Tuberculosis – patients’ knowledge, attitudes and practices regarding their illness

OBJECTIVE: To determine tuberculosis (TB) patients’ knowledge, attitudes and practices with respect to their illness. DESIGN AND METHODS: A cross sectional study was conducted. 208 tuberculosis patients > 18 years of age who were currently receiving treatment were included. The study sample was selected from two major regional chest clinics in Trinidad. A pilot tested questionnaire was interviewer administered to each patient. RESULTS: Out of the 208 patients interviewed (response rate 65.0%), 129 were male, and 79 were female. The majority of patients had either secondary or tertiary level of education (54.8%), whereas only 43.8% had either primary level of education or none at all. Analysis revealed that TB knowledge was affected by a patient’s level of education, where persons with secondary/tertiary levels of education had a greater knowledge about TB (p<0.005). The majority (78.4%) of patients believed that they were not stigmatized; however, 191 (91.8%) patients urged for increased public awareness about TB in order to change perceptions toward the disease. The majority of patients were compliant towards their management advice, as well as taking their prescribed medications, however non- compliance was noted to be more likely in the under 50 year age group (9.8%), rather than the over 50 year age group (1.1%). CONCLUSION: Patients with at least secondary level education had better knowledge about tuberculosis than those with primary level education. Patients indicated the need for more public awareness about TB. Compliance with management (medication and attendance at clinics) was good among the majority of the patients.

Barriers to Swiss guideline-recommended cholesterol management in general practice.

BACKGROUND: Standard guidelines for the management of dyslipidaemia are often not followed in general practice. The reasons for guideline non-adherence are not known. METHODS: Charts of 1000 consecutive unselected patients of 20 general practitioners in northwestern Switzerland were reviewed. An independent committee of experienced study physicians checked the data and assessed the reasons for not measuring plasma cholesterol and for not treating dyslipidaemia as recommended by guidelines. RESULTS: Complete data of 866 patients were studied. 29% of all patients qualified for secondary prevention. 6% had no additional cardiovascular risk factors (apart from cholesterol values), 24% had one and 41% had 2 or more additional cardio- vascular risk factors. Guidelines were followed in 44% of all cases and were not followed in 56%. In 37.5% of all cases we found diagnostic guideline non-adherence, and in 10% only treatment guideline non-adherence. 8.5% of all patients had both diagnostic and treatment non-adherence. The main reasons for diagnostic non-adherence were relevant comorbidity (45%) and GPs' belief that the risk did not require screening (42%). The main reasons for treatment non-adherence were GPs' belief that the risk did not require treatment (42%) and relevant comorbidity (38%). CONCLUSION: More than half of all patients aged 35-80 years are not screened or treated according to current guidelines. The reasons are to an equal extent patient-related (relevant comorbidity) and physician-related (acceptance and knowledge of guidelines). These reasons should be considered when programmes to improve the quality of GPs' adherence to guidelines are implemented.

[The present and future status of "scarless" surgery]. / Das Konzept der narbenlosen Eingriffe ("scarless surgery"). Ein Weg in die Zukunft?

The concept of scarless surgery aims at further minimization of diagnostic and therapeutic interventions. Based on the success of flexible gastroenterological endoscopy and laparoscopic surgery, it combines their advantageous approaches in a synergistic manner. Animal experiments have achieved encouraging results in respect to the feasibility of various types of interventions in the peritoneal and retroperitoneal cavity. Further studies and improvement of instruments will have to prove the practicality and superiority of this concept for medical outcome and efficiency compared to present standards of practice in the potential fields of application. The replacement of certain minimally invasive procedures with scarless intervention techniques seems reasonable, as do new fields of application. After further improvement of the methodology, adequate organization, infrastructure, and teaching structures will have to be developed. If they succeed, the concept of scarless surgery can expect a promising future.

cAMP-dependent protein kinases of rat pituitary GH3 cells.

Two isoenzymes (type I and type II) of cAMP-dependent protein kinases were found in GH3 cytosol, isozyme type II activity being the predominant form (approximately 90%). Photoaffinity labeling of GH3 cell extracts with 8-N3-[32P]cAMP revealed three cAMP-binding proteins exhibiting molecular weights of 53,000, 51,000 and 48,000, respectively. The latter represents the regulatory subunit of type I isoenzyme whereas the 53,000 and 51,000 cAMP-binding proteins correspond to two different molecular forms of the type II isoenzyme regulatory subunit which are phosphorylated by a cAMP-dependent mechanism.