Functional knee brace use by non-injured subjects while performing an anaerobic capacity task: preliminary study.

AIM: The objective of this paper was to investigate if performance was hindered in non-injured braced athletes during an anaerobic task. If performance was affected, could accommodation to wearing a knee brace occur and thus decreasing performance hindrance concern while using a functional knee brace (FKB). METHODS: A 2x3 non-braced (NBr) and braced repeated measure factorial design. Five healthy athletes completed all testing. Subjects performed the Repeated High Intensity Shuttle Test (RHIST) over six days (three days NBr and three days braced). Running times were recorded each testing day to determine performance measures and percent fatigue levels while using a FKB and if accommodation to FKB use was possible. RESULTS: Non significant (F1,4=1.42, P=0.299) faster group mean performance time, was recorded for braced subjects relative to the non-braced condition. Although relatively faster performance levels were noted during the braced testing conditions during days 1 and 3 compared to the non-braced condition, these results were also not significant (F2,8=2.82, P=0.118). Lower percent fatigue level was recorded during all three braced days compared to non-braced days. Further, a tendency for accommodation to knee brace trend use was noted as the percentage performance difference between the two conditions had decreased by the last day of testing. CONCLUSION: Use of a knee brace did not hinder performance once accommodation to using the knee brace occurred and fatigue was not a factor while using a knee brace. Additional research, using a larger sample size and longer testing duration, is required to confirm the potential accommodation trend.

The use of cynical humor by medical staff: implications for professionalism and the development of humanistic qualities in medicine.

Humor and laughter in medicine has received much attention in the medical literature. The use of humor by medical students, residents and medical personnel is not uncommon. Laughter can be therapeutic, for patients and practitioners alike. However, when inappropriately directed towards patients humor can be seen as unprofessional, disrespectful and dehumanizing. How physicians interpret their day-to-day professional experiences, and when and how they use humor is influenced by the perspective that is taken, the social distance from the event, culture and context. Some argue that social and physical distance makes it more acceptable to laugh and joke about patients, but not everyone agrees. To laugh with and not at others is the appropriate use of humor in medicine. To cry against the suffering of others and the injustice behind that suffering and not with them in their agony and frustration is the appropriate response to tragedy.

Opportunity lost: a frontline view of reference-based pricing.

The introduction in October 1995 of reference-based pricing as a cost-saving measure for British Columbia's drug benefit program represented an opportunity for collaboration between frontline practitioners and the bureaucracy that supports some of their work. If well-established principles of continuing education, quality improvement and modern management had been followed, practitioners in the field could have focused their individual and collective talents effectively and constructively on the task of improving cost-effectiveness in drug prescribing. Although the reference-based pricing program may well achieve its purpose of saving money, it is sad that it was not used to build bridges of common interest and mutual trust between two camps that are often in conflict.

Ecosystem and population health: the role of Canadian physicians at home and abroad.

Seemingly intractable problems of overpopulation, ecologic degradation, diminishing resources and regional warfare are having a profound effect on global population health. Canadian physicians can assist in ameliorating these problems by helping to modify the overconsumption of natural resources at home and by participating in international health projects focused at the community level, where the health of individuals and that of their environment intersect. The author describes the work of the Canadian Hunger Foundation in Vietnam and Sri Lanka, where a team of professionals worked with local farmers to improve the local water supply, decrease soil erosion and increase food production. The team observed changes in the physical health of communities that resulted in part from interventions that empowered them to address their own problems.

Riding Fletcher's Trolley: The unlikely renaissance of the generalist in modern medicine.

We are witness to a major change in the direction and focus of medical education and practice. After a period of fascination with increasingly specialized and technologically driven medical practice, we are moving to a more balanced view in which generalists are likely to play a greater role. We must recognize the trends in society that parallel this view and respond to the changing expectations of our patients. Training systems must reflect our understanding of this new era.

The relationship between theophylline clearance and age in adult life.

Fifty three subjects (31 normal volunteers and 22 patients with asthma) between the ages of 20 and 87 years had their theophylline clearance measured. Volume of distribution (V) and terminal elimination half-life (t1/2) were also calculated in the volunteers who received i.v. theophylline. Although patients tended to have higher clearance values than volunteers, in both groups the oldest third had the lowest clearances. For the combined group (corrected for the patient effect) the oldest third (mean age 70 years) had a mean clearance of 0.53 versus 0.72 for the middle third (mean age 47 years) and 0.73 ml/min/kg CBW for the youngest third (mean age 26 years). There was no statistically significant age related change in V/kg CBW but t1/2 did rise with increasing age. Thus, although clearance does not fall with increasing age during younger adult life, there is a fall during late adult life becoming apparent in the seventh, eighth and ninth decades.

Circadian variation in theophylline absorption during chronic dosing with a slow release theophylline preparation and the effect of clock time of dosing.

1. Eight volunteers were given seven doses of 200 mg of slow release theophylline at either 11.00 h and 23.00 h (regimen 1) or 17.00 h and 05.00 h (regimen 2). At the time of the sixth dose (60 h) hourly blood sampling was started and continued for 24 h. After at least 1 week volunteers crossed over to the other regimen. 2. Volunteers retired to bed at 23.00 h and arose after the 07.00 h sample during both regimens. 3. During regimen 1 there was a marked rise in mean tmax from 3.3 h after dosing at 11.00 h to 9.3 h after dosing at 23.00 h (P less than 0.001). There was also a fall in AUC(0,12) from 89.9 mg l-1 h after dosing at 11.00 h to 79.0 mg l-1 h after dosing at 23.00 h. There was no difference in mean Cmax values. 4. During regimen 2 these circadian changes were abolished with mean values after both dosing times lying between those observed during regimen 1. 5. A marked delay in absorption occurs at night and cannot be explained by food intake.

The bioavailability of oral intermediate-dose methotrexate. Effect of dose subdivision, formulation, and timing in the chemotherapy cycle.

The oral bioavailability of methotrexate is variable and may be dose-dependent. The absorption of 'interval' oral methotrexate, which is given between cycles of chemotherapy, is unknown. The bioavailability of oral methotrexate has been studied in eight patients, acting as their own controls, to assess the effect of subdivision of the dose, the formulation, and the timing of the methotrexate within the chemotherapy cycle. The mean bioavailability for all the oral methods of administration was 28.2% +/- 3.7% compared with the same dose given IV. Absorption was uninfluenced by subdivision of the dose, liquid or tablet formulation, or administration on day 1 or day 10 of the chemotherapy cycle.

Relationship between protein binding and extravascular drug concentrations of a water-soluble drug, cytosine arabinoside.

The degree of binding of a drug to plasma proteins has a marked effect on its distribution, elimination, and pharmacological effect. Since only the unbound fraction is available for distribution into extravascular space, the ratio of drug in cerebrospinal fluid (CSF) or saliva to that in plasma is often regarded as a physiological measure of the free fraction of a drug. CSF: plasma and saliva: plasma ratios of cytosine arabinoside (araC) have been measured in patients with acute leukaemia and found to be 0.1-0.28, implying a binding of 72-90%. The protein binding of araC was measured by equilibrium dialysis in the plasma of patients with acute leukaemia at presentation. The mean binding ratio was 2.3 +/- 6.8, implying that there was little or no protein binding. There was no correlation between alpha-1 acid glycoprotein (AAG) levels and protein binding. The low CSF and saliva: plasma araC ratios found, suggest that drugs such as araC which have low lipid solubility do not pass freely into extravascular space. Thus the CSF or saliva: plasma ratio cannot be considered a good physiological measure of protein binding for drugs with poor lipid solubility.

STRIPE: an interactive computer program for the analysis of drug pharmacokinetics.

A computer program for the analysis of drug pharmacokinetics is described. The program is written in BASIC for use with a Hewlett Packard HP85 microcomputer. The pharmacokinetic parameters are estimated by linear regression of the log concentrations against time and the exponentials are separated by curve stripping.