[Special care units for the treatment of acutely ill, cognitively impaired geriatric patients in Germany]. / Spezialisierte Stationen zur Behandlung von akut erkrankten geriatrischen Patienten mit zusätzlichen kognitiven Beeinträchtigungen in Deutschland.

During recent years, specialized wards have been established in geriatric hospital departments as a consequence of the growing need of special care for acutely ill older patients, who are also cognitively impaired. However, there are neither established standards nor any commonly agreed concept of care. A written survey among 12 specialized wards in Germany revealed some characteristics of these wards: extended geriatric assessment, special education of staff including validation and gerontopsychiatric issues, and particular equipment/architecture, such as hidden doors and group rooms, and in some cases loop tracks for walking, therapeutic facilities, and 'living rooms' on the wards. There is a wide variability with respect to the designation of these wards, the number of beds, length of stay, and admission criteria. It appears from this survey that there should be an exchange of empirical experience made on these wards, and there is a need of collaborative research on its usefulness.

Paracetamol for pain relief after surgical removal of lower wisdom teeth.

BACKGROUND: Paracetamol has been commonly used for the relief of postoperative pain following oral surgery. In this review we investigated the optimal dose of paracetamol and the optimal time for drug administration to provide pain relief, taking into account the side effects of different doses of the drug. This will inform dentists and their patients of the best strategy for pain relief after the surgical removal of wisdom teeth. OBJECTIVES: To assess the beneficial and harmful effects of paracetamol for pain relief after surgical removal of lower wisdom teeth, compared to placebo, at different doses and administered postoperatively. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register; the Cochrane Pain, Palliative and Supportive Care Group's Trials Register; CENTRAL; MEDLINE; EMBASE and the Current Controlled Trials Register. Handsearching included several dental journals. We checked the bibliographies of relevant clinical trials and review articles for studies outside the handsearched journals. We wrote to authors of the identified randomised controlled trials (RCTs), to manufacturers of analgesic pharmaceuticals, we searched personal references in an attempt to identify unpublished or ongoing RCTs. No language restriction was applied. The last electronic search was conducted on 24th August 2006. SELECTION CRITERIA: Randomised, parallel group, placebo controlled, double blind clinical trials of paracetamol for acute pain, following third molar surgery. DATA COLLECTION AND ANALYSIS: All trials identified were scanned independently and in duplicate by two review authors, any disagreements were resolved by discussion, or if necessary a third review author was consulted. The proportion of patients with at least 50% pain relief was calculated for both paracetamol and placebo. The number of patients experiencing adverse events, and/or the total number of adverse events reported were analysed. MAIN RESULTS: Twenty-one trials met the inclusion criteria. A total of 2048 patients were initially enrolled in the trials (1148 received paracetamol, and 892 the placebo) and of these 1968 (96%) were included in the meta-analysis (1133 received paracetamol, and 835 the placebo). Paracetamol provided a statistically significant benefit when compared with placebo for pain relief and pain intensity at both 4 and 6 hours. Most studies were found to have moderate risk of bias, with poorly reported allocation concealment being the main problem. Risk ratio values for pain relief at 4 hours 2.85 (95% confidence interval (CI) 1.89 to 4.29), and at 6 hours 3.32 (95% CI 1.88 to 5.87). A statistically significant benefit was also found between up to 1000 mg and 1000 mg doses, the higher the dose giving greater benefit for each measure at both time points. There was no statistically significant difference between the number of patients who reported adverse events, overall this being 19% in the paracetamol group and 16% in the placebo group. AUTHORS' CONCLUSIONS: Paracetamol is a safe, effective drug for the treatment of postoperative pain following the surgical removal of lower wisdom teeth.

Occasional physical inactivity combined with a high-fat diet may be important in the development and maintenance of obesity in human subjects.

BACKGROUND: A better understanding of the environmental factors that contribute to obesity is imperative if any therapeutic effect on the increasing prevalence of overweight and obesity in the United States is to be achieved. OBJECTIVE: This study examined the effect of the interaction of diet composition and physical inactivity on energy and fat balances. DESIGN: Thirty-five normal-weight and obese subjects were randomly assigned to either a 15-d isoenergetic high-carbohydrate (HC) or high-fat (HF) diet according to a crossover design. During the first 14 d, body weight and physical activity were maintained. On day 15, subjects spent 23 h in a whole-room indirect calorimeter and were fed a diet similar to that consumed during the previous 7 d while remaining physically inactive. RESULTS: Energy intakes required to maintain body weight stability during the first 14 d were similar between diets. Normal-weight and obese subjects consuming both diets had a positive energy balance on the sedentary day (day 15), suggesting that subjects were less active in the calorimeter. There was no significant effect of diet composition on total energy balance and total protein-energy balance on day 15; however, carbohydrate balance was more positive with the HC (2497.8 +/- 301.2 kJ) than with the HF (1159 +/- 301.2 kJ) diet (P = 0.0032). Most importantly, fat balance was more positive with the HF (1790.8 +/- 510.4 kJ) than with the HC (-62.8 +/- 510.4 kJ) diet (P = 0.0011). CONCLUSION: Chronic consumption of a high-carbohydrate diet could provide some protection against body fat accumulation in persons with a pattern of physical activity that includes frequent sedentary days.

Diphthong changes in style shifting from Southern English to Standard American English.

This study was undertaken to identify the acoustic correlates of the diphthongs /aI/ and /contains as a subset I/ in individuals who were trained to "style shift" between Standard American English (SAE) and Southern English (SE). The diphthongs were produced by four individuals from the coastal southern dialect region who were selected from among those who had successfully completed an accent-reduction program. Results showed that diphthongs used in SE were shorter and had less noticeable transitional elements than those in SAE. The difference was more apparent for /aI/ than /contains as a subset I/. There were no instances in which a diphthong was completely replaced by a vowel in SE. Findings indicate that acoustic analysis may be a useful tool in identifying dialectal elements, particularly for those individuals who are learning to style shift.

[Communications difficulties during the medical interview]. / Dificultades en la comunicación durante la entrevista médica.

The aims of medical interview are to obtain diagnostic information, to obtain an empathetic communication with the patient, to educate him about his disease and to establish a personal link allowing a lasting relationship. We analyze some features of communication with patients. Individualized communication, recognizing his identity and personal aspects, "looking from the patient". Context, a shared but not mentioned value, part of the world of emotions and ideas. An analog and digital language, the former precise in words and the latter more diffuse, with gestures, not verbal. Coherence, as the similitude between what we think, feel and say. If there is no coherence, communication is impaired. Emotions, always present, rending communication more valid and real. We need to recognize, express and respond to emotions. An emotionless patient becomes a distant and impersonal object, an "it". When emotions are incorporated the patient is a "him" with whom I share and dialog. Empathy is an emotional comprehension, a personal bond. It improves relationships and creates links. Compassion is a variation of empathy that includes spiritual aspects and values. Negative emotions as rage, frustration and aggression creates communicational difficulties. We must recognize, express and clarify them to improve the situation. Difficult patients with whom communication is difficult such as confuse, agitated, terminal, elder, manipulating or hypochondriac subjects. The idea of transference and counter transference in these complicated situations is analyzed.

A comparison of outcome and cost of open vs. laparoscopic cholecystectomy.

One hundred elective completed laparoscopic cholecystectomies performed during the period July 1990 to June 1991 were prospectively analyzed for age, sex, and the study variables. A control group of 100 age- and sex-matched patients undergoing elective open cholecystectomy in the year prior to the advent of laparoscopic cholecystectomy was retrospectively analyzed. Both groups were comparable with regard to height, weight, severity of disease, and co-morbidity. The mean operative time for the laparoscopic cholecystectomy group was 107 min vs. 72 min for the open cholecystectomy group. Other significant differences included the use of cholangiography (24% vs. 93%), placement of drains (4% vs. 27%), and morbidity (3% vs. 7%). There was no mortality in either group. The mean length of hospital stay was 1.6 days for the laparoscopic cholecystectomy group vs. 4.8 days in the open cholecystectomy group. The resultant difference in hospital charges to the patient favored laparoscopic cholecystectomy with a mean charge of $6471 vs. $8896 for the open cholecystectomy group. The results of this study support the conclusions that laparoscopic cholecystectomy is a safe and effective alternative to open cholecystectomy and results in a significantly shorter hospital stay with considerable cost savings.

Problems in the control of hypertension in the community.

A hypertension survey was conducted in Montreal to determine the extent, nature and distribution of the control of hypertension. Of the 12 055 persons screened in shopping centres, workplaces and a random sample of homes in four census tracts the hypertension was not controlled in 69.0% to 80.3% of those with the condition in each setting. Nearly two thirds of those with hypertension were aware of their condition, 13% were aware but had never been treated, 13% were receiving treatment inadequate to control their hypertension, and 11% had discontinued treatment, most reporting that they had done so on the advice of their physician. Among those screened in their home, discontinuance of therapy was most often reported by those with a low income, but lack of awareness of their condition was no more prevalent in this group than in the other income groups. Efforts to control hypertension should be directed to the variety of causes of lack of control, which may occur with various frequencies in different communities, and for which screening alone may be inadequate.

Intra-specific host sharing in the manipulative parasite Acanthocephalus dirus: does conflict occur over host modification?

The acanthocephalan parasite Acanthocephalus dirus induces a colour change in the intermediate host, the aquatic isopod Caecidotea intermedius, which increases transmission to definitive hosts (creek chub, sunfish). We examined the potential for conflict to occur between infective (cystacanth) and non-infective (acanthor, acanthella) stages of A. dirus over the level of colour modification that should be induced when these stages share a host. Using a field survey, we showed that host sharing by infective and non-infective stages was relatively common and that infective and non-infective stages differed in their effects on colour modification. Non-infective stages induced a colour change over 40% of the body, whereas infective stages induced a colour change over 80%. Thus, conflict could occur between stages over the level of modification that should be induced. We then showed that mixed-stage infections induced a colour change in the host that was consistent with the level of modification induced by the infective stage. We discuss the potential significance of these results to patterns of host modification and their effects on stage-related survival in nature.

[Improving the quality of clinical interview teaching: evaluation of an intervention with medical students]. / Mejorando la calidad de la enseñanza de entrevista clínica: evaluación de una intervención en estudiantes de medicina.

BACKGROUND: Quality of clinical interview is a key issue both for patient satisfaction and for diagnostic efficiency. Its adequacy relates to better clinical diagnosis treatment plans and patient compliance. AIM: To measure the quality of interviews performed by medical students in three Chilean medical schools before receiving specific training on the subject and to compare the scores obtained after introductory courses on interview. MATERIAL AND METHODS: The interviews were videotaped and then evaluated using an objective scale, that measures 33 skills grouped in six areas: opening, problem exploration, non verbal facilitation, interpersonal patient reaction and closing. The students were assigned to an experimental group that received an interactive workshop with role-plays, vignettes and videotape feedback, and to a non intervention group that received the usual bedside training on medical interviews. RESULTS: Both groups shared the same skill level before the training, with better scores on nonverbal, patient reaction and problem exploration, and worse ones on closing and interpersonal skills. Comparing pre and post-test results, the overall score improved in the experimental group (from 33.2 to 38.3, p = 0.002) and worsened among non intervened students. There were statistically significant changes for opening (p < 0.002), problem exploration (p < 0.05), non verbal facilitation (p < 0.0001) and closing (p < 0.0001). CONCLUSIONS: It is important to train students not only in specific knowledge contents but in the process of interview. This training should encourage the development of empathy and closing skills.