Diabetes and Hypertension Consistently Predict the Presence and Extent of Coronary Artery Calcification in Symptomatic Patients: A Systematic Review and Meta-Analysis

Background: The relationship of conventional cardiovascular risk factors (age, gender, ethnicity, diabetes, dyslipidaemia, hypertension, obesity, exercise, and the number of risk factors) to coronary artery calcification (CAC) presence and extent has never before been assessed in a systematic review and meta-analysis. Methods: We included only English language studies that assessed at least three conventional risk factors apart from age, gender, and ethnicity, but excluded studies in which all patients had another confirmed condition such as renal disease. Results: In total, 10 studies, comprising 15,769 patients, were investigated in the systematic review and seven studies, comprising 12,682 patients, were included in the meta-analysis, which demonstrated the importance of diabetes and hypertension as predictors of CAC presence and extent, with age also predicting CAC presence. Male gender, dyslipidaemia, family history of coronary artery disease, obesity, and smoking were overall not predictive of either CAC presence or extent, despite dyslipidaemia being a key risk factor for coronary artery disease (CAD). Conclusion: Diabetes and hypertension consistently predict the presence and extent of CAC in symptomatic patients.     

Administration of medications via the intramuscular route: an integrative review of the literature and research-based protocol for the procedure

Administering injections is an activity inherent to nursing practice. A critical review of nursing fundamentals texts found that the "proper" procedure was often non-research based and reflected myths, traditions, and out-of-date recommendations regarding the technique. This article is an integrative review of the extensive research conducted by a variety of researchers in health-related disciplines during the last seven decades. The pertinent research is reviewed and critiqued and serves as the basis for a clinical practice protocol. This research-based procedure ensures efficient and effective nursing care related to intramuscular injections.     

Retrobulbar hemorrhage after 12,500 retrobulbar blocks

To determine the incidence of hemorrhage after retrobulbar nerve block, 12,500 consecutive cases were reviewed. Fifty-five retrobulbar hemorrhages occurred after retrobulbar injection, a prevalence of 1 in 227 (0.44%). This compares favorably with the quoted prevalence of 1%-3% in the literature. Acquired vascular disease was a significant risk factor (P < 0.017). Surgery was postponed in 41 (75%) of the cases in which a hemorrhage developed. Although retrobulbar hemorrhage is considered a serious complication of retrobulbar anesthesia, the eventual visual outcome after surgery in these patients was not significantly different from the control group.     

Cleavage of rat prolactin occurs within rat mammary tissue, and the cleaved form is present in serum but not in milk

A biofeedback gait training system for step length is proposed, adapted to the correction of spatial walking asymmetries by means of a simple, quick and reliable method for daily clinical use. The system is composed of a walkway and a gait analysis device (locometer) measuring the main temporal and distance factors of gait. The step length is imposed on the subject by lighted targets appearing on the walkway, alternately on the right and left side; the subject is asked to place a swinging foot on the lighted target. Feedback to the subject is supplied by direct visual information (the subject looking at the movement and the position of the foot with respect to the lighted target) and an acoustic signal delivered in real time when the length step error is greater than an allowed value. The method is validated on a population of hemiparetic patients who have suffered from a stroke and who have been reeducated with traditional rehabilitation methods. The patients were divided into two groups; one group following a gait training with biofeedback (BFB group) and one group following a gait training without biofeedback (reference group). Preliminary results are presented, showing a significant beneficial effect of the biofeedback method in increasing the step length of paretic limbs and in correcting step-length asymmetry.     

Consent - The Luddite's Lifeline

At first glance the task of adapting statute law to take account of electronic media seems relatively simple, although tedious and mechanical. In fact, the contrary is the case. Much work has been done already in this area around the world with little evidence of consistency. This article considers recent Australian legislation, in particular, as it deals with 'writing' and 'signature'. It concludes that making validity conditional on consent of the recipient will, in many cases, prevent the new law from realising its full potential as a facilitator of electronic communication.     

A closer look at service level metrics

Defined service level metrics that define acceptable frame relay network performance are increasingly offered and requested. The work of the Frame Relay Forum in providing a common vocabulary to describe frame relay service delivery is examined in this article. Copyright © 1999 John Wiley & Sons, Ltd.     

The relationship of HIV prevalence in pregnant women to that in women of reproductive age: a validated method for adjustment

OBJECTIVE: To devise and validate a method for adjusting HIV seroprevalences in pregnant women to estimate population prevalences among all women in their child-bearing years. DESIGN: Birth and termination rates from women with known HIV infection in the United Kingdom were calculated according to the likely route of HIV infection and whether HIV infection was diagnosed. METHODS: Birth and termination rates were weighted and combined to produce summary statistics. Comparisons were then made with population birth and termination rates to derive summary relative inclusion ratios (RIRs), the relative probabilities of including HIV-infected and uninfected women in seroprevalence surveys of pregnant women. RESULTS: The derived RIRs for women having live births were close to unity: 1.03 [95% confidence intervals (CI) 0.90-1.17] for London and 0.80 (Cl, 0.71-0.89) for elsewhere in England and Wales. This indicates that currently observed overall seroprevalences among pregnant women having live births in London would be similar to those among all women of the same age, while elsewhere it would be slightly underestimated. Sensitivity analysis indicated that RIRs could, however, vary three-fold (0.47-1.56) according to the proportion of diagnosed maternal infections and the mix of maternal HIV-exposure categories. The method was validated by using it to predict the ratio of unlinked seroprevalences between women having terminations and live births in London. It predicted a ratio of 1.74: 1, which is close to the observed ratio of 2.07 : 1. CONCLUSIONS: Application of HIV seroprevalences from pregnant women to whole populations may need adjustment for fertility rates among HIV-infected women. A general method for this has been derived and validated. Gathering fertility data for HIV-infected women is a useful adjunct to serosurveillance.