ABSTRACT
BACKGROUND: Although the use of epidemiologic studies to demonstrate learning needs appears to be infrequent, this study addressed the discrepancies in the prescribing practices for the initial treatment of tuberculosis in Virginia between public and private clinicians, comparing them with the treatment regimens recommended by the Centers for Disease Control and Prevention and the American Thoracic Society (CDC-ATS). METHODS: Data examined were the 1995 to 1998 reported cases of tuberculosis within the Commonwealth of Virginia. The study population consisted of 770 laboratory-confirmed tuberculosis cases, living in Virginia, whose isolates were tested for isoniazid susceptibility and were prescribed an initial drug regimen. Prevalence rates, prevalence odds ratios, and logistic regression were used to determine the estimated risk for receipt of the CDC-ATS treatment regimen. RESULTS: Of the 770 cases, 28.7% did not receive the CDC-ATS recommended drug regimen. Prevalence rates and odds for not receiving the recommended regimen were highest among persons of United States origin, Caucasians, females, persons under age 15, and persons from the southwest region of Virginia. Logistic regression indicated a slight increase in the estimated risk of not receiving the CDC-ATS regimen from a private physician (OR: 1.40; CI: 0.97, 2.04) when compared to a public physician. FINDINGS: Private tuberculosis care providers were less compliant with CDC-ATS guidelines than public tuberculosis care providers. Because providers did not follow the recommended treatment guidelines universally, it is advised that all tuberculosis care providers in Virginia would benefit from increased education regarding adequate treatment regimens for tuberculosis and the prevention of multidrug-resistant tuberculosis.
Subject(s)
Antibiotics, Antitubercular/administration & dosage , Drug Utilization/standards , Guideline Adherence/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Tuberculosis, Multidrug-Resistant/drug therapy , Adolescent , Adult , Aged , Centers for Disease Control and Prevention, U.S. , Clinical Competence , Education, Medical, Continuing , Female , Humans , Male , Middle Aged , Needs Assessment , Quality of Health Care , Tuberculosis, Multidrug-Resistant/epidemiology , United States , Virginia/epidemiologyABSTRACT
The use of a balloon as a dissecting tool was pioneered by Gauer and Kieturakis in the early 1990s.This newapplication of balloon dissection in surgery allows the creation of a working space in which a procedure is performed. This is combined with minimally invasive techniques that confer the advantages of shorter recovery and less pain for several different procedures.
ABSTRACT
A new refraction system employing traditional modes of testing combined with microprocessor-based electronics and new optical technology was evaluated in a controlled study to determine if the instrument produced subjective refractions corresponding to the traditional refractor. Subjects ranged in age from 14 to 25 years and the study excluded any individual exhibiting ocular or systemic diseases and binocular problems. In addition, tests were made to determine if "instrument myopia" was present. The results showed that data from the IVEX Refraction System correlated highly with data from the standard refractor, but a small amount (0.25 D to 0.37 D) of instrument myopia was present in most instances.
Subject(s)
Optometry/instrumentation , Refraction, Ocular , Adolescent , Adult , Data Display , Equipment Design , Evaluation Studies as Topic , Humans , MicrocomputersABSTRACT
To determine the influence of wide variations in dietary levels of calcium, zinc and phytic acid (as sodium phytate) on growth and cataract incidence, juvenile chinook salmon held at 10-11 degrees C were fed daily to satiation for 105 d one of nine purified diets containing one of three levels (grams/kilogram) of calcium (averaged 4.8, 17.7, 50.2), zinc (averaged 0.05, 0.15, 0.39) and phytic acid (1.62, 6.46, 25.8). Diets were formulated to have a calcium-phosphorus ratio of close to unity when considering phosphorus sources other than sodium phytate. High dietary phytic acid concentration (25.8 g/kg) depressed chinook salmon growth, food and protein conversion [protein efficiency ratio (PER)] and thyroid function, increased mortality, promoted cataract formation (zinc at 0.05 g/kg) and induced anomalies in pyloric cecal structure. Calcium at 51 g/kg (or phosphorus) exacerbated the effects of high dietary phytate and low dietary zinc on cataract incidence. Moreover, high dietary levels of calcium (48-51 g/kg) coupled with phosphorus significantly impaired the growth and appetite of low phytic acid (1.62 g/kg) groups and led to nephrocalcinosis in low and high phytic acid groups. Plasma zinc levels were directly related to dietary zinc concentration and inversely related to dietary phytic acid level. Calcium (51 g/kg) and/or phosphorus reduced zinc bioavailability when the diet concurrently contained 0.05 g zinc and 25.8 g of phytic acid per kilogram. It is concluded that zinc is essential for normal eye development in juvenile chinook salmon. Further, zinc deficiency could not be induced in chinook salmon fed diets with high ratios of calcium (or phosphorus) to zinc alone. This required the simultaneous presence of a strong mineral (zinc)-binding agent.
