Visual Communication and Creative Processes Within the Primary Care Consultation.

Discussion of the value of image, metaphor and creative principles to good consulting skill and patient education within the Primary Care setting is important in enhancing improved patient-physician interactions. A broad-based view of the techniques used in undergraduate and postgraduate teaching within Medical Education in the UK and US are canvassed to establish the best practices and efficacy of using drawings and images as communication tools between physicians and patients. A descriptive analysis of the author's use of image and metaphor is analysed to assess how such convey medical information and help in the improvement of consultation and patient understanding.

Immediate Implants.

Immediate implants have become a popular option for replacing teeth. This article describes the surgical and restorative considerations involved in the planning and placement of an immediate implant. Immediate implants require appropriate hard and soft tissue assessment.

Educational impact of paediatric palliative simulation study days.

Background: The use of simulation-based medical/nursing teaching is increasingly widespread. Simulation-based teaching offers an immersive learning experience where professionals can practice communication and practical skills in a safe, authentic environment. We designed a paediatric palliative simulation study day primarily aimed at nursing staff who manage these patients in the community/hospice.

Children and young adults with CF in the USA have better lung function compared with the UK.

Background: People with cystic fibrosis (CF) are managed differently in the USA and UK providing an opportunity to learn from differences in practice patterns.

Objectives: To compare cross-sectional demographics, practice patterns and clinical outcomes between US and UK CF patients.

Methods: This was a cross-sectional study using 2010 data from patients in the US Cystic Fibrosis Foundation and the UK Cystic Fibrosis patient registries.

Longevity of patients with cystic fibrosis in 2000 to 2010 and beyond: survival analysis of the Cystic Fibrosis Foundation patient registry.

Background: Advances in treatments for cystic fibrosis (CF) continue to extend survival. An updated estimate of survival is needed for better prognostication and to anticipate evolving adult care needs.

Objective: To characterize trends in CF survival between 2000 and 2010 and to project survival for children born and diagnosed with the disease in 2010.

Key findings of the US Cystic Fibrosis Foundation's clinical practice benchmarking project.

Benchmarking is the process of using outcome data to identify high-performing centres and determine practices associated with their outstanding performance. The US Cystic Fibrosis Foundation (CFF) Patient Registry contains centre-specific outcomes data for all CFF-certified paediatric and adult cystic fibrosis (CF) care programmes in the USA. The CFF benchmarking project analysed these registry data, adjusting for differences in patient case mix known to influence outcomes, and identified the top-performing US paediatric and adult CF care programmes for pulmonary and nutritional outcomes.

Better nutritional status in early childhood is associated with improved clinical outcomes and survival in patients with cystic fibrosis.

Objectives: To evaluate the relationship between nutritional status early in life and the timing and velocity of height growth, lung function, complications of cystic fibrosis, and survival.

Study Design: Prospective, observational study using data from the Cystic Fibrosis Foundation Registry (US) for patients born between 1989 and 1992 (n = 3142).

Results: Weight-for-age percentile (WAP) at 4 years of age was positively associated with height-for-age percentiles throughout childhood.

Validation and use of a parametric model for projecting cystic fibrosis survivorship beyond observed data: a birth cohort analysis.

Background: The current lifetable approach to survival estimation is favoured by CF registries. Recognising the limitation of this approach, we examined the utility of a parametric survival model to project birth cohort survival estimates beyond the follow-up period, where short duration of follow-up meant median survival estimates were indeterminable.

Methods: Parametric models were fitted to observed survivorship data from the US CF Foundation (CFF) Patient Registry 1980-1994 birth cohort.

The application of current lifetable methods to compare cystic fibrosis median survival internationally is limited.

Background: Comparing international estimates of survival can be a useful way of highlighting differences in life expectancy between cystic fibrosis (CF) populations. In this study, we compared survival in two CF populations.

Methods: The current lifetable method takes age-specific mortality rates observed in a given year and applies them to a hypothetical population assuming those rates will remain the same in the future.

Respiratory microbiology of patients with cystic fibrosis in the United States, 1995 to 2005.

Background: Numerous improvements in diagnostic and therapeutic strategies for patients with cystic fibrosis (CF) have occurred during the past 2 decades. We hypothesized that these changes could impact trends in respiratory microbiology.

Methods: Data from the Cystic Fibrosis Foundation Patient Registry were used to examine trends in the incidence and prevalence of bacterial pathogens isolated from patients with CF in the United States from 1995 to 2005.

Bacterial contamination of cystic fibrosis clinics.

Background: Respiratory pathogens from CF patients can contaminate inpatient settings, which may be associated with increased risk of patient-to-patient transmission. Few data are available that assess the rate of bacterial contamination of outpatient settings. We determined the frequency of contamination of CF clinics and the effectiveness of alcohol-based disinfectants in reducing hand carriage of bacterial pathogens.

Evidence-based practice recommendations for nutrition-related management of children and adults with cystic fibrosis and pancreatic insufficiency: results of a systematic review.

The Cystic Fibrosis Foundation established a process of systematic review of evidence to inform the development of clinical care guidelines and encourage evidence-based practice. The Subcommittee on Growth and Nutrition reviewed the evidence in two areas: energy intake and dosing for pancreatic enzyme replacement therapy. Evidence-based recommendations are presented here.

Current issues in quality improvement in cystic fibrosis.

The modern history of cystic fibrosis (CF) is one of continuous improvement. Guidelines and evidence-based medicine provide a general roadmap for directing improvement efforts. Data and measurement are central to quality improvement (QI), a way of keeping score and staying on track.

Comparison of three measurements of cardiac surgery mortality for the Northern New England Cardiovascular Disease Study Group.

Background: There is no consensus on the optimal period during which to assess death after coronary artery bypass graft (CABG) surgery. Three measures are commonly used: in-hospital, 30-day, and procedural (either in-hospital or 30-day) mortality. We used a regional database to calculate the CABG mortality rate using each of these mortality measures.

Perioperative stroke and long-term survival after coronary bypass graft surgery.

Background: Stroke is a devastating complication of coronary artery bypass graft (CABG) surgery. In-hospital outcomes have been described, yet the long-term effect of stroke on mortality following CABG surgery has not been well studied.

Methods: We examined the survival of 35,733 consecutive patients undergoing isolated CABG surgery in northern New England from 1992 through 2001.

Survival in patients with peripheral vascular disease after percutaneous coronary intervention and coronary artery bypass graft surgery.

Background: Patients with peripheral vascular disease (PVD) undergoing coronary revascularization have high rates of adverse outcomes. Whether there are important differences in outcomes for surgical versus percutaneous coronary revascularization is unknown. The objective of this study was to compare survival in patients with PVD who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) surgery for multivessel coronary artery disease.

Development and validation of a prediction model for strokes after coronary artery bypass grafting.

Background: A prospective study of patients undergoing coronary artery bypass graft surgery (CABG) was conducted to identify patient and disease factors related to the development of a perioperative stroke. A preoperative risk prediction model was developed and validated based on regionally collected data.

Methods: We performed a regional observational study of 33,062 consecutive patients undergoing isolated CABG surgery in northern New England between 1992 and 2001.

Consequences of transvaginal follicular puncture on well-being in cows.

The purpose of this study was to evaluate the impact of repeated follicular puncture used in the ovum pick-up technique on the welfare of cows. The evaluation relies on the physiological measurement of stress, milk production criteria, immune status, and the histological examination of ovaries. Two groups of five Holstein cows were submitted to epidural anaesthesia and genital palpation with insertion of an intravaginal ultrasound probe for transvaginal puncture (the puncture was not performed in the control group).

Median household income and mortality rate in cystic fibrosis.

Context: Poverty has been shown to be a determinant of health outcomes in many epidemiologic studies.

Objective: The goal of this study was to assess the association between household income and the mortality rate in cystic fibrosis (CF) patients.

Design, Setting, And Patients: We selected white patients diagnosed before 18 years old and having 1 or more records in the Cystic Fibrosis Foundation Patient Registry since 1991.

Gender-related changes in the practice and outcomes of percutaneous coronary interventions in Northern New England from 1994 to 1999.

Objectives: We sought to determine whether the changing practice of interventional cardiology has been associated with improved outcomes for women, and how these outcomes compare with those for men.

Background: Previous work from the early 1990s suggested women are at a higher risk than men for adverse outcomes after percutaneous coronary interventions (PCIs). From 1994 to 1999 data were collected on 33,666 consecutive hospital admissions for a PCI in Northern New England.

Case-mix adjustment for evaluation of mortality in cystic fibrosis.

Comparison of patient mortality rates in cystic fibrosis (CF) obtained from different institutions requires the use of case-mix adjustment methods to account for baseline differences in patient and disease characteristics. There is no current professional consensus on the use of case-mix adjustment methods for use in comparing mortality rates in CF. Characteristics used for this case-mix adjustment should include those that are different across institutions and are associated with patient survival.

Survival of patients with diabetes and multivessel coronary artery disease after surgical or percutaneous coronary revascularization: results of a large regional prospective study. Northern New England Cardiovascular Disease Study Group.

Objectives: We sought to assess survival among patients with diabetes and multivessel coronary artery disease (MVD) after percutaneous coronary intervention (PCI) and after coronary artery bypass grafting surgery (CABG).

Background: The Bypass Angioplasty Revascularization Investigation (BARI) demonstrated that diabetics with MVD survive longer after initial CABG than after initial PCI. Other randomized trials or observational databases have not conclusively reproduced this result.

Improved in-hospital mortality in women undergoing coronary artery bypass grafting. Northern New England Cardiovascular Disease Study Group.

Background: Few studies have examined the changes in in-hospital mortality for women over time. We describe the changing case mix and mortality for women undergoing coronary artery bypass grafting (CABG) from 1987 to 1997 in northern New England.

Methods: Data were collected on 8,029 women and 21,139 men undergoing isolated CABG.