Intellectual conflicts of interest among cardiology and pulmonology clinical practice guidelines.

Background: Intellectual conflicts of interest (COI), like financial COI, may threaten the validity and trustworthiness of clinical practice guidelines (CPGs). However, comparatively little is known about intellectual COI in CPGs. This study sought to estimate the prevalence of intellectual COI and corresponding management strategies among cardiology and pulmonology CPGs.

Primary Care Residents Improve Knowledge, Skills, Attitudes, and Practice After a Clinical Curriculum With a Hospice.

Effective approaches to teaching attitudes, knowledge, and skills to resident physicians in primary care that can be implemented in any residency program are needed. We examined the feasibility and impact of a single palliative care residency curriculum, including a clinical rotation with a hospice program, across 5 cohorts of residents in 7 divergent primary care residency programs (both family medicine and internal medicine). The didactic content was drawn from the national Education for Physicians on End-of-Life Care Project.

The n-of-1 clinical trial: the ultimate strategy for individualizing medicine?

N-of-1 or single subject clinical trials consider an individual patient as the sole unit of observation in a study investigating the efficacy or side-effect profiles of different interventions. The ultimate goal of an n-of-1 trial is to determine the optimal or best intervention for an individual patient using objective data-driven criteria. Such trials can leverage study design and statistical techniques associated with standard population-based clinical trials, including randomization, washout and crossover periods, as well as placebo controls.

Residents from five training programs report improvements in knowledge, attitudes and skills after a rotation with a hospice program.

Background: The faculty of the Center for Palliative Studies teach residents from 5 different primary care residency training programs who rotate at San Diego Hospice: 3 in Internal Medicine, 2 in Family Medicine. Residents participate in the care of patients in the inpatient care setting and make joint home visits with physicians and other team members. A series of 4 lectures on end-of-life care is given on Tuesday mornings: management of pain, other symptoms, interdisciplinary roles of chaplains, social workers, nurses, and grief/bereavement are discussed.

The revised Declaration of Helsinki--is justice served?

The World Medical Association revised the Declaration of Helsinki in October 2000. The Declaration is intended to provide a universal set of principles, which direct the ethical conduct of clinical medical research involving human subjects throughout the world. Previous research ethics codes emphasized the principles of informed consent and beneficence toward research subjects.

Pooling of Chlamydia laboratory tests to determine the prevalence of ocular Chlamydia trachomatis infection.

With the Global Elimination of Trachoma by 2020 program underway, it has become increasingly important to identify the prevalence of ocular chlamydia infection in communities. DNA amplification tests are the gold standard, but are prohibitively expensive. In the present paper, we investigate whether pooling multiple specimens into a single test is feasible.

[Apical hypertrophic cardiomyopathy with right ventricular involvement].

We report right ventricular involvement in apical hypertrophic cardiomyopathy (HCMP) in two women and one man, aged from 19 to 44 years-old, who presented different signs from those with left ventricular disease (who have good clinical evolution), with signs and symptoms of severe diastolic restriction, showing great atrial enlargement and two with atrial fibrillation and death due to thromboembolism. The right ventricular involvement in apical HCMP leads to a worst prognosis than isolated left ventricular disease, does not have the typical electrocardiographic changes and presents with ventricular restriction and tricuspid regurgitation.

Severe metabolic alkalosis.

Our patient's acid-base disturbance may be among the highest recorded in nonfatal cases of metabolic alkalosis. This case also shows that life-threatening alkalemia can be safely and effectively treated by defining and removing the causes of alkalosis and applying aggressive supportive therapy with fluid repletion and potassium and electrolyte replacement. The need for potentially dangerous therapy such as exogenous acid administration, dialysis, or forced mechanical depression of respiration should not routinely be used on the basis of blood pH alone, and it should never replace thoughtful, organized supportive care.

Similarities and differences in the approach of R. M. Reitan and A.R. Luria.

The approaches of Reitan and Luria to the brain-behaviour relationships are compared in terms of the dichotomy between clinical neuropsychology and behavioural neurology, indirect inference and direct inference, standard approach and flexible approach. The underlying neuropsychological models of Halstead and Reitan and of Luria are confronted. The outcomes of a pilot study comparing the results of the Halstead-Reitan Neuropsychological Test Battery (HRNTB) and Luria's Neuropsychological Investigation (LNI) in Christensen's version are briefly mentioned.

Comparison of test results obtained with two neuropsychological test batteries.

Compared test results of two neuropsychological test batteries, the Halstead-Reitan Neuropsychological Test Battery (HRNTB) and Luria's Neuropsychological Investigation (LNI), to investigate the possibility of coming to the same conclusions concerning the brain-behavior relationships with the help of neuropsychological methods based on controversial theoretical assumptions. Test data were obtained from a sample of 31 inpatients of a psychiatric hospital. The concordance concerning the presence of brain dysfunction, its lateralization, and main localization was evaluated.

Neurogenic hypercholesterolemia: influence of autonomic drugs.

Eleven substances capable of either augmenting or depleting the alpha- and - beta-adrenergic capacities of the autonomic nervous system were administered to rats exhibiting hypothalamic hypercholesterolemia and to normal controls. Only the beta-adrenergic blocking agents propranolol and possibly 6-OH dopamine were observed to alter (raise) the serum cholesterol concentration, and this occurred in both experimental and control animals. Neither atropine, nor the serotonin-depleting agent, rho-chlorophenylalanine, nor the serotonin-antagonist cyproheptadine, were observed to alter serum cholesterol level.

A precise catecholamine assay for small plasma samples.

The time, temperature, and pH of the trihydroxyindole reaction were controlled to minimize interference between norepinephrine (NE) and epinephrine (E) so that, in plasma catecholamine assay within normal human physiologic range, NE contributes less than 1 per cent to the fluorescence produced from E, and E contributes only 0.5 to 10 per cent to NE fluorescence; assay and blank measurements show superior stability. Elution from alumina and instrumental factors, such as optical filters, were optimized so that a single 5 ml.

Plasma catecholamine response of coronary-prone subjects (type A) to a specific challenge.

Plasma norepinephrine (NE) and epinephrine (E) were assayed in 15 men prone to develop coronary heart disease (type-A behavior pattern) and in 15 coronary-disease-resistant men (type-B behavior pattern) under resting, noncompetitive conditions and also immediately before, during, and after participation in a nonphysical competitive struggle. The average concentration of catecholamines was virtually the same in both groups under resting conditions. Under competitive conditions the NE concentration of the coronary-susceptible group rose an average of 30%, while that of the resistant group remained essentially unchanged.