Esophageal cancer. American College of Gastroenterology

Antimicrobial resistance among common respiratory pathogens has become a significant problem. However, there remain multiple treatment options, including the newer macrolides, third-generation cephalosporins, beta-lactam/beta-lactamase inhibitor antibiotics, and the newer fluoroquinolones.     

Clinical guideline, part 2. Screening for thyroid disease: an update. American College of Physicians

PURPOSE: To review information on the benefits of screening with a sensitive thyroid-stimulating hormone (TSH) test for thyroid dysfunction in asymptomatic patients seeking primary care for other reasons. This paper focuses on whether screening should be aimed at detection of subclinical thyroid dysfunction and whether persons with mildly abnormal TSH levels can benefit. DATA SOURCES: A MEDLINE search for studies of screening for thyroid dysfunction and of treatment for complications of subclinical thyroid dysfunction. STUDY SELECTION: Studies of screening with thyroid function tests in the general adult population or in patients seen in the general office setting were selected (n=33). All controlled studies of treatment in patients with subclinical hypothyroidism or subclinical hyperthyroidism were also included (n=23). DATA EXTRACTION: The prevalence of overt and subclinical thyroid dysfunction, the evidence for the efficacy of treatment, and the incidence of complications in defined age and sex groups were extracted from each study. DATA SYNTHESIS: Screening can detect symptomatic but unsuspected overt thyroid dysfunction. The yield is highest for women older than 50 years of age: In this group, 1 in 71 women screened could benefit from relief of symptoms. Evidence of the efficacy of treatment for subclinical thyroid dysfunction is inconclusive. CONCLUSIONS: Even though treatment for subclinical thyroid dysfunction is controversial, office-based screening to detect overt thyroid dysfunction may be indicated in women older than 50 years of age. Large randomized trials are needed to determine the likelihood that treatment will improve quality of life in otherwise healthy patients who have mildly elevated TSH levels.     

Findings from the American College of Epidemiology's survey on Ethics guidelines. The American College of Epidemiology Ethics and Standards of Practice Committee

PURPOSE: A survey to establish both the need and subject areas for a possible new set of ethics guidelines for epidemiologists was conducted among a random sample of 300 North American (Canada, Mexico, and United States) members of three major United States-based professional epidemiology organizations. METHODS: An 88% response rate revealed wide agreement on topics to be included in any new set of guidelines, but uncertainty prevailed about the need for new guidelines; 41% agreed that there was a need to develop a new set, 43% had no opinion, and 16% disagreed. RESULTS: There was almost no difference in preferences between men and women for topics to be included in a new set of guidelines, or between those aware or unaware of extant ethics guidelines in epidemiology. Fifty-four percent were aware of such guidelines and only 29% of these said they could describe the content of the guidelines. CONCLUSION: More needs to be done to evaluate the utility of ethics codes in epidemiology.     

The National Cancer Data Base report on completeness of American Joint Committee on Cancer staging in United States cancer facilities. The American College of Surgeons Commission on Cancer and the American Cancer Society

BACKGROUND: American Joint Committee on Cancer (AJCC) staging is increasingly accepted as a prognostic standard for cancer management. The Commission on Cancer requires approved cancer programs to use AJCC staging for all cancers. Previous studies document increasing use of AJCC staging by hospitals with cancer programs. This review examines programmatic and clinical factors affecting AJCC staging completeness. METHODS: The data are registry records submitted to the National Cancer Data Base (NCDB) for cases diagnosed during 1993 or, for comparison, 1988. RESULTS: The mean facility staging rate was 87% in 1993, up from 65% in 1988. Approximately 64% of facilities staged greater than 90% of their stageable cases; 3% staged less than 5%. Even facilities with "complete" staging implementation were unable to stage substantial portions of some sites. Accessibility of tumor and overall prognosis affected the choice between pathologic and clinical staging. Staging completeness and the mix of pathologic and clinical staging also differed by state of the reporting facility. CONCLUSIONS: AJCC staging use is high among common tumors for which treatment is dependent upon stage of disease. However, if accurate staging is not expected to affect the treatment or outcome of the case or the overall outcome is poor, staging is less frequently recorded.     

ACR presidential address: Rheum for more. American College of Rheumatology

Regional brain injury in three neonates with hypoglycemic encephalopathy are presented using serial 99mTc-hexamethyl propyleneamine oxime (HMPAO) SPECT and, for comparison, MRI. During the acute stage, both 99mTc-HMPAO SPECT and MRI reveal abnormalities in the posterior cerebrum. Technetium-99m-HMPAO SPECT reveals further areas of insult, for example the frontal lobes. The degree of hypoperfusion correlates with the clinical severity of hypoglycemia during the neonatal period and subsequent neurological sequelae. Follow-up with HMPAO SPECT several months after insult demonstrates persistent hypoperfusion in some areas, mainly in the occipital and posterior parietal regions. MRI can depict morphological changes with superior resolution. Because morphological change generally follows slowly after functional change, MRI is less sensitive than HMPAO SPECT in detecting and predicting the extent of hypoglycemic cerebral injury during the acute phase. HMPAO SPECT during the acute stage is a valuable tool for evaluating the extent and severity of brain injury in neonates with hypoglycemic encephalopathy.     

American College of Sports Medicine position stand. Exercise and fluid replacement

It is the position of the American College of Sports Medicine that adequate fluid replacement helps maintain hydration and, therefore, promotes the health, safety, and optimal physical performance of individuals participating in regular physical activity. This position statement is based on a comprehensive review and interpretation of scientific literature concerning the influence of fluid replacement on exercise performance and the risk of thermal injury associated with dehydration and hyperthermia. Based on available evidence, the American College of Sports Medicine makes the following general recommendations on the amount and composition of fluid that should be ingested in preparation for, during, and after exercise or athletic competition: 1) It is recommended that individuals consume a nutritionally balanced diet and drink adequate fluids during the 24-hr period before an event, especially during the period that includes the meal prior to exercise, to promote proper hydration before exercise or competition. 2) It is recommended that individuals drink about 500 ml (about 17 ounces) of fluid about 2 h before exercise to promote adequate hydration and allow time for excretion of excess ingested water. 3) During exercise, athletes should start drinking early and at regular intervals in an attempt to consume fluids at a rate sufficient to replace all the water lost through sweating (i.e., body weight loss), or consume the maximal amount that can be tolerated. 4) It is recommended that ingested fluids be cooler than ambient temperature [between 15 degrees and 22 degrees C (59 degrees and 72 degrees F])] and flavored to enhance palatability and promote fluid replacement. Fluids should be readily available and served in containers that allow adequate volumes to be ingested with ease and with minimal interruption of exercise. 5) Addition of proper amounts of carbohydrates and/or electrolytes to a fluid replacement solution is recommended for exercise events of duration greater than 1 h since it does not significantly impair water delivery to the body and may enhance performance. During exercise lasting less than 1 h, there is little evidence of physiological or physical performance differences between consuming a carbohydrate-electrolyte drink and plain water. 6) During intense exercise lasting longer than 1 h, it is recommended that carbohydrates be ingested at a rate of 30-60 g.h(-1) to maintain oxidation of carbohydrates and delay fatigue. This rate of carbohydrate intake can be achieved without compromising fluid delivery by drinking 600-1200 ml.h(-1) of solutions containing 4%-8% carbohydrates (g.100 ml(-1)). The carbohydrates can be sugars (glucose or sucrose) or starch (e.g., maltodextrin). 7) Inclusion of sodium (0.5-0.7 g.1(-1) of water) in the rehydration solution ingested during exercise lasting longer than 1 h is recommended since it may be advantageous in enhancing palatability, promoting fluid retention, and possibly preventing hyponatremia in certain individuals who drink excessive quantities of fluid. There is little physiological basis for the presence of sodium in n oral rehydration solution for enhancing intestinal water absorption as long as sodium is sufficiently available from the previous meal.     

Coping With Intergenerational Family Conflict Among Asian American College Students.

Two coping strategies--problem solving and social support seeking--were hypothesized to differentially moderate the effects of intergenerational family conflict on well-being and adjustment in a college sample of 117 Asian American young adult children. Results indicated that social support served as a protective-stabilizing factor that buffered the effects of family conflict on positive affect and somatic distress. Problem-solving coping served as a protective-reactive factor that had a positive effect on positive affect when family conflict was low and a negative effect when family conflict was high. The potential implications of these findings for counseling and conducting research on Asian American college students are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Management of acute myocardial infarction. Synopsis of ACC and AHA practice guidelines. American College of Cardiology and American Heart Association

The average time that elapses from a patient's first awareness of heart attack symptoms to start-up of specific reperfusion therapy is currently 4 hours. The National Heart Attack Alert Program wants to see this time reduced to 2 hours. Such dispatch would surely benefit patients, because when it comes to thrombolytic therapy, the sooner the better. Dr Ryan summarizes the new recommendations for handling patients with acute myocardial infarction rapidly and efficiently, from the 911 call and transport to the emergency department, through the important first 24 hours of hospitalization, to hospital discharge and long-term management.     

The College of American Pathologists, 1946-1996. Quality Assurance Service

Since its creation in 1970, the College of American Pathologists Quality Assurance Service Committee has provided important and highly respected interlaboratory programs for daily quality control. In 1988, this committee extended its domain by announcing Q-Probes, a unique benchmarking program for laboratory quality assurance. Because of the success and rapid growth of this program during the next 2 years, the Quality Assurance Service Committee expanded into two committees, namely, QAS-QC and QAS-QA, with expertise concentrated, respectively, in quality control and quality assurance. These committees have compiled a history of significant scientific and educational contributions to members, the international laboratory community, other physicians, and patients. New directions for both committees are now underway so that their contributions can continue in the rapidly changing field of pathology and laboratory medicine.     

Pilot studies for proficiency testing using fluorescence in situ hybridization with chromosome-specific DNA probes: a College of American Pathologists/American College of Medical Genetics Program

This paper proposes that a comprehensive, long-term program with a case-management focus will produce better outcomes and be more cost-effective than the current approach to managing the illnesses of women on Temporary Assistance for Needy Families (or TANF, formerly known as AFDC) who are afflicted with both drug dependency and mental illness, i.e. a dual diagnosis. It is proposed that this comprehensive approach would diminish the generational cycle of substance abuse, dysfunction (including violence), and dependence on public support, which is too often the pattern in single-parent homes where the mother has been dually diagnosed. For our purposes, dual diagnosis is defined as any mental health diagnosis using the DSM-IV criteria coexisting with a diagnosis of substance abuse, whether licit or illicit. Current drug policy, particularly as it applies to those with a dual diagnosis, has an emphasis on criminal justice system solutions. It is extremely expensive (incarceration alone is variously estimated as costing $25,000 to $45,000 per year per person), and does little to treat, prevent, or consequently, reduce the problem. The model design discussed in this article provides for comprehensive treatment and support services to women with a dual diagnosis receiving TANF. Its goal is to help break the family cycle of system dependency. The article hypothesizes that if a well-designed program evaluation is implemented, it will demonstrate savings in reduced health care, criminal justice, and social service costs.     

Academic Stress Among College Students: Comparison of American and International Students.

This study compared academic stressors and reactions to stressors between American and international students using Gadzella's Life Stress Inventory (B. M. Gadzella, 1991). Five categories of academic stressors (i.e., frustrations, conflicts, pressures, changes, and self-imposed) and four categories describing reactions to these stressors (i.e., physiological, emotional, behavioral, and cognitive) were examined. The sample consisted of 392 international and American students from 2 Midwestern universities. American students reported higher self-imposed stressors and greater behavioral reactions to stressors than international students. Respondent's status (American or international) and interaction of status and stressors emerged as the 2 strongest predictors of their behavioral, emotional, physiological, and cognitive reaction to stressors. Five stressors attained statistical significance in the regression model. The findings emphasize the need to recognize cultural differences in stress management. Implications for mental health providers in the university arena are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

African American client skin tone and clinical judgments of African American and European American psychologists.

After reviewing a photograph and case materials depicting an African American female client, African American and European American psychologists were randomly assigned to one of three skin tone versions of a photograph (light, medium, or dark) and completed a questionnaire. No relationships were found between client skin tone or psychologist sex and either primary diagnosis or treatment recommendation. However, African American psychologists rated the client more physically attractive and likely to benefit from therapy, and they expressed more positive feelings about the client and about working with the client, than did European American psychologists, who more strongly endorsed severe mental disorder diagnoses for the client. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intergenerational Family Conflict and Coping Among Hmong American College Students.

Problem solving and social support, as different styles of coping with intergenerational family conflict, were examined among 86 Hmong American college students. Problem solving and social support were hypothesized to differentially moderate the effects of family conflict on psychological adjustment. Furthermore, the effects of attributions of blame on the adjustment of Hmong American college students were examined. Results indicate that social support buffered and problem solving enhanced the negative effects of family conflict on symptoms of distress but not on affect. Additionally, there were significant interaction effects between family conflict and self-blame on distress. Specifically, students who were more likely to blame themselves reported higher levels of distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)