A qualitative application of the diffusion of innovations theory to examine determinants of guideline adherence among physical therapists.

Background: Evidence-based practice has become a major issue in physical therapy. Many evidence-based guidelines, however, are not used extensively after dissemination, and interventions aimed at increasing guideline adherence often have limited effects.

Objective: As a prerequisite for changing this situation, the aims of this study were to gain an in-depth understanding of the determinants of guideline adherence among physical therapists in the Netherlands and to evaluate the opportunities of a theoretical framework in this respect.

Validation of the urine column measurement as an estimation of the intra-abdominal pressure.

Objective: To evaluate the efficacy of the urine column (UC) measurement compared to the intra-vesicular pressure (IVP) measurement as an estimation of intra-abdominal pressure (IAP) in patients with IAP up to 30 mmHg.

Methods: Fifteen patients undergoing a laparoscopic cholecystectomy were studied. All patients were catheterized.

Study of the human pelvis using CAT-scan: gender differences and anatomy of the ramus ossis ischii.

Objective: In a descriptive study we present the CAT-scan norm data of pelvic sizes in Caucasian men and women. The study was performed to investigate possible differences in pelvic sizes between men and women and the inter-individual range of pelvic sizes. The data may be useful as a guide in the development of orthoses and prostheses.

The dopamine agonist apomorphine differentially affects cognitive performance in alcohol dependent patients and healthy controls.

Background: Reduced metabolic activity in frontal brain regions, and reduced striatal dopamine receptor densities have been shown in alcohol dependent patients. Little is known on functional changes in the fronto-striatal-thalamic dopaminergic neurocircuitry in these patients. The objective of this study was to assess sensitivity of prefrontal dopamine receptors in alcohol dependent patients.

Reproducibility of the ambulatory arterial stiffness index in hypertensive patients.

Background: We studied the repeatability of the ambulatory arterial stiffness index (AASI), which can be computed from 24-h blood pressure (BP) recordings as unity minus the regression slope of diastolic on systolic BP.

Methods: One hundred and fifty-two hypertensive outpatients recruited in Nijmegen (mean age = 46.2 years; 76.

Clinical results in paediatric cochlear implantation.

Surgical aspects of paediatric cochlear implantation and peri- and postoperative complications were evaluated in 137 consecutive patients. In 52 children with postmeningitic deafness, 60% of the cochleae showed ossification of some degree at surgery. In eight patients, this led to a partial insertion of the electrode array; in two patients a double array was used.

Options for the treatment of psoriasis: a multifactorial approach.

The expression of psoriasis is highly variable and may even differ within a single patient. This comprises not only extent of lesions, severity in terms of erythema induration, and scaling or visibility of the lesions, but particularly the responsiveness to antipsoriatic treatments in the past. Therefore, the management of psoriasis has to reconcile the variability of treatment responses, which, to some extent, may be genetically determined but also are the result of nongenetic factors, including triggering factors and adaptation (habituation) to treatments.

Women's positions during the second stage of labour: views of primary care midwives.

Aim: This paper is a report of a study to explore the views of midwives on women's positions during the second stage of labour.

Background: Many authors recommend encouraging women to use positions that are most comfortable to them. Others advocate encouragement of non-supine positions, because offering 'choice' is not enough to reverse the strong cultural norm of giving birth in the supine position.

Bacteraemia coincides with low citrulline concentrations after high-dose melphalan in autologous HSCT recipients.

Mucosal damage to the intestines induced by myeloablative conditioning for allogeneic PBSC transplant (PBSCT) can be determined by the concentration of citrulline, which is a functional marker of small intestinal enterocytes. Low citrulline concentrations in blood coincide with and are a response to severe mucosal barrier injury. We treated 29 patients with high-dose melphalan 200 mg/m(2) (Mel-200) to prepare for an autologous PBSCT and collected plasma samples from each patient starting before the myeloablative regimen and three times per week thereafter until discharge.

Subjective benefit after BAHA system application in patients with congenital unilateral conductive hearing impairment.

Objective: To study whether unilateral Bone-anchored Hearing Aid (BAHA) fitting led to subjective hearing benefit in patients with congenital unilateral conductive hearing impairment.

Study Design: Prospective evaluation on 20 patients.

Setting: Tertiary referral center.

Multilayer compression bandaging in the acute phase of deep-vein thrombosis has no effect on the development of the post-thrombotic syndrome.

Objective: The purpose of this randomized study was to evaluate the influence of immediate multilayer compression bandages before application of elastic stockings in the acute phase of deep-vein thrombosis (DVT) on development of the post-thrombotic syndrome (PTS).

Methods: Sixty-nine patients with acute symptomatic DVT were randomized to immediate bandaging (n = 34) or no bandaging (n = 35). After reduction of edema sized-to-fit elastic stockings were applied in all patients after 7-14 days.

Crystals of monosodium urate monohydrate enhance lipopolysaccharide-induced release of interleukin 1 beta by mononuclear cells through a caspase 1-mediated process.

Objective: Recent studies suggest that crystals of monosodium urate (MSU), deposited in joints of patients with acute gouty arthritis, activate the NACHT domain, leucine-rich repeat and pyrin domain-containing protein (NALP)3 inflammasome. In the present study we have investigated whether production of proinflammatory cytokines by crystals was exacerbated during costimulation with Toll-like receptor (TLR) ligands.

Methods: Mononuclear cells of 22 healthy donors were stimulated by various concentrations of MSU crystals in the absence or presence of lipopolysaccharide (LPS), Pam3Cys and flagellin.

Acute neuropsychological effects of MDMA and ethanol (co-)administration in healthy volunteers.

Rationale: In Western societies, a considerable percentage of young people expose themselves to 3,4-methylenedioxymethamphetamine (MDMA or "ecstasy"). Commonly, ecstasy is used in combination with other substances, in particular alcohol (ethanol). MDMA induces both arousing as well as hallucinogenic effects, whereas ethanol is a general central nervous system depressant.

Which physiological mechanism is responsible for the increase in blood pressure during leg crossing?

Objective: To determine which physiological mechanism is responsible for the blood pressure increase during leg crossing at knee-level in the sitting position.

Methods: Finger blood pressure was measured with the Finometer in 102 participants (47 men) before and during leg crossing: 24 treated hypertensive patients, 50 diabetic individuals (25 with and 25 without antihypertensive medication) and 28 healthy volunteers. Mean age, 53 +/- 15 years (range 21-82 years).

A randomised phase III study on capecitabine, oxaliplatin and bevacizumab with or without cetuximab in first-line advanced colorectal cancer, the CAIRO2 study of the Dutch Colorectal Cancer Group (DCCG). An interim analysis of toxicity.

Background: Targeting the vascular endothelial growth factor or the epidermal growth factor receptor (EGFR) has shown efficacy in advanced colorectal cancer (ACC), but no data are available on the combination of these strategies with chemotherapy in the first-line treatment. The CAIRO2 study evaluates the effect of adding cetuximab, a chimeric mAb against EGFR, to capecitabine, oxaliplatin and bevacizumab in the first-line treatment of ACC.

Patients And Methods: In all, 755 patients were randomly assigned between treatment with capecitabine, oxaliplatin and bevacizumab with or without cetuximab.

Octreotide acetate in dominant cystoid macular dystrophy.

Purpose: Dominant cystoid macular degeneration (DCMD) is an autosomal dominant trait of cystoid macular edema with poor visual prognosis. Until now, no efficient treatments for DCMD have been reported. The authors evaluated a somatostatin-analogue (octreotide acetate) as treatment for DCMD.

Bone-anchored hearing aid system application for unilateral congenital conductive hearing impairment: audiometric results.

Objective: To study the audiologic outcome of bone-anchored hearing aid (BAHA) application in patients with congenital unilateral conductive hearing impairment.

Study Design: Prospective audiometric evaluation on 20 patients.

Setting: Tertiary referral center.

Religion, spirituality, health and medicine: why should Indian physicians care?

Religion, spirituality, health and medicine have common roots in the conceptual framework of relationship amongst human beings, nature and God. Of late, there has been a surge in interest in understanding the interplay of religion, spirituality, health and medicine, both in popular and scientific literature. A number of published empirical studies suggest that religious involvement is associated with better outcomes in physical and mental health.

Are there inequalities in choice of birthing position? Sociodemographic and labour factors associated with the supine position during the second stage of labour.

Objective: to establish which factors are associated with birthing positions throughout the second stage of labour and at the time of birth.

Design: retrospective cohort study.

Setting: primary care midwifery practices in the Netherlands.

Psoriasis: consensus on topical therapies.

Objective: A consensus conference was convened to evaluate the topical treatment of psoriasis.

Participants: Members of the International Psoriasis Council (IPC) with broad clinical experience in the treatment of psoriasis and a specialist in meta- and pharmacoeconomic analyses were invited to participate on the consensus panel. Those accepting the invitation convened in Saariselkä, Finland.

East meets West: cross-cultural perspective in end-of-life decision making from Indian and German viewpoints.

Culture creates the context within which individuals experience life and comprehend moral meaning of illness, suffering and death. The ways the patient, family and the physician communicate and make decisions in the end-of-life care are profoundly influenced by culture. What is considered as right or wrong in the healthcare setting may depend on the socio-cultural context.

The impact of pain on daily activities following open mesh inguinal hernia repair.

Background: In groin hernia repair studies, chronic pain is a frequently used primary endpoint. However, its impact on daily life activities has been less investigated. Such an outcome is relevant for the patient and surgeon and cannot be extrapolated out of pain scores.

Recurrent ATP1A2 mutations in Portuguese families with familial hemiplegic migraine.

Familial hemiplegic migraine is a rare autosomal dominant subtype of migraine with aura. Three genes have been identified, all involved in ion transport. There is considerable clinical variation associated with FHM mutations.