Assessment and treatment of elopement: a replication and extension.
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The current investigation replicated and extended the assessment and treatment methodology of elopement. The environmental variables that maintained elopement were identified in each case, and successful treatments were implemented for the 3 participants in settings that were similar to those in which elopement occurred. (+info)
A philosophical analysis of the evidence-based medicine debate.
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BACKGROUND: The term "evidence-based medicine" (or EBM) was introduced about ten years ago, and there has been considerable debate about the value of EBM. However, this debate has sometimes been obscured by a lack of conceptual clarity concerning the nature and status of EBM. DISCUSSION: First, we note that EBM proponents have obscured the current debate by defining EBM in an overly broad, indeed almost vacuous, manner; we offer a clearer account of EBM and its relation to the alternative approaches to medicine. Second, while EBM proponents commonly cite the philosophical work of Thomas Kuhn and claim that EBM is a Kuhnian 'paradigm shift,' we argue that such claims are seriously mistaken and unduly polarize the EBM debate. Third, we suggest that it is much more fruitful to understand the relationship between EBM and its alternatives in light of a different philosophical metaphor: W.V. Quine's metaphor of the web of belief. Seen in this way, we argue that EBM is an approach to medical practice that is indeed importantly different from the alternatives. SUMMARY: We can have a more productive debate about the value of EBM by being clearer about the nature of EBM and its relationship to alternative approaches to medicine. (+info)
Time use during acute and chronic illness visits to a family physician.
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OBJECTIVE: To identify differences in time use during acute and chronic care visits. POPULATION: Patients coming to outpatient offices of physician members of a practice-based research network in Ohio. MEASURES: Direct observation and coding of physician activities during acute and chronic care visits. RESULTS: Time use varied by visit type with more time spent on compliance assessment, negotiation, and nutrition advice during chronic care visits. Acute care visits included more time for procedures, physical examination, feedback on test results and health education. CONCLUSION: Physicians structure their use of time to fit the differing goals of acute and chronic care visits. (+info)
Adjuvant therapy after excision and radiation of isolated postmastectomy locoregional breast cancer recurrence: definitive results of a phase III randomized trial (SAKK 23/82) comparing tamoxifen with observation.
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BACKGROUND: Adjuvant systemic treatment for patients with isolated locoregional recurrence (ILRR) of breast cancer is based on a single reported randomized trial. The trial, conducted by the Swiss Group for Clinical Cancer Research, compared tamoxifen (TAM) with observation after complete excision of the ILRR and proper radiotherapy. We performed a definitive analysis of treatment outcome at >11 years of follow-up, after the majority of the patients had a subsequent event of interest. Patient and methods One hundred and sixty-seven patients with 'good-risk' characteristics of disease were randomized. 'Good-risk' was defined as estrogen receptor expression in the ILRR, or having a disease-free interval of >12 months and a recurrence consisting of three or less tumor nodules, each +info)
Cost-benefit analysis of mollusc eating in a shorebird. I. Foraging and processing costs estimated by the doubly labelled water method.
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Although the energy costs of foraging and food processing in vertebrates may be considerable, they have rarely been quantified separately. Here we present estimates for both cost factors based on a series of trials with a shorebird, the red knot Calidris canutus, fed natural and artificial prey types under naturalistic but fully controlled indoor aviary conditions. During eight 1-day trials we successfully manipulated the extent to which the five red knots were (1) actively probing and walking (i.e. foraging) and (2) actually ingesting prey (i.e. processing food) that was (3) either hard-shelled or not (i.e. crushing). Energy expenditures, estimated by the doubly labelled water (DLW) method, calibrated for use in this particular condition, varied between 1.5 and 4 W. A hierarchical analysis of variance indicated that the crushing of hard-shelled prey entailed no extra cost. We arrived at the following breakdown of cost components under the thermoneutral conditions of the experiment: a cost of active rest/maintenance of 1.665 W, an additional cost of foraging of 0.602 W and an additional digestive processing cost of 1.082 W. These cost levels are all well within the range of expectation and are consistent with the results of a separate outdoor aviary experiment in which the thermostatic costs needed separate estimation. On the basis of the cost and performance functions of gizzards of different mass, it was shown that under the conditions of this experiment the red knots expended the bare minimum for a balanced budget, maintaining the smallest possible gizzard. Under field conditions a larger gizzard would be required. (+info)
Safety of vendor-prepared foods: evaluation of 10 processing mobile food vendors in Manhattan.
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OBJECTIVES: Unsanitary food handling is a major public health hazard. There are over 4,100 mobile food vendors operating in New York City, and of these, approximately forty percent are processing vendors--mobile food units on which potentially hazardous food products are handled, prepared, or processed. This pilot study assesses the food handling practices of 10 processing mobile food vendors operating in a 38-block area of midtown Manhattan (New York City) from 43rd Street to 62nd Street between Madison and Sixth Avenues, and compares them to regulations stipulated in the New York City Health Code. METHODS: Ten processing mobile food vendors located in midtown Manhattan were observed for a period of 20 minutes each. Unsanitary food handling practices, food storage at potentially unsafe temperatures, and food contamination with uncooked meat or poultry were recorded. RESULTS: Over half of all vendors (67%) were found to contact served foods with bare hands. Four vendors were observed vending with visibly dirty hands or gloves and no vendor once washed his or her hands or changed gloves in the 20-minute observation period. Seven vendors had previously cooked meat products stored at unsafe temperatures on non-heating or non-cooking portions of the vendor cart for the duration of the observation. Four vendors were observed to contaminate served foods with uncooked meat or poultry. CONCLUSIONS: Each of these actions violates the New York City Code of Health and potentially jeopardizes the safety of these vendor-prepared foods. More stringent adherence to food safety regulations should be promoted by the New York City Department of Health. (+info)
Changes in leisure-time physical activity and risk of death: an observational study of 7,000 men and women.
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Associations of regular leisure-time physical activity and changes in leisure-time physical activity with risk of death were studied in 7,023 healthy men and women aged 20-79 years in Copenhagen, Denmark. Physical activity was estimated in both 1976-1978 and 1981-1983. Men consistently engaging in a moderate or high degree of physical activity, respectively reported at both examinations, had significantly lower risks of death than men reporting low activity at both examinations. Adjusted relative risks were 0.71 (95% confidence interval (CI): 0.57, 0.88; p = 0.002) and 0.61 (95% CI: 0.48, 0.76; p < 0.001), respectively. Similar relative risks were found in women: 0.64 (95% CI: 0.52, 0.79; p < 0.001) and 0.66 (95% CI: 0.51, 0.85; p = 0.001), respectively. Men who increased their leisure-time physical activity from low to moderate or high had a significantly lower risk of death than men reporting low physical activity at both examinations (relative risk = 0.64, 95% CI: 0.50, 0.81; p < 0.001). In this study, maintaining or adopting a moderate or high degree of physical activity was associated with lower risk of death across a wide range of ages in both sexes. (+info)
Risk indicators for falls in institutionalized frail elderly.
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The aim of this study was to identify individual predisposing risk indicators for falls in a sample of institutionalized frail elderly in southern Germany. The design was a prospective observational study with a 1-year follow-up (October 1998-September 1999). The study population included 472 long-term-care residents whose mean age was 84 years; 77% were female. Risk indicators for accidental falls were analyzed by using logistic regression. Residents were found to have an incidence density rate of falls of 2,558 per 1,000 resident-years. Multiple logistic regression analysis revealed short-term memory loss, transfer assistance, urinary incontinence, positive fall history, and use of trunk restraints as predictors of falls. In a further logistic regression analysis, depressive symptoms, transfer assistance, urinary incontinence, and positive fall history were associated with frequent falls. Using these risk indicators as a screening procedure to identify fallers would be easy to administer and could be accomplished by nursing staff. Study results encourage specifically addressing urinary incontinence, cognitive impairment, use of restraints, depression, and transfer difficulties as modifiable predisposing risk factors for falls. Fall history represents an important nonmodifiable marker to identify residents at high risk. (+info)