Practices and perceptions among pediatricians regarding adolescent contraception with emphasis on intrauterine contraception.

STUDY OBJECTIVE: This study was conducted to characterize pediatricians' current practice patterns and perceived barriers related to adolescent contraception counseling with an emphasis on intrauterine contraception (IUC). DESIGN: We performed a mailed survey study to 400 general pediatricians. SETTING: Surveys were mailed to pediatricians at their individual office locations. PARTICIPANTS: General pediatricians belonging to the Massachusetts Pediatric Society were included in the study. INTERVENTIONS: The survey instrument assessed current practice patterns and perspectives as related to contraception counseling for adolescents. MAIN OUTCOME MEASURES: Use of contraception among adolescent patients, policy to recommend IUC to adolescents in various clinical scenarios, and barriers to adolescent contraceptive counseling. RESULTS: Over 50% of pediatricians considered abstinence their favored method of contraception for adolescents, while fewer than 20% reported discussing IUC as an option. Female pediatricians were more likely to discuss IUC (25% vs 8%, P = .01), as were younger pediatricians (28% vs 14%, P = .13). Given 8 clinical scenarios suitable for IUC use, less than 25% of pediatricians would offer IUC to a teen unless she had a history of a vaginal delivery or abortion. Seventy percent of pediatricians reported lack of training with IUC, and more than 30% reported legal, fertility and parental concerns as barriers to discussing IUC with adolescents. CONCLUSIONS: Efforts are warranted to improve the education of pediatricians regarding the most current guidelines for proper IUC use in adolescents with the goal to increase the frequency with which this effective contraceptive method is discussed with this vulnerable population.

Carcinossarcoma uterino: relato de um caso com invasão da bexiga, mimetizando mullerianose com transformação maligna / Carcinosarcoma of the uterus: report of a case with invasion of the urinary bladder, resembling mullerianosis with malignant transformation

Introdução: Os carcinossarcomas uterinos são neoplasias infrequentes, correspondendo a apenas 3-9 por cento de todas as neoplasias ginecológicas, representam 48 por cento de todos os sarcomas, e possuem incidência de 8,2 por 1 milhão mulheres/ano. As principais manifestações clínicas são o sangramento vaginal anormal em idade pós-menopausa e dor abdominal. Caracterizam-se morfologicamente por elementos epiteliais e estromais. Podem eventualmente invadir estruturas adjacentes, inclusive a bexiga urinária. Relato do caso: Apresentamos um caso de carcinossarcoma uterino com invasão de bexiga mimetizando mullerianose com transformação maligna. A paciente do sexo feminino de 69 anos apresentava hematuria macroscópica como queixa única. Durante a investigação diagnóstica, após cistoscopia com exame anatomopatológico, foi sugerida a hipótese de mullerianose com transformação benigna. A paciente foientão encaminhada para ressecção cirúrgica da neoplasia. Durante o procedimento cirúrgico, notou-se a existência deuma massa tumoral uterina que invadia a bexiga urinária, e, após análise anatomopatológica, mostrou tratar-se de umcarcinossarcoma uterino com invasão vesical. Conclusão: Manifestações incomuns em doenças com grande potencialde malignidade, além de retardar o processo diagnóstico, interferem diretamente no prognóstico do paciente.

Development and validation of a method for the determination of a therapeutic peptide with affinity for the human B1 receptor in human plasma using HPLC-MS/MS.

The peptide described in this report (MW 1180 Da; 10-amino acid synthetic peptide) is a potent and selective antagonist of the human B1 receptor (B1) that has been investigated for the treatment of chronic pain. A method to quantitate this peptide in human plasma has been developed to support human clinical trials designed to evaluate the safety, pharmacokinetics, and efficacy of this compound. Plasma samples (0.2 mL) were extracted using a Waters Oasis MAX (10 mg) 96-well plate and the resulting samples were analyzed using an Applied Biosystems API-5000 HPLC-MS/MS with an electrospray ionization (ESI) source. The method was validated for the determination of the B1 peptide in human plasma over the concentration range of 1-50 ng/mL. Isotopically labeled B1 peptide ((13)C6(15)N(2)-B1 peptide) was used as an internal standard. Interday precision and accuracy, determined from analysis of quality control (QC) samples, yielded coefficients of variation (CV) of less than 5.3% and accuracy within a 2.4%. Within batch precision and accuracy determinations provided CV values of less than 7.3% and accuracy within a 6.0% bias. Precautions had to be taken to prevent B1 peptide loss to container surfaces and contamination of the HPLC-MS/MS. The validated assay was used in support of human clinical trials.

Benefits of multidisciplinary case conferencing using audiovisual compared with telephone communication: a randomized controlled trial.

Multidisciplinary case conferencing using a video-link was compared with multidisciplinary case conferencing by telephone. One hundred patients were randomized to either videoconferencing (intervention group, 50 patients) or audioconferencing (control group, 50 patients). The effectiveness of the intervention compared with the control was evaluated in terms of: the number of conferences per patient, average length of conference, length of treatment, number of occasions of service, degree of multidisciplinary team involvement, recorded level of communication, quality of the management plan (in terms of the number of points contained in it) and staff satisfaction. The intervention and control groups showed significant differences on only two of the outcome measures: the mean number of case conferences per patient was less for the intervention group, and the intervention group had a shorter length of treatment (6 days) than the control group (10 days). The study did not demonstrate any significant differences in occasions of service or time commitment, which might have resulted in lower costs. However, the introduction of case conferencing by video-link was accompanied by a high level of satisfaction on the part of the 14 team members who were interviewed.

Seated-popliteal weight bearing prosthesis for a bilateral amputee.

Bilateral lower limb amputees suffer from a lack of stability when seated without prostheses due to lack of ground reaction forces through the stumps. In patients for whom ambulation is not a realistic goal, the seated-popliteal weight bearing prosthesis provides a solution for stability when seated in a wheelchair, without the problem of tibial pressure experienced with patellar-tendon-bearing prostheses.

Severe cervical spinal cord injuries related to rugby union and league football in New South Wales, 1984-1996.

OBJECTIVE: To determine the frequency and circumstances of serious cervical cord injuries associated with rugby union and league football in New South Wales. DESIGN: Retrospective review of patients with rugby football-related cervical spinal cord injuries. SETTING: The two central spinal units in NSW, from January 1984 to July 1996. OUTCOME MEASURES: Admission to spinal units; injury resulting in permanent tetraplegia. RESULTS: During the review period, 115 rugby football players (56 union and 59 league) were admitted to the spinal units because of cervical spinal cord injuries. 49 patients had resultant permanent neurological deficits (complete tetraplegia [quadriplegia])--26 associated with rugby union and 23 with rugby league. Two patients died of injury sequelae within two weeks of admission. There was no significant change in the rate of football-related admissions to spinal units for either code. There was a small decline in the number (from 15 in 1984 to 1987 to 7 in 1992 to 1996) and incidence (from 1.2 to 0.5 per 10,000 participants) of patients with tetraplegia associated with rugby union. When this decline was tested as a trend over the years, it was found to be statistically significant (P = 0.06). No significant trend was found in the tetraplegia data associated with rugby league. Cervical spinal cord injuries leading to complete tetraplegia were most commonly associated with scrum-like plays in union and with tackles in league. CONCLUSION: Serious cervical spinal injuries associated with both codes of rugby continue to occur in NSW. Rugby football in its various forms is still an inherently dangerous game.

Catastrophic injuries to the eyes and testicles in footballers.

OBJECTIVE: To report the occurrence of uncommon but catastrophic eye and testicle injuries to rugby league and rugby union footballers in New South Wales. METHODS: A retrospective review of players who had permanent football-related injuries and who claimed financial compensation from a voluntary sports injury insurance scheme from 1978-1994. RESULTS: An average of 100 000 rugby league and rugby union players per year were registered with the insurance scheme in NSW. As a consequence of playing football, 15 players lost 90%-100% vision in one eye, five lost 75% vision in one eye, four lost 50% of vision in one eye and two lost 75% vision in both eyes. Eye injuries were caused by "gouging" with fingers, kicks, or blows from fists, elbows and knees; five cases appeared to be intentional. Fourteen players had testicular injuries: in 11 players this resulted in complete loss of one testicle, and in three partial loss of one or both testicles. The immediate cause of the injuries to the testicles was kicking and kneeing, usually during tackles; at least three of the injuries appeared to be intentional. RECOMMENDATIONS: Rules relating to tackles, kicks and other assaults to the head or groin should be strengthened and policed. Officials, players, parents and the public should be educated to support this.

Finite element analysis in the design and characterization of an absorbable cement restrictor.

The benefit of using a cement restrictor to achieve cement pressurization during total hip arthroplasty is well established. An absorbable cement restrictor design has been developed with the use of a finite element model. The non-linear axisymmetric model was used to optimize specific parameters so as to perform within acceptable limits when tested over a specified range of medullary canal sizes. The results achieved from a hybrid experimental/analytical design methodology allowed for a shorter development cycle for the initial size and each additional size in the design family thereafter. The resulting cement restrictor design was compared to and exceeded the performance of currently clinically accepted devices in resisting migration.

Should a ventilator be removed at a patient's request? An ethical analysis.

The request of a ventilator-dependent quadriplegic person to be removed from the ventilator presents the health care team with an ethical dilemma. Application of ethical principles to case facts guides the decision maker. The ethical principle of autonomy requires that persons be respected and free to determine their course in life. The ethical principle of beneficence requires the health care team to actively benefit or do good for the patient. The ethical principle of nonmaleficence requires the health care team to refrain from harming a patient. The ethical duty of fidelity requires the nurse to be faithful to commitments made to patients. Ethical principles and duties are clear and straightforward. The decision of how they apply to a given case is not. However, applying them to a case, while not providing definitive answers, will provide the certainty that the decision was the best possible in a particular set of circumstances. An increasing number of cases similar to Joe's is being resolved in favor of discontinuing the ventilator. Emotional havoc could be the result to nurses who care for these patients. Individuals and institutions must begin planning strategies to deal with these and similar ethical dilemmas. Strategies might include anticipatory counseling, ethical decision making education programs and utilization of a nurse trained in ethics as a staff resource person. Nurses should attend and be involved in discussions of institutional ethics committees.(ABSTRACT TRUNCATED AT 250 WORDS)

Personality factors of critical care nurses.

Two hundred members of the American Association of Critical-Care Nurses responded to a mail-out survey done to determine the psychologic profile of critical care nurses in terms of self-esteem, gender identity, and selected personality characteristics. The instruments used were Cattell's 16 PR, the Personal Attributes Questionnaire (PAQ), and the Texas Social Behavior Inventory (TSBI). Their personality factors tended to be aggressive, assertive, competitive, persevering, moralistic, resourceful, and mechanical. The nurses who enjoyed the field most were of the androgynous or masculine type and had high levels of self-esteem. On the basis of these findings, the nurse recruiter or faculty member doing career counseling could assess the personality characteristics, gender identity, and self-esteem levels of interested nurses. The goal would be to identify nurses who would both enjoy the field and remain active in critical care nursing after orientation. The goal could also be to help nurses dissatisfied with critical care nursing to seek means of improving their self-esteem.

Determining interrater reliability of nurses' assessments of pupillary size and reaction.

Pupil changes provide vital information related to the cause and location, and at times, severity of disease processes which alter level of consciousness. Size and reactivity are sensitive to a variety of influences including local eye damage, functional state of brainstem, local systemic drugs, seizures and anoxia. Therefore, accurate measurement of pupillary size and reactivity is essential. The purposes of this study were to determine if pairs of nurses (1) achieved the same measurement of pupil sizes with and without an objective measure, and (2) selected the same descriptor for pupillary reaction to light. Sixty-eight pairs of nurses employed in adult and pediatric units of a large teaching hospital participated in the study. Interrater reliability of pupillary assessment of 136 nurses was determined. There was no significant difference in the reliability of nurses assessing pupillary size regardless of whether they used a penlight pupil gauge to measure or used observation without a pupil gauge. Agreement among the nurses on the pupillary size was high. Agreement on the pupillary reaction, however, was poor to good.