Use of evidence in the process of practice change in a clinical team: a study-forming part of the Autocontrol Project.

The Autocontrol Project is concerned with the accessing, processing and communication of high quality information so that a clinical team can make and implement decisions for practice change, and then evaluate if improvement has been achieved. High quality information is used as evidence for change. In this study, we have evaluated how evidence is used by a clinical team to explain an identified problem of inappropriate use of blood gas tests.

Long-term experience with the omniscience cardiac valve.

Background And Aims Of The Study: This study reports mortality and morbidity rates observed with the Omniscience valve prosthesis. Complication rates were calculated from a prospective, long-term follow up study of patients with the Omniscience valve prosthesis in the aortic, mitral, or both aortic and mitral positions.

Methods: The Omniscience heart valve was implanted into 200 consecutive patients (42.

A young man with first-episode psychosis: case presentation and discussion.

Objective: To review and discuss the issues and challenges involved in the treatment of first-episode psychosis in young patients, including choice of appropriate antipsychotic agents and adjunctive medications, dosing regimens, and biopsychosocial interventions.

Methods: The case of a young man in his late teens with a history of substance abuse who experienced an acute dystonic reaction to treatment for his psychotic episode is presented and discussed.

Results: Each contributing author provides an evaluation of the intervention strategies presented in the patient's history and factors that influenced the treatment outcomes.

Rocuronium is the best non-depolarizing relaxant to prevent succinylcholine fasciculations and myalgia.

Purpose: To determine which non-depolarizing relaxant among d-tubocurarine, vecuronium, atracurium, mivacurium and rocuronium prevented muscular fasciculations and myalgia following succinylcholine.

Methods: In this double blind randomized study, 120 female patients scheduled for laparoscopic procedures were studied. They were divided into six groups of 20 according to the non-depolarizing pretreatment used: NaCl 0.

Informatics methodologies for evaluation research in the practice setting.

A continuing challenge in health informatics and health evaluation is to enable access to the practice of health care so that the determinants of successful care and good health outcomes can be measured, evaluated and analysed. Furthermore the results of the analysis should be available to the health care practitioner or to the patient as might be appropriate, so that he or she can use this information for continual improvement of practice and optimisation of outcomes. In this paper we review two experiences, one in primary care, the FAMUS project, and the other in hospital care, the Autocontrol project.

Cardiovascular disease. Physician attitudes toward prevention and treatment.

Objective: Survey of physician attitudes toward practising cardiovascular disease prevention.

Design: Questionnaire administered via telecommunication from 1992 through 1994.

Setting: The FAMUS (Family Medicine, University of Sherbrooke) project, between 1992 and 1996, used weekly telecommunication to collect data from 200 general practitioners throughout the province of Quebec on cardiovascular disease risk factors and their treatment.

Analytical evaluation of the testosterone assay on the Bayer Immuno 1 system.

Objectives: To evaluate the analytical performance of the testosterone assay performed on the Bayer immuno 1 system from Bayer Corporation.

Design And Methods: The precision was measured using three Bayer TESTpoint Ligand controls, three Medical Decision Pools and the Bayer SETpoint Testosterone calibrators. The linearity was verified by diluting two serum samples containing high testosterone concentrations with the zero calibrator and the minimum detectable concentration determined by repetitive analysis of the zero calibrator.

Antibody interference in thyroid assays: a potential for clinical misinformation.

Measurements of thyrotropin and of total and free thyroxine and triiodothyronine are widely used diagnostic methods for thyroid function evaluation. However, some serum samples will demonstrate a nonspecific binding with assay reagents that can interfere with the measurement of these hormones. Several recent case reports have described the presence of such interferences resulting in reported abnormal concentrations of thyroid hormones inconsistent with the patient's thyroid state.

[Arterial embolism of the lower limb after extracorporeal lithotripsy. A case report].

The authors report a case of arterial embolism of the right lower limb after extracorporeal lithotripsy for left pelvic ureteric stone. This probable complication of lithotripsy has never been reported in the literature.

DNase I acutely increases cystic fibrosis sputum elastase activity and its potential to induce lung hemorrhage in mice.

The potential of DNase I to increase cystic fibrosis sputum elastase activity and lung damage was evaluated. Sputum from CF patients induced little lung hemorrhage when instilled intranasally in C57BL/6 mice. However, sputum treated in vitro by the addition of 1 mg/ml bovine DNase I showed increased neutrophil elastase activity (7.

Analytical performance of Bayer Immuno 1 estradiol and progesterone assays.

We evaluated the analytical performance of new estradiol and progesterone assays performed on the Bayer Immuno 1 system. Within-run and between-day CVs for estradiol at concentrations of 116.8-6645.

Development of an assay for urinary free cortisol determination on the Technicon Immuno 1 system.

Objectives: To develop and evaluate a method using an ethyl acetate extraction procedure for the determination of urinary free cortisol on the Technicon Immuno 1 system from Bayer Corporation.

Design And Methods: We tested the assay precision, linearity, and correlation with the Urinary Kallestad Quanticoat Cortisol radioimmunoassay. We also studied the efficiency of the extraction procedure, performed a cross-reactivity study with different cortisol metabolites, and determined the reference values.

[Intra-parotid neurogenic tumors of the facial nerve. Value of MRI].

Facial nerve intraparotid neuromas are rare. We report two cases with no facial paralysis. In the first case, the clinical protocol for the evaluation of a parotid mass did not suggest the intramastoid tumor extension.

Analytical evaluation of the CK-MB mass assay on the Technicon Immuno 1 system.

Objectives: To evaluate the performance of the Technicon Immuno 1 CK-MB mass assay.

Design And Methods: The precision was measured using the BioRad Liquichek CK-MB controls and the Technicon Immuno 1 SETpoint CK-MB calibrators. The linearity was verified by diluting 9 patient serum samples containing high CK-MB concentrations, and the minimum detectable concentration determined by repetitive analysis of the zero calibrator.

[Not Available].

To review the epidemiology, risk factors, clinical features and outcomes of Listeria monocytogenes infection in the Eastern Townships of Quebec, a retrospective study was completed over the period 1976 to 1995. Cases were identified from positive cultures and diagnosis given by the infectious diseases service of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec. A total of 12 cases were in the study.

[Postoperative hematoma distant from the surgical site. A case report and review of the literature].

Significant post-operative hemorrhage is a rare complication of intracranial surgery. Hemorrhage remote from the site of neurosurgical intervention is rare, with only 37 cases reported in the literature. We present the case of a 62 year old woman who presented a right occipital hematoma following excision of a large left sphenoidal meningioma.

[Abnormal response of growth hormone to oral glucose tolerance test in obesity].

In obesity, it is well known that basal growth hormone (GH) levels can be suppressed and they may show an impaired response to various stimuli like hypoglycemia, stress, and GHRH. However, the inhibitory effect of hyperglycemia on GH in this condition has not been well studied. We analyzed the GH response to an oral glucose tolerance test (OGTT) in 25 unselected patients with morbid obesity who were not diabetic, glucose intolerant or affected by renal or hepatic disease.

Mixed anxiety and depression: from theory to practice.

The 10th International Classification of Disease (ICD-10) introduced the concept of mixed anxiety-depression to define patients presenting both anxiety and depressive symptoms of limited number and/or intensity, not sufficiently severe to fulfill criteria for a specific diagnosis of depressive or anxiety disorder. Epidemiologic surveys have shown that these patients may display significant levels of functional impairment, have unexplained somatic symptoms and a high use of nonpsychiatric medical care, have long-lasting symptoms, and are at risk for more severe psychiatric disorders. A DSM-IV field trial concluded that patients with affective-symptoms not meeting thresholds for DSM-III-R disorders were at least as common as patients with anxiety or mood disorders, and that their symptoms were associated with significant distress or impairment.

RNA-labelled Ro and La ribonucleoprotein complexes reassembled in vitro; characterization by gel shift analysis.

Ro and La RNP complexes were reassembled from in vitro labelled hY5 RNA and HeLa cell extracts. These complexes were then visualized through retardation of migration of labelled hY5 RNA in non-denaturing polyacrylamide gels. Three major complexes (named A, B, and C) were formed when crude cellular extracts (S100 fraction) were used.

Neuroblastoma: an enigmatic disease.

Neuroblastoma is the most common extra-cranial solid tumor of childhood. It originates in cells of the neural crest, and so can be found anywhere along the paravertebral sympathetic chain or in the adrenal gland. In the last 15 years, new developments in the genetics and biology of neuroblastoma, have led to a better understanding of the natural history and prognostic features of this cancer.