A comparison of ECG cancellation techniques applied to the surface recording of somatosensory evoked potentials.

The use of somatosensory evoked potentials (SEPs) for determining spinal cord integrity in a clinical setting is well known. The poor signal-to-noise (SNR) ratio of such measurements has led to ensemble averaging being employed to extract the signal from the background noise. Over the thoracic region, the poor SNR is largely the result of interference generated by the cardiac musculature. Therefore, any reduction in the level of this cardiac interference will greatly improve the performance of any SEP monitoring system. Three methods were investigated as techniques to reduce the cardiac interference in SEP measurements. These were clipping, gating and adaptive noise cancellation (ANC). It was found that, although clipping and gating performed as well as, if not better than, ANC, these techniques were both very sensitive to the setting of a threshold level. The linear ANC scheme employed circumvented the problem associated with a threshold level, and with an order of 50, SNR improvement figures of approximately sixfold were achievable over the entire thoracic region.

Health care and consumer control: Pittsburgh's Town Meeting for Seniors.

Since 1988 two hospitals in Pittsburgh have conducted a semiannual Town Meeting for Seniors designed to provide community- based health education so that seniors can make informed decisions not only about medical care, but also about issues such as Medigap insurance, advance directives, and proper nutrition. Attendees have been predominantly white and middle class, reflecting the demographics of the surrounding area. The Town Meeting has been enthusiastically received by consumers and has led to the creation of several new community programs, including exercise classes, driver education classes, durable power of attorney workshops, and expanded insurance counseling services.

[Contraception and sexology]. / Contraception et sexologie.

PIP: This work argues that contraceptive education urgently requires a new approach that will take into account the client's sexuality at the time the choice of method is made. Emotional factors such as a conscious or unconscious desire for pregnancy or motherhood, family pressures to produce a grandchild, or shame and distrust of contraception may contribute to contraceptive failure. Methods applied at the time of coitus such as condoms or spermicides may not be appropriate for clients for who contraception is a source of anxiety or guilt. The more effective, noncoital-dependent methods including oral contraceptives (OCs), IUDs, and sterilization may generate anxiety over infertility. Their efficacy may lack appeal for clients who enjoy an element of risk. The practitioner's attitude and knowledge may be further influences on the counseling over method choice. Among reversible methods, OCs are ideal for most women as long as they individually prescribed. OCs may be particularly important to the sexual expression of specific groups such as those over 35 with no risk factors other than age. Low-dose progestin-only OCs may be prescribed for this group, although about 10% of users change methods because of menstrual problems. IUDs are usually successfully used by women who have been carefully selected to exclude contraindications. In some cases the partner may be annoyed by the string, which can be rolled up and pushed out of the way or shortened by the practitioner. IUDs are often the best alternative for women with contraindications to OCs or who tolerate their side effects poorly. Spermicides may cause dermatoses or allergies that cause the woman to avoid intercourse. Some women dislike using spermicides because they must be applied prior to each use. Their bad taste is a disadvantage for some couples. Involving the male partner in application of the spermicide may remove some objections. The Billings or cervical mucus method should be avoided by women with irregular cycles and those who are reluctant to touch their genitalia. Diaphragms and cervical caps can be inserted by the male partner is desired. Menstrual extraction, insertion of an IUD within 72 hours of unprotected intercourse, or use of sufficiently high dose of oral hormones prevent pregnancy in most cases, but should not be relied upon for routine contraception. Much misinformation persists about the side effects of female sterilization, which is said to cause weight gain or sexual problems or to be followed inevitably by total hysterectomy. Most women are satisfied with the operation and express no regrets. Although reversal rates are improving, sterilization should be considered definitive. Condom use remains limited despite some increases related to fear of HIV infection. Condoms may increase performance anxiety in some men. Couples should be taught to use condoms in a more sensual manner. Withdrawal is still widely used throughout the world despite lack of esthetics appeal and high failure rate.^ieng

Health promotion and disease prevention in the elderly. Comparison of house staff and attending physician attitudes and practices.

The purpose of this study was to evaluate and compare attending physician and house staff attitudes and practices regarding health promotion and disease prevention in the elderly. Seventy-four physicians (38 house staff and 36 attending physicians) were surveyed from four sites in Pittsburgh, Pa, regarding their agreement with recommendations of the American Cancer Society and the Canadian Task Force. Two hundred fifty patients were interviewed and their charts were reviewed for performance of the recommendations. In all patients, physicians agreed highly with the American Cancer Society and the Canadian Task Force recommendations (agreement, 80% to 100%), with the exception of proctoscopy and thyroid examinations. Physicians performed screening procedures much less frequently. House staff and attending physicians differed regarding their attitudes about prevention. House staff felt the need for more formal instruction and were more positive regarding a healthy life-style and commitment to health promotion. The significant predictors of tests (defined as either examination or test ordered by a physician) were presence of a checklist, site of practice, and physician status. A logistic regression analysis was performed; however, this model could not entirely explain the variations found. Although physicians agreed with recommendations for screening, the attending physicians and house staff (particularly attending physicians) were less likely to perform the screening, especially in the elderly.

The need for psychosexual counselling in family planning practice.

In this review article, the case in favour of the need for psychosexual counselling in family planning practice will be presented. Since psychosexual counselling is a multidisciplinary subject, family planning clinics and practices are ideally suited to the task. In presenting the case, liberal illustrative examples are provided in order to depict what the current and suggested extended facilities and techniques involve. The article is also intended to act as a comprehensive guide for students, nurses, medical practitioners and specialists alike, to bring them up to date in new concepts in history taking, physical examination and the sexually explicit aspects of family planning. Traditionally taught concepts may well be out of date in a modern society.