Primary care guidelines for geriatric assessment. A structured, comparative analysis.

A structured geriatric assessment (GA) improves the quality of health care; however, the quality of GA guidelines has hardly been investigated. Eight guidelines were identified by systematically searching guideline databases, web sites of guideline developers, and PubMed. The methodological quality was assessed by two appraisers using the German Guideline Evaluation Instrument (DELBI). Guideline content was extracted; organizational and medical recommendations were compared. The methodological appraisal revealed a broad range of quality. The domains "Scope and purpose" and "Clarity and presentation" showed good results. The domains "Applicability" and "Editorial independence" had results that were not as good. Medical recommendations agreed to a great extent. GA should be delivered continuously for all older people in their homes by one responsible assessor. In cooperation with relatives, patient-centered therapy goals should be defined. Differences were identified in profession, instruments, aims, and "tailoring." The quality of primary care guidelines for GA may be improved. Details of organization of a GA require further research.

Inactivation of Mycobacterium avium ssp. paratuberculosis in milk by UV treatment.

AIMS: To determine the effect of UV radiation on the viability of two strains of Mycobacterium avium ssp. paratuberculosis (Map) inoculated into milk. METHODS AND RESULTS: Mycobacterium avium ssp. paratuberculosis in a ultra heat treated milk matrix was subjected to increasing doses of UV-C radiation from 0 to 1836 mJ ml(-1) using a pilot-scale UV reactor (20 l capacity). Survival of Map was monitored by culture on Herrold's egg yolk medium, Middlebrook 7H10 medium and the FASTPlaqueTB phage assay. Differences in sensitivity to UV treatment were observed between strains, however, at 1000 mJ ml(-1) a Map kill rate of 0.1-0.6 log(10) was achieved regardless of strain used or method employed to enumerate Map. Although the inactivation trend was similar on the culture and phage assay, the former gave a consistently higher viable count. CONCLUSIONS: The use of UV radiation alone does not represent an alternative to current pasteurization regimes for a large reduction in viable Map in milk. SIGNIFICANCE AND IMPACT OF THE STUDY: To the authors' knowledge the work here represents the first pilot-scale UV treatment process used to assess UV efficacy to inactivate Map in milk. The results are similar to those obtained with a laboratory-scale process indicating the difficulties associated with UV treatment of an opaque liquid and the recalcitrance of Map towards inimical treatments.

PCR-based DGGE fingerprinting and identification of methanogens detected in three different types of UASB granules.

Methane is produced by various methanogenic bacteria present in upflow anaerobic sludge blanket (UASB) bioreactors. Methane can be used to predict and improve UASB bioreactor efficiency. The methanogen population in the granules can be influenced by the composition of the substrate. The aim of this study was to fingerprint and identify the methanogens present in three different types of UASB granules that had been used to treat winery, brewery and peach-lye canning effluents. This was done using polymerase chain reaction (PCR)-based denaturing gradient gel electrophoresis (DGGE) and DNA sequence analysis. The DGGE fingerprints obtained from the methanogen reference cultures of Methanosaeta concilii, Methanosaeta thermophila, Methanosarcina barkeri, Methanosarcina mazeii and Methanobacterium formicicum were compared to the DGGE profiles of the Archaea in the different granules. The positions of the DGGE bands that did not correspond well to the bands of the known species were sequenced and compared to sequences available on GenBank using the Blastn search option. The aligned DNA sequences were used to construct a phylogenetic tree. Based on the data obtained, a DGGE marker was constructed which was used to provide a quick method to identify the Archaeal members of the microbial consortium in UASB granules.

Effects of clonidine on anxiety disorders.

To examine the role of the noradrenergic system in anxiety disorders, 23 patients (nine with generalized anxiety disorders and 14 with panic disorders) were studied for four weeks with clonidine hydrochloride, a predominantly presynaptic noradrenergic agonist, and with placebo. A double-blind crossover design was used. The effect of clonidine was comparable in both anxiety disorders and superior to placebo in patients who tolerated the drug. The conditions of 17% of the patients became worse with the medication. The main effect of clonidine was a decrease of anxiety attacks and "psychic" symptoms. Somatic symptoms were least affected. The complexity of the results may be explained through the postsynaptic effects of clonidine, which in part neutralize its presynaptic nonadrenergic effects. It may also indicate disturbances in other neurotransmitter systems that are not affected by clonidine.

Purging in BCR-ABL-positive acute lymphoblastic leukemia using immunomagnetic beads: comparison of residual leukemia and purging efficiency in bone marrow vs peripheral blood stem cells by semiquantitative polymerase chain reaction.

Twenty autologous bone marrow (BM) and 25 peripheral blood stem cell (PBSC) grafts were collected from a total of 40 consecutive patients with BCR-ABL+ acute lymphoblastic leukemia (ALL) in first (n = 37) or second (n = 3) complete morphological remission and subsequently purged with a cocktail of anti-CD19, -CD10, AB4 MoAbs and immunomagnetic beads (IMB). Residual BCR-ABL-positive cells before purging were detected in 19 of 20 BM grafts at a median of 4 (range 0-6) logs and in 17 of 25 evaluable PBSC grafts at a median of 1 (range 0-3) log above the limit of detection assessed by a semiquantitative limiting log10-dilution RT-PCR (P < 0.0001). IMB purging depleted a median of 2.5 (range 1-4) log of residual BCR-ABL+ cells from BM and a median of 1 (range 0-2) log from PBSC grafts, achieving RT-PCR negativity in 1/20 BM and 12/25 PBSC grafts after purging. Cell recoveries were 62% and 86% (P < 0.0001) of MNC and 74% and 97% (P = 0.065) of CD34+ cells after BM and PBSC purging, respectively. BM purging was superior using the triple MoAb cocktail which depleted 2.64 +/- 0.4 log (n = 14) compared to 1.6 +/- 0.4 log (n = 5) using the MoAb cocktail not including AB4 (P = 0. 02). We conclude that unpurged BM grafts contain 2-3 log more residual BCR-ABL+ cells than unpurged PBSC grafts and that purging efficacy is superior in BM compared to PBSC grafts, but median titers in purged BM grafts still exceed those in purged PBSC grafts. Bone Marrow Transplantation (2000) 25, 97-104.

Prescribing of selective serotonin reuptake inhibitors, anxiolytics, and sedative-hypnotics by general practitioners in The Netherlands: a multivariate analysis.

A study of the prescribing of anxiolytics and sedative-hypnotics and the occurrence of anxiety or sleep disorders before and after the initiation of selective serotonin reuptake inhibitor (SSRI) therapy may provide insight into differences in individual SSRIs. The purpose of our study was to evaluate whether and in what way the likelihood of being prescribed an anxiolytic or sedative-hypnotic or receiving a diagnosis of an anxiety or sleep disorder differed in patients prescribed either fluoxetine or paroxetine by a general practitioner (GP) in the Netherlands, where these two agents are the most commonly prescribed SSRIs. Episodes of SSRI treatment were constructed from a recently available GP database in the Netherlands. Logistic regression analysis was used to determine whether, after controlling for other observable factors, the receipt of paroxetine or fluoxetine was a statistically significant determinant for receipt of an anxiolytic or sedative-hypnotic or a diagnosis of an anxiety or sleep disorder. We found that patients who were prescribed fluoxetine as their index drug were less likely to receive a concomitant sedative-hypnotic on their index date compared with patients receiving paroxetine. After controlling for other observable factors, such as use of anxiolytics and sedative-hypnotics before SSRI therapy or on the index date or the existence of comorbid anxiety or sleep disorders, patients starting fluoxetine therapy were no more likely than patients starting paroxetine therapy to receive an anxiolytic or sedative-hypnotic or a diagnosis of an anxiety or sleep disorder during the 60-day post period. The likelihood of a patient's being diagnosed with or receiving a prescription for an anxiety or sleep disorder does not appear to be a differentiating factor between the prescribing of fluoxetine or paroxetine by GPs in the Netherlands.

Results of systematic screening for serious gastrointestinal bleeding associated with NSAIDs in Rostock hospitals.

OBJECTIVES: Gastrointestinal bleeding and ulcers may lead to life-threatening complications. One of the causes is use of non-steroidal anti-inflammatory drugs (NSAIDs). METHODS: All hospital admissions in 1998 to the Departments of Internal Medicine, including the Intensive Care Unit and the Department of Surgery, in 2 hospitals in Rostock were prospectively screened for gastrointestinal bleeding. Whether the bleeding was due to an adverse drug reaction ADR or not was assessed using the rating scale of Begaud et al. [1985] for each drug taken. The risk profile and the drug history of all patients with gastrointestinal bleeding were registered. RESULTS: A total of 58 patients with gastrointestinal bleeding due to NSAIDs were documented. Risk factors for bleeding were cardiac diseases, hypertension, diabetes, age over 60 years, history of ulcer, a Helicobacter pylori infection, smoking and consumption of alcohol together with drugs known to have a risk of causing gastrointestinal bleeding and ulcers (antiplatelet drugs, anticoagulants, corticosteroids). About 70% of these patients had 3 or more risk factors, but only 20% had been receiving effective prophylaxis with a proton pump inhibitor. CONCLUSION: Gastrointestinal problems resulting from the use of NSAIDs are clinically important. It is concluded, that individual risk profiles, as a criterion for the prophylactic use of effective protective drugs, would be helpful in patients management.

[CT diagnosis of recurrent rectal carcinoma following surgery]. / CT-diagnose recidief rectumcarcinoma na heelkunde.

It is well known that CT-scan imaging is very useful for diagnosing recurrence of a rectal carcinoma after surgical resection. According to this technique of investigation, more than 95% of recurrences are discovered and their size and pattern can be accurately defined. Furthermore, in case a postoperative fibrosis may be confused with a true recurrence, it is possible to punction percutaneously the mass with the help and guidance of the CT-scan. These findings were assessed and confirmed in 43 patients in the present retrospective study.

Treatment of winery effluent with upflow anaerobic sludge blanket (UASB)--granular sludges enriched with Enterobacter sakazakii.

Three upflow anaerobic sludge blankets (UASBs) were evaluated for the treatment of winery wastewater: the first was seeded with granular sludge enriched with Enterobacter sakazakii and reached a 90% COD removal within 17 d at hydraulic retention time of 24 h; the second was seeded with brewery granules and achieved 85% COD removal within 50 d, the third was seeded with just sludge and showed the typical problems encountered with conventional sludge seeding and had continuously to be re-seeded. A PCR-based technique was developed for the rapid detection of E. sakazakii in the granular sludge.

Survey of cadaveric donors to a body donation program: 1978-1993.

Body donation files from the Department of Anatomy at Northeastern Ohio Universities College of Medicine were reviewed from the 569 donors used in our program from 1978-1993. The data were entered into a computerized database to evaluate the characteristics of people who have contributed to the body donation program for cadaveric dissection. The purpose of this review was to reveal a profile of the people who have contributed to our program and enable us to identify any deficiencies or disproportionate representation of donors which can be used when targeting future applicants. Donors to our program were predominantly male (58%), although there was a clear trend for increasing numbers of females over the latter period of the program. Donors were almost exclusively white (98%) with an average age at death of 73 years (range 18-98 years). The combination cardiovascular (46%), cancer (27%), and pulmonary dysfunction (16%) accounted for nearly all deaths of our donors. Approximately half of the donors (49%) were married and they completed an average of 12.5 years of education. The typical donor bequested at, or near, the time of death. From these data we conclude that certain characteristics of our donors can be primarily attributable to the population base of our sample. Other characteristics, for example, gender, age at death of females, and educational level, show marked departures from population values and suggest some unique attributes of our donors. Bequests to our body donation program do not appear to represent a long-term plan, but rather a decision made just prior to death.

Survey of cadaveric donor application files: 1978-1993.

Information derived from application files of potential cadaveric donors to our body donation program from the period of 1978-1993 was entered into a customized database to assess the characteristics of people contributing to such a program. A total of 1,267 application files were reviewed and the following information analyzed: 1) year of application submission, 2) age, 3) sex, 4) race, 5) marital status, 6) education, 7) occupation, and 8) disposition of cremains (return or not to family). Overall the typical body donor applicant to our program was likely to be a white married female homemaker of about 70 years of age. She was a high school graduate and chose not to have her cremains returned to her family. The males closely follow the above mentioned characteristics (with the exception of occupation), but were outnumbered by females in nearly every category throughout the span of our analysis. An analysis of the application numbers over the 15 year period of our survey indicated a reduction in applications during the period of 1982-1984 and a linear increase of applicant numbers from 1989 to 1993. Finally, we observed a tendency for married couples to donate together with 32.1% of our married applicants showing this phenomenon.

Suppression of third-order intermodulation in a klystron by third-order injection.

The first observations and measurements are reported on suppression of the third-order intermodulation (IM3) product arising from nonlinear mixing of two drive frequencies in a klystron, by externally injecting a wave at the IM3 product frequency. Optimum amplitude and phase of the injected wave for maximum suppression are examined. Results indicate that suppression of the IM3 product by as much as 30 dB can be achieved. Experimental results compare favorably with predictions of a 1D simulation code that takes into account all kinematical and dynamical effects including charge overtaking and space charge forces.