MICA protein, and the pattern of its expression by freshly isolated cells has not been established. In the present experiments, we used antibodies raised in rabbits against alpha1 and alpha2 domain-peptides to study the expression of MICA. By western blot and immunoprecipitation, we detected a band of 62 000 Mr in various cell lines (THP-1, U937, HeLa, A431, Raji, MOLT-4, and HUV-EC-C) and in freshly isolated keratinocytes, endothelial cells, and monocytes but not in CD4+ and CD8+ T cells, and CD19+ cells (B lymphocytes). It was not possible to up-regulate the expression of MICA in different cells by stimulation with gamma-interferon, but the expression of MICA was induced in phytohemagglutinin-stimulated T cells. We confirmed that MICA is expressed at the cell surface by flow cytometry. Results of immunoprecipitation studies of beta2-microglobulin (beta2m)- or MICA-depleted, metabolically labeled HeLa cells indicated that MICA was not associated with beta2m. Although the function of MICA is still unknown, its restricted pattern of tissue expression, the fact that it is expressed on the cell surface, and its polymorphic nature suggest that this new molecule, encoded close to HLA class I, may play a role in the interaction between epithelial cells and cells of the immune system.