Physicians' Perception of Oral Nutritional Supplement Acceptance and Tolerability in Malnourished Outpatients: PerceptiONS Study.

Malnutrition is a common condition associated with various pathologies such as infections, neoplasms and digestive system disorders. Patients can be managed using different strategies, which include dietary modifications or oral nutritional supplements (ONS). It is important to promote good ONS adherence in order to attain clinical efficacy and cost-effectiveness. Several factors (amount, type, duration and tolerability) may have an impact on ONS adherence. PerceptiONS is a descriptive, cross-sectional observational study based on an ad hoc electronic survey designed to explore physicians' perception of malnourished outpatients prescribed ONS. The survey considered adherence, acceptance/satisfaction, tolerability and benefits within the context of Spain's healthcare system. The perceptions of 548 physicians regarding the experience of 2516 patients were analyzed. From the physicians' perspective, 57.11% of patients adhered to over 75% of the prescribed ONS. The organoleptic properties of ONS represented the aspect with the most positive impact on adherence, with smell (43.72%) ranking as the top characteristic. In general, patients were satisfied (90.10%) with the ONS, with their related benefits (88.51%) and their organoleptic properties (90.42%), and accepted ONS in their daily diet (88.63%). ONS improved patients' general condition (87.04%), quality of life (QoL) (81.96%) and vitality/energy (81.28%). Physicians would prescribe the same ONS again in 96.4% of the cases.

Clinical outcomes of aneurysmal subarachnoid hemorrhage patients treated with oral diltiazem and limited intensive care management.

BACKGROUND: Aneurysmal subarachnoid hemorrhage (SAH) patients are frequently treated with prophylactic nimodipine and undergo invasive monitoring of blood pressure and volume status in an intensive care unit (ICU) setting to decrease the incidence of delayed ischemic neurological deficit (DIND) and improve functional outcomes. The goal of this study was to examine the incidence of DIND and poor functional outcomes in a consecutive series of SAH patients treated with a different regimen of prophylactic oral diltiazem and limited use of intensive care monitoring. METHODS: The study involved a consecutive series of 123 aneurysmal SAH patients treated by the senior author who were admitted within 72 hours of hemorrhage and who never received nimodipine or nicardipine. Functional outcomes were graded using the Glasgow Outcome Scale (GOS). RESULTS: Of the 123 patients identified, favorable outcomes (GOS 4 and 5) were achieved in 74.8%. The incidence of DIND was 19.5%. Hypertensive, hypervolemic, hemodilutional (HHH) therapy was used in 10 patients (8.1%) and no patients were treated for DIND by endovascular means. Seven patients (5.7%) had a poor functional outcome or death because of DIND and two of these were related to complications of HHH therapy. These results were compared to contemporary series of SAH patients managed with other treatment protocols. CONCLUSIONS: Functional outcomes of patients treated with a regimen of oral diltiazem, limited use of ICU monitoring and HHH therapy for DIND compare favorably with other contemporary series of SAH patients.

Massachusetts Risk Management Survey (MaRMS) of teaching hospital physicians.

OBJECTIVE: To assess and compare the risk management knowledge of physicians from Massachusetts teaching hospitals. DESIGN: A survey. SETTING: Participating Massachusetts teaching hospitals. PARTICIPANTS: 639 of some 2,000 staff physicians of participant hospitals who were sent surveys. An additional 174 postgraduate year 1 (PGY1) and PGY3 house officers also completed the survey. MAIN OUTCOME MEASURES: Percent of questions answered correctly, and comparisons between staff physicians and house officers. RESULTS: Staff physicians scored higher (87%) than PGY1s and PGY3s combined (81%), P<0.001. Scores among staff physicians did not differ according to field of medicine, age, proportion of time spent in clinical practice, or years in practice. PGY3s did not score significantly higher than PGY1s (82% vs. 80%). Some 40% of physicians said they ordered more tests than necessary because of malpractice worries; they indicated 72% of their colleagues do so as well. Physicians in obstetrics-gynecology and emergency medicine were more likely to respond yes to this question than physicians in other fields of medicine (P<0.001), as were physicians who had been defendants in a malpractice suit (88 P=0.013). CONCLUSIONS: Surveyed staff physicians have an adequate risk management knowledge. Training directors should encourage house officers to attend risk management programs to improve their knowledge. Physicians might overestimate the amount spent on defense medicine based on their perceptions of other physicians.

The use of omeprazole for resistant oesophagitis in children.

Following failure of conventional therapy for reflux oesophagitis, 15 children were treated with omeprazole 20 mg daily for a period of up to three months initially. Treatment resulted in a marked symptomatic improvement as measured by incidence of pain, vomiting, dysphagia and haematemesis. Four children failed treatment and required fundoplication. No complications from the use of omeprazole were recorded and some children have continued long-term treatment.

Role of host-produced stimuli and learning in host selection behavior ofCotesia (=Apanteles) marginiventris (Cresson).

The study was conducted to determine how various factors, including learning, influence the host-selection behavior of the larval parasitoid Cotesia (=Apanteles)marginiventris (Cresson). Frass, silk, and feeding damage fromSpodoptera frugiperda (J.E. Smith) larvae elicited visits and antennal examinations by females of the parasitoid. Learning played a role in the effective response to these stimuli in that previous contact experience with hosts and/or chewed leaves, exuviae, frass, or hemolymph significantly enhanced the response of the parasitoid. Previous contact with host plants alone did not improve the responses. Experienced parasitoids were more active and spent less time at rest than inexperienced parasitoids. Previous experience was also found to be of significant importance in the ability of the parasitoid to discriminate between parasitized and unparasitized host larvae.