Nocturnal leg cramps in children: incidence and clinical characteristics.
(9/878)
The records of 2527 healthy children seen in an ambulatory care clinic were evaluated for nocturnal leg cramps in the preceding 12 months, frequency and duration of the cramps, whether the cramps affected one leg or both legs at a time, whether there was associated muscle cramps in feet, whether the cramps occurred when the child was awake or asleep, and whether there was residual tenderness in the affected muscles. Nocturnal leg cramps were present in 185 children for an overall incidence of 7.3%. Leg cramps were noted only in children aged > or = 8 years. The incidence increased at 12 years and peaked at 16 to 18 years of age. A majority (81.6%) of the affected children had nocturnal leg cramps 1 to 4 times per year. The mean duration of episodes was 1.7 minutes. Leg cramps were unilateral in 98.9% of cases and the ipsilateral foot also was involved in 18.9% of cases. One hundred thirty-five (73%) children had leg cramps while asleep, and the remaining 23 (12.4%) children had leg cramps in either state. Fifty-seven (30.8%) children had residual tenderness in the affected muscles. The mean duration of residual tenderness was 33.2 minutes (range: 2 minutes-1 day). We conclude that nocturnal leg cramps are common in children aged > 12 years. A majority of the affected children have leg cramps 1 to 4 times per year. The cramps are usually unilateral and occur when the children are asleep. Normal duration of the leg cramp is < 2 minutes. Residual tenderness is present in approximately 30% of the affected children. Residual tenderness, if present, usually lasts for half an hour. (+info)
Hepatitis C prevalence and risk factors in the northern Alberta dialysis population.
(10/878)
Hepatitis C virus (HCV) is an emerging global public health issue with particular relevance in multiply transfused renal dialysis patients. This cross-sectional study evaluated the prevalence and risk factors for HCV infection among renal dialysis patients in northern Alberta, Canada. Ninety-two percent of eligible patients (n = 336) provided informed consent to participate. Participants were interviewed to gather risk factor information and, using multiple logistic regression analysis with exact inference, a predictive model for HCV infection in this population was developed. The prevalence of HCV infection in the population was 6.5%, and all positive patients had at least one identifiable risk factor. The multivariate analysis showed that the risk of HCV infection was greater for those in the 18-55 years age category (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.2-27.9), patients who had been on dialysis > 5 years (OR = 3.7, 95% CI 1.2-12.0), and patients who had > or = 2 high risk life-style behaviors (OR = 5.0, 95% CI 1.5-16.7). Transfusion prior to 1990 was marginally associated with HCV status (OR = 4.0, 95% CI 0.96-16.3). This study documented previously unreported life-style risk factors for HCV infection in patients with renal failure, confirmed the expected decline in transfusion-acquired HCV infection in this population, and provided evidence against nosocomial transmission of HCV. (+info)
Assessment of physician performance in Alberta: the physician achievement review.
(11/878)
The College of Physicians and Surgeons of Alberta, in collaboration with the Universities of Calgary and Alberta, has developed a program to routinely assess the performance of physicians, intended primarily for quality improvement in medical practice. The Physician Achievement Review (PAR) provides a multidimensional view of performance through structured feedback to physicians. The program will also provide a new mechanism for identifying physicians for whom more detailed assessment of practice performance or medical competence may be needed. Questionnaires were created to assess an array of performance attributes, and then appropriate assessors were designated--the physician himself or herself (self-evaluation), patients, medical peers, consultants and referring physicians, and non-physician coworkers. A pilot study with 308 physician volunteers was used to evaluate the psychometric and statistical properties of the questionnaires and to develop operating policies. The pilot surveys showed good statistical validity and technical reliability of the PAR questionnaires. For only 28 (9.1%) of the physicians were the PAR results more than one standard deviation from the peer group means for 3 or more of the 5 major domains of assessment (self, patients, peers, consultants and coworkers). In post-survey feedback, two-thirds of the physicians indicated that they were considering or had implemented changes to their medical practice on the basis of their PAR data. The estimated operating cost of the PAR program is approximately $200 per physician. In February 1999, on the basis of the operating experience and the results of the pilot survey, the College of Physicians and Surgeons of Alberta implemented this innovative program, in which all Alberta physicians will be required to participate every 5 years. (+info)
Edmonton Regional Palliative Care Program: impact on patterns of terminal cancer care.
(12/878)
The Edmonton Regional Palliative Care Program was established in July 1995 to measure the access of patients with terminal cancer to palliative care services, decrease the number of cancer-related deaths in acute care facilities and increase the participation of family physicians in the care of terminally ill patients. In this retrospective study the authors compared the pattern of care and site of deaths before establishment of the program (1992/93) and during its second year of operation (1996/97). Significantly more cancer-related deaths occurred in acute care facilities in 1992/93 than in 1996/97 (86% [1119/1304] v. 49% [633/1279]) (p < or = 0.001). The number of inpatient days decreased, from 24,566 in 1992/93 to 6960 in 1996/97. More cancer patients saw a palliative care consult team in 1996/97 than in 1992/93 (82% v. 22%). The shift from deaths in acute care facilities to palliative hospices suggests that the establishment of an integrated palliative care program has increased access of patients with terminal cancer to palliative care. (+info)
Prevalence and incidence of carpal tunnel syndrome in a meat packing plant.
(13/878)
OBJECTIVES: To determine prevalence and incidence of carpal tunnel syndrome (CTS) in a modern meat packing plant. The secondary objective was to explore the relation between ethnicity and CTS. METHODS: Six hundred and sixty five workers were interviewed and examined to find the prevalence of CTS. Subsequently, 421 workers without CTS were followed up and examined at a median interval of 253 days; of those, 333 remained without CTS and were again examined at a median interval of 148 days. RESULTS: The prevalence and incidence of CTS was 21% and 11/100 person-years, respectively. The incidence for Asian mixed, white, and other ethnicities was 12.0, 12.2, and 7.2 cases/100 person-years, respectively. The observed incidence for men and women was 9.7 and 18.4 cases/100 person-years, respectively. This difference was not quite significant (p = 0.068) with an estimated relative risk (women v men) of 1.9 (95% confidence interval (95% CI) 0.9 to 3.8). The interaction between sex and use of tools was significant (p = 0.04), however, although the relative risk for CTS in women who used tools was 4.2 the numbers were small and not significant. The relative risk for men who used tools was 0.64 and not significant. The percentage of incident cases with comorbid disease was only 6.3% (3/47). CONCLUSIONS: The prevalence and incidence of CTS in this workforce were higher than in the general population. However, the prevalence of CTS in this modern, mechanised plant was not significantly different from that reported in older plants. No relation was found between ethnicity, age, body mass index, and CTS for either prevalence or incidence. Comorbid disease among the cases of CTS is significantly less than that found in other industry. (+info)
Frontiers in transplantation of insulin-secreting tissue for diabetes mellitus.
(14/878)
Transplantation of insulin-secreting tissue represents a physiologic approach to reverse diabetes mellitus. Pancreas transplants yield a remarkable enhancement in quality of life and appear to modify the devastating neurovascular complications of diabetes. A more attractive approach is transplantation of insulin-secreting cells, a procedure of low invasiveness with the exciting prospect of modulating graft immunogenicity before transplantation, so as to minimize requirements for toxic immunosuppressive drugs. The Surgical-Medical Research Institute at the University of Alberta in Edmonton, and several others centres throughout the world, has demonstrated that islet cell transplants can reverse insulin dependence and induce remarkable glycemic stability for several years. However, widespread success has been denied because of insufficient donor tissue, early failures to reverse insulin dependence and the loss of graft function with time. Promising new research approaches to these problems are reviewed, including xenogeneic sources of cells, engineering islet cells with genes that induce expression of immunoprotective molecules, and neogenesis factors that may sustain populations of transplanted beta cells. (+info)
Use of walk-in clinics by rural and urban patients.
(15/878)
OBJECTIVE: To compare use of walk-in clinics by rural and urban family practice patients and to describe patients' perceptions of the quality of care in physicians' offices. DESIGN: Questionnaire completed by patients in family physicians' offices. SETTING: Nine community-based family practices located in rural and urban areas of Alberta. PARTICIPANTS: Patients who had visited their family physicians' offices during April, May, June, or July 1997. Response rate was 89.6% (403 of 450 questionnaires were completed). MAIN OUTCOME MEASURES: Use of walk-in clinics, patients' perceptions of the quality of care in physicians' offices. RESULTS: Overall, 27.5% of patients (22.2% of rural, 35.5% of urban patients) attended walk-in clinics in the 6 months before visiting their family physicians' offices: 43.3% went during weekdays when their family physicians' offices were open. Significantly more rural (91.1%) than urban (60.7%) patients felt they could contact their doctors during evenings and weekends (P.004). Significantly more urban (67.2%) than rural (33.3%) patients did not call their own physicians before going to walk-in clinics (P.002). Patients who attended walk-in clinics were more likely (P.01) than patients who did not to rate their family physicians' office hours poor to good (27.9% vs 15.6%). CONCLUSIONS: Many patients attending the offices of community-based family physicians in both urban and rural areas of Alberta also attend walk-in clinics. Family practice patients attend walk-in clinics primarily because their own physicians' offices are less convenient. (+info)
A review of trauma systems using the Calgary model.
(16/878)
Surgeons caring for severely injured patients have witnessed tremendous change over the past 2 decades with the rapid evolution of trauma systems. This paper describes the evolution of trauma systems in Canada, using the one in Calgary as a model. Canadian system guidelines were produced by the Trauma Association of Canada in 1993. Participation in Canadian accreditation is accelerating as increasingly more centres across the country undergo external review each year. Reporting of trauma outcomes, including standardized mortality and a variety of performance measures, is becoming the norm. Injury is being treated as a disease with comprehensive control strategies aimed at reducing death and disability rates through prevention, treatment and rehabilitation. (+info)