Current Status Of Patient Research Articles

Malignant meningioma: an indication for initial aggressive surgery and adjuvant radiotherapy.

Malignant meningiomas constitute a rare subset of meningiomas and display a marked propensity for postsurgical recurrence. This retrospective study evaluates the various parameters which alter the recurrence rate. The records of all malignant meningioma patients treated from 1984 through 1992 were reviewed, and the time to recurrence or current patient status was determined, and the influence of various patient and disease parameters were analyzed. Thirty-eight patients were treated with 48 malignant meningioma resections performed (28 total and 20 subtotal), 25 at initial presentation and 23 for recurrent disease; 19 patients received postoperative radiotherapy. Subtypes included 32 anaplastic meningioma, 11 hemangiopericytoma, 2 meningiosarcoma, and 3 papillary meningioma. Followup ranged from 3 to 144 months, with five patients excluded from analysis. Actuarial disease free/progression free survival (DFS) at 5 years was 39% following total resection versus 0% after subtotal resection (p=0.001). For all totally excised lesions, the 5-yr DFS was improved from 28% for surgery alone to 57% with adjuvant radiotherapy (p=NS). Adjuvant irradiation following initial resection increased the 5-yr DFS rates from 15% to 80% (p=0.002). When administered for recurrent lesions, adjuvant radiotherapy improved the 2-yr DFS from 50% to 89% (p=0.015), but had no impact on 5-yr DFS. Multivariate analysis indicates extent of resection, adjuvant radiotherapy, and recurrence status are independent prognostic factors. Malignant meningiomas display a tendency for post surgical recurrence, with recurrence significantly increased for multicentric and recurrent disease. Complete surgical resection and the administration of adjuvant irradiation following initial resection are crucial to long-term control.

The clinicopathological significance of K-RAS point mutation and gene amplification in endometrial cancer.

The aim of this study was to examine the prevalence and clinicopathological significance of K-RAS oncogene activation in endometrial carcinoma and atypical hyperplasia. We analysed K-RAS point mutation and gene amplification in 55 endometrial carcinomas using polymerase chain reaction associated with restriction fragment length polymorphism and genomic differential polymerase chain reaction. Point mutations at codon 12 of K-RAS oncogene were identified in 8 of 55 (14.5%) tumour specimens. In addition, we were unable to detect any K-RAS gene amplification in any of the endometrial carcinomas studied. No correlation was found between K-RAS gene mutation and age at onset, histological subtype, grade of differentiation, clinical stage or current patient status. We conclude that K-RAS mutation is a relatively common event in endometrial carcinomas, but with no clear prognostic value.

Methodological issues in determining rates of childhood immunization in office practice. A study from pediatric research in office settings (PROS).

To compare 3 methods for measuring pediatric office immunization rates. Retrospective and prospective cross-sectional surveys. Children 2 and 3 years old from 15 pediatric practices in 11 states. Immunization rates were determined for each practice using 3 methods. The Consecutive method used data from the practice's medical records of patients seen consecutively in the office; the Chart method used data from randomly selected practice medical records; and the Active method (reference standard) used a combination of medical record data with a telephone interview to collect additional immunization data and current patient status, using data only on current patients. Analyses were based on a mean of 57, 62, and 51 (Consecutive, Chart, and Active method, respectively) patients per practice. Patients were considered fully immunized if they had received 4 doses of DTP/DT vaccine, 3 doses of OPV/IPV, and 1 dose of MMR vaccine by their second birthday Comparisons were made using the paired t test. The mean immunization rate by method was Consecutive, 81.5% (range, 51%-97%); Chart, 71.6% (range, 42%-94%); and Active, 79.6% (range, 53%-96%). Within a given practice, the differences between methods varied considerably (0 to 28 percentage points). The mean difference from the reference standard Active method was 8 percentage points (P < .001) for the Chart method and -1.9 percentage points (P = .36) for the Consecutive method. The largest difference was between the Consecutive and Chart methods (mean difference, 9.9 percentage points; P = .003). Practitioners uniformly found the Consecutive method easiest to implement. Practice-specific immunization rates are one of the few objective measures of the quality of preventive pediatric care. Pediatric practices monitoring their immunization rates should consider using the Consecutive method, a simple, acceptable, and valid measure of practice immunization rate.

Objectivity in physiotherapy assessment

Physiotherapists are clear about the meaning of objective and subjective information when assessing a patient. Objective data are considered to be a set of ‘facts’ representing the patients current status; the blood gas results, X-ray changes, goniometry measurements or lung function tests. Subjective information is used to embellish the objective facts: the patients' attitudes, opinions, social history and the physiotherapists interpretation of the facts (Goldberg, 1994; O'Shaughnessy, 1994).

'Condition diagramming': a new approach to teaching clinical integration.

Integration of clinical material appears to involve three major steps: identification of the pertinent information; organization of that information in some logical sequence; and determination of its meaning to specific applications. The concept of 'Condition Diagramming' has been developed to help students to integrate the large volumes of clinical data that they are expected to learn. It utilizes a defined format to establish what information is needed and where it fits in relation to the patient's current status. Data organized in this manner may be easier to comprehend and use in medical decision-making. Several potential applications of this approach are presented.

When Psychiatrists Are Liable: Risk Management and Violent Patients

In an era of rapid discharge and community treatment, psychiatrists must assess, with insufficient information, their patients' potential for committing a violent act outside of the hospital every time they authorize a pass or a discharge. The authors review court decisions on prediction of dangerousness and research data on the risk of homicide, assault, and suicide among released mental patients. They then discuss a risk-management approach to decision-making that consists of three components--risk assessment, risk evaluation, and risk reduction. The authors also provide a decision table that clinicians can use to identify factors that suggest a high risk of violence in a patient's current status, history, and treatment response.

Teaching short-term psychological counselling to primary-care residents: A course description

Although primary-care physicians are increasingly expected to provide short-term psychological counselling services, few programs exist to teach residents the necessary skills. The Department of Family Practice and Community Health at the University of Minnesota Medical School has developed a 10-week course for this purpose. This program familiarizes residents with the structure and process of psychological counselling as it may be conducted in a physician's office. Initially, participants are given a schema for assessing the patient's current status and for planning intervention. Residents then review their own videotapes and practice skill building. Evaluation of the course has been highly favorable. In their unsolicited comments, participants prefer a problemoriented approach to a concept-oriented one. The findings from this course suggest the development of a two-stage program of counselling courses for undergraduate medical students and residents.

Muscular dystrophy. I. History, clinical status, muscle strength, and biopsy findings.

The etiology of juvenile muscular dystrophy remains obscure despite many decades of clinical and laboratory observations.* The establishment of a program of preventive and remedial care for such patients in this hospital stimulated us to repeat and reassess some of the older observations and to report our findings. The clinical history, spinal fluid findings, motor status, and biopsy material from a group of children with juvenile muscular dystrophy are herein presented. MATERIAL AND METHODS Thirty-one children with a history of motor weakness suggestive of muscular dystrophy have been seen in the course of this series of studies. History of the familial incidence of the disease, if any, and of its onset was obtained and the patient's current status established. The strength of muscle groups was evaluated by the physiotherapist (M. J. W.) in accordance with motor function against gravity and against resistance. Biopsies of deltoid and of gastrocnemius muscles were