Deficiencies of cross-training between pediatrics and otolaryngology.

Objective: Conditions relating to the ear, nose and throat are very frequent problems encountered by general pediatricians. Similarly, a major percentage of patients seen and operated on by the general otolaryngologist are of the pediatric age group. It is my hypothesis that there is a deficiency of cross-training between these two specialties.

Home hemodialysis and the caregivers' experience: a critical analysis.

The caregivers' role is often unrecognized and invisible. Caregivers are usually female and, in most situations, the caregiver is the patient's spouse or life partner. Caregivers often experience emotional stress, anxiety, depression and worsening health, and caregivers of individuals with end stage renal disease also report feelings of isolation and overwhelming exhaustion.

Neuroleptic dysphoria: revisiting the concept 50 years later.

Objective: To review the concept of neuroleptic dysphoria, its historical development and the current state of the art.

Method: This paper is based on extensive but selective literature review and also draws on our extensive clinical and research experiences.

Results: Although the construct of neuroleptic dysphoria was recognized shortly following the introduction of the first antipsychotic, chlorpromazine, it took several years for the concept to receive adequate research and clinical attention.

Heparin-induced thrombocytopenia--a big deal? It should be!

Heparin is the anticoagulant of choice for hemodialysis patients. Risks for developing heparin-induced thrombocytopenia (HIT) are increased in patients regularly receiving heparin. About five to eight per cent of these individuals will develop an adverse antigen-antibody reaction, which will be discussed.

Quotidian dialysis--update 2005.

Purpose Of Review: The interest in quotidian hemodialysis has increased further after the HEMO study reported that high-dose thrice-weekly hemodialysis failed to improve clinical outcomes. This, in combination with a significant volume of newly published data, made a review of the topic of quotidian hemodialysis timely.

Recent Findings: The published research has revealed further evidence of cardiovascular and quality-of-life improvements as well as financial benefits with quotidian hemodialysis.

Peritoneal dialysis in Ontario: a natural experiment in physician reimbursement methodology.

Background: The factors that determine dialysis modality selection and distribution are not well understood. Physician reimbursement incentives have been suggested to play an important role. Under the fee-for-service system in Ontario that existed prior to July 1998, nephrologists were paid about sevenfold more for a hemodialysis (HD) patient than for a patient on peritoneal dialysis (PD).

Impact of atypical antipsychotics on quality of life in patients with schizophrenia.

Schizophrenia is a long-term disabling illness that affects approximately 1% of the population. Its course is generally chronic with acute psychotic exacerbations that may require frequent hospitalisations. The clinical picture includes a range of symptoms such as delusions, hallucinations, agitation, suspiciousness, hostility, conceptual disorganisation, blunted affect, emotional and social withdrawal, lack of spontaneity, poverty of speech and a wide range of neurocognitive deficits.

Reconsideration of pacemakers and MR imaging.

The presence of an implanted pacemaker is widely regarded as an absolute contraindication to magnetic resonance (MR) imaging; however, this viewpoint is based largely on safety concerns in the 1982-1996 period. Since 1996, changes in pacemaker electronics including decreased ferromagnetic content, increased sophistication of the circuitry, and onboard computer capabilities suggest that the absolute contraindication of MR imaging for pacemaker patients should be reconsidered. In addition, there are now data from prospective trials of 232 patients with demand pacemakers who underwent MR imaging at 0.

New approaches to hemodialysis.

Treatment of end-stage renal disease with dialysis is characterized by high mortality rate, low quality of life, and high cost. Recent randomized controlled studies showed that increasing the dialysis dose above the currently recommended levels in thrice-weekly hemodialysis does not decrease the patient mortality rate. Short daily hemodialysis or daily home nocturnal hemodialysis are promising alternatives.

Oral hygiene in the elderly: a quality improvement initiative.

This paper describes a unit-based quality improvement initiative to ameliorate mouth care of elderly residents in a long-term care facility. Using the Nursing Role Effectiveness Model developed by Irvine et at. (1998) as the organizing framework, this project highlights the importance of the nurse's role in quality improvement initiatives.

Understanding, retaining, and removing dispersive and pseudodispersive ophthalmic viscosurgical devices.

Purpose: To analyze and explain the rheologic behavior of pseudodispersive viscoadaptive ophthalmic viscosurgical devices (OVDs) and compare it with that of dispersive OVDs.

Setting: York Finch Eye Associates and Humber River Regional Hospital, Toronto, Ontario, Canada.

Methods: Poiseuille's law was used as a basis of understanding fluid aspiration.

Daily (quotidian) nocturnal home hemodialysis: nine years later.

Daily nocturnal home hemodialysis was developed to satisfy the need for a highly effective, smooth, and cost-effective home dialysis therapy. It combines the benefits of the following dialysis methods: long, frequent, and home hemodialysis. It provides a high dialysis dose for small, as well as large, molecules including beta(2)-microglobulin; improves quality if life; and leads to control of hyperphosphatemia without the need for phosphate binders, as well as dissolution for extraosseous calcifications.

Alpha-blocker therapy can be withdrawn in the majority of men following initial combination therapy with the dual 5alpha-reductase inhibitor dutasteride.

Objectives: The Symptom Management After Reducing Therapy (SMART-1) study examined the combination of the dual action 5alpha-reductase inhibitor (5ARI) dutasteride, and alpha(1)-blocker tamsulosin, followed by withdrawal of tamsulosin in men with symptomatic BPH.

Methods: 327 BPH patients were randomised to 0.5mg dutasteride and 0.

Simultaneous bilateral cataract surgery.

Purpose: To evaluate the safety and outcomes of simultaneous bilateral cataract surgery (SBCS).

Setting: York Finch Eye Associates and Humber River Regional Hospital, Toronto, Ontario, Canada.

Methods: This retrospective study reviewed the results of 1020 consecutive patients (2040 eyes) who had SBCS by endolenticular phacoemulsification through a clear corneal incision on the corneal steep axis with foldable posterior chamber intraocular lens implantation.

Resolution of massive uremic tumoral calcinosis with daily nocturnal home hemodialysis.

Background: Derangements in bone mineral metabolism are an invariable consequence of end-stage renal disease (ESRD). Extraosseous tumoral calcification is a relatively uncommon complication that can be associated with substantial morbidity.

Methods: The authors report a case of an ESRD patient who had severe tumoral calcification of his shoulder, hands, and feet despite daily conventional hemodialysis.

PD and the future: the role of PD in the overall management of ESRD.

Given the epidemic growth of ESRD and the high costs of dialysis therapy, there is an urgent need to define the optimal dialysis modality distribution. The factors influencing dialysis modality distribution are complex and not well understood. Based on survey results that have assessed the attitudes of nephrologists in Canada, the USA and the UK, it appears that there is underutilization of both peritoneal dialysis (PD) and home hemodialysis (HD) in these countries.